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Agenda Item
ASR
Control 24-000479 |
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MEETING
DATE: |
06/25/24 |
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legal entity taking action: |
Board
of Supervisors |
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board of supervisors district(s): |
All
Districts |
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SUBMITTING Agency/Department: |
County
Executive Office (Approved) |
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Department contact person(s): |
Kim
Derrick (714) 834-2564 |
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Kellie
Aumond (714) 834-2482 |
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Subject: Approve
Contract for County of Orange Dental Plan Claims Administration
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ceo CONCUR |
County Counsel Review |
Clerk of the
Board |
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Concur |
Approved Agreement to Form |
Consent Calendar |
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3 Votes Board Majority |
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Budgeted: N/A |
Current
Year Cost: N/A |
Annual
Cost: FY 2024-25 $63,500 |
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Staffing
Impact:
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No |
#
of Positions: |
Sole
Source: No |
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Current Fiscal Year Revenue: N/A
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Prior Board Action: 7/18/2023 #8, 8/9/2022 #6, 6/4/2019
#12 |
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RECOMMENDED
ACTION(S):
Authorize the
County Procurement Officer or Deputized designee to execute contract with
California Physicians’ Service, dba Blue Shield of California for dental claims
administration for the self-insured County of Orange Dental Plan estimated at
$390,700 for a period of three years effective January 1, 2025, through
December 31, 2027, renewable for two additional one-year periods per Board
policy.
SUMMARY:
Approval of the
contract with California Physicians’ Service, dba Blue Shield of California
will provide for continued administration of dental claims for the self-insured
County of Orange Dental Plan.
BACKGROUND
INFORMATION:
The County offers
a self-insured dental plan for eligible employees and their dependents. This
plan covers an average enrollment of 2,450 managers, attorneys and craft/plant
employees along with approximately 3,700 dependents. In September 2023, your
Board approved the First and Restated County of Orange Dental Plan (previously
titled Management and Attorney Dental Plan) with an effective date of January
1, 2024. California Physicians’ Service, dba Blue Shield of California (Blue
Shield) is the County’s current claims administration provider for the
self-insured County of Orange Dental Plan (Dental Plan). Blue Shield’s contract
expires on December 31, 2024. In anticipation of the contract expiration, Human
Resource Services (HRS) issued Request for Proposal (RFP) Number 017-202401-MC
on February 2, 2024. The Orange County Preference Policy (OCPP) was applicable
and incorporated into this solicitation. No OCPP qualified vendors submitted a
response. The RFP closed on March 7, 2024, and the County received five
responsive proposals from the following vendors:
- Blue
Shield of California
- Delta
Dental
- The
Cigna Group
- Sun
Life
- United
Concordia Dental
RFP Evaluation Process:
An RFP evaluation
committee was established consisting of five members, which included staff from
Child Support Services, County Executive Office-Budget and three staff members
from HRS-Employee Benefits. The County’s Benefits Consultant, Mercer Health and
Benefits, provided analytical support and summary exhibits to the committee in the
complex areas of provider network, geographical matching and provider
disruption, plan design differences, performance guarantees, administrative
capabilities and estimated proposed cost to the County. A County Deputy
Purchasing Agent (DPA) attended all committee meetings to monitor the selection
process.
The evaluation
committee was charged with selecting a proposal that best meets the needs of
the County based on the following criteria:
- Proposed cost to County;
- Ability to duplicate current/proposed plan
design, including ability to auto-adjudicate plan provisions;
- Network disruption for the Dental Plan;
- Administrative capabilities;
- Ability to duplicate proposed performance
guarantees;
- Qualifications and experience with similarly
sized public entities; and
- Responsiveness to the RFP, including edits to
Model Contract and Scope of Service
The evaluation
process consisted of two phases:
Phase I:
The committee
evaluated each proposal in accordance with the pre-determined criteria outlined
above and independently scored each proposal. The members of the evaluation
committee met to discuss their individual observations, comments and scores for
each criterion in the five proposals. The DPA documented the committee member’s
scores and established a rank order for the proposals.
Phase II:
The
two highest scoring vendors were selected as finalists and requested to make an
oral presentation to the evaluation committee. Following the finalist
interview, the evaluation committee completed the scoring process. See
Attachment A for the final scoring summary.
In addition,
members of the County’s CEO / OC Information Technology (OCIT) / Enterprise
Privacy & Cybersecurity office reviewed the cybersecurity compliance
questionnaires to ensure the vendors met minimum acceptable standards for
cybersecurity.
RFP Scoring:
The table below
represents the collaborative scoring effort made by the committee and is the basis
for the HRS recommendation. Based on the evaluation results, Blue Shield
received the highest overall evaluation score as shown below:
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PROPOSER |
FINAL SCORE |
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Blue Shield |
89.8 |
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Delta Dental |
82.0 |
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United Concordia |
72.9 |
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The Cigna Group |
68.6 |
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Sun Life |
57.9 |
Blue Shield
Blue
Shield is a California-based nonprofit organization. Blue Shield has been
providing dental services for more than 30 years and serves over 550,000 dental
members. Blue Shield has been the claims administrator for the County’s
self-insured dental plan for the past 17 years and understands the needs and
expectations of the County and its plan participants.
PPO Network
Blue Shield has
more than 47,000 access points in California and more than 390,000 nationwide.
County of Orange members will have a 100 percent access rate, which means on
average members will have access to at least one primary and one specialty
dentist within less than one mile of their home address. They also offer a wrap
network, which allows for a reduction in cost and less out of pocket expenses
for those members using one of the out-of-network wrap dental providers.
Maintaining the current PPO network will result in no disruption to our
members. In 2023, Blue Shield had over 130,000 members on its dental PPO plans
in California.
Claims
Administration
Blue Shield is
able to administer the current plan design without any variations. Blue Shield
was flexible in working with the County to modernize the dental plan document
and implement changes in 2024. Blue Shield offers a monthly reporting package,
quarterly utilization reporting and ad-hoc reporting at no cost. The claim
processing system is integrated with their customer service system to allow the
customer service representatives access to view claims and better support our
members.
Customer
Service
Blue
Shield offers a dedicated customer service team and an Ombudsman to assist on
complex and/or urgent issues. Participants will have toll-free access to a live
customer service representative from 5 a.m. to 8 p.m. (Pacific Time), Monday
through Friday. Blue Shield provides a customized website to allow participants
to view plan information, find a dentist, print or request an ID card, view
claim status and calculate dental treatment costs. Blue Shield’s mobile
application displays dental plan member information similar to what is found on
the website.
Contract
Scope and Language
Under the Scope of
Services for the contract, Blue Shield will provide complete dental claims
administration services, including customer service and a preferred dental
provider network with negotiated discounts for the self-funded PPO Dental Plan.
The contract before your Board contains language modifications to the County’s
model contract, including previously approved revisions to the insurance
provisions, which have been deemed as acceptable by HRS, County Counsel and
Risk Management. The proposed contract contains the County’s standard
indemnification language. See Attachment E for the approved Risk Assessment
Form.
The Contractor's
performance has been confirmed as satisfactory. HRS has verified there are no
concerns that must be addressed with respect to Contractor's ownership/name,
litigation status or conflicts with County interests.
The contract
includes subcontractors. See Attachment D - Contract Summary Form for
information regarding subcontractors. This contract, due to the nature of the
services, could require the addition of subcontractors. In order to add
subcontractor(s) to the contract, the contractor must seek express consent from
the department. Should the addition of a subcontractor affect the scope of work
and/or contract amount, the department will bring the item back to the Board of
Supervisors for approval. In the past subcontractor(s) have been used for this
contract.
Performance
Guarantees
Blue Shield
commits to meeting the County’s dental claims processing, customer service,
account management and net promoter score standards by placing up to 22 percent
of their fees at risk should they fail to meet the contract standards. In
addition, Blue Shield has placed 20 percent of its fees at risk if it does not
meet a 35 percent total in-network discount guarantee for plan year 2025.
Contract and Prior Board Actions:
Blue Shield is the
incumbent provider and therefore, there are Prior Board Actions and other
administrative actions associated with the contract.
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On June 4, 2019, the Board approved the
execution of the contract with Blue Shield for dental claims administration
for the self-insured Management and Attorney Dental Plan effective January 1,
2020. |
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On November 4,
2020, the First Amendment was executed to revise the Performance Standard for
First Call Resolution. This Amendment did not require Board approval per
County Procurement Office and Board policy. |
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On August 9,
2022, the Board approved the execution of Amendment Number Two to extend the
contract with Blue Shield for dental claims administration for the
self-insured Management and Attorney Dental Plan a period of one-year,
effective January 1, 2023, through December 31, 2023. |
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On July 18, 2023, the Board approved the
execution of Amendment Number Three to extend the contract with Blue Shield
for dental claims administration for the self-insured Management and Attorney
Dental Plan a period of one-year, effective January 1, 2024, through December
31, 2024. |
FINANCIAL IMPACT:
The estimated cost for the three-year
contract is $390,700. As part of the proposal, Blue Shield is offering a
$50,000 communications credit for the first year of the contract.
Appropriations for this contract will be
included in the FY 2024-25 Budget and will be included in the budgeting process
for future fiscal years. The Contract is contingent upon funding by the County
during the term of this Contract. If such funding is not approved, this
Contract will be immediately terminated without penalty to the County.
STAFFING IMPACT:
N/A
ATTACHMENT(S):
Attachment A - Final Scoring
Summary
Attachment B - Final Panel Scoring Sheets
Attachment C - Contract with Blue Shield
Attachment D - Contract Summary Form
Attachment E - Risk Assessment Form