Title:
Title
Approvals for Implementation of Pathways to Health + Home Program (Two-Thirds Vote Required)
End
FileID
File ID: 2018-01686
Location
Location: Citywide
Recommendation:
Recommendation
Adopt a Resolution by two-thirds vote: 1) waiving the requirement for 10-day posting of agreements over $1 million for supplement No. 1 to City Agreement 2018-0696 with Healthy Community Forum for the Greater Sacramento Region dba Sacramento Covered (Sacramento Covered), pursuant to City Code section 4.04.020(C); and 2) authorizing the City Manager or City Manager’s designee to: a) increase revenue and expenditure budgets by $4,260,550 in the Pathways Program (I02000900) to account for contributions to Pathways from local health partners; b) suspend competitive bidding in the best interest of the City for additional Pathways care coordination and housing services provided by Sacramento Covered through March 31, 2019; c) execute contract supplement No. 1 (attached hereto as Exhibit A) to Agreement 2018-0696 with Sacramento Covered to extend Pathways outreach services through March 31, 2019 and add care coordination and housing services through March 31, 2019, with an increase in the total not-to-exceed amount by $581,850 for a new total not-to-exceed amount of $1,561,450; d) execute contract supplement No. 2 (attached hereto as Exhibit B) to Agreement 2017-1528 with Sacramento Covered to extend Pathways IT services through January 31, 2019 and increase the total not-to-exceed amount by $25,000 for a new total not-to-exceed amount of $975,000; e) execute 21 incentive agreements with Pathways partners in accordance with the schedule of amounts and partners identified in this report and as reflected in the agreements (attached hereto as Exhibits C through W), for a not-to-exceed amount of $1,505,000 for all 21 agreements; and f) accept future donations from community partners in the Pathways Program (I02000900) and increase revenue and expenditure budgets by a like amount.
Contact: Anira Khlok, Homeless Services Program Analyst, (916) 808-7948, Office of the City Manager
Body
Presenter: None.
Attachments:
01-Description/Analysis
02-Resolution
03-Exhibit A- Sacramento Covered Outreach Entity Contract Supplement
04-Exhibit B- Sacramento Covered IT Contract Supplement
05-Exhibit C- Sacramento Covered Incentive Agreement
06-Exhibit D- Lutheran Social Services of Northern California (LSS) Incentive Agreement
07-Exhibit E- TLCS, Inc. (TLCS) Incentive Agreement
08-Exhibit F- Peach Tree Healthcare Incentive Agreement
09-Exhibit G- Health and Life Organization, Inc. (HALO) Incentive Agreement
10-Exhibit H- Cares Community Health dba One Community Health Incentive Agreement
11-Exhibit I- Sacramento Native American Health Center, Inc. (SNAHC) Incentive Agreement
12-Exhibit J- Sacramento Steps Forward (SSF) Incentive Agreement
13-Exhibit K- Sacramento Self-Help Housing Incentive Agreement
14-Exhibit L- Volunteers of America Northern California and Northern Nevada, Inc. (VOA) Incentive Agreement
15-Exhibit M- Molina Healthcare of California Incentive Agreement
16-Exhibit N- Health Net Community Solutions, Inc. Incentive Agreement
17-Exhibit O- WellSpace Health Incentive Agreement
18-Exhibit P- The Salvation Army Incentive Agreement
19-Exhibit Q- River City Medical Group Incentive Agreement
20-Exhibit R- Blue Cross of California Partnership Plan, Inc. Incentive Agreement
21-Exhibit S- Access Dental Plan Incentive Agreement Incentive Agreement
22-Exhibit T- LIBERTY Dental Plan of California, Inc. Incentive Agreement
23-Exhibit U- Elica Health Centers Incentive Agreement
24-Exhibit V- Community Link Capital Region Incentive Agreement
25-Exhibit W- Aetna Better Health of California Incentive Agreement
Description/Analysis
Issue Detail: In June 2017, the City of Sacramento was accepted into the State Department of Health Care Services’ (DHCS) Whole Person Care (WPC) program, with a budget of up to approximately $64 million over a four-year term, inclusive of local funding re-aligned to support WPC and federal matching dollars, to support development of the WPC program model and to fund new services. WPC is a statewide Medi-Cal waiver program that allows communities to create a system of supportive services aimed to improve health outcomes and reduce utilization of high-cost services for vulnerable populations. In Sacramento, the WPC program is called the Pathways to Health + Home (Pathways) program and will support broader City strategies to reduce and prevent homelessness, by creating a robust system of outreach, case management and supportive services for those frequent users of health care, homeless services, and emergency services.
DHCS’ WPC program operates over the course of five “program years” which generally match calendar years from 2016 through 2020. However, because the City applied in the second round of WPC funding, the City’s Program Years 1 and 2 were shortened and both contained in calendar year 2017. Accordingly, the Pathways program is at the end of Program Year 3. Pathways Program Year 4 will run from January 1, 2019 through December 31, 2019. Program Year 5 will run from January 1, 2020 through December 31, 2020. As of November 23, 2018, Pathways has 559 individuals enrolled and has served a total of 884 individuals. A total of 31,146 services, including outreach, navigation, care coordination, and housing support, have been provided to the community. Pathways is collaborating with over 20 health care, housing, and social service providers to ensure continuity of care for program enrollees.
Extension of Outreach Services and Addition of Care Coordination and Housing Services:
Staff recommends approval of a contract supplement to the professional services agreement #2018-0696 with Sacramento Covered to extend outreach services through March 31, 2019 and add care coordination and housing services through March 31, 2019. Such supplement will ensure that outreach services continue to be delivered to participants for the first three months of Program Year 4, and that Sacramento Covered can fill current gaps in care coordination and housing services that cannot be addressed within the existing program structure. The supplement will improve continuity of care for Pathways enrollees.
Although the City issued a RFQ in January 2018 for Pathways service providers, the RFQ did not encompass the short-term and limited scope care coordination and housing services now needed through March 31, 2019. Accordingly, staff is recommending suspension of bidding for Sacramento Covered to provide care coordination and housing services through March 31, 2019. Provision of these services by Sacramento Covered is in the best interest of the City because given their current contract scope of services as an Outreach Entity, Sacramento Covered is easily able to incorporate enhanced care coordination and housing services into their existing workflow without disrupting the current care coordination process.
Extension of IT Services:
Staff also recommends approval of contract supplement No. 2 to the nonprofessional services agreement #2017-1528 with Sacramento Covered for IT services to ensure that Pathways enrollee data, care coordination activities, and program outcomes continue to be monitored and tracked through January 31, 2019. The agreement was originally executed in 2017 and contract supplement no. 1 executed on August 20, 2018 to incorporate additional services including but not limited to, performing core enrollment, eligibility, and referral functions for the Pathways Program.
Incentive Agreements:
The Pathways program enables the local community to transform healthcare and housing systems serving vulnerable populations through a collaborate effort involving many local community partners. To encourage participation in the Pathways process, DHCS allows the payment of incentive payments to partners who are providing services and/or participating in the Pathways program design. The City’s program application that was submitted to DHCS specifies the categories of entities that can receive incentive funding and the maximum allowable amounts for such incentive payments. The Pathways team has outlined incentive payments in the table below for activities performed in Program Year 3, reflecting the commitment of the various community partners who support and will continue to support the Pathways program. Staff recommends Council approval of the following incentive payment amounts for each partner, totaling $1,505,000 for all incentive payments. Staff will return to council in 2019 to request approval for additional incentive agreements.
Table A: Proposed Incentive Agreements
Policy Considerations: The Pathways program aligns with the federal directive and City commitment that funding for addressing homelessness follow a “housing first” approach, which offers permanent housing as quickly as possible for individuals and families experiencing homelessness. In housing first programs, supportive services are offered (but not required as a condition of tenancy) to help people keep their housing and avoid returning to homelessness. This evidence-based approach is consistent with the strategies and funding priorities of the other public agencies working to end homelessness in Sacramento. Partnering with other agencies to leverage resources and improve livability is consistent with the City Council’s past actions and current direction.
Economic Impacts: None.
Environmental Considerations: The actions specified in this report do not constitute a
“project” under the California Environmental Quality Act (CEQA) because they are continuing administrative activities and amount to general policy and procedure making [CEQA Guidelines section 15378(b)(2)].
Sustainability: Not Applicable.
Commission/Committee Action: None.
Rationale for Recommendation: The Pathways program is an opportunity for a community to transform healthcare and housing systems serving vulnerable populations by aligning services and data through performance-based contracts. The recommended contract partners have extensive experience working in Sacramento and providing services and support to vulnerable populations. The Pathways program offers an opportunity to leverage the experience and expertise of these organizations in a large, collaborative program that aims to change the way services are delivered in Sacramento. While Pathways is currently only funded for four calendar years, a key goal of Pathways is to achieve long-term sustainability and continue program services after the program sunsets.
The WPC funding mechanism for drawing down matching dollars requires the delivery of the services and meeting program outcomes before funds are provided. In this way, the City must expend funds to draw down the federal match. In Program Year 3, the City successfully met all reporting requirements for DHCS and has established strong program and financial controls. In order to maintain current level of service, the City must enter into contracts sized to meet the outcomes necessary to draw down the maximum match-funding in Program Year 4.
Financial Considerations: Staff is recommending an increase of $581,850 to Agreement #2018-0696 with Sacramento Covered for extended outreach services and addition of care coordination and housing services through March 31, 2019, with a new total not-to-exceed amount of $1,561,450. Staff is also recommending an increase of $25,000 to Agreement #2017-1528 with Sacramento Covered for continued IT services through January 31, 2019, with a new total not-to-exceed amount of $975,000. Staff is further recommending execution of 21 incentive agreements with the entities identified in Table A, with a total amount of $1,505,000 for all 21 agreements. Expenditures for all agreements and contract supplements proposed in this report total $2,111,850.
Staff is also recommending an increase in revenue and expenditure budgets of the Pathways program (I02000900) in the amount of $4,260,550 to account for contributions to the program from local health partners which will support Program Year 4 activities. City anticipates receiving DHCS payment for contracted costs during the next IGT payments slated for May 2019 and October 2019. Table B below summarizes the anticipated funding plan for Program Year 4 of the City’s Pathways Program:
Table B: Program Year 4 Anticipated IGT Payment Structure
There is sufficient funding in the Pathways Program I02000900 to cover the contract amounts outlined in this report.
Local Business Enterprise (LBE): All the Pathways service partners are local businesses with established operations in Sacramento and have a history of serving Sacramento’s medically fragile and homeless populations.