TRANSMITTAL LETTER FOR BOARD MEETING OF OCTOBER 20, 2022
COMMITTEE ON PROCUREMENT
Mr. Brian A. Perkovich, Executive Director
Title
Issue purchase order and enter into an agreement for Contract 22-RFP-08 On-site Health Care Services with Concentra Health Services, Inc. in an amount not to exceed $1,250,000.00, Account 101-25000-612260, Requisition 1580030
Body
Dear Sir:
Authorization is requested to issue a purchase order and enter into an agreement with Concentra Health Services, Inc. (Concentra) to provide on-site health care services for District employees for the period from January 1, 2023 through December 31, 2025.
The purpose of this contract is to select a vendor to provide on-site health care services for use by the District’s employees. The COVID-19 pandemic has underscored how critical employee health and wellness are in allowing the District to fulfill its essential mission. The District continues to explore ways to safeguard the health of its employees and create a culture of health in the workplace. This is in direct alignment with the strategic plan which seeks to foster a culture that recognizes the value of every employee. The reintroduction of on-site health care services would have the following objectives: 1) reduce the cost of primary care services and prescription drugs; 2) enhance employee health by improving access to services; 3) improve management of chronic conditions and medication adherence; 4) advance the District employee wellness efforts; and 5) improve employee job satisfaction by providing a visible example that the District values the health and wellness of its employees.
On June 8, 2022, Request for Proposal 22-RFP-08 On-site Health Care Services was publicly advertised. One hundred twenty-four (124) firms were notified and twenty-four (24) requested proposal documents. On July 8, 2022, the District received three (3) responsive proposals from the following vendors: Concentra; Everside Health, LLC; and Med Investors Development, LLC d/b/a One to One Health.
The proposals were evaluated by staff from Human Resources, Safety, Maintenance and Operations, and the Procurement and Materials Management departments. The criteria for these evaluations were outlined in Request for Proposal 22-RFP-08 and included: an understanding of the services; experience providing these services; methodology for delivery of services; breadth and quality of services; plan for staffing and scheduling services; experience and qualifications of personnel; implementation plan; administrative services; privacy and confidentiality practices; financial stability; compliance with insurance and licensure requirements; and cost.
Following the preliminary evaluation of proposals, excluding cost, all three proposers were deemed to be finalists and were invited to interviews conducted August 24-25, 2022. On September 2, 2022, a solicitation was sent to the finalists requesting an unqualified “best and final” offer. The “best and final” offers were returned to the Director of Procurement and Materials Management on September 12, 2022.
Based on the evaluation of proposals, finalist interviews and pricing, the Human Resources Department recommends Concentra as the selected vendor. Concentra has been operating on-site health care clinics since 1993. In addition to its 520 medical centers, it currently operates 150 on-site clinics, 14 of these in the public sector (ex. Cleveland Department of Public Health, Louisville Metro Government, Metro Nashville), for employers ranging in size from 400 employees to 50,000 employees. It employs approximately 1,800 clinicians and 1,200 physical therapists. Concentra has experience with the District employee population having provided occupational health services and pre-employment physicals and drug testing services under other District contracts.
The on-site health care services provided by Concentra would include the following: primary care services; acute/urgent care services (abrasions/lacerations, allergic reactions, muscle or back injuries, cold/flu, minor burns, eye problems, sprains/strains, etc.); prescribing and dispensing medications; health and wellness activities; injury assessment; basic laboratory services (influenza tests, metabolic tests, mono spot tests, strep throat rapid tests, urinalysis, etc.); and telemedicine. Primary care services include physical examinations; diagnosing and treating common and chronic health conditions; conducting preventive screenings; administering vaccinations; and providing health coaching and counseling. These services are not meant to replace the need for a primary care physician but can serve as an additional resource for employees to get the care they need for routine health issues without the need to schedule an appointment with their regular physician or make a visit to an urgent care clinic. The services can also act as an access point for those employees that do not have a primary care physician. Medications dispensed by the nurse practitioner could include antibiotics, diabetes medications, blood pressure medications, gastrointestinal medications, non-narcotic pain medications, etc. The nurse practitioner would not dispense any controlled substances or medications deemed narcotics. Concentra has strict protocols for the ordering, storage, security, and management of on-site medication inventory. These protocols are managed by the on-site provider with oversight from the Medical Director. In addition, the District will be leveraging the on-site provider for required job-specific screenings such as respirator clearance evaluation questionnaires, spirometry, and audiometric testing where possible. These screenings are currently provided under separate service contracts each year.
Concentra will also work to integrate the on-site health care services with existing wellness initiatives. As part of every on-site health care visit, the provider will review the employee’s health history, identify any gaps in care and lifestyle risk factors, and assess readiness to change. Based on this information, the provider can help close gaps in care, provide health counseling appropriate to the health risks identified, and refer to the appropriate programs. This can be especially important for those employees that do not have a primary care physician. Concentra will work closely with the District to understand any current clinical and/or wellness programs available through its health plans, Employee Assistance Program, or other resources. It will learn the processes used by these wellness partners so it can direct employees how to engage these programs or provide a direct handoff to the program partner. This can increase engagement in these health and wellness programs which can have a positive impact on the overall health of the employee population.
Concentra’s staffing model for the on-site health care services will include an Advanced Practitioner (either a Nurse Practitioner or Physician Assistant) and a Medical Assistant. Concentra will be responsible for recruiting and hiring both positions, which will be employees of Concentra. The District will have a role in the final selection to help ensure a good fit with the District culture. Physician oversight of all clinical services will also be provided as required by Illinois law. This oversight will be performed by a local Medical Director assigned to the contract. Concentra will ensure all personnel assigned to the contract possess and maintain the appropriate credentials and licensure to perform the services. Only practitioners with five or more years of clinical experience will be considered.
The proposed on-site health care service model would create a rotating schedule with the Stickney Plant as the primary location (given its population of approximately 600 employees) and then extending services to the Calumet Plant and O’Brien Plant locations. The District, in coordination with Concentra, would develop a plan to update the existing space at the Stickney Plant that was set up for the prior nursing services. Once the Stickney location is operational, the District will work with Concentra to set up a space and establish services at the Calumet Plant and O’Brien Plant locations. A sample schedule might be as follows:
Location Hours
Monday Stickney 7:00 am - 3:00 pm
Tuesday Calumet 7:00 am - 3:00 pm
Wednesday Stickney 7:00 am - 3:00 pm
Thursday O’Brien 7:00 am - 3:00 pm
Friday Stickney 7:00 am - 3:00 pm
To access services, employees can call the clinic to schedule an appointment or schedule an appointment on the secure patient portal. Walk-ins will also be accommodated. Concentra’s model also provides telemedicine services for employees at other District locations or when on-site appointments are not available. During normal clinic hours, employees can contact the on-site clinic to schedule a telemedicine appointment with the District’s nurse practitioner. After hours, employees can access telemedicine services from Concentra’s dedicated team of telemedicine clinicians.
Concentra utilizes the industry leading Allscripts TouchWorks® electronic medical record platform to maintain patient records for all its on-site clinics and medical centers. This system will be installed during implementation and provides a single integrated database for records that gives the clinician access to the patient’s complete record; allows the clinician to e-prescribe medications, order laboratory tests, and process referrals to specialists or physical therapists; provides a direct connection to external entities such as Quest Diagnostic; and integrates with the Allscripts Practice Management® reporting system. This integrated technology platform is compliant with all Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Regulations. Concentra’s system is protected by user security protocols, system-level security protocols (access control, database monitoring, malware/virus protection, intrusion detection and protection), and physical security protocols at its facilities. The District will not have access to the electronic medical record system or any patient records. To ensure employee privacy and confidentiality, the only data provided to the District is in aggregate form and does not contain any individual patient information.
The integration of the electronic medical record system with the practice management system allows for the capture of critical utilization and clinical service data that can be used by Concentra to perform data analytics and develop quarterly and annual trend reporting. It can be used to help evaluate the on-site clinics performance, measure clinical outcomes, and compare results against key performance indicators. This data includes ICD-10 diagnostic codes which allow the information to be compared to claims data under the health plan. It can also be used to evaluate the return-on-investment of the clinic by illustrating the impact on both direct and indirect costs. Direct savings would include redirection of care that would have gone to the health plan, occupational testing performed in the clinic, lost workdays avoided, shortened duration of care, and elimination of unnecessary visits to the urgent care clinic or emergency room. Indirect costs would include items such as increased productivity, reduced absenteeism/presenteeism, and identification of undiagnosed chronic conditions or better management of existing chronic conditions.
To show their commitment to the success of the program, Concentra is willing to include performance guarantees in the contract that will place a percentage of the management fees at risk. These performance guarantees would be mutually agreed upon and could cover areas such as clinic implementation, clinic utilization, Patient Net Promoter Score, Net Patient Experience Rating, and wait times.
Implementation of the Concentra on-site health care services typically requires 90 - 120 days. This includes site assessments and planning for physical alterations and furniture/equipment needs; development of the clinic schedule; recruiting, hiring, and training personnel; setup of the physical spaces; installation and setup of all technology needs; ordering necessary startup supplies; and development of a communication plan. Concentra would assign an Implementation Project Manager to the District to manage this process. Concentra’s communication plan would include a pre-opening engagement campaign, a grand opening campaign, and a post-opening engagement campaign. The clinician would spend time out in the plant facilities, engaging with employees and extending invitations to visit the on-site clinic. Ongoing communications resources would include flyers, quarterly postcards, monthly wellness calendars, on-site health events (ex. blood pressure checks, biometric screenings, vaccinations, etc.), lunch-n-learn seminars, and attendance at quarterly new employee orientations.
The costs for on-site health care services are comprised of the following: implementation and setup costs; staffing, management, and medical oversight costs; and ongoing operational costs. Implementation and set up costs are a combination of a fixed cost for technology setup and pass-through costs for furniture, fixtures, equipment, clinic staff recruitment, initial medical and prescription drug supplies, etc. Upon approval by the District, Concentra would procure the items needed for implementation at its discounted pricing and pass the cost through to the District with no mark-up. Implementation costs are estimated to be $76,000.00 and will be a one-time expense. The staffing, management and medical oversight fees are fixed costs averaging approximately $330,000.00 per year. Operational costs are those expenses needed to keep the clinic operational such as medical supplies, vaccines, medications, laboratory fees, technology and data connectivity fees, office supplies, hazardous waste removal, etc. These items are also procured by Concentra and the costs are passed through to the District with no mark-up. These costs will vary based on utilization of the health care services but have been estimated by Concentra to be $60,000.00 per year based on other similar clients.
A partnership with Concentra to reintroduce on-site health care services would reinforce the District’s commitment to the health and wellbeing of its employees, our greatest asset. This would support Strategic Goal #3 - Workforce Excellence by fostering a culture that recognizes the value of every employee. Demonstrating this commitment to our employees through a visible, tangible program such as this can lead to a healthier, more engaged, and motivated staff ready to help the District achieve its vision. It will also serve as another tool to help the District attract top talent as it builds its workforce of the future.
The Diversity Section reviewed the request for proposal and concluded that the contract does not provide practical opportunities for subcontracting since there will only be one nurse assigned to provide the on-site health care services. As such, Appendix A and Appendix V were not included.
In view of the foregoing, it is requested that the Director of Procurement and Materials Management be authorized to award a contract to Concentra in the amount of $1,250,000.00. The estimated annual expenditures are as follows: $460,000.00 in 2023, $390,000.00 in 2024, and $400,000.00 in 2025. Funds will be requested for 2023, 2024, and 2025 in Account 101-25000-612260, and are contingent on the Board of Commissioners’ approval of the District’s budget for those years.
Recommended, Beverly K. Sanders, Director of Human Resources
Recommended, Darlene A. LoCascio, Director of Procurement and Materials Management
Respectfully Submitted, Barbara J. McGowan, Chairman Committee on Procurement
Disposition of this agenda item will be documented in the official Regular Board Meeting Minutes of the Board of Commissioners for October 20, 2022
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