Agenda Item AGENDA STAFF REPORT ASR Control 22-000954
MEETING DATE:	05/23/23
legal entity taking action:	Board of Supervisors
board of supervisors district(s):	2
SUBMITTING Agency/Department:	Health Care Agency (Approved)
Department contact person(s):	Annette Mugrditchian (714) 834-5026
	Veronica Kelly (714) 834-7024

Subject: Renewal of Contract for Psychiatric and Basic Medical Services

ceo CONCUR

County Counsel Review

Clerk of the Board

Concur

Approved Agreement to Form

Discussion

3 Votes Board Majority

Budgeted: N/A

Current Year Cost: N/A

Annual Cost: FY 2023-24 $3,091,610
FY 2024-25 $3,261,049

Staffing Impact:

# of Positions:

Sole Source: N/A

Current Fiscal Year Revenue: N/A

Funding Source: State: 100% (Mental Health Services Act/Prop 63)	County Audit in last 3 years: No
Levine Act Review Completed: Yes

Prior Board Action: 5/24/2022 # 40, 5/19/2020 #18

RECOMMENDED ACTION(S):

Approve Amendment No. 3 to renew the Contract with CEP America-Psychiatry, PC dba Vituity for provision of Psychiatric and Basic Medical Services for the term July 1, 2023, through June 30, 2025, for an increased amount not to exceed $6,352,659, for a revised cumulative contract total amount not to exceed $14,731,707.

Authorize the County Procurement Officer or Deputized designee to execute Amendment No. 3 to the Contract with CEP America-Psychiatry, PC dba Vituity, as referenced in the Recommended Action above.

SUMMARY:

Approval of Amendment No. 3 with CEP America-Psychiatry, PC dba Vituity for the provision of Psychiatric and Basic Medical Services will provide on-site Psychiatric and Basic Medical Services to all adults seen at the Orange County Mental Health and Recovery Services Crisis Stabilization Unit.

BACKGROUND INFORMATION:

On May 19, 2020, your Honorable Board of Supervisors (Board) approved the contract with CEP America-Psychiatry, PC dba Vituity (Vituity) for the provision of Psychiatric and Basic Medical Services at the County Crisis Stabilization Unit (CSU) for the term of July 1, 2020, through June 20, 2022. Amendment No. 1 with Vituity was executed under Deputy Purchasing Agent delegated authority.

On May 24, 2022, the Board approved Amendment No. 2 to renew the Contract with Vituity, for the term of July 1, 2022, through June 30, 2023. Prior to contract expiration, the Health Care Agency (HCA) plans to issue a solicitation to continue services. The Orange County Preference Policy is not applicable to this Amendment. The contractor received salary increases during the 5/22 amendment and also requested increases for the next two years. Vituity produced a market study that justified the requests and what was ultimately agreed upon in negotiations was significantly lower than the initial proposal. Psychiatrists are a limited resource due to the national shortage and the proposed increases will allow salaries to remain competitive ensuring that a high level of quality care is maintained for the very vulnerable population that is served at the CSU.

Scope of Services

The Psychiatric and Basic Medical Services (BMS) are provided on-site at the County CSU. The contracted Psychiatric and BMS staff work collaboratively and seamlessly with the County CSU clinicians and peer staff toward the common goal of treating and stabilizing adult clients who are experiencing mental health emergencies that cannot wait until their regularly scheduled appointments and successfully linking them to ongoing care in our County. The County CSU provides emergency mental health evaluations and crisis stabilization services on a 24 hours a day, seven days a week and 365 days a year basis. Crisis stabilization services include, yet are not limited to, psychiatric evaluations, counseling/therapy services, nursing assessments, collateral services and consultations with significant others and outpatient providers, individual and family education, peer support and crisis intervention services. As a designated outpatient facility, the County CSU may evaluate and treat individuals for no longer than 23 hours and 59 minutes.

The Psychiatric Services includes on-site licensed Psychiatrists and psychiatric Nurse Practitioners to conduct a comprehensive assessment of all individuals presenting to the County CSU, including a basic medical screening which incorporates a review of systems and consultation with the BMS practitioners. The psychiatric and medical practitioners also provide consultation and psychiatric telephonic support to the Crisis Assessment Team and other health professionals regarding potential mental health referrals (i.e., local medical emergency department physicians, adult crisis residential programs, etc.).

BMS provides treatment for headaches, flu-like symptoms, basic wound care, sutures and treatment of chronic yet stable medical conditions, serving as a bridge until the person is seen by their treating medical provider. Providing these services allows individuals in mental health crises, whose primary care needs are psychiatric, to be safely brought to the County CSU. The BMS practitioner also provides consultations to the local emergency departments in order to bring individuals to the County CSU more expeditiously. BMS are provided by licensed Nurse Practitioners who are under direct supervision of a licensed physician.

Performance Outcomes

Over the past two years, Vituity was required to achieve, track and report Performance Outcome Metrics, on a quarterly basis. Outcomes reflected below are for FY 2021-22 and FY 2022-23:

Performance Outcomes	FY 2021-22	FY 2022-23 (through end of March)
Total Admissions	1,848	1,628
At least 55 percent of individuals admitted shall be successfully stabilized and returned to the community.	82%	76%
Contractor shall provide timely evaluations as measured by completing 95 percent of CSU admissions within one hour of individual’s arrival on a monthly basis.	100%	100%
Contractor shall provide the least restrictive alternatives and an effective medication approach that results in seclusion and restraint use of 1.1 percent or less of admissions per month.	1%	1%

Vituity has seen 77 percent of clients admitted to the County CSU that are on involuntary Welfare & Institution Code 5150 psychiatric holds. Vituity is exceeding performance metric of stabilizing individuals and returning them to the community and providing timely evaluations of all individuals served. Vituity is performing satisfactorily in all other areas of the performance outcome metrics.

HCA has verified there are no concerns that must be addressed with respect to Vituity's ownership/name, litigation status or conflicts with County interests.

The proposed Amendment No. 3 with Vituity does not include subcontractors or pass through to other providers. See Attachment B for Contract Summary Form.

HCA requests the Board approve Amendment No. 3 to the Contract for provision of Psychiatric and Basic Medical Services with Vituity, as referenced in the Recommended Action.

FINANCIAL IMPACT:

Appropriations for this Contract will be included in Budget Control 042 FY 2023-24 Budget and will be included in the budgeting process for future years.

The proposed Contract includes provisions allowing HCA to terminate the Contract, reduce the level of services, and/or renegotiate the levels of services provided, as necessary. This includes a notice that allows HCA adequate time to transition or terminate service to clients, if necessary.

STAFFING IMPACT:

N/A

ATTACHMENT(S):

Attachment A – Amendment No. 3 to Contract MA-042-20011529 for the Provision of Psychiatric and Basic Medical Services with CEP America-Psychiatry, PC dba Vituity
Attachment B - Contract Summary form
Attachment C - Redline version of Attachment A
Attachment D - Welfare and Institutions Code, Section 5520-5523