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HomeMy WebLinkAboutAgreement A-16-060-2 with UHC.pdf COUNTY OF FRESNO Fresno, CA - 1 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 AMENDMENT II TO AGREEMENT THIS AMENDMENT, hereinafter referred to as “Amendment II”, is made and entered into this ____ day of __________, 2017, by and between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter referred to as “COUNTY”, and UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY, INC., a California non-profit organization, whose address is 650 Zediker Avenue, Building 3, Parlier, California 93648-0790, hereinafter referred to as “CONTRACTOR” (collectively the “parties”). WHEREAS the parties entered into that certain Agreement, identified as COUNTY Agreement No. A-16-060, effective February 2, 2016, and Agreement No. 16-060-1, effective July 12, 2016, hereinafter collectively referred to as “Agreement”, whereby CONTRACTOR agreed to provide certain primary preventative medical services to COUNTY’s Department of Public Health; and WHEREAS the parties now desire to amend the Agreement regarding changes as stated below and restate the Agreement in its entirety. NOW, THEREFORE, in consideration of their mutual promises, covenants and conditions, hereinafter set forth, the sufficiency of which is hereby acknowledged, the parties agree as follows: 1. That the existing COUNTY Agreement No. A-16-060, Page 2, beginning with Paragraph 2, “Term,” Line 10 with the word “This” and ending on Line 11 with the word “2018” be deleted and the following inserted in its place: “This Agreement shall become effective upon execution and shall terminate on the 29th day of September, 2018.” 2. That the existing COUNTY Agreement No. A-16-060, Page 3, beginning with Paragraph 4, “Compensation,” Line 15 with the word “In” and ending on Line 18 with the word “2017” be deleted and the following inserted in its place: “In no event shall actual services performed under this Agreement be in excess of Five Hundred Ninety-Six Thousand, Seven Hundred Thirty-Two and No/100 Dollars ($596,732) during the period of September 30, 2016 through September 29, 2017.” 3. That all references in existing COUNTY Agreement No. A-16-060 to “Exhibit A” shall be changed to read “Revised Exhibit A”, where appropriate, attached hereto and incorporated herein COUNTY OF FRESNO Fresno, CA - 2 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 by reference. 4. That all references in existing COUNTY Agreement No. A-16-060 to “Exhibit B” shall be changed to read “Revised Exhibit B”, where appropriate, attached hereto and incorporated herein by reference. 5. Except as otherwise provided in this Amendment II, all other provisions of the Agreement remain unchanged and in full force and effect. This Amendment II shall become effective September 30, 2016. 6. COUNTY and CONTRACTOR agree that this Amendment II is sufficient to amend the Agreement, and that upon execution of this Amendment II, the Agreement, Amendment I, and Amendment II together shall be considered the Agreement. /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// Revised Exhibit A Scope of Work Page 1 of 19 YEAR 1 Component 1b: Strategies to build support for healthy lifestyles, particularity for those at high risk, to support diabetes and heart disease and stroke prevention efforts Program Strategy 1.5: Plan and execute strategic public data-driven actions through a network of partners and local organizations to build support for lifestyle change # Activity Timeline Responsible Deliverables 1 County will work with UHC to provide National Diabetes Prevention Program (NDPP) training and certification to four identified Health Clinic System staff. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of meeting agendas/minutes, and list of identified partners. • a copy of certifications, and • training materials. 2 County will conduct NDPP capacity/readiness assessment utilizing an evaluation tool created by UCD with network partners to determine if resources are available within community to deliver the program. September 30, 2015 – September 29, 2016 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of the assessment results. 3 Based on results of assessment, County will identify UHC’s readiness to implement and sustain an NDPP. County will then develop a strategic plan to build capacity and implement a NDPP program in conjunction with UHC. County will participate in planning for a statewide NDPP summit led by CDPH staff. Planning will include participation in planning meetings, developing summit materials, identifying appropriate key partners/stakeholders to identify the strategic direction and priorities for increasing referrals, utilization, and reimbursement of NDPP. September 30, 2015 – September 29, 2016 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of meeting agendas/minutes, and • a copy of developed Spanish language materials. • a copy of planning meeting agendas/minutes. 4 County will work with UHC to refer patients and interested community members to scheduled NDPP classes at Health Clinic System health centers. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a listing of classes scheduled, • referral and attendance logs (summary numbers only). 5 County will work with UCD to identify and collect public data for required performance measure 1.5. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 1.6: Implement evidence-based engagement strategies to build support for lifestyle change # Activity Timeline Responsible Deliverables Revised Exhibit A Scope of Work Page 2 of 19 Program Strategy 1.6: Implement evidence-based engagement strategies to build support for lifestyle change 1 County will work with UHC to conduct a strengths, weaknesses, opportunities, and threats (SWOT) analysis regarding lifestyle change with identified priority population(s), and/or organizations that serve them. Implement community engagement principles within identified communities. September 30, 2015 – September 29, 2017 HE, HES1, HES2, Epidemiologist, and UHC Submit to CDPH: • SWOT analysis, and • a copy of SWOT analysis results. 2 Utilizing the Chronic Disease Prevention Messaging Toolkit, County will work with UHC to develop a plan for how partners (CBOs, Fresno County Department of Public Health, Health Clinic Systems, community champions) will work together to conduct outreach, build support for and increase referrals to NDPP. Review and update annually. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of planning meeting agendas/minutes, and • the outreach plan. 3 In collaboration with CDPH, County will adapt CDC NDPP communications and marketing materials and work with UHC to mobilize champions to disseminate in target communities as a means to increase reach to and engagement of priority populations. Assess reach and outcomes of lifestyle change strategies and marketing efforts and refine as necessary. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of County marketing plan. • a copy of promotional materials developed, • distribution and reach log. 4 County will work with UHC and UCD to identify and collect public data for required performance measure 1.6. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2015 – September 29, 2016 HE, HES1, HES2, and UHC Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 1.7: Increase coverage for evidence-based supports for lifestyle change by working with network partners # Activity Timeline Responsible Deliverables 1 County will work with network partners to conduct an assessment utilizing an evaluation tool created by UCD to identify what health insurance plans are offered to employees and essential benefits included for prediabetes and prevention of type 2 diabetes. Identify challenge and barriers to coverage for lifestyle change programs (LCPs). September 30, 2015 – September 29, 2016 HE, HES1, HES2 Submit to CDPH: • a copy of the assessment results. 2 Based on assessment results, County will develop and implement an action plan to establish or increase insurance coverage of LCPs within county. September 30, 2015 – September 29, 2016 PI, HE, HES1, HES2 Submit to CDPH: • a copy of CDC adapted marketing materials. • action plan timeline. Revised Exhibit A Scope of Work Page 3 of 19 Program Strategy 1.7: Increase coverage for evidence-based supports for lifestyle change by working with network partners 3 County will work with UCD to identify and collect public data for required performance measure 1.7. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2015 – September 29, 2016 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Component 2a: Health System Interventions to Improve the Quality of Health Care Delivery to Populations with the Highest Hypertension and Pre-diabetes Disparities Program Strategy 2.1: Increase electronic health records (EHR) adoption and the use of health information technology (HIT) to improve performance (pursuant to federal and state guidelines) # Activity Timeline Responsible Deliverables 1 County will conduct an environmental scan utilizing an evaluation tool created by UCD to assess EHR/Meaningful Use of select providers/health systems regarding implementation, related policies and procedures, and capacity of UHC, focusing on achievement of blood pressure control initiatives to identify gaps and opportunities for collaboration. Engage with UHC to maximize understanding of EHR policy and practice landscape within the local area. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of scan. 2 County will recruit providers/health systems to participate in Central Valley Health Information Exchange (CVHIE) to promote reporting on National Quality Forum (NQF) 18 and 59 and standardized clinical quality measures for management and treatment of patients with hypertension. September 30, 2015 – September 29, 2016 PI, HE, and Epidemiologist Submit to CDPH: • a copy of meeting agendas/minutes. 3 County will work with UCD to identify and collect public data for required performance measure 2.1. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2015 – September 29, 2016 HE, HES1, HES2, and UHC Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.2: Increase the institutionalization and monitoring of aggregated/standardized quality measures at the provider level # Activity Timeline Responsible Deliverables Revised Exhibit A Scope of Work Page 4 of 19 Program Strategy 2.2: Increase the institutionalization and monitoring of aggregated/standardized quality measures at the provider level 1 County will work with UHC to identify and provide web links for TA and training to Health Center Controlled networks in the area (or similar health systems) in order to develop and implement toolsets (e.g., clinical quality dashboards) to provide clinicians with public performance data. County will work with UHC to assess capacity for providers and/or health systems, utilizing an evaluation tool created by UCD, to electronically track, monitor and report aggregated/standardized quality measures to the Centers for Medicare and Medicaid Services, CDPH, and others. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of the training materials. • an assessment report of the environmental scan. 2 County will work with UHC to convene representatives from county Federally Qualified Health Centers (FQHCs) and CVHIE to develop protocols and processes for monitoring and sharing standardized quality measures at the provider level. September 30, 2015 – September 29, 2016 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of meeting agendas/ minutes. 3 County will work with UHC to expand health system EHR analytics or participation in clinical quality dashboards for Health Clinic System patients with hypertension, prediabetes, and diabetes. Promote quality improvement through the implementation of systems that provide relevant and timely patient public data to providers and health systems. September 30, 2015 – September 29, 2016 HE, HES1, HES2, and UHC Submit to CDPH: • a summary of systems in use. 4 County will work with UHC and UCD to identify and collect public data for required performance measure 2.2. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2015 – September 29, 2016 HE, HES1, HES2, and UHC Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.3: Increase engagement of non-physician team members in hypertension management in community health care systems # Activity Timeline Responsible Deliverables 1 County will work with UHC to conduct environmental scan of providers and hospital/clinic systems and health insurance plans, utilizing an evaluation tool created by UCD, to determine which team members are currently engaging in hypertension management. Results will be used to determine baseline in county. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Subcontractor will submit to County: • a list of proposed and interviewed clinic systems. Submit to CDPH: • a copy of the scan results. Revised Exhibit A Scope of Work Page 5 of 19 Program Strategy 2.3: Increase engagement of non-physician team members in hypertension management in community health care systems 2 Based on scan results, County will work with UHC to promote adoption by Health Clinic System providers of procedures/protocols that support the implementation of comprehensive health care teams. Monitor and track providers that adopt procedures/protocols. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Subcontractor will submit to County: • a list of clinic systems that adopted the recommended procedures/protocols Submit to CDPH: • a copy of adopted procedures/ protocols. 3 County will work with UHC to utilize scan results to identify evidence and practice tools to share with the provider community that support the implementation of evidence-based guidelines for hypertension, such as the Million Hearts International (MHI) hypertension protocols (i.e., through local medical society). Identify training and TA needs to facilitate adoption/implementation of tools by UHC. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of training materials, and • meeting agendas/minutes. 4 County will work with UHC to develop a workgroup and project workplan to fill 1-2 of the evidence gaps specified in The Community Guide at http://www.thecommunityguide.org/cvd/RGteambasedcare.html . September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a summary of the evidence gathered and gap(s) identified. 5 County will work with UHC and UCD to identify and collect public data for required performance measure 2.3. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2015 – September 29, 2016 HE, HES1, HES2, and UHC Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.4: Increase use of self-measured blood pressure monitoring tied with clinical support # Activity Timeline Responsible Deliverables 1 Conduct asset mapping/environmental scans, utilizing an evaluation tool created by UCD, to determine the CBOs or health systems that are currently providing blood pressure and or diabetes screening/monitoring and who they serve (demographics) for baseline and target. Identify blood pressure/diabetes champions from within the community. County will work with UHC to provide assessment or analysis results to augment and enhance Health Clinic System provider’s capacity and reach. Analysis should include feasibility and compatibility of self- management programs for hypertension (e.g., Check. Change. Control) with existing community health care programs. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of the scan results. • a copy of analysis report. Revised Exhibit A Scope of Work Page 6 of 19 Program Strategy 2.4: Increase use of self-measured blood pressure monitoring tied with clinical support 2 County will work with UHC to research model practices, outcomes, and benefits to promote the adoption and EHR use with Health Clinic Systems that include integrated hypertension algorithms and supports for provider prompts/feedback, patient communication, and public data tracking, monitoring, and reporting. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of sample adopted EHR systems. 3 County will work with UHC and UCD to identify and collect public data for required performance measure 2.4. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.5: Implement systems to facilitate identification of patients with undiagnosed hypertension and people with pre- diabetes # Activity Timeline Responsible Deliverables 1 County will work with UHC to conduct asset mapping/environmental scans that determine the CBOs in UHC service areas which are currently providing blood pressure and or diabetes screening/monitoring and who they serve (demographics) for baseline and target. Identify blood pressure/diabetes champions from within the community. County will work with UHC to complete an assessment of Health Clinic System to identify patients with undiagnosed hypertension and/or pre- diabetes, provide referral for education and provider feedback about home blood pressure/blood sugar monitoring, and provider prompts and patient contact system for managing patients with hypertension/blood sugar. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a written summary of the scan, and • list of community Champions. • a copy of the assessment. 2 County will work with UHC to Develop and implement a plan for improving the system for identifying and monitoring patients with hypertension in Health Clinic System. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of the plan. 3 County will work with UCD to identify and collect public data for required performance measure 2.5. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Revised Exhibit A Scope of Work Page 7 of 19 Component 2b: Community Clinical Linkage Strategies to Support Heart Disease and Stroke and Diabetes Prevention Efforts Program Strategy 2.6: Increase engagement of CHWs to promote linkages between health systems and community resources for adults with high blood pressure and adults with pre-diabetes or at high risk for type 2 diabetes # Activity Timeline Responsible Deliverables 1 County will work with UHC to conduct an environmental scan utilizing an evaluation tool created by UCD, to assess existing programs that target adults with hypertension and adults with prediabetes or at high risk for type 2 diabetes. Begin with Fresno Metro Ministry’s Community Resource Directory. County will assess where CDPH, PHI and other partners currently are with fiscal reimbursement strategies for Community Health Workers (CHW s) within health plans. County will work with UHC to conduct an environmental scan, utilizing an evaluation tool created by UCD of existing clinics, the California Health Workforce Alliance report, and local health care systems to identify which have CHWs or similar staff. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of the scan results. 2 As a result of the health system scan, County will work with UHC to develop a plan to promote systematic change to involve Health Clinic System CHWs to promote linkages between health systems and community resources to improve outcomes for heart disease and diabetes. Coordinate with others working on CHW initiatives for awareness, input, and support. Work with CHWs for their input and guidance on promotional strategies between health systems and community resources. Monitor change. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of the plan and • a summary of changes made. 3 County will work with UCD to identify and collect public data for required performance measure 2.6. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.7: Increase engagement of community pharmacists in the provision of medication-/self-management for adults with high blood pressure # Activity Timeline Responsible Deliverables 1 County will conduct environmental scan/assessment utilizing an evaluation tool created by UCD to determine which providers, health insurance plans etc. are using pharmacists as part of the team for medication/self-management. Based on the results of the community scan build relationships with health systems to promote inclusion of community pharmacists as part of the health care team. September 30, 2015 – September 29, 2016 HE, HES1, HES2 Submit to CDPH: • a copy of the scan results. Revised Exhibit A Scope of Work Page 8 of 19 Program Strategy 2.7: Increase engagement of community pharmacists in the provision of medication-/self-management for adults with high blood pressure 2 County will identify and convene appropriate partners to identify and share best practices, including training of pharmacists and mechanism of payment; promoting inclusion of pharmacists in the team for community-based medication reconciliation/reporting to providers and hypertension self-management. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of meeting agendas/minutes. 3 County will work with UCD to identify and collect public data for required performance measure 2.7. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2015 – September 29, 2016 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.8: Implement systems and increase partnerships to facilitate bi-directional referral between community resources and health systems, including lifestyle change programs # Activity Timeline Responsible Deliverables 1 County will conduct environmental scan utilizing an evaluation tool created by UCD of existing 211 services within Fresno County. Identify current and potential 211 service availability and/or identify other entities that could serve as a source for community referrals to LCPs. County will institute 211 service LCPs for hypertension and pre- diabetes, and/or identify other entities that could serve as a source for community referrals to LCPs. Develop tracking/monitoring system for referrals. September 30, 2015 – September 29, 2016 HE, HES1, HES2 Submit to CDPH: • a copy of the scan results. • a copy of meeting agendas/minutes, • 211/referral system service promotion materials, and • a summary of the tracking/monitoring system. 2 County will work with UHC to conduct assessment of Subcontractor referral practices for patients with a diagnosis of hypertension and prediabetes, and viability of utilizing 211 for referral to LCPs. County will develop and implement a communications plan to assist with communication, awareness, and outreach strategy to maximize reach and impact of 211. September 30, 2015 – September 29, 2017 HE, HES1, HES2 Submit to CDPH: • a copy of assessment results. • a copy of 211 communication plan. 3 County will work with UHC to educate Health Clinic System providers about community resources available for patients with hypertension and pre-diabetes, and the benefits of using a community referral system, such as 211, within their organization (e.g. utilizing EHR to refer patients to community resources). Determine what resources/systems are needed to ensure bi-directional referrals are made. September 30, 2015 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of training materials, and • 211/referral system service promotion materials. Revised Exhibit A Scope of Work Page 9 of 19 Program Strategy 2.8: Implement systems and increase partnerships to facilitate bi-directional referral between community resources and health systems, including lifestyle change programs 4 County will work with UCD to identify and collect public data for required performance measure 2.8. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2015 – September 29, 2016 HE, HES1, HES2, and UHC Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. YEAR 2 Component 1b: Strategies to build support for healthy lifestyles, particularity for those at high risk, to support diabetes, heart disease and stroke prevention efforts Program Strategy 1.5: Plan and execute strategic data-driven actions through a network of partners and local organizations to build support for lifestyle change # Activity Timeline Responsible Deliverables 1 County will work with UHC to refer patients and interested community members to scheduled NDPP classes at health centers and promote the classes through public relations/media. September 30, 2016 – September 29, 2017 HE, HES1, HES2, HES3 and UHC Submit to CDPH: • a copy of classes scheduled, • referral and attendance logs (summary numbers only). 2 County will work with UCD to identify and collect public data for required performance measure 1.5. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2016 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 1.6: Implement evidence-based engagement strategies to build support for lifestyle change # Activity Timeline Responsible Deliverables 1 Utilizing the Chronic Disease Prevention Messaging Toolkit, County will work with UHC to develop a plan for how partners (CBOs, Fresno County Department of Public Health, UHC, community champions) will work together to conduct outreach/marketing, build support for and increase referrals to NDPP. Review and update annually. September 30, 2016 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of planning meeting agendas/minutes, and • the outreach/marketing plan. 2 In collaboration with CDPH, County will work with UHC to adapt CDC NDPP communications and marketing materials and mobilize champions to disseminate in target communities as a means to increase reach to and engagement of priority populations. Assess reach and outcomes of lifestyle change strategies and marketing efforts and refine as necessary. September 30, 2016 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of promotional materials developed, and • distribution and reach log. Revised Exhibit A Scope of Work Page 10 of 19 Program Strategy 1.6: Implement evidence-based engagement strategies to build support for lifestyle change 3 County will work with UCD to identify and collect public data for required performance measure 1.6. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2016 – September 29, 2017 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 1.7: Increase coverage for evidence-based supports for lifestyle change by working with network partners # Activity Timeline Responsible Deliverables 1 Based on assessment results, County will develop and implement an action plan to establish or increase insurance coverage of LCPs within county. September 30, 2016 – September 29, 2017 PI, HE, HES1, HES2 Submit to CDPH: • action plan timeline. 2 County will work with UCD to identify and collect public data for required performance measure 1.7. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2016 – September 29, 2017 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Component 2a: Health System Interventions to Improve the Quality of Health Care Delivery to Populations with the Highest Hypertension and Pre-diabetes Disparities Program Strategy 2.1: Increase electronic health records (EHR) adoption and the use of health information technology (HIT) to improve performance (pursuant to federal and state guidelines) # Activity Timeline Responsible Deliverables 1 County will recruit providers/health systems to participate in CVHIE to promote reporting on NQF 18 and 59 and standardized clinical quality measures for management and treatment of patients with hypertension. September 30, 2016 – September 29, 2017 PI, HE Submit to CDPH: • a copy of meeting agendas/minutes. 2 County will work with UHC to create and/or adapt existing Patient- centered Medical Home (PCMH) certification materials for use with partners of the California Primary Care Association or the County Medical Society. September 30, 2016 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of promotional materials, • materials distribution log, and • meeting agendas/minutes. 3 County will work with UCD to identify and collect public data for required performance measure 2.1. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2016 – September 29, 2017 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.2: Increase the institutionalization and monitoring of aggregated/standardized quality measures at the provider level # Activity Timeline Responsible Deliverables Revised Exhibit A Scope of Work Page 11 of 19 Program Strategy 2.2: Increase the institutionalization and monitoring of aggregated/standardized quality measures at the provider level 1 County will work with UHC to convene representatives from FQHCs and CVHIE in the county to develop protocols and processes for monitoring and sharing standardized quality measures at the provider level. September 30, 2016 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of meeting agendas/ minutes. 2 County will work with UHC to expand health system EHR analytics or participation in clinical quality dashboards for Health Clinic System patients with hypertension, pre-diabetes, and diabetes. Promote quality improvement through the implementation of systems that provide relevant and timely patient public data to providers and health systems. September 30, 2016 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a summary of systems in use. 3 County will work with UCD to identify and collect public data for required performance measure 2.2. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2016 – September 29, 2017 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.3: Increase engagement of non-physician team members in hypertension management in community health care systems # Activity Timeline Responsible Deliverables 1 Based on scan results, County will work with UHC to promote adoption by Health Clinic System providers of procedures/protocols that support the implementation of comprehensive health care teams. County will monitor and track procedures/protocols adopted by providers. September 30, 2016 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of adopted procedures/ protocols. 2 County will work with UHC to Utilize scan results to identify evidence and practice tools to share with the provider community that support the implementation of evidence-based guidelines for hypertension, such as the MHI hypertension protocols i.e., through local medical society. Identify training and TA needs to facilitate adoption/implementation of tools with Health Clinic Systems. September 30, 2016 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of training materials, and • meeting agendas/minutes. 3 County will work with UHC to develop a workgroup and project work plan to fill 1-2 of the evidence gaps specified in The Community Guide at http://www.thecommunityguide.org/cvd/RGteambasedcare.html September 30, 2016 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a summary of the evidence gathered and • a summary of gap(s) identified. 4 County will work with UCD to identify and collect public data for required performance measure 2.3. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2016 – September 29, 2017 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Revised Exhibit A Scope of Work Page 12 of 19 Program Strategy 2.4: Increase use of self-measured blood pressure monitoring tied with clinical support # Activity Timeline Responsible Deliverables 1 County will work with UHC to research model practices, outcomes, and benefits to promote the adoption and EHR use by Health Clinic System that include integrated hypertension algorithms and supports for provider prompts/feedback, patient communication, and public data tracking, monitoring, and reporting. September 30, 2016 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of sample adopted EHR systems. 2 County will work with UCD to identify and collect public data for required performance measure 2.4. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2016 – September 29, 2017 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.5: Implement systems to facilitate identification of patients with undiagnosed hypertension and people with prediabetes # Activity Timeline Responsible Deliverables 1 County will work with UHC to develop and implement a plan for improving the system for identifying and monitoring patients with hypertension in Health Clinic System. September 30, 2016 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of the implementation plan. 2 County will work with UCD to identify and collect public data for required performance measure 2.5. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2016 – September 29, 2017 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Component 2b: Community Clinical Linkage Strategies to Support Heart Disease and Stroke and Diabetes Prevention Efforts Program Strategy 2.6: Increase engagement of CHWs to promote linkages between health systems and community resources for adults with high blood pressure and adults with pre-diabetes or at high risk for type 2 diabetes # Activity Timeline Responsible Deliverables 1 As a result of the health system scan, County will develop a plan to promote systematic change to involve Health Clinic System CHWs to promote linkages between health systems and community resources to improve outcomes for heart disease and diabetes. County will work with UHC to coordinate with others working on CHW initiatives for awareness, input, and support. County will work with CHWs for their input and guidance on promotional strategies between health systems and community resources and monitor change. September 30, 2016 – September 29, 2017 HE, HES1, HES2, UHC Submit to CDPH: • a copy of the plan and • a summary of changes made. Revised Exhibit A Scope of Work Page 13 of 19 Program Strategy 2.6: Increase engagement of CHWs to promote linkages between health systems and community resources for adults with high blood pressure and adults with pre-diabetes or at high risk for type 2 diabetes 2 County will work with UCD to identify and collect public data for required performance measure 2.6. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2016 – September 29, 2017 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.7: Increase engagement of community pharmacists in the provision of medication-/self-management for adults with high blood pressure # Activity Timeline Responsible Deliverables 1 County will identify and convene appropriate partners to identify and share best practices, including training of pharmacists and mechanism of payment; promoting inclusion of pharmacists in the team for community-based medication reconciliation/reporting to providers and hypertension self-management. September 30, 2016 – September 29, 2017 HE, HES1, HES2 Submit to CDPH: • a copy of meeting agendas/ minutes. 2 County will work with UCD to identify and collect public data for required performance measure 2.7. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2016 – September 29, 2017 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.8: Implement systems and increase partnerships to facilitate bi-directional referral between community resources and health systems, including lifestyle change programs # Activity Timeline Responsible Deliverables 1 County will institute 211 service LCPs for hypertension and prediabetes, and/or identify other entities that could serve as a source for community referrals to LCPs. Develop tracking/monitoring system for referrals. September 30, 2016 – September 29, 2017 HE, HES1, HES2 Submit to CDPH: • a copy of meeting agendas/ minutes, • 211/referral system service promotion materials, and • summary of the tracking/monitoring system. Revised Exhibit A Scope of Work Page 14 of 19 Program Strategy 2.8: Implement systems and increase partnerships to facilitate bi-directional referral between community resources and health systems, including lifestyle change programs # Activity Timeline Responsible Deliverables 2 County will work with UHC to educate Health Clinic Systems about community resources available for patients with hypertension and pre- diabetes, and the benefits of using a community referral system, such as 211, within their organization (e.g. utilizing EHR to refer patients to community resources). Determine what resources/systems are needed to ensure bi-directional referrals are made. September 30, 2016 – September 29, 2017 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of training materials, and • 211/referral system service promotion materials. 3 County will work with UCD to identify and collect public data for required performance measure 2.8. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2016 – September 29, 2017 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. YEAR 3 Component 1b: Strategies to build support for healthy lifestyles, particularity for those at high risk, to support diabetes and heart disease and stroke prevention efforts Program Strategy 1.5: Plan and execute strategic data-driven actions through a network of partners and local organizations to build support for lifestyle change # Activity Timeline Responsible Deliverables 1 County will work with UHC to refer patients and interested community members to scheduled NDPP classes at Health Clinic System health centers. September 30, 2017 – September 29, 2018 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of classes scheduled, • referral and attendance logs (summary numbers only). 2 County will work with UCD to identify and collect public data for required performance measure 1.5. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2017 – September 29, 2018 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. 3 County will work with UHC to submit evaluation data to CDC in order to achieve NDPP recognition status. September 30, 2017 – September 29, 2018 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of evaluation data Program Strategy 1.6: Implement evidence-based engagement strategies to build support for lifestyle change # Activity Timeline Responsible Deliverables Revised Exhibit A Scope of Work Page 15 of 19 Program Strategy 1.6: Implement evidence-based engagement strategies to build support for lifestyle change 1 Utilizing the Chronic Disease Prevention Messaging Toolkit, County will work with UHC to develop a plan for how partners (CBOs, Fresno County Department of Public Health, Health Clinic System, community champions) will work together to conduct outreach/marketing, build support for and increase referrals to NDPP. Review and update annually. September 30, 2017 – September 29, 2018 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of planning meeting agendas/minutes, • the outreach/marketing plan. 2 In collaboration with CDPH and UHC, County will adapt CDC NDPP communications and marketing materials and mobilize champions to disseminate in target communities as a means to increase reach to and engagement of priority populations. Assess reach and outcomes of lifestyle change strategies and marketing efforts and refine as necessary. September 30, 2017 – September 29, 2018 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of promotional materials developed, • distribution and reach log. 3 County will work with UCD to identify and collect public data for required performance measure 1.6. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2017 – September 29, 2018 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 1.7: Increase coverage for evidence-based supports for lifestyle change by working with network partners # Activity Timeline Responsible Deliverables 1 Based on assessment results, County will develop and implement an action plan to establish or increase insurance coverage of LCPs within county. September 30, 2017 – September 29, 2018 PI, HE, HES1, HES2 Submit to CDPH: • action plan timeline. 2 County will work with UCD to identify and collect public data for required performance measure 1.7. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2017 – September 29, 2018 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Component 2a: Health System Interventions to Improve the Quality of Health Care Delivery to Populations with the Highest Hypertension and Prediabetes Disparities Program Strategy 2.1: Increase electronic health records (EHR) adoption and the use of health information technology (HIT) to improve performance (pursuant to federal and state guidelines) # Activity Timeline Responsible Deliverables Revised Exhibit A Scope of Work Page 16 of 19 Program Strategy 2.1: Increase electronic health records (EHR) adoption and the use of health information technology (HIT) to improve performance (pursuant to federal and state guidelines) 1 County will recruit providers/health systems to participate in CVHIE to promote reporting on NQF 18 and 59 and standardized clinical quality measures for management and treatment of patients with hypertension. September 30, 2017 – September 29, 2018 PI, HE, Epidemiologist Submit to CDPH: • a copy of meeting agendas/minutes. 2 County will work with UCD to identify and collect public data for required performance measure 2.1. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2017 – September 29, 2018 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.2: Increase the institutionalization and monitoring of aggregated/standardized quality measures at the provider level # Activity Timeline Responsible Deliverables 1 County will work with UHC to convene representatives from FQHCs and CVHIE in the county to develop protocols and processes for monitoring and sharing standardized quality measures at the provider level. September 30, 2017 – September 29, 2018 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of meeting agendas/minutes. 2 County will work with UHC to expand health system EHR analytics or participation in clinical quality dashboards for Health Clinic System patients with hypertension, pre-diabetes, and diabetes. Promote quality improvement through the implementation of systems that provide relevant and timely patient public data to providers and health systems. September 30, 2017 – September 29, 2018 HE, HES1, HES2, and UHC Submit to CDPH: • a summary of systems in use. 3 County will work with UCD to identify and collect public data for required performance measure 2.2. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2017 – September 29, 2018 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.3: Increase engagement of non-physician team members in hypertension management in community health care systems # Activity Timeline Responsible Deliverables 1 Based on scan results, County will work with UHC to promote adoption by Health Clinic System providers of procedures/protocols that support the implementation of comprehensive health care teams. Monitor and track providers who adopt procedures/protocols. September 30, 2017 – September 29, 2018 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of adopted procedures/protocols. Revised Exhibit A Scope of Work Page 17 of 19 Program Strategy 2.3: Increase engagement of non-physician team members in hypertension management in community health care systems 2 County will work with UHC to utilize scan results to identify evidence and practice tools to share with the provider community that support the implementation of evidence-based guidelines for hypertension, such as the MHI hypertension protocols i.e., through local medical society. Identify training and TA needs to facilitate adoption/implementation of tools with UHC. September 30, 2017 – September 29, 2018 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of training materials, and • meeting agendas/minutes. 3 County will work with UHC to develop a workgroup and project work plan to fill 1-2 of the evidence gaps specified in The Community Guide at http://www.thecommunityguide.org/cvd/RGteambasedcare.html September 30, 2017 – September 29, 2018 HE, HES1, HES2, and UHC Submit to CDPH: • a summary of the evidence gathered and • gap(s) identified. 4 County will work with UCD to identify and collect public data for required performance measure 2.3. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2017 – September 29, 2018 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.4: Increase use of self-measured blood pressure monitoring tied with clinical support # Activity Timeline Responsible Deliverables 1 County will work with UHC to research model practices, outcomes, and benefits to promote the adoption and EHR use with Health Clinic System health centers that include integrated hypertension algorithms and supports for provider prompts/feedback, patient communication, and public data tracking, monitoring, and reporting. September 30, 2017 – September 29, 2018 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of sample adopted EHR systems. 2 County will work with UCD to identify and collect public data for required performance measure 2.4. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2017 – September 29, 2018 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.5: Implement systems to facilitate identification of patients with undiagnosed hypertension and people with prediabetes # Activity Timeline Responsible Deliverables 1 County will work with UHC to develop and implement a plan for improving the system for identifying and monitoring patients with hypertension in Health Clinic System. September 30, 2017 – September 29, 2018 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of the plan. Revised Exhibit A Scope of Work Page 18 of 19 Program Strategy 2.5: Implement systems to facilitate identification of patients with undiagnosed hypertension and people with prediabetes 2 County will work with UCD to identify and collect public data for required performance measure 2.5. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2017 – September 29, 2018 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Component 2b: Community Clinical Linkage Strategies to Support Heart Disease and Stroke and Diabetes Prevention Efforts Program Strategy 2.6: Increase engagement of CHWs to promote linkages between health systems and community resources for adults with high blood pressure and adults with pre-diabetes or at high risk for type 2 diabetes # Activity Timeline Responsible Deliverables 1 As a result of the health system scan, County will work with UHC to develop a plan to promote systematic change to involve Health Clinic System CHWs to promote linkages between health systems and community resources to improve outcomes for heart disease and diabetes. Coordinate with others working on CHW initiatives for awareness, input, and support. Work with CHWs for their input and guidance on promotional strategies between health systems and community resources. Monitor change. September 30, 2017 – September 29, 2018 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of the plan and • a summary of changes made. 2 County will work with UCD to identify and collect public data for required performance measure 2.6. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2017 – September 29, 2018 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Program Strategy 2.7: Increase engagement of community pharmacists in the provision of medication-/self-management for adults with high blood pressure # Activity Timeline Responsible Deliverables 1 Identify and convene appropriate partners to identify and share best practices, including training of pharmacists and mechanism of payment; promoting inclusion of pharmacists in the team for community-based medication reconciliation/reporting to providers and hypertension self-management. September 30, 2017 – September 29, 2018 HE, HES1, HES2 Submit to CDPH: • a copy of meeting agendas/ minutes. 2 County will work with UCD to identify and collect public data for required performance measure 2.7. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2017 – September 29, 2018 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Revised Exhibit A Scope of Work Page 19 of 19 Program Strategy 2.8: Implement systems and increase partnerships to facilitate bi-directional referral between community resources and health systems, including lifestyle change programs # Activity Timeline Responsible Deliverables 1 County will institute 211 services LCPs for hypertension and pre- diabetes, and/or identify other entities that could serve as a source for community referrals to LCPs. Develop tracking/monitoring system for referrals. September 30, 2017 – September 29, 2018 HE, HES1, HES2 Submit to CDPH: • a copy of meeting agendas/minutes, • 211/referral system service promotion materials, and • a summary of the tracking/monitoring system. 2 County will work with UHC to educate Health Clinic System providers about community resources available for patients with hypertension and pre-diabetes, and the benefits of using a community referral system, such as 211, within their organization (e.g. utilizing EHR to refer patients to community resources). Determine what resources/systems are needed to ensure bi-directional referrals are made. September 30, 2017 – September 29, 2018 HE, HES1, HES2, and UHC Submit to CDPH: • a copy of training materials, and • 211/referral system service promotion materials. 3 County will work with UCD to identify and collect public data for required performance measure 2.8. Attend required webinars and trainings on public data collection and performance measures sponsored by CDPH. September 30, 2017 – September 29, 2018 HE, HES1, HES2 Submit to CDPH: • a compilation of public data collected, and • a copy of event agendas. Revised Exhibit B Page 1 of 3 PERSONNEL Position Title and Name Annual Salary % FTE Program Salary Ben. Rate Ben. Cost Chief Clinical Services Officer 115,066$ 0.30 34,520$ 23% 7,940$ Program Coordinator 86,985$ 0.80 69,588$ 23% 16,005$ Health Educator 45,760$ 4.75 217,360$ 23% 49,993$ Registered Dietition 54,760$ 1.20 65,712$ 23% 15,114$ Patient Navigator (CHW) 40,000$ 2.40 96,000$ 23% 22,080$ Data & Analytics Director 100,000$ 0.25 25,000$ 23% 5,750$ Transportation Driver 26,000$ 0.50 13,000$ 23% 2,990$ Sub-Total 10.20 521,180$ 119,871$ Total Personnel 641,051$ EQUIPMENT Equipment 5,000$ Total Equipment 5,000$ OPERATIONAL General Office Supplies 2,500$ Total Operational 2,500$ TRAVEL Local travel 3,000$ Conferences/Trainings 15,000$ Total Travel 18,000$ OTHER Meeting supplies, interpretation, child care 5,390$ Education/Training Materials 25,000$ Printing and reproduction 5,000$ Total Other 35,390$ Total Direct Costs 701,941$ Administrative (Indirect) Costs 92,090$ TOTAL BUDGET 794,031$ YEAR 1 (Feb. 2 - Sept. 29, 2016) Revised Exhibit B Page 1 of 3 PERSONNEL Position Title and Name Annual Salary % FTE Program Salary Ben. Rate Ben. Cost Chief Clinical Services Officer 109,323$ 0.30 32,797$ 23%7,543$ Program Coordinator 95,909$ 0.80 76,727$ 23%17,647$ Patient Navigators (CHW)35,311$ 2.40 84,746$ 23%19,492$ Health Educators 37,906$ 4.75 180,054$ 23%41,412$ Data Analytics Director 59,028$ 0.25 14,757$ 23%3,394$ Transportation Drivers 26,000$ 0.50 13,000$ 23%2,990$ Sub-Total 9.00 402,081$ 92,479$ Total Personnel 494,560$ OPERATIONAL General Office Supplies 3,110$ Total Operational 3,110$ TRAVEL Local travel 4,079$ Conferences/Trainings 2,611$ Total Travel 6,690$ OTHER Meeting supplies, interpretation, child care 2,876$ Education/Training Materials 12,458$ Total Other 15,334$ Total Direct Costs 519,694$ Administrative (Indirect) Costs 77,038$ TOTAL BUDGET 596,732$ YEAR 2 (Sept. 30, 2016 - Sept. 29, 2017) Revised Exhibit B Page 1 of 3 PERSONNEL Position Title and Name Annual Salary % FTE Program Salary Ben. Rate Ben. Cost Program Coordinator 86,986$ 0.75 65,240$ 23% 15,005$ Patient Navigator (CHW) 40,000$ 1.20 48,000$ 23% 11,040$ Health Educator 45,760$ 2.50 114,400$ 23% 26,312$ Transportation Driver 26,000$ 0.50 13,000$ 23% 2,990$ Sub-Total 4.45 240,640$ 55,347$ Total Personnel 295,987$ OPERATIONAL General Office Supplies 2,500$ Total Operational 2,500$ TRAVEL Local travel 3,000$ Conferences/Trainings 1,000$ Total Travel 4,000$ OTHER Meeting supplies, interpretation, child care 1,000$ Education/Training Materials 10,204$ Total Other 11,204$ Total Direct Costs 313,691$ Administrative (Indirect) Costs 27,124$ TOTAL BUDGET 340,815$ YEAR 3 (Sept. 30, 2017 - Sept. 29, 2018)