Agenda 09/13/2022 Item #16E 3 (Risk Management Groupo Health Plan)09/13/2022
EXECUTIVE SUMMARY
OBJECTIVE: To provide continuing services for Managed Care and Preferred Provider Payor
Network to Collier County’s Group Health Plan.
CONSIDERATIONS: The Board of Commissioners through the Risk Management Division
offers a comprehensive group health insurance program to its employees and their eligible
dependents. The program includes a partially self-funded group health plan also known as the
“Plan.” In order to properly manage the Plan and control costs, the County employs the services
of a Utilization Management and Large Case Management firm as well as a local
Physician/Hospital Preferred Provider Network (PPO). Currently, the County utilizes
Community Health Partners for these services.
Typically, Utilization Management and Large Case Management services are incorporated as
part of claims administration services procured under a Group Health Third Party Administration
(TPA) Agreement. These services are not based locally with most firms operating outside the
State of Florida. Thus, these firms are not familiar with the local physicians and providers in the
community. Community Health Partners is the only locally based physician hospital organization
that can provide these types of services. This local presence also offers greate r transparency and
control to self-insured Plans such as the County’s program, the District School Board’s program
and the Collier County Sheriff’s program.
On September 26, 2017 (Agenda Item No. 16.E.20), the County entered into Agreement #17 -
7209 “Managed Care & Preferred Provider Payor Network” (“Agreement”) with Naples
Physician Hospital Organization, Inc. d/b/a Community Health Partners (“CHP”). The
Agreement provides Utilization Management, Large Claims Case Management, and access to
CHP’s local physician/hospital network to serve members covered under the Collier County
Group Health Plan. CHP was the only proposer for these services. The initial term is for three (3)
years with two (2) additional one (1) year renewal periods. The Agreement will expire on
December 31, 2022. CHP has demonstrated professional and responsive services during the term
of the Agreement and has agreed to an amendment to continue to offer these services.
Therefore, given the above, Staff recommends approval of the attached First Amendment to the
Agreement. The First Amendment will extend the term of the agreement for a period of three
years, beginning January 1, 2023 and ending December 31, 2025 with an option for two (2)
additional one-year renewals and update the Schedule 4.7 accordingly.
Section Eleven, sub-paragraph 11 of the Collier County Procurement Ordinance 2017-18, as
amended, allows the Board to make a finding that it is in the best interest of the County to
continue with standardized support services with Naples Physician Hospital Organization, Inc.
d/b/a Community Health Partners for Managed Care and Preferred Provider Payor Network
access.
FISCAL IMPACT: The estimated cost in FY 23 to provide managed care and network services
based upon an average enrollment of 2,400 employees is $125,000. 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.
16.E.3
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09/13/2022
LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires
majority vote for approval. -RTT
RECOMMENDATION: That the Board approves and authorizes the Chairman to execute the
First Amendment to Agreement #17-7209 “Managed Care & Preferred Provider Payor Network
Agreement” with Physician Hospital Organization, Inc. d/b/a Community Health Partners,
approve expenditures under the First Amendment and approve Single Source Waiver, and
authorize the expenditures under the First Amendment.
PREPARED BY: Jeff Walker, CPCU, ARM, Director, Risk Management
ATTACHMENT(S)
1. 17-7209 CHP_Amend#1_VendorSigned (PDF)
2. FY22 Waiver Request 056 - CHP (Managed Care and Network Services) (PDF)
3. 17-7209 2018 Managed Care_Contract_FullExec (PDF)
16.E.3
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09/13/2022
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.E.3
Doc ID: 22849
Item Summary: Recommendation to approve the First Amendment to the Agreement # 17-7209
“Managed Care & Preferred Provider Payor Network” with Naples Physician Hospital Organization, Inc.
d/b/a Community Health Partners and approve expenditures under the First Amendment and approved
Single Source Waiver.
Meeting Date: 09/13/2022
Prepared by:
Title: Benefits Analyst – Risk Management
Name: Sonja Sweet
07/19/2022 4:14 PM
Submitted by:
Title: Division Director - Risk Management – Risk Management
Name: Jeff Walker
07/19/2022 4:14 PM
Approved By:
Review:
Risk Management Jeff Walker Director Review Completed 07/19/2022 4:25 PM
Procurement Services Ana Reynoso Level 1 Purchasing Gatekeeper Completed 07/19/2022 4:39 PM
Procurement Services Sue Zimmerman Additional Reviewer Completed 07/19/2022 6:55 PM
Procurement Services Sara Schneeberger Additional Reviewer Completed 07/20/2022 8:41 AM
Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 07/20/2022 8:49 AM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 07/21/2022 3:16 PM
Office of Management and Budget Susan Usher Additional Reviewer Completed 08/22/2022 1:55 PM
County Manager's Office Dan Rodriguez Level 4 County Manager Review Completed 08/30/2022 10:06 AM
Board of County Commissioners Geoffrey Willig Meeting Pending 09/13/2022 9:00 AM
16.E.3
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16.E.3.aPacket Pg. 2766Attachment: 17-7209 CHP_Amend#1_VendorSigned (22849 : CHP Managed Care - First Amendment)
16.E.3.aPacket Pg. 2767Attachment: 17-7209 CHP_Amend#1_VendorSigned (22849 : CHP Managed Care - First Amendment)
16.E.3.aPacket Pg. 2768Attachment: 17-7209 CHP_Amend#1_VendorSigned (22849 : CHP Managed Care - First Amendment)
Waiver Request Form
Revised 06/17/2021
Instructions
Completed waiver requests accompanied by any associated backup documentation (sole source letter, business case, etc.) must be
submitted to the division’s Procurement Strategist for any procurement, without competition, in excess of $3,000. Waiver requests
greater than $50,000 will require approval by the Board of County Commissioners.
Sole source refers to a procurement where the selection of one particular supplier to the exclusion of all others may be based on having
only one supplier in the marketplace, proprietary technology, copyright, patent, or a supplier’s unique capability.
Single source refers to a procurement directed to one source because of standardization, warranty, geographic territory, or other factors,
even though other competitive sources may be available.
Requester Name: Division:
Item/Service: Vendor Name:
Historical
Countywide
Spend: ______________________
Requested
date range: _____________
Not to Exceed
Amount per
Fiscal Year: __________________
Is there an agreement associated with this
waiver to be reviewed by Contracts?
Yes No
Sole Source Single Source One Time Purchase Multiple Purchases
Description of Purchase: Enter a description of the item(s) that will be purchased under this waiver.
Purpose: Describe in detail, the public purpose of the requested item(s) and why it is essential to County operations.
Information Technology: Select Yes if the products/services are related to Information Technology. If yes, please provide the Purchasing
Compliance Code (PCC) number or email approval documentation.
Yes No If yes, provide the PCC number:__________________________________________________
16.E.3.b
Packet Pg. 2769 Attachment: FY22 Waiver Request 056 - CHP (Managed Care and Network Services) (22849 : CHP Managed Care - First Amendment)
Waiver Request Form
Revised 06/17/2021
Justification: Identify the criteria that qualifies this purchase as a sole or single source. Select from the list below.
Check all that apply (if box is checked, please make sure to provide an explanation below):
Sole Source
Only Authorized Vendor or Distributor: Is this vendor the only vendor authorized to sell this product/service? If yes, explain
below and provide documentation from the manufacturer confirming claims made by the distributors.
No Comparable Product or Service: Is there another vendor who can provide a similar product/service, regardless of cost,
convenience, timeliness, etc.?
Product Compatibility: Does this product/service provide compatibility with existing equipment that prohibits switching to
another comparable brand/vendor? If yes, provide the detailed explanation below, including what would occur if the other brand/vendor
were used.
Proprietary: Is this product/service proprietary? If yes, provide a detailed explanation below on how its use is restricted by
patent, copyright or other applicable laws and provide documentation validating that claim.
Single Source
Standardization: Is this product/service part of a purchase that the County has already standardized on? If yes, please provide
the detailed information below.
Date of BCC Standardization: ___________________ BCC Agenda Item number: __________________
Warranty: Is this the only vendor able to complete factory-authorized warranty services on County owned equipment? If yes,
provide the documentation verifying the warranty.
Geographic Territory: Is this vendor the only vendor authorized to sell this product/service in our region? If yes, provide
documentation from the manufacturer confirming those claims.
Other Factors: Any other reason not listed above, explain below.
Explain: How does this purchase meet the identified sole or single source criteria listed above?
16.E.3.b
Packet Pg. 2770 Attachment: FY22 Waiver Request 056 - CHP (Managed Care and Network Services) (22849 : CHP Managed Care - First Amendment)
Waiver Request Form
Revised 06/17/2021
How was the decision made to use this vendor? Describe in detail if a formal standardization process was performed via
Procurement or if there is a historical precedence established for the use of the product, please explain purchase, and use history and the
current level of County investment in the product.
Explain why it is in the County’s best interest to use this product/service rather than issuing a competitive solicitation: What are
the benefits from the continued use? Are there costs that would be incurred if a different vendor/product were used? What would occur if
another brand/vendor were used?
Explain how this pricing compares to other vendors/products and is it considered to be fair and reasonable: Provide information
on historical use and whether pricing has increased/decreased. If sole source and no other product is available, provide the cost for
addressing the needs via an alternate approach.
Will this purchase obligate us to future ancillary products or services? Either in terms of maintenance or standardization.
Yes No
If yes, explain what types:
16.E.3.b
Packet Pg. 2771 Attachment: FY22 Waiver Request 056 - CHP (Managed Care and Network Services) (22849 : CHP Managed Care - First Amendment)
Waiver Request Form
Revised 06/17/2021
Market research and market alternatives: When was the last time a market evaluation was performed to determine if either the
technology or vendor offerings have changed? Based on the life expectancy of the product, when do you anticipate evaluating the market
again? Please attach a detailed market evaluation report should the complexity, duration, and dollar amount of the purchase be a high risk
to the County.
It is a felony to knowingly circumvent a competitive process for commodities or services by fraudulently specifying sole
source. Florida Statute 838.22(2).
Requested by: Signature: Date:
Division Director: Signature: Date:
Department Head: Required if over $50,000 Signature: Date:
Procurement Strategist: Signature: Date:
Procurement Director:
Or designee Signature: Date:
For Procurement Use Only:
Approved Requesting Additional Information Requires RFI/Intent to Sole Source Rejected
Procurement Comments:
Current FY Approval Multi-Year Approval Start Date: ______________ End Date: __________
16.E.3.b
Packet Pg. 2772 Attachment: FY22 Waiver Request 056 - CHP (Managed Care and Network Services) (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2773Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2774Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2775Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2776Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2777Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2778Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2779Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2780Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2781Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2782Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2783Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2784Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2785Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2786Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2787Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2788Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2789Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2790Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)
16.E.3.cPacket Pg. 2791Attachment: 17-7209 2018 Managed Care_Contract_FullExec (22849 : CHP Managed Care - First Amendment)