Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Agreement with Solventum Health Information Systems, Inc. to Provide Coding & Reimbursement System Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Solventum Health Information Systems, Inc. to provide coding & reimbursement system services for the term of December 7, 2024 through December 6, 2029, in an amount not to exceed $1,500,000.
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BACKGROUND:
San Mateo Medical Center (SMMC) has a continuing need for a coding and reimbursement software system. Utilization of this system reduces the chance of coding errors, resolves coding and claims edits at the time of coding, and provides quality and statistical advantages to SMMC. In May 2024, SMMC completed a Request for Proposals for coding & reimbursement system services.
DISCUSSION:
Solventum Health Information Systems, Inc. (Solventum) was elevated due to their additional capabilities including advanced analyzers, cloud hosting, clinical documentation integrity functionality, and coding assignment that factor in Federally Qualified Health Center (FQHC) status. The advanced analyzers allow us to utilize our new Electronic Health Record Epic’s full functionality and incorporate risk of mortality and severity of illness information on our patients. Cloud hosting frees up server space for IT as well as allows for increased speed in accessing the encoder systems. The clinical documentation integrity (CDI) encoder will replace the third-party contract SMMC has with ChartWise to allow use of Epic in its place. The addition of the FQHC reimbursement function is expected to improve the accuracy of SMMC’s FQHC payments estimates. This agreement is going to this Board late due to prolonged negotiations with the vendor.
County Attorney has reviewed and approved the resolution and agreement as to form.
The resolution contains the County’s standard provisions allowing amendment of the County fiscal obligations by a maximum of $25,000 (in aggregate).
The Information Services Department has reviewed and approved the IT component of this agreement.
The County’s Contract Compliance Committee has approved a waiver request for a five-year term for this agreement.
It is anticipated that government and regulatory changes will be updated in the system within 30 business days 100% of the time.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-26 Projected |
|
Percentage of occurrences that government and regulatory changes will be updated in the system within 30 business days |
100% |
100% |
EQUITY IMPACT:
Solventum’s coding and reimbursement software system will positively impact the delivery of community healthcare by facilitating fair and accurate coding and billing for SMMC’s services. SMMC’s patients span a wide spectrum of races, ethnicities, gender, and gender-identities. Within the past 18 months, the largest cohorts of specialty care patients at SMMC were female (56%), Hispanic or Latino (58%), and primarily Spanish speaking (55%).
FISCAL IMPACT:
The term of the agreement is December 7, 2024 through December 6, 2029. The amount of the agreement is not to exceed $1,500,000 for the 5-year term. Funds in the amount of $150,000 are included in the SMMC FY 2024-25 Recommended Budget. Funds in the amount of $300,000 will be included in the SMMC FY 2025-26 Recommended Budget.
The payment provisions and levels of services in this contract differ from those of the previous contract, due to the addition of advanced analyzers, cloud hosting, CDI functionality, and coding assignment that factor in FQHC, as well as the 5% annual increase of the service fees. The added capabilities will enhance patient data analysis, replace third-party systems, improve reimbursement estimate accuracy, and increase server efficiency. The total value of the new contract represents a 41% increase compared to that of the previous contract.
Expenses at SMMC are covered by fees for services or third-party payors whenever possible. The portion of expenses for services provided to the medically indigent or to those covered by programs that do not meet the full costs of care is covered by the County’s General Fund contribution to SMMC and is within the existing annual appropriation.
ATTACHMENT:
RFP Matrix