Agenda Item   

AGENDA STAFF REPORT

 

                                                                                                                        ASR Control  21-000913

 

MEETING DATE:

11/02/21

legal entity taking action:

Board of Supervisors

board of supervisors district(s):

All Districts

SUBMITTING Agency/Department:

Health Care Agency   (Approved)

Department contact person(s):

Hieu Nguyen (714) 834-2367 

 

 

Clayton Chau (714) 834-2830

 

 

Subject:  Contracts for Population Health and Equity

 

      ceo CONCUR

County Counsel Review

Clerk of the Board

Concur

Approved Agreement to Form

Discussion

 

 

3 Votes Board Majority

 

 

 

    Budgeted: Yes

Current Year Cost: $6,282,272

Annual Cost: FY 2022-23 $9,423,407
FY 2023-24 $2,355,852

 

 

 

    Staffing Impact:

No

# of Positions:

Sole Source: N/A

    Current Fiscal Year Revenue: N/A

  Funding Source: FED: 100% (CDC National Initiative to Address COVID-19 Health Disparities)

County Audit in last 3 years: No

 

 

    Prior Board Action: 06/22/2021 #70, 04/27/2021 #51

 

RECOMMENDED ACTION(S):

 

 

1.

Approve Contract with Institute for Healthcare Improvement for provision of Population Health and Equity Partnership Services for the term of November 2, 2021, through September 30, 2023, for an amount not to exceed $1,761,531.

 

2.

Approve Contract with Multi-Ethnic Collaborative of Community Agencies for provision of supporting Partner Outreach, Engagement, and Grants Administration Support Services for the term of November 2, 2021, through September 30, 2023, for an amount not to exceed $15,300,000 ($1,200,000 for expenses related to outreach and engagement of community participants and $14,100,000 to be allocated to various subrecipient participation and implementation grants to community partners and participation stipends for community residents involved in the Orange County Health Equity Coalition, Social Determinants of Health Priority Action Areas and other grant related activities). 

 

3.

Approve Contract with Advance OC for provision of OC Health Equity Map Community Engagement and Platform Enhancements Services for the term of November 2, 2021, through September 30, 2023, for an amount not to exceed $600,000.

 

4.

Approve Contract with Public Health Institute for provision of Workforce Development and Health Equity Technical Assistance Services for the term of November 2, 2021, through September 30, 2023, for an amount not to exceed $200,000.

 

5.

Approve Contract with Celery Design Collaborative, LLC. for provision of OC Health Equity Coalition Media and Communication Campaign Services for term of November 2, 2021, through September 30, 2023, for an amount not to exceed $200,000. 

 

6.

Pursuant to Contract Policy Manual Section 3.4-114, authorize the County Procurement Officer or authorized Deputy, to exercise a contingency contract cost increase in an amount not to exceed 10 percent of the Contract amounts for the first year of the Contracts, for the entire term of the Contracts, including renewals, and within the scope of work set forth in the Contracts.  The use of this contingency contract cost increase is subject to approval requirements established by the County Procurement Officer.

 

7.

Authorize the County Procurement Officer or authorized Deputy to execute the Contracts with Institute for Healthcare Improvement, Multi-Ethnic Collaborative of Community Agencies, Advance OC, Public Health Institute and Celery Design Collaborative, LLC as referenced in the Recommended Actions above.

 

 

 

 

SUMMARY:

 

Approval of the Contracts will support the implementation of activities related to the Centers for Disease Control and Prevention National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, including Racial and Ethnic Minority Populations and Rural Communities Grant, which is in alignment with the Health Care Agency’s strategic plan of promoting population health and equity by addressing social conditions in the community to reduce COVID-19 disparities.

 

 

 

BACKGROUND INFORMATION:

 

On March 17, 2021, the Office for State, Tribal, Local and Territorial Support from the Centers for Disease Control and Prevention announced a non-competitive no cost sharing or matching grant.

 

On April 27, 2021, your Honorable Board of Supervisors (Board) approved the Health Care Agency (HCA) to apply for the Centers for Disease Control and Prevention (CDC) National Initiative to Address COVID-19 Health Disparities Among Population at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities Grant (Grant).

 

On June 22, 2021, the Board approved HCA’s acceptance of the CDC Grant award in the amount of $22,886,119.

 

The CDC Grant is much broader in scope than other federal COVID-19 grants that have been issued. Its intention is to address the health inequities that were highlighted by the COVID-19 pandemic. The CDC Grant allows HCA to develop an initiative focused solely on addressing health inequities through tackling the social determinants of health. This will complement current HCA public and behavioral health efforts related to COVID-19.

 

Social determinants of health can best be defined as the conditions that determine the health and well-being of an individual such as food security, employment, and housing. The concept asks for health experts and policymakers to address the upstream factors that impact an individual’s health. Addressing the social determinants of health is not resigned only to the healthcare system of care, but the entire System of Care. Through this grant, HCA will be touching primarily on the County’s Behavioral and Physical Health systems, while keeping the County’s other Systems of Care which include Benefits and Supportive Services, Community Corrections and Housing  in mind. Furthermore, by tackling the social determinants of health for the most high-risk communities, the CDC Grant aligns with the HCA strategic plan’s focus on mitigating population health inequities.

 

Under the CDC Grant, there are four CDC approved grant strategies that will set the foundation for the activities of the Grant and help determine Provider performance: 

 

1.

Expand existing and/or develop new mitigation and prevention and services to reduce disparities among higher risk and/or underserved populations.

2.

Increase and improve data collection and reporting for populations experiencing a disproportionate burden of COVID-19 infection, severe illness and death that will guide the continued response to the COVID-19 pandemic.

3.

Build, leverage and expand infrastructure support for COVID-19 prevention and control among higher risk and/or underserved populations.

4.

Mobilize partners and collaborators to advance health equity and address social determinants of health related to COVID-19 health disparities among higher risk and/or underserved populations.

 

In collaboration with the community and contracted Providers, HCA anticipates achieving the following performance and process outcomes for the above four strategies:

 

CDC Performance Outcomes:

Strategy 1 Measures:

·   Increased number of COVID-19 mitigation and prevention resources and services delivered in support of populations that are underserved and disproportionately affected by type.

·   Increased Number of COVID-19/SARS-COV-2 tests completed by test type, results, race/ethnicity.

Strategy 2 Measure:

·  Increased number of improvements to data collection, quality and reporting capacity for recipients, partners and agencies related to COVID-19 health disparities and inequities.

Strategy 3 Measure:

·  Increased number of improvements to infrastructure to address COVID-19 health disparities/inequities.

Strategy 4 Measure:

·  Increased number or expanded proportion of new, expanded or existing partnerships mobilized to address COVID-19 health disparities and inequities.

HCA Outcome & Process Measures:

·  Reduction in the negative impact of current and future public health crises on vulnerable communities.

·  New, expanded, strengthened community partnerships through capacity building and direct support.

·  Increased alignment among organizations who have a part in health outcomes and equity.

·  Increased use of population health data across the County.

·  Demonstrate proof of concept to support future funding for population health and equity efforts.

 

HCA will meet the four strategies and their associated performance and process outcomes through improved outreach and engagement; standardizing data collection, reporting and use practices; increasing health equity infrastructure for COVID-19 prevention; and mobilizing community partners and collaborators to tackle social conditions that contribute to COVID-19 disparities in higher risk and/or underserved populations. To successfully achieve these outcomes, HCA will engage community partners along with industry experts to initiate the Equity in OC Initiative to ensure successful implementation of the CDC Grant, support on-going COVID-19 pandemic recovery, and build improved infrastructure for future pandemics. The Equity in OC Initiative has three phases, associated activities, contracted Providers and their roles to support implementation, which include:

 

Phase 1 (5 months):  Planning, Recruitment & Readiness

To convene the community to identify and select priority action areas related to specific social determinants of health and engage community teams in taking collective actions by changing the conditions that contribute to COVID-19 disparities.

Activities:

·        To support the Equity in OC Initiative, convene an OC Health Equity Coalition (Coalition) with cross-sector community stakeholders.

·        With the Coalition, identify three social determinants of health priority action areas (e.g., food insecurity, digital divide, access to green spaces, social inclusion and safety).

·        Convene six population health equity collectives (i.e., API, Black, Individuals with Disability, Latinx, LGBTQ and Older Adults) to support increased capacity.

·        Create awareness about opportunities to join the Equity in OC Initiative.

·        Recruit teams from individual communities to join the Equity in OC Initiative.

·        Prepare content and expert knowledge about community-based methods to reduce disparities related to action areas.

·        Prepare action area-specific data gathering and metrics for local participant use.

Roles:

Institute for Healthcare Improvement (IHI): Population Health and Equity Partnership Services 

·         Lead strategic planning effort to identify three social determinants of health priority action areas and performance metrics.

·         Guide the use of data and community input to select three social determinants of health priority action areas.

·         Gather experts and existing best practices to address each social determinants of health priority action area.

 

Multi-Ethnic Collaborative of Community Agencies (MECCA): Partner Outreach, Engagement and Grant Administration Support Services

·         Engage in outreach with communities interested in joining the initiative. Focus will be on targeted previously under-represented or disengaged communities.

·         Administer participation grants and stipends for partner community-based organizations and historically under-represented populations.

·         Administer grants to six population health equity collectives to support their organization and collective action.

 

Advance OC: Data Analytic and OC Equity Map Engagement and Platform Enhancement Services 

·         Support selection of social determinants of health priority action areas using the OC Equity Map, community surveys, and other data sources.

·         Support selection and development of outcome and process metrics for each action area.

·         Engage communities in understanding COVID-19 disparities and in building will to collaborate to make changes.

 

Celery Design Collaborative, LLC. (Celery): Communication and Media Campaign Services

·         Create communication tools to support activities of the Equity in OC Initiative and how COVID-19 disparities are linked to social determinants of health.

·         Create communication materials to support the Equity in OC Initiative, including recruitment and education tools.

·         Develop website and social media platforms to assure transparency about the Equity in OC Initiative activities, progress and learnings form the phases and activities.

 

Public Health Initiative (PHI): Workforce Development and Equity Technical Assistance

·         Convene learning collaborative of cross-jurisdictions of Southern California local health departments for shared learnings and collaborations for on-going COVID-19 recovery.

·         Provide technical assistance to HCA as it operationalizes health equity along with community partners to reduce the impact of COVID-19 disparities.

Phase 2 (15 months):  Action and Learning

To focus on supporting communities to make local changes that reduce COVID-19 disparities resulting from social determinants of health, participants will receive guidance and coaching from experts in the given action area and access to implementation grants for change activities (e.g., create urban farms in local neighborhoods, improve health literacy and access to information, increase broadband access in communities impacted by COVID-19).

Activities:

·         Convene participating communities in the “Action and Learning Community” (ALC) to learn from experts and each other about how to make changes to address the three social determinants of health priority action areas.

·         Host learning sessions to support collaborative learning from experts.

·         Conduct monthly webinars with participants of the social determinants of health priority action areas to provide coaching and technical assistance.

·         Support six population health equity collectives to act on the identified needs for their respective communities.

Roles:

IHI: 

·         With experts in priority action areas, facilitate learning sessions with experts on interventions that address priority action areas.

·         Between learning sessions, hold monthly webinars to coach local community teams on how to successfully apply their interventions.

·         Support communities to identify and gather metrics that accurately track performance outcomes.

 

MECCA:

·         Administer implementation grants to participating communities to support their local changes that address the social determinants of health priority action areas.

·         Focus on monitoring and continued, as appropriate, issuance of participation grants and stipends to support involvement of small organizations and frequently under-represented populations.

·         Continue to administer grants to the six population health equity collectives to support their formation and collective action.

 

Advance OC: 

·         Support ongoing use and refinement of data to accurately capture outcome and process measures for each action area.

·         Continue to engage communities in understanding COVID-19 disparities and in building support for collaborative change.

 

Celery: 

·         Create communication tools to promote the Equity in OC Initiative activities, learning and progress in the ALC.

·         Curate and add to the Equity in OC Initiative website.

·         Deploy social media platforms to assure transparency about initiative activities, progress and learning.

 

PHI:

·         Provide ongoing learning and best practices sharing from other local health departments and communities on effective COVID-19 mitigation and recovery strategies.

·         Provide trainings, in collaboration with Advance OC, to community partners on data collection/reporting and community power sharing in reducing the impact of COVID-19 disparities.

Phase 3 (3 months):  Harvesting, Future Action Planning, and Dissemination

To harvest critical learnings from the Action and Learning phase; to tell the initiative story through case studies and other compelling dissemination write-ups; to deepen HCA and community capability to advance health equity initiatives and better position the County for future funding.   

Activities:

·        Support social determinates of health priority action area participating teams to create sustainability plans.

·        Gather key learning and compelling stories that demonstrate the positive impact of local change activities.

·        Curate the tools and techniques that worked in participating communities to assure they are available to others seeking similar outcomes in the future.

Roles:

IHI:

·          Facilitate sustainability planning

·           Support harvesting activities to gather key learning and other contents to be curated

 

MECCA:

·         Finalize grant administration and prepare summary report of grantees’ performance and process outcomes.

 

Advance OC:

·         Evolve the OC Equity Map capabilities and useability in light of learning throughout the community engagement process.

 

Celery: 

·         Continue to curate the website to be a resource for communities not directly involved in the initiative but who are interested in similar efforts in their communities.

·         Continue to deploy communications on social media platforms to assure transparency about the Equity in OC Initiative activities, progress, and learning.

 

PHI:

·         Continue facilitation of the Southern California Local Health Departments Learning Collaborative.

·         Continue to provide technical assistance to HCA as necessary.

 

All Providers were selected either due to their expertise in one or more of the following areas:

 

1.

Established reputation for specializing in leading community-based strategy development processes specific to health policy and programming, especially social determinants of health; and/or

2.

Unique experience in communicating, educating and translating the concept of “social determinants of health” into actionable items for government, CBOs and community implementation; and/or

3.

Unique knowledge of Orange County-specific data, populations, and state and local regulations required for programming implementation.

 

The proposed Contracts are sole source contracts and completed Sole Source Request Forms are attached to this Agenda Staff Report as Attachment G. Immediate implementation of the CDC Grant and the activity phases through the Contracts with the selected population health equity experts will allow HCA to address critical health equity gaps identified as a result of the COVID-19 Pandemic.

 

The Orange County Preference Policy is not applicable to these contract awards.

 

These Contracts noted above do not currently include subcontractors or pass through to other providers. See Attachment F for Contract Summary Forms.

 

It should be noted that Dr. Clayton Chau is currently a non-paid member of the Advisory Committee with Advance OC and his capacity in this role is limited to providing subject matter expertise as a public health and health care professional. Advance OC’s Advisory Committee members are a network of independent advisors and do not convene, are not members of Advance OC’s board of directors, and do not provide input or become involved in the operations of Advance OC.

 

HCA requests the Board to approve the Contracts with as referenced in the Recommended Actions above.

 

 

 

FINANCIAL IMPACT:

 

Appropriations and offsetting revenue for these Contracts are included in Budget Control 042 FY 2021-22 Budget and will be included in the budgeting process for future years.

 

Should services need to be reduced or terminated due to lack of funding, the Contracts contain language that allows HCA to give a 30-day notice to either terminate or renegotiate the level of services to be provided. The notice will allow HCA adequate time to transition or terminate services to clients, if necessary.

 

 

 

STAFFING IMPACT:

 

N/A

 

ATTACHMENT(S):

 

Attachment A – Contract MA-042-22010163 for Population Health and Equity Partnership Services with Institute for Healthcare Improvement
Attachment B – Contract MA-042-22010253 for Partner Outreach, Engagement, and Grants Support Services with MECCA
Attachment C – Contract MA-042-22010255 for OC Health Equity Map Community Engagement and Platform Enhancements Services with Advance OC
Attachment D – Contract MA-042-22010526 for Health Equity Technical Assistance Services with Public Health Institute
Attachment E – Contract MA-042-22010330 for OC Health Equity Coalition Media and Communication Campaign Services with Celery Design Collaborative, LLC.
Attachment  F – Contract Summary Forms for Attachments A – E
Attachment  G – Sole Source Request Forms for Attachments A – E