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; Jennifer Traumann; Jill Ravitch; Mark Essick; Kathleen Pozzi
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
ACCESS Sonoma Safety Net Initiative Agreement - IBM Phase 5
End
Recommended Action:
Recommended action
A) Authorize the Director of Health Services, or designee, to execute Addendum 4 to the Statement of Work with International Business Machines Corporation for implementation of Phase 5 of the ACCESS Sonoma Data Hub Project, and any amendments that do not substantially change the scope of work or increase funding, in an amount not-to-exceed $1,500,000 through December 31, 2020.
B) Adopt a resolution adjusting the fiscal year 2020-2021 adopted budget by increasing revenues and expenditures in the Department of Health Services by $792,663 to reflect additional revenues and expenditures related to implementation of Phase 5 of the ACCESS Sonoma Data Hub Project. (4/5th Vote Required)
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 implementation of the project added expanded security roles, electronic authorization forms, and system infrastructure.
On July 23, 2019 the Board approved Addendum 3 to the Statement of Work with IBM for Phase 4 implementation of the project. Phase 4 implementation of the project added a new test environment for ACCESS Sonoma, new consent management functions for Interdepartmental Multi-Disciplinary Teams and Community Partners, new alert functionality, additions for additional data to be shared by the Interdepartmental Multi-Disciplinary Teams, and support for Joe Rodota Trail outreach and engagement.
The Sonoma County Safety Net Departments are now requesting approval to execute Addendum 4 to the Statement of Work with IBM for Phase 5 implementation of the Data Hub project. Phase 5 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 5 implementation is anticipated to be completed in the Winter of 2020.
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 configured criminal justice data, expanded security roles, electronic authorization forms, and system infrastructure related to Phase 4 implementation of the project.
Phase 4 efforts included setting up an environment in the data center for testing and ACCESS Sonoma development, piloting improvements to consent management, and adding an alert function for important care team notices. The COVID-19 cohort with two new assessments was developed in response to the COVID-19 pandemic. Phase 4 efforts were completed in February 2020. Due to the Joe Rodota Trail emergency response, it was necessary to move the following deliverables from Phase 4 to Phase 5: 1) mental health diversion cohort care plan, 2) addition of criminal justice data to the data hub, 3) addition of housing data to the data hub, 4) client portal for self-progress tracking, and 5) expanded security roles to encompass criminal justice data.
Since July 2018, the Interdepartmental Multi-Disciplinary Team has used the initial system functionality to support integrated case management of six cohorts of vulnerable community members: (1) Emergency Rapid Response (2017 Complex fires and 2019 Kincaid fires); (2) High needs homeless - individuals who suffer from serious and persistent mental illness and have co-occurring conditions and co-morbidities; (3) Emergency Department High Utilizers - individuals who inappropriately over-utilize emergency department services; (4) Mental Health Diversion - participants are individuals who are diverted from the criminal justice system to more appropriate services in the community; (5) Homeless Encampment (HEART/JRT) - care coordination for individuals living in encampments throughout the County, and most recently (6) COVID-19 Vulnerable - homeless individuals 65 years or older or those with underlying health conditions that make them more at risk for the COVID-19 virus.
ACCESS Sonoma Results
Over the past two years, ACCESS Sonoma has served over 3,971 clients across six 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 751 of the 3,971 clients have received direct case management by the ACCESS Sonoma Interdepartmental Multi-Disciplinary Team resulting in over 2,000 encounters and contacts with these high-needs clients. To date, Access Sonoma has directly assisted over 423 with securing shelter and 154 with securing permanent housing. 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 for Phase 4. 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. There will be ongoing costs for licenses and staffing to maintain the ACCESS Sonoma system after the full implementation of the project. The Department will request funding from your Board for ongoing software licensing and staffing costs later this fiscal year.
ACCESS Sonoma Phase 5
The Sonoma County Safety Net Departments are now requesting approval to execute Addendum 4 to the Statement of Work with IBM for Phase 5 implementation of the Data Hub project. Phase 5 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 5 implementation is anticipated to be completed in the Winter of 2020.
IBM Statement of Work Addendum 4 does the following: 1) integrates a significant new stream of justice system data; 2) creates a provider portal for clinics, hospitals, and homeless shelters; and 3) provides for development of the technology component necessary to facilitate relocation of the system data component to the cloud at a future time.
The implementation cost for Phase 5 of the project is $1,500,000. Funding sources for Phase 5 are as follows: Homeless Mentally Ill Outreach and Treatment Program - $142,640; Community Development Commission Homeless Housing Assistance and Prevention (HHAP) $300,000; Intergovernmental Transfer - $425,163; FY 19-20 unearned revenue deferred to FY 20-21 to fund this project - $67,500; and FEMA/Coronavirus Aid, Relief, and Economic Security Act (CARES) $564,697. The Department will be requesting appropriations for the $564,697 FEMA/CARES eligible COVID-19 related expenditures in an upcoming COVID-19 Section board item September 1, 2020.
ACCESS Sonoma Phase 6
ACCESS Sonoma, Phase 6 will build upon Phase 5 functionality with additional data sets for the data hub, data analytics and reporting along with expanded cognitive capabilities. Continuing to onboard community partners and creating a client portal is also planned as a major component of Phase 6. The cost of Phase 6 will be similar to the cost of Phase 5.
Below is a listing of funding sources and amounts for each phase:
|
|
Phase 1 |
Phase 2 |
Phase 3 |
Phase 4 |
Phase 5 |
Total |
|
1991 Health Realignment |
247,082 |
|
|
174,000 |
|
421,082 |
|
Child Support Services |
|
|
|
150,000 |
|
150,000 |
|
Community Development Commission |
|
|
|
75,000 |
|
75,000 |
|
County Medical Services Program (CMSP) |
|
|
|
126,000 |
|
126,000 |
|
FEMA/Coronavirus Aid, Relief, and Economic Security Act (CARES) |
|
|
|
|
564,697 |
564,697 |
|
Hewlett Foundation Grant |
|
|
1,000,000 |
|
|
1,000,000 |
|
Homeless Housing Assistance and Prevention (HHAP) |
|
|
|
|
300,000 |
300,000 |
|
Homeless Mentally Ill Outreach and Treatment Program |
|
|
|
518,000 |
142,640 |
660,640 |
|
Human Services Department |
250,000 |
|
|
|
67,500 |
317,500 |
|
Inter-Governmental Transfer |
|
799,918 |
800,000 |
457,000 |
425,163 |
2,482,082 |
|
Probation Department |
150,000 |
|
|
|
|
150,000 |
|
Santa Rosa Memorial Hospital Foundation |
300,000 |
|
|
|
|
300,000 |
|
Whole Person Care |
250,000 |
1,000,000 |
|
|
|
1,250,000 |
|
Total |
1,197,082 |
1,799,918 |
1,800,000 |
1,500,000 |
1,500,000 |
7,797,000 |
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’s draft 5 Year Strategic Plan Healthy and Safe Communities pillar, Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable, by serving to 1) expand the integrated system of care to address gaps in services to the County’s most vulnerable and 2) create a “no wrong door” approach to services to encourage individuals to enter services.
In addition to alignment with the County’s draft 5 Year Strategic Plan, this project supports the Department of Health Services’ 2019-2023 Strategic Plan Goal 2 by serving to provide individuals, families, and communities access to high quality and coordinated services for health, recovery, well-being, and self-sufficiency. Completion of Phase 5 of the Data Hub project is a key strategy in strengthening coordination of services with an emphasis on high-need residents.
The Sonoma County Recovery and Resiliency Framework recognized the County’s partnership with IBM to develop a multi-departmental database to support the work of ACCESS Sonoma County to identify target populations in need of services and track data metrics for success. This project is linked to Goal S3: Build capacity with cross sector partners and community members to improve coordination and communication.
Prior Board Actions:
On July 23, 2019 the Board approved 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.
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 20-21 Adopted |
FY 21-22 Projected |
FY 22-23 Projected |
|
Budgeted Expenses |
|
|
|
|
Additional Appropriation Requested |
792,663 |
|
|
|
Total Expenditures |
792,663 |
0 |
0 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
300,000 |
|
|
|
Fees/Other |
492,663 |
|
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
792,663 |
0 |
0 |
Narrative Explanation of Fiscal Impacts:
The implementation cost for Phase 5 of the project is $1,500,000, of which $142,640 was expensed in FY 19-20. The project is funded as follows: Homeless Mentally Ill Outreach and Treatment Program - $142,640 expensed in June 2020; Intergovernmental Transfer - $425,163; Community Development Commission Homeless Housing Assistance and Prevention (HHAP) $300,000; Human Services Department has already contributed $67,500; and FEMA/Coronavirus Aid, Relief, and Economic Security Act (CARES) $564,697; FEMA/CARES was identified as a funding source based upon scope of work that relates to COVID-19 of $564,697 and are included in the appropriation request for the COVID-19 Section Board item that will be brought before the Board on September 1, 2020 (2020-0751). Appropriations are being requested for the remaining balance after the Homeless Mentally Ill Outreach and Treatment expense and the FEMA/CARES funding have been removed from the $1,500,000 phase cost.
|
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:
Attachment 1 - International Business Machines Corporation Statement of Work Addendum 4
Attachment 2 - Budget Resolution
Related Items “On File” with the Clerk of the Board:
None