Title:
Title
Approvals for Implementation of Pathways to Health + Home Program
End
FileID
File ID: 2018-01686
Location
Location: Citywide
Recommendation:
Recommendation
Pass a Motion authorizing the City Manager or City Manager’s designee to: 1) execute supplemental agreement no. 3 to city agreement 2018-0696 with Healthy Community Forum for Greater Sacramento Region dba Sacramento Covered and extend services through June 30, 2019 for an increase of $526,900, with a new total not-to-exceed amount of $2,088,350; 2) execute supplemental agreement no. 1 to city agreement 2019-0258 with Sacramento Native American Health Center (SNAHC) for an increase of $71,400, with a new total not-to-exceed amount of $294,150; 3) execute supplement agreement no. 1 to city agreement 2019-0259 with Elica Health Center (Elica) for an increase of $77,250, with a new total not-to-exceed amount of $283,500; and 4) execute supplemental agreement no. 1 to city agreement 2019-0257 with WellSpace Health, Inc. for an increase of $138,000, with a new total not-to-exceed amount of $550,500.
Contact: Emily Halcon, Homeless Services Coordinator, (916) 808-7896; Anira Khlok, Homeless Services Program Analyst, (916) 808-7948, Office of the City Manager
Body
Presenter: None.
Attachments:
1-Description/Analysis
2-Sacramento Covered Outreach Contract Supplement
3-SNAHC Hub Entity Contract Supplement
4-Elica Hub Entity Contract Supplement
5-WellSpace Health, Inc. Hub Entity Contract Supplement
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. 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 which began on January 1, 2019 and ends on December 31, 2019. Program Year 5 will run from January 1, 2020 through December 31, 2020. As of April 15, 2019, Pathways had 634 individuals enrolled and had served a total of 1,186 individuals through the life of the program. A total of 69,005 services, including outreach, navigation, care coordination, and housing support, have been provided to the community. Additionally, Pathways has housed a total of 278 individuals. Pathways is collaborating with over 20 health care, housing, and social service providers to ensure continuity of care for program enrollees and is continuing to explore other partnerships.
Extension and Expansion of Sacramento Covered’s Outreach, Care Coordination, and Housing Services
The City issued a Request for Qualifications (#Q18021011002) in January 2018 for Pathways service providers. Sacramento Covered was selected to provide outreach services and executed a contract with the City for such services through December 31, 2018. In December 2018, Sacramento Covered’s outreach services were extended through March 31, 2019. Additionally, to avoid gaps in service until additional providers could be retained, Sacramento Covered’s contract was expanded to include temporary enhanced care coordination and housing services through March 31, 2019. Due to further delays in obtaining new providers, Sacramento Covered’s agreement was again extended in March 2019 to run through April 30, 2019. Also, in March 2019, Sacramento Covered was selected through a competitive Request for Qualifications (#Q19021011001) process to provide both housing and care coordination services to Pathways clients on a long-term basis. Staff is working on developing these longer-term contracts, but desires to continue the outreach, care coordination, and housing services through June 30, 2019 by expanding the existing contract.
Staff recommends approval of a contract supplement to the professional services agreement #2018-0696 with Sacramento Covered to maintain the provision of outreach, enhanced care coordination and housing services for Pathways enrollees through June 30, 2019. The attached contract supplement will expand the following services: 1) outreach service capacity will increase from 750 enrollees to 900; 2) housing services capacity will increase from 125 to 300 individuals; and 3) enhanced care coordination services will increase from serving 200 individuals to 250. Additionally, Sacramento Covered will receive a higher payment for enhanced care coordination services because program enrollees are higher acuity and have more complex needs and therefore required additional staff time and support for care coordination activities. The approval of the attached contract supplement will enable the program to enroll more individuals and position the program towards meeting the program goal of serving 1,000 individuals at any point in time. Staff will return to City Council seeking approval for a new contract for these services around June 2019.
Expanding Pathways Hub Capacity
The City of Sacramento currently contracts with four Federally Qualified Health Centers (FQHC), or Hubs, who provide medical case management and care coordination for Pathways enrollees. Pathways Hubs ensure that program enrollees connect with their primary care provider, manage their medical conditions, assist individuals with securing specialty care, and even expediting appointments as needed. Staff recommends approvals of the contract supplements for SNAHC (Agreement #2018-0696), Elica Health Centers (Agreement #2019-0259) and WellSpace Health, Inc. (Agreement #2019-0257) to expand medical care coordination to support an additional 100 new program enrollees through December 31, 2019. Furthermore, each Hub will receive an increased Per Member Per Month (PMPM) payment rate from the City as the population being served is higher acuity and therefore requires more staff time and resources to dedicate to each enrollee. Staff is seeking approval of contract supplements for three of the four Pathways Hubs and will not be amending the contract with the remaining Hub, One Community Health, as Council recently approved their contract on April 23, 2019 which incorporated a new enrollee service panel and an increased PMPM payment rate. Each of the Pathways Hubs has the capacity to support new program enrollees and will be able to assist the City with meeting the goal of serving 1,000 program enrollees at any given point in time.
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 through December 31, 2020, a key goal of Pathways is to achieve long-term sustainability and continue program services after the program sunsets.
Financial Considerations: There is sufficient funding in the Pathways Program I02000900 to cover the supplemental contract amounts outlined in this report, which total $813,550.
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.