HomeMy WebLinkAboutBlue Cross of California Partnership Plan Inc.-Provider Capacity Incentive Program_A-25-175.pdf COtj County of Fresno Hall of Records, Room 301
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Fresno,California
601 Board of Supervisors 93721-2198
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May 6, 2025
Present: 5- Vice Chairman Garry Bredefeld, Supervisor Luis Chavez, Supervisor Nathan Magsig,
Chairman Buddy Mendes, and Supervisor Brian Pacheco
Agenda No. 35.1 Public Health File ID: 25-0222
Re: Approve and authorize the Chairman to execute a retroactive revenue agreement with CalViva Health
Net, LLC for the Population Health Management Program grant, effective January 1, 2024 through
December 31, 2026,total not to exceed$7,153,788; approve and authorize the Chairman to execute a
retroactive revenue agreement with Blue Cross of California Partnership Plan, Inc. and its affiliates
(Anthem)for the Provider Capacity Incentive Program grant, effective January 1, 2024 through
December 31, 2026,total not to exceed$931,290; approve and authorize the Chairman to execute a
revenue agreement with Kaiser Foundation Health Plan, Inc.for the California Population Health Needs
Assessment Funding grant, effective upon execution through December 31, 2026,which includes one
optional one-year extension, total not to exceed $50,000; adopt Budget Resolution increasing the FY
2024-25 appropriations and estimated revenues for Population Health Management Fund 0080, Org
1169 in the amount of$759,525 and$5,836,519 respectively(4/5 vote); and approve and authorize the
Department of Public Health Director,or designee,to make non-material changes to the Department's
services, staffing, and responsibilities through amendments to the Agreements,which are necessary
or advisable in the Director's determination as in the best interest of the County, subject to approval by
County Counsel as to legal form and by the Auditor-Controller/Treasurer-Tax Collector as to
accounting form,without modifying the maximum compensation
APPROVED AS RECOMMENDED
Ayes: 5- Bredefeld, Chavez, Magsig, Mendes, and Pacheco
Agreement No. 25-174,Agreement No. 25-175,Agreement No. 25-176, Resolution No.25-135
County of Fresno Page 39
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Board Agenda Item 35.1
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DATE: May 6, 2025
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Multiple Retroactive Revenue Agreements with Managed Care Plans for Population
Health Management Programs
RECOMMENDED ACTION(S):
1. Approve and authorize the Chairman to execute a retroactive revenue agreement with
CalViva Health Net, LLC for the Population Health Management Program grant, effective
January 1, 2024 through December 31, 2026, total not to exceed $7,153,788;
2. Approve and authorize the Chairman to execute a retroactive revenue agreement with Blue
Cross of California Partnership Plan, Inc. and its affiliates (Anthem)for the Provider Capacity
Incentive Program grant, effective January 1, 2024 through December 31, 2026, total not to
exceed $931,290;
3. Approve and authorize the Chairman to execute a revenue agreement with Kaiser
Foundation Health Plan, Inc. for the California Population Health Needs Assessment Funding
grant, effective upon execution through December 31, 2026, which includes one optional
one-year extension, total not to exceed $50,000;
4. Adopt Budget Resolution increasing the FY 2024-25 appropriations and estimated revenues
for Population Health Management Fund 0080, Org 1169 in the amount of$759,525 and
$5,836,519 respectively(4/5 vote); and,
5. Approve and authorize the Department of Public Health Director, or designee,to make
non-material changes to the Department's services, staffing, and responsibilities through
amendments to the Agreements,which are necessary or advisable in the Director's
determination as in the best interest of the County, subject to approval by County Counsel
as to legal form and by the Auditor-Controller/Treasurer-Tax Collector as to accounting form,
without modifying the maximum compensation.
There is no additional Net County Cost associated with the recommended actions. Approval of the first
three recommended actions will allow the Department of Public Health (Department)to implement separate
revenue agreements with CalViva Health Net, LLC (CalViva), Blue Cross of California Partnership Plan,
Inc. (Anthem), and Kaiser Foundation Health Plan Inc., (Kaiser)to support the Department's effort to
address social determinants of health through preventative population health intervention services to
Medi-Cal residents of Fresno County. The fourth recommended action will increase the FY 2024-25
appropriations and estimated revenues in the amount of$5,836,519 in the Department's Special Revenue
Fund 1169 to align appropriations and revenues with the funding amount received from these agreements
this fiscal year. This item is countywide.
County of Fresno Page 1 File Number.25-0222
File Number:25-0222
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, the Department will forego acceptance of
$8,135,077 in grant funding to address population health intervention services for residents experiencing
the highest health disparities, causing no new strategies to be implemented and limiting the ability to
leverage with existing programs.
RETROACTIVE AGREEMENT:
The first two recommend actions are retroactive to January 1, 2024, due to the funding agencies' request
for program start date, proposal review and deliverable requirements, and coordination between funding
agencies.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The recommended
revenue agreements are fully funded by grant funding. The fourth recommended action is required to
increase the FY 2024-25 appropriations and estimated revenues in the amount of$759,525 and
$5,836,519 respectively in the Department's Special Revenue Fund 1169. The increase is necessary to
align appropriations and revenues with the funding amount received from the revenue agreements this
fiscal year. Total funding for each recommended action will occur in lump sum disbursements and are
outlined below:
CalViva
• Term Maximum: (1/1/2024 - 12/31/2026): $7,153,788
Anthem
• Term Maximum (1/1/2024 - 12/31/2026): $931,290
Kaiser
• Term Maximum (Execution - 12/31/2025): $50,000
Sufficient appropriations and estimated revenues will be included in the Department of Public Health's Org
1169 FY 2025-26 Recommended Budget and in subsequent budget requests.
DISCUSSION:
The California Department of Health Care Services under its CalAIM program has issued a Population
Health Management (PHM) Policy Guide (May 2024)that outlines the requirements for Managed Care
Plans to support local health jurisdictions in supporting their local Community Health Assessment (CHA)
and Community Health Improvement Plan (CHIP). The PHM main goals are:
• Build trust with and meaningfully engage Medi-Cal members;
• Gather, share, and assess timely and accurate data to identify efficient and effective opportunities
for intervention through processes such as data-driven risk stratification, predictive analytics,
identification of gaps in care, and standardized assessment processes;
• Address upstream drivers of health through integration with public health and social services;
• Support all Medi-Cal members in staying healthy;
• Provide care management services for Medi-Cal members at higher risk of poor outcomes;
• Provide transitional care services (TCS)for Medi-Cal members transferring from one setting or level
of care to another;
• Reduce health disparities; and
• Identify and mitigate Social Drivers of Health
The proposed agreements have areas of focus that will align with the Department's population health
priorities and the recent CHA(2023)and CHIP (2024-2028) Community Health Assessment and
County of Fresno Page 2 File Number.25-0222
File Number:25-0222
Community Health Improvement Plan - County of Fresno.
The proposed agreements will fund staffing to support data analysis and infrastructure, project
management, communications, and administrative support. In addition, there is funding to support
expansion of Mobile Health services to metropolitan areas, Community Information Exchange, and the
Community Health Worker(CHW) Network.
On February 25, 2025, your Board adopted a resolution recognizing the Department for receiving a 2024
California State Association of Counties Challenge Award for the Rural Mobile Health program in
partnership with the CHW Network as an innovative and effective program that addresses critical
community needs. Both of these programs are being supported by the Managed Care Plans in the
recommended actions.
Each of the proposed agreements are based on member count for each organization, which varies year to
year and are evaluated by each organization on an annual basis. Approval of the recommended actions will
authorize the Director to make non-material changes to services, staffing, and responsibilities of the
Department, as needed, to adjust with these annual fluctuations and mitigate disruptions in services
through amendments. Amendments will be approved by the County's County Counsel and the County's
Auditor Controller/Treasurer-Tax Collector's Office.
The agreements vary from standard County template as they were drafted by each organization and are
standard for each organization to provide grant funding to outside agencies. All agreements were approved
by County Counsel and HR-Risk.
REFERENCE MATERIAL:
BAI #4, February 25, 2025
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk- Revenue Agreement with CalViva
On file with Clerk- Revenue Agreement with Anthem
On file with Clerk- Revenue Agreement with Kaiser
On file with Clerk- Budget Resolution (Org 1169)
CAO ANALYST:
Ron Alexander
County of Fresno Page 3 File Number.25-0222
Agreement No. 25-175
LETTER OF AGREEMENT
BETWEEN BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN,INC. AND
COUNTY OF FRESNO
THIS LETTER OF AGREEMENT (the "Agreement") by and between Blue Cross of California
Partnership Plan, Inc. and its affiliates ("Anthem") and County of Fresno ("Sponsored Party")
is effective upon the date of complete execution of the Agreement(the "Effective Date").
AGREEMENT:
NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency of
which is hereby acknowledged, the parties agree as follows.
1. Anthem and Sponsored Party each desire to participate in a Provider Capacity Incentive
Program(the "Program") geared toward improving the quality of life and health outcomes of
the Medi-Cal managed care population through the implementation of delivery system
infrastructure, Enhanced Care Management(ECM) capacity building, and Community
Supports (CS) capacity building and take up, and Community Health Assessments (CHA)
and Community Health Improvement Projects (CHIPS). Anthem and Sponsored Party both
agree to provide the Program goals, metrics and objectives as specified in Exhibit A, attached
hereto and incorporated herein.
2. To the extent any provision contained in this Agreement conflicts with the terms and
conditions of Sponsored Party's Participation Agreement with Anthem, then Sponsored
Party's Participation Agreement shall control.
3. The parties acknowledge and agree that all information related to the Program created and/or
furnished by one party to the other party as a result of this Agreement is proprietary and
confidential. Sponsored Party and Anthem agree not to use such proprietary and confidential
information except for the purpose of carrying out their obligations under this Agreement.
Neither party shall disclose any proprietary and confidential information to any person or
entity without the other party's express written consent, except as required pursuant to
applicable law, regulatory requirements, or legal order, in which case such party shall
immediately notify the other party of the receipt of any such request for disclosure prior to
the disclosure.
4. The Agreement will commence on January 1, 2024 and will be in force until December 31,
2026 unless the Agreement is extended as specified in Section 5 or earlier terminated as
specified in Section 6.
5. The term of this Agreement may be extended for no more than two, one-year periods only
upon written approval of both parties before the first day of the next one-year extension
period. The County of Fresno Department of Public Health Director or his or her designee(s),
is authorized to execute Amendments to this Agreement on behalf of the Grantee to comply
Page 1 of 6
with the fulfillment of the Services, Terms, Termination, and other relevant requirements
subject to approval by Grantee's legal counsel as to legal form.
6. Either party may terminate this Agreement with or without cause on thirty(30) days' prior
written notice to the other party. This Agreement will automatically terminate upon one or
more of the following events:
a. Termination of Sponsored Party's Participation Agreement with Anthem; or
b. Sponsored Party fails to meet requirements and measurements as outlined in Exhibit
A.
7. The parties hereto represent to each other that to their knowledge this Agreement(i) has been
validly executed and delivered, and(ii) has been duly authorized by all corporate action
necessary for the authorization.
8. This Agreement shall be construed and interpreted in accordance with the laws of the State of
California.
9. This Agreement is solely for the benefit of Sponsored Party and Anthem and will not be
construed to give rise to or create any liability or obligation to, or to afford any claim or
cause of action to, any other person or entity.
10. Each party agrees to indemnify, defend, and hold harmless the other party from and against
any and all liability, loss, claim, damage or expense, including defense costs and legal fees,
incurred in connection with a breach of any representation and warranty made by a party in
this Agreement, and for claims for damages of any nature whatsoever, arising from a party's
performance or failure to perform its obligations hereunder.
11. Sponsored Party agrees that capacity funds cannot be used for: capital campaigns,
endowments, annual drives, operating deficit, debt retirement,replacement of previously
funded services, direct services billable to other payers, or miscellaneous line items.
12. Sponsored Party agrees to provide progress reports at least quarterly or as requested and
submit outcome documentation by the end of the 3 year cycle. Outcome documentation of
incentive activities includes using templates provided by ANTHEM. Training and technical
assistance will be provided by ANTHEM.
Page 2 of 6
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be duly executed.
BLUE CROSS OF CALIFORNIA
PARTNERSHIP PLAN, INC.
Name: Les Ybarra
Date: 04/09/2025
County of Fresno
By:
Name: Ernest Buddy Mendes
Title: Chairman of the Board of Supervisors
of the County of Fresno
Date: S—{o -o?Da S
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of Cailfornia
For accounting use only: By eputy
Org No.: 1169
Account No.: 3530
Fund No.: 0080
Subclass No.: 17369
Page 3 of 6
EXHIBIT A
The CalAIM Capacity Building Incentive Payment Program (IPP) is for Anthem California
Medicaid business-only. Unless otherwise defined in this Agreement, all defined terms shall have
the meanings set forth in the Sponsored Party Participation Agreement. Either parry may modify
the terms and conditions of the Program at any time upon written approval of both parties. The
County of Fresno Department of Public Health Director or his or her designee is authorized to sign
the written approval on behalf of the Sponsored Party.
Under the Program, Anthem will advance to Sponsored Party one lump sum in the amount of
$931,290 as an incentive to assist Sponsored Party with:
❑ Data infrastructure needs that align with ECM/CS requirements
❑ Billing/reporting assistance and development
® Staffing costs to support initial and growth capacity that aligns with Anthem's network
needs (Geography, Cultural, PoF specific, etc.)
❑ Training and other Staff development/retention activities
❑ Health equity and health disparities around specific communities of focus
[I CS Service model/program development
❑Development and maintenance of HIE/HIT technology or community based EHR
❑Community-based training forums
❑Consulting/Program planning costs that focus on broad engagement across all
stakeholders.
❑Service model/program development to support Jail Re-Entry, Child Services PoF
integration.
❑X CHA/CHIP
Sponsored Party shall deposit payments into a special revenue interest bearing fund outside of
the County general fund. The County general fund shall be reimbursed on a monthly basis for
costs incurred under this agreement. This special revenue fund is to be used exclusively for
Medi-Cal population health management funding and interest earned. Acceptance of this funding
requires that the interest accruing from these payments must be used for Medi-Cal Population
Health Management program-related activities and shall be used to defray costs incurred by the
program,measurably expand the program, improve the quality of services above the level of
services already funded under the Agreement, or support other strategies to improve population
Page 4 of 6
health. The interest earned on payments is not included in fiscal year budgets or the grant amount
breakdown and disbursement of funding.
Approved Milestones:
Timeline— 1/1/2024-12/31/2026
Activity Cost DHCS Bold Goal(s)
• Staffing $931,290 funding Close racial/ethnic
in full for all 3 disparities in well-
years. child visits and
immunizations by 50
percent
Ensure Anthem
exceeds the 50th
percentile for all
children's preventive
care measures
SPONSORED PARTY ACTIVITIES/DELIVERABLES/OUTCOMES & REPORTING:
Grantee is agreeing to work in partnership with Anthem on achieving/impacting the DHCS Bold Goal(s)identified
above.
During the Program Grant Period(January 1,2024—December 31,2026), Sponsored Party will provide annual
reporting after each fiscal year to Anthem that includes the following:
Program Activity ACTIVITIES/DELIVERABLES/OUTCOMES
Staffing 1. Report total positions hired and total dollar amounts.
Please see example below:
Total
LEGEND Total Positions Dollars
AS Administrative Support X $$$$$
CE Community Engagement
Comm Communications
DI Data Infrastructure
IS Implementation Strategies
PM Project Management
IN-KIND
Page 5 of 6
Provided that Sponsored Party meets its Program Activity as specified herein during the term of
the Agreement, then Anthem will waive repayment of such sponsorship, or a prorated portion,
thereof.
If the Sponsored Party Participation Agreement between Anthem and Sponsored Party is
terminated for any reason during the duration of this Agreement, Sponsored Party understands
and agrees that it will repay a prorated amount of the Sponsorship.
Provider Capacity Incentive Payment Prozram Funds Services and Goals
Measurements
In order to be eligible for Provider Capacity IPP funds, Sponsored Party is required to choose I
or more goals as outlined below:
1. CHA/CHIP
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