DATE: December 3, 2024
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Agreement with Manifest MedEx for a Community Information Exchange
RECOMMENDED ACTION(S):
TITLE
1. Under Administrative Policy No. 34 for competitive bids or requests for proposals (AP 34), determine that an exception to the competitive bidding requirement under AP 34 is satisfied and a sole source is warranted due to unusual or extraordinary circumstances, and that the best interests of the County would be served by entering into an agreement with Manifest MedEx as this contractor is the current sole technical host of a Health Information Exchange platform used for Fresno County patient data transmission;
2. Approve and authorize the Chairman to execute an Agreement with Manifest MedEx to implement a Community Information Exchange platform for the utilization of data exchange among varied partner data systems, effective January 1, 2025, not to exceed five consecutive years, which includes a five-year base contract total of $8,600,000 and optional expansion services of $6,100,000, total not to exceed $14,700,000; and
3. Authorize the County Administrative Officer or his designee(s), to execute Amendment to Agreement to comply with the fulfillment of the Scope of Work, technical specifications, and implementation phase requirements subject to approval by County Counsel as to legal form, with no increase to the contract maximum; and to execute any future Business Associate Agreements with future public agencies and affiliates; and any subsequent documents necessary to implement the actions above, for a period not to exceed five years.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the recommended actions will enable the Department of Public Health (DPH), the Department of Behavioral Health (DBH) and the Department of Social Services (DSS) in the initial phases to more efficiently access and exchange data with healthcare facilities and providers, and monitor, track, and improve care coordination and outcomes data of Fresno County residents. The Fresno County Community Information Exchange (CIE), formerly known as the Integrated Data Systems represents a groundbreaking initiative aimed at revolutionizing data utilization to improve the well-being of Fresno County residents. The recommended agreement will be partially funded with American Rescue Plan Act - State Local Fiscal Recovery Funds (ARPA-SLFRF) up to $5,000,000, and CIE system participants will fund ongoing annual maintenance costs $3,600,000. This item is countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, the DPH will not be able to utilize Manifest MedEx (MX) to begin the initial phase to more efficiently develop access and exchange data amongst DBH and DSS, nor the future varied partners and providers, and monitor, track and improve care coordination and outcomes data of Fresno County residents. Existing, manual, less efficient and less comprehensive methods would continue to be utilized for these purposes.
SUSPENSION OF COMPETITION/SOLE SOURCE CONTRACT:
It is requested that the County find under AP 34 that an exception to the competitive bidding requirement is satisfied, and a sole source is warranted due to unusual or extraordinary circumstances, as MX is in a unique position to support the County as a technical host for the provision of a CIE Platform because they are currently the provider of Health Information Exchange services for all hospitals and some clinics in Fresno County. In addition, they are also the Health Information Exchange for the Central Valley hospitals, Fresno County departments of Public Health and Behavioral Health and this allows for more efficient care coordination across central valley counties. Operating in this capacity has allowed MX to develop a greater understanding of the need for having a platform designed to foster interoperability and seamless data exchange among varied partner data systems to facilitate the coordination and provision of essential community resources while also serving as a tool for analyzing health-related services and ensure coordination of care. The existing infrastructure is a financial benefit to the County of Fresno in developing a CIE that will have the capability to bridge into the existing infrastructure versus building new infrastructure that would require new connection fees to the existing partners. The Internal Services Department - Purchasing Division concurs with the Department’s assessment that this satisfies the exception to the competitive bidding process required by AP 34.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The recommended agreement maximum compensation ($14,700,000) will be funded with ARPA-SLFRF ($5,000,000) and ongoing annual maintenance cost will be supported by participants utilizing the CIE System. The Department of Public Health has requested funding from various stakeholders to support future costs. County departments participating in the CIE will be requested to fund the ongoing annual maintenance cost. Sufficient appropriations and estimated revenues are included in DPH Org 5620 FY 2024-25 Adopted Budget and will be included in future budget requests for the duration of the term.
DISCUSSION:
On January 4, 2022, the Board approved Agreement No. 22-011 with Central Valley Health Information Exchange (CVHIE) and MX for the provision of a Health Information Exchange (HIE) system for patient data transmission for the Department of Public Health and Behavioral Health.
On May 21, 2024, the Board approved Amendment I to Agreement No. 22-011 with MX for the provision of a HIE system as CVHIE had ceased operations.
The proposed recommended actions will support the Fresno County Community Information Exchange (CIE), an innovative initiative aimed at modernizing data sharing methods to enable seamless data exchange across different systems. MX’s existing technology and database of the local population enables highly efficient matching algorithms, which can expedite care coordination with local providers and potentially leverage existing infrastructure. The vision of the CIE is to establish a data-driven, interconnected community in Fresno County, providing timely and effective support to those in need. The mission is to facilitate data sharing across different sectors to enhance communication and coordinated services for students and families in Fresno County. The CIE initiative will enable the coordination and provision of essential community resources and serve as a tool for analyzing health, social, and education-related services. MX, as the technical host, will provide and manage a flexible platform for the CIE. This platform will be designed to promote interoperability and seamless data exchange among diverse partner systems.
MX will oversee the integration and transformation of records-level data within a centralized, scalable system manner, ensuring role-based access and field-level governance controls to protect privacy and security for the users and their data. As the CIE expands, the technical host will play a crucial role in accommodating new partners and data systems, thereby enhancing the platform’s capabilities to meet growing demands. The Technical Operational Plan (TOP) is a working document that parties are utilizing and will be edited as the relationship continues.
Within the CIE initiative, there are two upcoming pilots, the Suicide Prevention and Home Visitation projects are scheduled for phased development between 2024 and 2026. These initiatives are strategically designed to generate immediate and tangible outcomes at the community level while concurrently establishing foundational partnerships, governance structures, and technical infrastructure to facilitate future expansion and broader impact.
The current policies for MX can be found at the following link: https://www.manifestmedex.org/resources/. Please note that these policies are subject to change from time to time. DPH drafted TOP (Attachment A) to guide the development process of the initial phases. As other County departments onboard into the CIE the TOP will need to be adjusted to meet their specific needs within the existing framework.
The approval of the proposed action No. 3 will allow the County Administrative Officer (CAO) or designee to sign Health Insurance Portability and Accountability Act (HIPAA) Business Associate Agreements (BAA) on behalf of your Board for future Participant Affiliates to exchange client data, thereby creating another opportunity to identify and reach Fresno County residents in need of public health programs and services. DPH is currently in discussion with two potential future Participant Affiliates, Sanger Unified School District and Central Unified School District. Additionally, this will allow the CAO to modify the scope, technical specifications, and implementation phases to ensure that as other County departments are ready to connect to the system, their specific needs are met while staying within the contract maximum.
The recommended agreement with MX varies from the County’s model contract template as it is drafted by MX. The agreement deviates from the standard County insurance provisions, in that it includes mutual indemnification and limitation of liability insurance provisions. The recommended agreement differs from the standard County language, in that it is for a five-year initial term with one potential five-year extension. The proposed agreement specifies that a determination by your Board on the extension will be made when there is twelve months remaining on the then-existing term of the proposed agreement. The County in years 3-5 may not have sufficient funding for expansion into additional phases, which could result in additional time required for completion.
The recommended agreement includes security requirements that are consistent with industry and HIPAA standards. Within the County’s infrastructure, access to data will be limited to specific employees that require access to the data sets. Departments, in conjunction with MX, will monitor employee access into the system. Management of the CIE and employee access will conform to the County’s existing HIPAA Management Directives.
REFERENCE MATERIAL:
BAI #44, May 21, 2024
BAI #27, January 4, 2022
ATTACHMENTS INCLUDED AND/OR ON FILE:
Sole Source Acquisition Request
On file with Clerk - Agreement with Manifest MedEx
Attachment A - Technical Operation Plan (TOP)
CAO ANALYST:
Ron Alexander