Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise Rogers, Chief, Health System
Srija Srinivasan, Director, Family Health Services & Health Coverage Unit
Subject: Amendment to the Agreement with Healthways, Inc. to Provide Health Insurance Outreach, Enrollment and Retention Services
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with Healthways, Inc. to provide health insurance outreach, enrollment and retention services for children and adult health coverage programs, extending the term to January 1, 2014 through December 31, 2018 and increasing the amount by $66,545 to an amount not to exceed $432,835.
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BACKGROUND:
Since 2003, the Health System has contracted with community-based organizations (CBOs) to provide outreach and enrollment services for low-income uninsured residents in need of health insurance coverage. In spring 2013, the Health System issued a Request for Proposals (RFP) to select entities interested in providing such services, in alignment with changes related to the Affordable Care Act. Healthways, Inc. was selected as one of five entities contracted to provide these services to targeted hard-to-reach populations. The selection process included obtaining endorsement by the Children’s Health Initiative (CHI) Oversight Committee, a Health System community advisory body that is part of the Health Plan of San Mateo’s governance structure.
In 2015 and 2016, your Board approved amendments to the agreement to extend the term through December 31, 2017 and provide support for additional outreach, enrollment and retention services. In June 2017, the balance of the agreement was increased by 3% as a cost of living allowance. The funding amounts, target numbers of residents to be reached, and a rate of cost/enrollment were drawn from a formula used by Covered California.
DISCUSSION:
As we awaited clarity on the Affordable Care Act’s core components, the Health System monitored the level of outreach and enrollment assistance provided by Healthways, Inc. and the continued need for outreach and enrollment assistance services. While we have reduced the percentage of uninsured residents to 4%, there remain 32,000 uninsured residents, as well as residents who need help keeping the coverage they have. Healthways, Inc. has demonstrated effectiveness in reaching and achieving trust with the North County population and new immigrant residents, and these services and capabilities complement the capacity provided by the Health System. The CHI Oversight Committee recommended one-year arrangements with the entities selected in the most recent RFP process.
The amendment and Resolution have been reviewed and approved by County Counsel as to form.
The Board is being asked to authorize the Director of the Health Coverage Unit or his/her designee to execute subsequent amendments which do not exceed an aggregate of $25,000.
This agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by ensuring uninsured residents living in the North County region of San Mateo County and new immigrant residents will be screened, enrolled, and retained in various health coverage programs. Maximizing enrollment in available health coverage programs strengthens the county’s ability to provide residents’ access to healthcare. Over the next fiscal year, it is anticipated that the contractor will enroll at least 870 children and adults.
PERFORMANCE MEASURE:
|
Measure |
FY 2016-17 Actual |
FY 2017-18 Projected |
|
Number of children and adults enrolled by the contractor |
1,008 |
870 |
FISCAL IMPACT:
The term of the amended agreement is January 1, 2014, through December 31, 2018. The agreement is being increased by $66,545 to a new amount not to exceed $432,835. Funds in the amount of $33,272 were included in the HCU FY 2017-18 Adopted Budget, and $33,273 in FY 2018-19 Recommended Budget.
The cost of the agreement is covered primarily by federal reimbursements from the Medi-Cal Administrative Activities program and the County General Fund, as well as from the CHI local funders. The Net County Cost for this agreement for FY 2017-18 is $18,093.