Title:
Title
Approvals for Implementation of Pathways to Health + Home Program [Two-Thirds Vote Required]
End
FileID
File ID: 2019-01588
Location
Location: Citywide
Recommendation:
Recommendation
Pass a Motion by two-thirds vote: 1) waiving the requirement for 10-day posting of agreements over $1.0 million pursuant to City Code section 4.04.020(C); and 2) authorizing the City Manager of City Manager’s designee to: a) execute a supplemental agreement No. 4 attached hereto as Attachment 2 to Agreement 2019-0260 with Sacramento Self-Help Housing, Inc. to extend Pathways Housing Services through March 31, 2020 for an amount not-to-exceed $348,000 for a new total not-to-exceed amount of $1,407,750; b) execute a supplemental agreement No. 2 attached hereto as Attachment 3 to Agreement 2019-0256 with Lutheran Social Services of Northern California to extend Pathways Housing Services through March 31, 2020 for an amount not-to-exceed $218,250 for a new total not-to-exceed amount of $568,250; c) execute a supplemental agreement No. 4 attached hereto as Attachment 4 to Agreement 2019-0257 with WellSpace Health, Inc. to extend Pathways Hub Services through March 31, 2020 with an increase in the total not-to-exceed amount by $174,555 for a new total not-to-exceed amount of $783,555; d) execute a supplemental agreement No. 2 attached hereto as Attachment 5 to Agreement 2019-0258 with Sacramento Native American Health Center, Inc. to extend Pathways Hub Services through March 31, 2020 with an increase in the total not-to-exceed amount by $72,270 for a new total not-to-exceed amount of $366,420; e) execute a supplemental agreement No. 2 attached hereto as Attachment 6 to Agreement 2019-0259 with Elica Health Centers to extend Pathways Hub Services through March 31, 2020 with an increase in the total not-to-exceed amount by $52,020 for a new total not-to-exceed amount of $335,520; d) execute a supplemental agreement No. 1 attached hereto as Attachment 7 to Agreement 2019-1542 with Healthy Community Forum for the Greater Sacramento Region dba Sacramento Covered to extend Pathways Outreach, Housing, Hub and IT Services through March 31, 2020 with an increase in the total not-to-exceed amount by $1,139,000 for a new total not-to-exceed amount of $2,268,000; and f) execute incentive agreements with Pathways partners in accordance with the schedule of amounts and partners identified in this report and as reflected in the agreements listed on Table 2, for a not-to-exceed amount of $1,470,000 for all agreements.
Contact: Emily Halcon, Homeless Services Manager, (916) 808-7896; Anira Khlok, Homeless Services Program Analyst, (916) 808-7948, Office of the City Manager
Body
Presenter: None.
Attachments:
01-Description/Analysis
02-Sacramento Self-Help Housing Contract Supplement
03-Lutheran Social Services of Northern California Contract Supplement
04-WellSpace Health, Inc. Contract Supplement
05-Sacramento Native American Health Center, Inc. Contract Supplement
06-Elica Health Centers Contract Supplement
07-Sacramento Covered MSA Contract Supplement
08-Sacramento Covered Incentive Agreement
09-Lutheran Social Services of Northern California (LSS) Incentive Agreement
10-River City Medical Group Incentive Agreement
11-Peach Tree Healthcare Incentive Agreement
12-Health and Life Organization, Inc. (HALO) Incentive Agreement
13-Cares Community Health dba One Community Health Incentive Agreement
14-Sacramento Native American Health Center, Inc. (SNAHC) Incentive Agreement
15-Sacramento Steps Forward (SSF) Incentive Agreement
16-Sacramento Self-Help Housing Incentive Agreement
17-Elica Health Centers Incentive Agreement
18-Molina Healthcare of California Incentive Agreement
19-Health Net Community Solutions, Inc. Incentive Agreement
20-WellSpace Health Incentive Agreement
21-Blue Cross of California Partnership Plan, Inc. Incentive Agreement
22-Dignity Health on behalf of its Greater Sacramento Division Incentive Agreement
23-The Regents of the University of California, on behalf of its UC Davis Health Incentive Agreement
24-Sutter Health 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.
Pathways is currently in Program Year 4 (PY 4) which began on January 1, 2019 and ends on December 31, 2019. Program Year 5 (PY 5) will run from January 1, 2020 through the end of the program on December 31, 2020. As of November 30, 2019, Pathways had 844 individuals enrolled and had served a total of 1,710 individuals through the life of the program. A total of 141,384 services, including outreach, navigation, care coordination, and housing support, have been provided to the community. Additionally, Pathways has helped house a total of 472 individuals. Pathways is collaborating with over 20 health care, housing, and social service providers to ensure continuity of care for program enrollees. This staff report requests an extension of existing service contracts to support service delivery for the first three months of Program Year 5 as well as seeks approval of 17 Program Year 4 Incentive Agreements for participating program partners. Staff will return to Council early in 2020 to request extensions of service contracts for the remainder of Program Year 5 which will run from April 1, 2020 through December 31, 2020.
Extension of Housing Services
The role of the Housing Services Entity is to work with unsheltered Pathways enrollees to
locate the most appropriate and available housing, both subsidized and non-subsidized. The Pathways Program is a unique model in that wrap-around services are provided to an enrollee to ensure a medical home is established and referrals to housing and social supports are made, with the ultimate goal of decreasing reliance on emergency response systems and decreasing homelessness within Sacramento. As the program ends, the City wants to support housing providers to continue housing clients quickly; this contract extension will ensure there is no interruption of housing services. The housing contract extensions will enable housing services to be delivered through March 31, 2020. Pathways is currently supported by three housing providers: Sacramento Self-Help Housing, Lutheran Social Services of Northern (LSS), California and Sacramento Covered. By extending the existing housing contracts, Pathways will be able to provide housing support services for up-to 975 enrollees for Quarter 1 of Program Year 5.
Extension of Hub Services
The role of the Hub Entity is to provide medical care coordination to enrollees of the Pathways program. The Hub Entity will provide individualized care management services aimed at achieving health, behavioral health, and housing stability with a focus on improving functioning levels, and quality of life of participants, as appropriate and acceptable to enrollees. Elica Health Centers, WellSpace Health, SNAHC, One Community Health and Sacramento Covered currently have active hub contracts and have been serving a range of 125 to 375 program enrollees each. To ensure continuity of care for program enrollees, staff recommends extending contract terms with each of these hub entities to continue Pathways services for the beginning of Program Year 5. Staff is seeking approval of 4 of 5 current hub contracts as the contract with One Community Health does not require Council approval. By extending the existing hub contracts, Pathways will be able to provide medical care coordination supports for up-to 1035 enrollees.
Extension of Outreach and IT Services
Staff recommends approval of a contract supplement to the nonprofessional master services agreement 2019-1542 with Sacramento Covered to extend outreach services through March 31, 2020. Such supplement will ensure that outreach services continue to be delivered to participants for the first three months of Program Year 5. Approval of this contract will also extend IT services through March 31, 2020 and ensure that Pathways enrollee data, care coordination activities, and program outcomes continue to be monitored and tracked. Table 1 below outlines the requested contract extensions as mentioned in the above narrative.
Table 1: Requested Contract Extensions for PY5 Activities
Incentive Agreements for Program Year 4
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 Table 2 below for activities performed in Program Year 4, 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 $1,470,000 for all incentive payments.
Table 2: Program Year 4 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 impact of Pathways on both service delivery for vulnerable populations and the expansion of partnerships with the health care community has been significant. Staff’s recommendation will allow the maintenance of the level of services under Pathways which include health care coordination, outreach and referral, as well as housing supports. These services will further be complemented by recently awarded one-time housing funds in the amount of $3,059,351.
Financial Considerations: There is sufficient funding in the Whole Person Care Multi-Year Operating Project (I02000900), in Operating Grants (Fund 2702) to fund the contract extensions and incentive agreements in the amount of $3,474,095.
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.