File #: 2019-0618   
Type: Consent Calendar Item Status: Agenda Ready
File created: 4/22/2019 In control: Health Services
On agenda: 7/23/2019 Final action:
Title: ACCESS Sonoma Safety Net Initiative Agreements
Department or Agency Name(s): Health Services, Human Services, Community Development Commission , Probation, Child Support Services, District Attorney, Sheriff's Office, Public Defender
Attachments: 1. Summary Report, 2. Attachment 1 - International Business Machines Corporation Statement of Work Addendum 3, 3. Attachment 2 - County Medical Services Program Governing Board Grant Agreement

To: Board of Supervisors of Sonoma County

Department or Agency Name(s): Department of Health Services, Human Services Department, Community Development Commission, Probation Department, Child Support Services Department, Office of the District Attorney, Sheriff’s Office, and Public Defender

Staff Name and Phone Number: Barbie Robinson, 565-7876; Karen Fies; David Koch; Margaret Van Vliet; Jennifer Traumann; Jill Ravitch; Mark Essick; Kathleen Pozzi

Vote Requirement: Majority

Supervisorial District(s): Countywide

 

Title:

Title

ACCESS Sonoma Safety Net Initiative Agreements

End

 

Recommended Action:

Recommended action

A)                     Authorize the Department of Health Services to execute Addendum 3 to the Statement of Work with International Business Machines Corporation for implementation of Phase 4 of the ACCESS Sonoma Data Hub Project, increasing the contract amount by $1,500,000 resulting in a new total not-to-exceed amount of $6,297,000, and any amendments that do not substantially change the scope of work or increase funding.

B)                     Authorize the Director of Health Services to execute a grant agreement with the County Medical Services Program Governing Board to accept $300,000 in revenue to support the ACCESS Sonoma Safety Net Initiative for the period May 1, 2019 to September 30, 2022.

end

 

Executive Summary:

On March 23, 2018 Sonoma County entered into an agreement with International Business Machines Corporation (IBM) to provide software and implementation of the ACCESS Sonoma Data Hub Project to support the County’s rapid response efforts. Sonoma County Safety Net Departments participating in the project include Health Services, Human Services, Community Development Commission, Probation, Child Support Services, District Attorney, Sheriff, and Public Defender. The ACCESS Sonoma Data Hub 1) provides a global view of clients that accounts for their multiple needs, allowing for coordinated front-end referrals and service delivery across the Safety Net Departments and 2) allows for continued analysis of each client’s needs, collaborative case management, and evaluation of outcomes to support more proactive and prevention-focused efforts aimed at addressing critical client needs.

On August 23, 2018 the Board approved Addendum 1 to the Statement of Work with IBM for Phase 2 implementation of the project which added homeless services information to the database, added client care planning and goal tracking, and incorporated security for future expansion.

On December 11, 2018 the Board approved Addendum 2 to the Statement of Work with IBM for Phase 3 implementation of the project. Phase 3 is currently underway and configures criminal justice data, expanded security roles, electronic authorization forms, and system infrastructure in anticipation of Phase 4 implementation of the project.

The Sonoma County Safety Net Departments are now requesting approval to execute Addendum 3 to the Statement of Work with IBM for Phase 4 implementation of the Data Hub project. Phase 4 of the project will continue to develop functionality and add data from systems not currently linked to the Connect360 database. It will include a system to electronically refer clients to community partners, a portal for clients to access the system via home or mobile devices, an alert system to advise the care team and clients of important events, additional reporting, and additional security to protect data as access to the system expands. Phase 4 implementation is anticipated to be completed in the Winter of 2019.

In support of the Data Hub project, on February 26, 2019, the Board approved a request by the Department of Health Services to apply for a grant in the amount of $300,000 from the County Medical Services Program Governing Board to support development of the ACCESS Sonoma program. The County submitted the grant application and on April 11, 2019, the County Medical Services Program Governing Board notified the County that our grant application had been approved.

The Board has also approved technical support to the ACCESS Sonoma project by approving the Information Services Department’s fiscal year 2019-2020 budget objective to “Provide continued technology consulting and services to the ACCESS Sonoma County project to support a secure mechanism to share and exchange data across Health and Human Services Partners in order to improve outcomes for those in need.”

 

Discussion:

In April 2017 the Sonoma County Board of Supervisors established one of its 2017 Strategic Priorities to Strengthen the County’s Safety Net system. The goal of this priority is to identify the most vulnerable residents, defined as those who are often high utilizers of County services across multiple departments, and develop coordinated strategies to improve their well-being, self-sufficiency, and recovery.

In response to the Board’s Safety Net Priority, the Sonoma County Safety Net Departments of Health Services, Human Services, Community Development Commission, Probation, Child Support Services, District Attorney, Sheriff, and Public Defender (Safety Net Departments) created an initiative - ACCESS Sonoma County - to begin developing strategies to identify and coordinate services for the most vulnerable residents. Because each of the Safety Net Departments maintain client data within their own systems, the creation of an integrated data hub was determined to be a critical factor in the successful implementation of the ACCESS Sonoma County initiative.

With the devastating fires in October 2017 underscoring the importance of the County’s initiative to strengthen its safety net system, on December 5, 2017 the Board of Supervisors adopted a resolution approving the development of the integrated data hub to facilitate implementation of disaster rapid response efforts, the ACCESS Sonoma County program, and the Whole Person Care project. In response to the Board’s direction, the Safety Net Departments launched the County’s first ever Interdepartmental Multi-Disciplinary Team, comprised of front line staff from each of the Safety Net Departments including case workers, eligibility workers, clinicians, probation officers and other direct service providers working with an Interdepartmental Multi-Disciplinary Team coordinator to establish care plans for program participants.

ACCESS Sonoma To-Date

In support of the County’s efforts to strengthen the Safety Net priority and the County’s rapid response efforts during the fires, the County entered into an agreement with IBM through which IBM provided a Rapid Prototyping Tool consisting of the IBM Connect 360 Master Data Management Patient Hub as well as a front end interface through its Watson Care Manager software. The IBM Connect 360 Master Data Management Patient Hub and Watson Care Manager interface serve two purposes. First, they provide a global view that accounts for our clients’ multiple needs, allowing for coordinated front-end referrals and service delivery across the Safety Net Departments. Second, the Master Data Management Patient Hub and Watson Care Manager interface allow for continued analysis of client needs, collaborative case management, and evaluation of outcomes to support more proactive and prevention-focused efforts aimed at addressing critical needs of the client.

The development of the IBM system has been planned in multiple phases with each phase delivering added functionality to the system. The Phase 1 Rapid Prototype delivered the core database (Data Hub) with an initial view of basic client information and was completed both on-time and within budget. Phase 2 added homeless services information to the database, added client care planning and goal tracking, and incorporated security for future expansion. Phase 3 configures criminal justice data, expanded security roles, electronic authorization forms, and system infrastructure in anticipation of Phase 4 implementation of the project. Phase 3 is currently on-time and on-budget.

Since July 2018, the Interdepartmental Multi-Disciplinary Team has used the initial system functionality to support case management of their first cohort of clients; the victims of the October 2017 fires who remained homeless weeks after the fires were extinguished. In addition to assisting the fire victims, the team is currently using the system to support case management of a second cohort of clients consisting of homeless residents who have complex mental health, substance abuse, and/or physical health issues contributing to their homelessness. Recently, we added a cohort of clients who are very high utilizers of local hospital emergency room services in an effort to help them utilize more appropriate and cost effective services.

ACCESS Sonoma Results

Over the past two years, ACCESS Sonoma has served over 1,350 clients across multiple cohorts. Most of these clients are homeless individuals who have complex medical, substance use, or mental health needs. ACCESS staff have provided direct services and referrals in the area of healthcare and social services to qualified clients through County programs and community partners. The services and referrals provided to these individuals have resulted in over 8,000 individual encounters and contacts with the clients.

Over 130 of the 1,350 clients have received direct case management by the ACCESS Sonoma Interdepartmental Multi-Disciplinary Team resulting in over 1,000 encounters and contacts with these high-needs clients. To date, Access Sonoma has directly assisted over 60 of these high needs clients with securing permanent or temporary housing/shelter. In addition, the Interdepartmental Multi-Disciplinary Team has helped them apply for and receive benefits such as Cal-Fresh, Medi-Cal, General Assistance, Social Security, and In-Home Support Services. Lastly, the Team is helping these clients find appropriate medical services, get help with substance abuse problems, resolve criminal justice matters, and enroll in job training.

Project Continuation and Funding

With the successful implementation of the first three phases of the project, the Sonoma County Safety Net Departments have determined that continued efforts to further implement the IBM Connect 360 Master Data Management Patient Hub and Watson Care Manager, including connecting to additional County data systems, will contribute substantially towards the goal of improving outcomes of the target population. Full system implementation will result in a system accessible by the Interdepartmental Multi-Disciplinary Team as well as regional hospitals and local non-profit partners.

The first three phases of the project have totaled $4,797,000. Over half of the funding for Phase 1, Phase 2, and Phase 3 ($2,550,000) was provided by grants and other outside funding sources such as State Whole Person Care, the William and Flora Hewlett Foundation, and the Well Being Trust. The balance of the funding for Phase 1, Phase 2, and Phase 3 was provided by Health Services, Human Services, and the Probation Department.

Several additional project phases are anticipated with full implementation in three to five years. Total cost for the full project is anticipated to be $6 million to $10 million. In addition to funding streams identified above, the County has outside funding of $126,000 committed from the County Medical Services Program Governing Board and $518,000 committed from the California Homeless Mentally Ill Outreach and Treatment Program to support Phase 4 of the project. Safety Net Department efforts to identify and acquire funding to support the project from community partners and foundations having an interest in the target population will continue during project implementation.

ACCESS Sonoma Data Hub Project Phase 4

The Sonoma County Safety Net Departments are now requesting approval to execute Addendum 3 to the Statement of Work with IBM for Phase 4 implementation of the Data Hub project. Phase 4 of the project provides for continued development of features and services and adds support for connectivity with additional County and partner organizations. Phase 4 implementation is anticipated to be completed in the Winter of 2019.

IBM Statement of Work Addendum 3 does the following: 1) sets forth the Phase 4 project scope, 2) defines Phase 4 “use cases,” 3) expands the technical solution with additional source systems, 4) establishes IBM and County responsibilities related to Phase 4 project implementation, and 5) provides schedule and pricing information.

The following are highlights of the additional capabilities provided through implementation of Phase 4 of the Data Hub:

1)                     Additional Data: Phase 4 will begin by incorporating housing data and adding approved data from criminal justice systems into the data hub along with validation of all existing data.

2)                     Additional Environment: Set up an additional environment in the data center to support testing and development of ACCESS Sonoma.

3)                     Consent Management: We will pilot the new cloud-based client consent with the Interdepartmental Multi-Disciplinary Team and add additional functionality associated with the policy matrix, Interdepartmental Multi-Disciplinary Team, and additional community partners.

4)                     Basic Referral Capability: Phase 4 will engage community partners to design a system to refer clients to regional community clinics in this phase, and expand to other community partners in future phases.

5)                     Basic Alert System: Phase 4 will add basic functionality for an alert system that notifies care team members of important issues.

6)                     Client Portal: Phase 4 will begin design of a client portal where clients can track progress toward achieving their goals.

7)                     Expanded Security Roles: Phase 4 will expand security roles to encompass justice data coming into the system and limiting access for non-justice roles.

The implementation cost for Phase 4 of the project is $1,500,000. Funding sources for Phase 4 are as follows: Homeless Mentally Ill Outreach and Treatment Program - $518,000; County Medical Services Program Governing Board grant - $126,000; Community Development Commission - $75,000; Child Support Services Department - $150,000; Intergovernmental Transfer - $457,000; and 1991 Health Realignment - $174,000. Revenue of $300,000 from the County Medical Services Program Governing Board grant will be received over three fiscal years. Revenue received in fiscal years 2020-2021 and 2021-2022, totaling $174,000, will be included as revenue in the applicable year in which it is received. The Safety Net Departments are in the process of requesting funding support from community partners, which may offset the use of Intergovernmental Transfer funding required for the project.

ACCESS Sonoma Phase 5

The Sonoma County Safety Net Departments will continue to plan for Phase 5 of the project. Phase 5 will continue to add additional data sets from new and existing Safety Net Departments and systems. This may include additional systems from the Human Services Department, health care clinics, and hospital data. Phase 5 will further expand the universal consent process to engage additional community partners, will further expand security to accommodate additional participants. We will begin piloting an expansion of Watson Care Manager to non-Interdepartmental Multi-Disciplinary Team case managers in one or more departments for consent-based general use. It is anticipated that the Safety Net Departments will return to the Board in early 2020 to request approval to amend the agreement with IBM for Phase 5 project efforts. The cost of Phase 5 will be similar to the cost of Phase 4.

Overall Project Expectations and Outcome Measures

Overall project expectations and outcome measures are clearly defined as follows:

1)                     Clients will achieve increased income and assets though access to job placement assistance and case management. This will be measured by job placement statistics.

2)                     Clients will have a reduced long-term dependence on public benefits due to the coordinated multi-disciplinary approach to service delivery. This will be measured by reduction in utilization of services analysis.

3)                     Clients will have greater housing stability through participation of Community Development Commission programs in the Interdepartmental Multi-Disciplinary Team. This will be measured by housing vulnerability index screening.

4)                     Clients will have improved health and well-being through coordinated referral to appropriate health partners such as Fully Qualified Health Centers. This will be measured by the number of client referrals to physical health providers.

5)                     The Interdepartmental Multi-Disciplinary Team will provide integrated client services and use coordinated client tracking, evidenced by access to comprehensive client data in Watson Care Manager.

6)                     The Interdepartmental Multi-Disciplinary Team will provide improved critical needs response and access to services due to the mobile capabilities and integrated nature of the Watson Care Manager coupled with the integrated nature of the Interdepartmental Multi-Disciplinary Team.

7)                     The Interdepartmental Multi-Disciplinary Team will experience collaborative information sharing through face-to-face interaction between Team members and through access to the 360 degree client view in Watson Care Manager.

8)                     The Safety Net Departments will experience expanded service capacity as the Interdepartmental Multi-Disciplinary Team stabilizes the highest utilizer’s reliance on services through efficient and effective service delivery. This will be measured by reduction in utilization of services analysis.

9)                     The County will experience reduced costs and duplicative administration as the Interdepartmental Multi-Disciplinary Team works collaboratively to reduce overlapping services and refers clients to the most cost efficient services. This will be measured by pre-service and post-service cost reports.

Project Coordination Efforts

The County’s Information Systems Department Systems and Programming Division has played a critical role in working with the Safety Net Departments as well as their software support staff and vendors to extract the appropriate client data for the Connect 360 Master Data Management Patient Hub. The Information Systems Department Technical Services Division is working with IBM to ensure technical requirements of hosting the on premise solution meet appropriate security and support guidelines.

Each of the Safety Net Departments have committed staff to the Interdepartmental Multi-Disciplinary Team. Staff are available or co-located with IBM for the duration of project implementation and provide information regarding County programs, policies, and business needs; the County technology environment; and confidentiality, privacy, authorization, and consent.

The Safety Net Departments have also been working with the Privacy Officer, County Counsel and outside legal counsel to address privacy and confidentiality issues. These efforts will continue alongside IBM’s project efforts.

Strategic Plan Alignment

The development and deployment of the IBM Master Data Management Patient Hub and Watson Care Manager interface aligns with the County Strategic Plan by providing a global view of the client that accounts for his/her multiple needs allowing for coordinated front-end referrals and service delivery across the Safety Net Departments with the goal of improved client well-being, self-sufficiency, and recovery.

In addition to alignment with the County’s Strategic Plan, this project supports the Department of Health Services’ Strategic Plan goal of providing individuals, families, and communities access to high quality and coordinated services for health, recovery, well-being, and self-sufficiency. Completion of Phase 4 of the Data Hub project is a key strategy in strengthening coordination of services with an emphasis on high-need residents.

 

Prior Board Actions:

On December 11, 2018 the Board approved Addendum 2 to the Statement of Work with International Business Machines Corporation for implementation of Phase 3 of the ACCESS Sonoma Data Hub Project, increasing the contract amount by $1,800,000 resulting in a new total not-to-exceed amount of $4,797,000.

On August 8, 2018 the Board approved Addendum 1 to the Statement of Work with International Business Machines Corporation for implementation of Phase 2 of the ACCESS Sonoma Data Hub Project, increasing the contract amount by $1,799,918 resulting in a new total not-to-exceed amount of $2,997,000.

On March 20, 2018 the Board approved a Statement of Work and Cloud Services Agreement with International Business Machines Corporation to provide software in support of the rapid deployment of an integrated data hub and front end user application for the ACCESS Sonoma County initiative, in an amount of $1,197,082.

On December 5, 2017 the Board 1) received a report on the activities underway to address the Board of Supervisors priority to Secure the Safety Net and 2) adopted a resolution approving the county Safety Net Departments and Community Development Commission to strengthen coordinated, client-centered care delivery strategies and develop an information hub to facilitate successful implementation of disaster rapid response efforts, ACCESS Sonoma County, and Whole Person Care projects.

 

Fiscal Summary

 Expenditures

FY 19-20 Adopted

FY 20-21 Projected

FY 21-22 Projected

Budgeted Expenses

0

 

 

Additional Appropriation Requested

1,500,000

 

 

Total Expenditures

1,500,000

0

0

Funding Sources

 

 

 

General Fund/WA GF

 

 

 

State/Federal

1,149,000

 

 

Fees/Other

351,000

 

 

Use of Fund Balance

 

 

 

Contingencies

 

 

 

Total Sources

1,500,000

0

0

 

Narrative Explanation of Fiscal Impacts:

The implementation cost for Phase 4 of the project is $1,500,000; funded as follows: Homeless Mentally Ill Outreach and Treatment Program - $518,000; County Medical Services Program Governing Board grant - $126,000; Community Development Commission - $75,000; Child Support Services Department - $150,000; Intergovernmental Transfer - $457,000; and 1991 Health Realignment - $174,000. Expenditures for the IBM Addendum will be added to the fiscal year 2019-2020 budget via the consolidated budget adjustments process. In addition to known current funding sources, the Safety Net Departments are in the process of requesting funding support from various organizations, which may offset the use of Intergovernmental Transfer funding required for the project.

Receipt of County Medical Services Program Governing Board grant funding is anticipated as follows: FY 19-20 - $126,000; FY 20-21 - $96,000; and FY 21-22 - $78,000. FY 20-21 and FY 21-22 grant funding, totaling $174,000, will be included as revenue in the applicable year received. Revenue from the County Medical Services Program Governing Board grant will be added to the fiscal year 2019-2020 budget via the consolidated budget adjustments process. Subsequent fiscal year revenue will be included in the appropriate year budgets.

 

Staffing Impacts:

 

 

 

Position Title (Payroll Classification)

Monthly Salary Range (A-I Step)

Additions (Number)

Deletions (Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Narrative Explanation of Staffing Impacts (If Required):

N/A

 

Attachments:

1) International Business Machines Corporation Statement of Work Addendum 3, 2) County Medical Services Program Governing Board Grant Agreement

 

Related Items “On File” with the Clerk of the Board:

None