Agenda 10/28/2008 Item #16E17
Agenda Item No. 16E17
October 28, 2008
Page 1 of 10
EXECUTIVE SUMMARY
Recommendation to approve the Second Amendment to the Community Health
Partners, Inc. Managed Care Services Agreement effective October 1, 2008 to provide
advocacy services to the Wellness Based Incentives Program.
OBJECTIVE: To provide Advocacy Services in support of the Wellness Based Incentives
Program.
CONSIDERATIONS: On September 23, 2008 the Risk Management Director presented a
report to the Board of Commissioners regarding the integration of behavior based wellness
incentives into the Collier County Group Health Plan.
The purpose of the program is to engage employees to participate in various wellness related
activities or "qualifiers" to prevent illness and to manage chronic disease. Employees are
enrolled in one of three plans with progressively better benefits (Basic, Select, or Premium)
based upon their completion of these qualifiers. The qualifiers include the completion of a
personal wellness profile; the gathering of weight, height and waist measurements; a complete
blood analysis; age and gender based screenings; and participation in diabetes management
and smoking cessation programs (if applicable).
The program utilizes the services of third party medical professionals or "advocates" who
provide support to covered members. The County currently has an agreement with
Community Health Partners (a/k/a "CHP") to provide a physician and hospital preferred
provider arrangement and to provide various managed care services including large case
management and disease management services. The CHP network encompasses all of the
major hospital facilities in the county as well as over 800 physicians. CHP is able to deliver the
professional resources as well as the case management and physician network necessary to
support the program.
In addition to assisting employees in the completion of their qualifier activities, the advocates
will also assist employees with a broad range of health care needs. They will review each
employee's personal wellness profile and counsel the employee as to the use of available
resources to improve their health. If necessary, the advocate will arrange for physician
appointments or schedule care through the MedCenter. They will also play an important role
in the management of employees with chronic health conditions such as diabetes, to assure
that they receive the care necessary to stabilize their condition.
Privacy is of prime importance to the protection of the employee and the success of the
program. CHP is a third party provider of healthcare services and will conform to the privacy
standards of HIPAA (the Health Insurance Portability and Accountability Act) to assLlre that the
personal health information of participants is fully protected. The county has an existing
HIPAA Business Associate Agreement with CHP to assure the proper management of
personal health information.
-.
The commencement date of the Second Amendment is October 1, 2008.
Agenda Item No. 16E17
October 28.2008
Page 2 of 10
FISCAL IMPACT: The estimated cost in FY 09 to provide advocacy services based upon an
average enrollment of 2,200 employees is $344,353.92. This fee also includes the transfer of
all Wellsource personal wellness profile costs ($8,214) currently paid by the County to CHP.
The new contract also reduces the scope of hospital pre-certification and concurrent stay
review services at a savings of $36,168. These funds will be used to offset the cost of
advocacy services.
Funds have been budgeted within Fund 517, Group Health and Life to fund the program.
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with
this item.
lEGAL CONSIDERATIONS: The Second Amendment is approved by William E. Mountford,
ACA, for legal sufficiency.
RECOMMENDATION: It is recommended that the Board of Commissioners approves the
Second Amendment to the Community Health Partners Managed Care Services Agreement
effective October 1, 2008 to provide Advocacy Services in support of the behavior based
wellness incentives program and authorize the Chairman to execute the Second Amendment.
PREPARED BY:
Jeff Walker, CPCU, ARM, Director Risk Management
Page 1 of 1
Agenda Item No. 16E17
October 28, 2008
Page 3 of 10
COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
Item Number:
Item Summary:
16E 17
Recommendation to approve the Second Amendment to the Community Health Partners,
Inc Managed Care Services Agreement effective October 1. 200B to prOVide advDcacy
services to the \l'Jelln6ss Based Incentives Program
Meeting Date:
10/28/200B 90000 AM
Approved By
Jeffrey A. Walker, CPCU,
ARM
Risk Management Director
Date
Administrative Services
Risk Management
101112008 3 :21 PM
Approved By
Lyn Wood
Purchasing Agent
Date
Administrative Services
Purchasing
10/101200810:31 AM
Approved By
Steve Carnell
Purchasing/General Svcs Director
Date
Administrative Services
Purchasing
10/14/20085:02 PM
Approved By
Len Golden Price
Administrative Services Administrator
Date
Administrative Services
Administrative Services Admin.
10114/2008 11 :55 PM
Approved By
Jeff Klatzlww
Assistant County Attorney
Date
County Attorney
County Attorney OffiGe
1011612008 8:58 AM
Approved By
OMS Coordinator
Applications Analyst
Date
Administrative Services
Information Technology
10116/200810;35 AM
Approved By
Randy Greenwald
Management/Budget Anaiyst
Date
County Manager's Office
Office or Management & Budget
1 D!i 6/2008 11 :01 AM
Approved By
,James V. Mudd
County Manager
Date
Board of County
Commissioners
County Manager's Office
10/20/2008 11 :38 AM
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Agenda Item No. 16E17
October 28,2008
Page 4 of 10
PHYSICIAN HOSPITAL 0 RGANIZATION
SECOND AMENDMENT TO
MANA~ED CAIQ; SERVICE AGREEMENT
Beqveen
BOARD OF COUNTY COMMISSIONERS COLI.IIi'.R COUNTY
AU
NAPLES PHYSICIAN HOSPITAL ORGANlZATION.INC
d/b/a COMMUNITY IlEum PARTNERS
THIS Amendment to the Managed Care Service Agreement (the "Amendment") is entered into
and becomes effective on October I, 2008, by and between Board of County Commissioners Collier
County, Florida hereafter referred to as "Payor", and Naples Physician-Hospital Organization, Inc., d/b/a
Community Health Partners, hereinafter referred to as "CHP".
RECITALS
WHEREAS, Board of County Commissioners Collier County, Florida has entered into that
certain Managed Care Service Agreement (the "Agreement"), effective Janwuy 1,2003, whereby, Board
of County Commissioners Collier County, FL desires and Community Health Partners agreed to provide
Managed Care and Utilization Review Services through a cost effective, coordinated, and integrated
health care delivery system to the Payor's self-insured Health Care Benefit Plan members
WHEREAS, the parties wish to amend the Agreement in accordance with the terms hereof.
NOW, THEREFORE, that in exchange for lawful consideration and intending to be legally
bound, the parties amend the Agreement, as fonows:
1. All defined terms used in the Amendment shall have the same meaning as ascribed to them in
the Agreement. Except as set forth herein, all other tenns and conditions set forth in the
Agreement, shall be unaffected hereby and shall remain in full force and affect.
2. Pursuant to Article II Provision of Services, Section 2.1 Utilization Management Program
shall be amended as follows:
Community Health Partner' Utilization Management Program shall use nationally
recognized guidelines to determine the appropriateness of medical services as well as the
delivery setting and length of stay for inpatient hospital and MRI services only; The
appropriateness guidelines have been developed to create practice pathways that integrate
with procedures that require Precertification.
09118108
Agenda Item No. 16E17
October 28. 2008
Page 5 of 10
3. Pursuant to Article n Provision of Services, Section 2.2 SmartChoice Program (Large Case
Management) shall be amended and the following added:
. The SmartCboice Disease Management portion of the program will be used on a
case by case as needed basis. There is no limit to the number of individuals
enrolled in this program.
. Reimbursement for this program will be calculated based on the number of
individuals enrolled.
4. Pursuant to Article II Provision of Services, Section 2.3 Access Healthline Program will be
deleted in its entirety and replcaced with the following:
2.3 REALm ADVOCACY PROGRAM
CHP agrees to:
1. Provide three (3) Community Health Partners employees dedicated to the Collier
County Government Health Advocacy Program. Employees will consist of:
. Two (2) Health Advocates (Job Description Exhibit 2)
. One (I) Health Coordinator
Each employee will work a minimum of Forty (40) hours per week. Local travel
will be required.
2. Health Advocacy staff will work with Collier County Government Wellness
Program Manager to collaborate on the start up, implementation, and day to day
management of the Health Advocacy Program.
3. Provide all applicable and necessary office equipment required for the employees
including but not limited to:
. Furniture
. Technology - computer, internet access, copier and fax machines
. Miscellaneous office supplies (paper, pens, notepads, etc.)
4. Secure and maintain three (3) year agreement with Well Source to provide Collier
county Government employees with access to the WellSource Personal Wellness
Profile and Health Activity Tracker program.
5. Create and maintain website specifically for the Health Advocacy Program.
Collier County Government agrees to:
1. Provide to CHP reimbursement for services on quarterly basis as established in
Schedule 4.7 attached. CHP will conduct a bi-annual review of services/staff
provided to the Health Advocacy Program and adjustment of payment tenDs may
be granted with mutual agreement by both parties.
2. Provide to CHP reimbursement for any travel related expenses of dedicated
Health Advocacy Program staff at the current mileage rate established by the
Internal Revenue Service (IRS).
3. Provide to CHP reimbursement for any unforeseen but related operational
expenses as approved by Director, Risk Management Collier County
Government.
09/18108
Agenda Item No. 16E17
October 28, 2008
Page 6 of 10
4. Provide to CHP monthly reimbursement for the hosting of the Health Advocacy
Program website.
S. Provide to CHP Health Advocate staff the following operational equipment:
. Office Space
· Telephone (Minimum of three (3))
· Appropriate printed/promotional material related to the Health Advocacy
Program.
5. Pursuant to Article n Provision of Services, Section 2.10 Program Fees and Schedule 4.7.
Section 2.10 and Schedule 4.7 shall be amended as foUows:
5.10 Board of County Commissioners Collier County shall pay Community Health
Partners the fees as listed on Schedule 4.7 herein, as compensation for Managed
Care Service programs ClIP provides.
6. Pursuant to Article ill Tenn and Tennination, Section 3.1 Tenn will be amended as follows:
This Letter of Agreement will be effective for a period of three (3) years and wilJ
terminate at midnight September 30,2011. At that time each party may negotiate another
term for services.
Either party may terminate this agreement and/or Health Advocacy Program for any
reason the first day of each calendar year with 90 day prior written notification to the
other party.
Agenda Item No. 16E17
October 28, 2008
Page 7 of 10
IN WITNESS WHEREOF, the undersigned have executed this First Amendment to be effective as of
January 1,2008.
A'ITEST:
Dwight E. Brock, Clerk of Courts
BOARD OF COUNTY COMMISSIONERS
COLLlER COUNTY. FLORIDA
By:
By:
Dates:
Print Name and Title
(Seal)
NAPLES PHYSICIAN HOSPITAL
ORGANIZA nON d/b/a COMMUNITY
HEALTH PARTNERS
First Witness
By:
Kevin Cooper. Co-Chainnan
PrintIType Witness Name
By:
David H. Greider, MD, Co-Chairman
Second Witness
PrintIType Witness Name
CORPORATE SEAL
(Corporations only)
Approved as to fonn and legal sufficiency.:
tr!JRJ<1M!- ~ 'i'17-t/~ z>
..w II-U /Ill JfcJ/It7IR;1R D
ASSistant county Attorney
09/18/08
Agenda Item No. 16E17
October 28, 2008
Page 8 of 10
SCHEDULE 4.7
PROGRAM FEES - Second Amendment Effective October 1, 2008
Board of County Commissioners Collier County, Florida shall pay Community Health Partners
the fees listed below for the Managed Care Service programs - Utilization Review Management
with Large Case Management, Maternity Case Management, Disease Management, and Health
Advocacy Program. Fee to be disbursed to:
Community Health Partners
851 Fifth Avenue N #201
Naples, FL 34102
Utilization Mana!!ement Fee:
CHP Utilization Review Management program with
Large Case Management/Care Coordination including Maternity
Management
$2. I3 pepm*
* to increase by 3% annually beginning January I, 2009, effective the first of the month of the
new contract year.
SmartChoice (Disease Manal!'ement Fee):
Six month program: $600.00 per person enrolled payable quarterly.
Health Advocacy Pro2ram Fees:
Year One:
Total amount due for period of October I, 2008-September 30, 2009: $344,353.92
Year Two:
Total amount due for period of October 1, 2009-September 30, 2010: $360,048.72
Year Three:
Total amount due for period of October 1, 20lO-September 30, 2011: $372,547.92
Payment shall be made quarterly one fourth of the total amount due October I , January 1, April I, and
July1, of each year.
TOTAL ANNUAL FEES FOR ALL PROGRAMS (Excludiol!' SmartChoice):
Year One:
Year Two:
Year Three:
$400,585.92 / $15. I 7 pepm based on 2200 employees
$417,864.72 / $15.83 pepm based on 2200 employees
$432,211.92/ $16.37 pepm based on 2200 employees
10/20/08
Agenda Item No. 16E17
October 28, 2008
Page 9 of 1 0
Payments not received as indicated above shall result in termination of this Letter of Agreement and
termination of the program.
10/20/08
Q
Community
Health Partners~
Agenda Item No. 16E17
October 28, 2008
Page 10 of 10
PHYSICIAN HOSPITAL ORGANIZATION
Health Advocacy Program
Job Description
Job Title:
Reports to:
R.N. Health Advocate
Chief Operating Officer of Community Health Partners
Description: The Health Advocate Program integrates Utilization Management, Case Management, Clinical Preventive
Care/Wellness Services, Medication and Educational Programs. Nurse Advocates work closely with providers, community
resources and the members for the best health outcomes. A goal of the Health Advocates is to facilitate member learning of
wellness strategies, promoting the prevention of complications and empowering for individual responsibility.
Primary Responsibilities:
. Advocacy
. Responsible for overseeing members participation with PWP and Biometric screenings
. Responsible for collecting data and reviewing with members to identify qualifiers
. Assist members with the process to achieve goals needed to meet qualifiers
. Responsible for overseeing quality of care being provided to members of the health plan,
. An understanding of the process of change in order to empower member personal health care.
. Provide educational materials, presentations and community resources.
. Assist with provider referrals for appropriate healthcare.
· Assist with the development of the healthcare plan in collaboration with the provider and member.
. Follow up with individual member progress and adjust the plan accordingly.
. Work collaboratively and efficiently to resolve provider issues.
. Program Planning
· Participate in ongoing program development, marketing, and enhancement in order to meet the needs of the
members and the health plan.
. Maintain data, follow-up and make referrals and evaluations for specifically assigned program such as nutritional
counseling, smoking cessation and wellness programs
. Other duties as assigned.
Qualifications:
. Current R.N. license in the State of Florida, BSN preferred.
. Valid Florida Drivers License.
. At least 3 years of case management and 3 years of clinical experience.
. Organizational skills.
· Excellent written and verbal communications skills.
. Ability to work independently and within a team setting.
. Problem solving skills.
· Proficient in Microsoft Excel, Word, Outlook, Windows and Internet Usage.
Performance Standards:
. Must comply with all company policies and rules.
· Must complete all assignments on a timely basis and in a correct manner.
Equipment Used:
· Computers, software packages, printers, photocopiers, facsimile machines, telephones, etc.
Working Conditions:
. Office environment
. Wellness Center
. W orksites
· Overtime may be required
. Local travel is required