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Item # 32
City of Santa Ana
20 Civic Center Plaza, Santa Ana, CA 92701
Staff Report
August 17, 2021
TOPIC: Feasibility and Fiscal Evaluation for a Municipal Public Health Agency
AGENDA TITLE:
Approve an Agreement with Health Management Associates to Provide Feasibility and
Fiscal Evaluation Services for a Municipal Public Health Agency in an Amount not to
Exceed $180,830 for a One-Year Term (Revive Santa Ana Program)
RECOMMENDED ACTION
1. Authorize the City Manager to execute an agreement with Health Management
Associates, Inc. to provide feasibility and fiscal evaluation services for a municipal public
health agency for a one-year term beginning on August 18, 2021 and expiring on August
18, 2022, in an amount not to exceed $180,830, which includes a $10,000 contingency,
subject to non-substantive changes approved by the City Manager and City Attorney.
2. Approve the Project Cost for a total estimated cost of $200,000, which includes $19,170
for contract administration and legal services and a $10,000 project contingency for any
additional services as directed by the City.
DISCUSSION
The COVID-19 pandemic and its aftermath have raised community and public awareness
of the importance of public health agencies. This unprecedented pandemic has also
raised the expectations for public health departments to address substantial local health
inequities amongst jurisdictions in Orange County.
The City of Santa Ana, like many other California jurisdictions, is considering whether the
current public health delivery structure is meeting the needs of its residents and requested
proposals from qualified firms to perform a feasibility and fiscal evaluation of creating its
own municipal public health agency. Currently, the County of Orange provides all public
health services to County residents, including Santa Ana.
Under California law, municipalities have responsibilities for public health functions; they
can transfer this authority to counties. Most communities have chosen to do this due to
the extent of duty, required infrastructure, and associated expenses.
Feasibility and Fiscal Evaluation for a Municipal Public Health Agency
August 17, 2021
Page 2
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Four cities in the State of California have their own health departments: Pasadena
(established in 1892), Long Beach (established in 1906), Vernon (established in 1986),
and Berkeley (established in 1880).
On April 13, 2021, the City released a Request for Proposals (RFP) for feasibility and
fiscal evaluation services for a municipal public health agency for Santa Ana. A total of
191 professional consultants were notified. Health Management Associates (HMA) was
the sole respondent to the RFP.
Upon an internal review of the HMA proposal and an interview, staff determined that this
firm is qualified to respond effectively to the proposed scope of services:
Identify the full range of specific public health services the Orange County Health
Care Agency (OCHCA) provides to Santa Ana residents and businesses and their
legally required mandates.
Identify OCHCA current service levels in comparing to local needs in each of the
mandated services.
Identify any OCHCA services above and beyond mandated services, and the
service levels they provide in each to Santa Ana residents.
Identify all funding sources for operation of the OCHCA.
Identify all state and federal mandates and statutes for the operation of a municipal
public health agency.
Review public health regulations (Health and Safety Code, California statues and
orders of the California Department of Public health, etc.) and identify a strategy
to qualify for funding for the creation of a public health agency.
Provide a statistically valid evaluation of the current health assessment for Santa
Ana residents and a narrative of the specific health issues facing the Santa Ana
residents, leading to the identification of public health priorities for the City of Santa
Ana.
Identify and evaluate service areas required to create and operate a municipal
health care agency. Develop three models: full-service municipal health agency,
basic limited municipal health agency (which could include limited services
provided by the City and remaining services provided by the County of Orange),
and regional health model. Each model should identify recommended staffing and
facilities, certification requirements, the process to form each agency, challenges
and opportunities, as well as funding sources available.
Assist in the development of recommendations of public health policies and plans
necessary to operate a public health agency in the City of Santa Ana.
Identify the pros and cons of creating our own public health agency.
Assist in the development of public health programs for the City of Santa Ana.
Map out the transition plan and timing for transition.
Provide a final document analyzing the feasibility and specific steps for the creation
of a public health agency for the City of Santa Ana, including a realistic timeline.
Feasibility and Fiscal Evaluation for a Municipal Public Health Agency
August 17, 2021
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Required to attend City Council meetings to give updates and present findings of
the evaluation.
The feasibility and fiscal evaluation for a municipal health agency for the City of Santa
Ana will be completed in approximately eight months. It will include a final evaluation and
options report, and a presentation to City Council.
Contract Administration and Contingency
It is anticipated that this project will require staff support and legal research and advice
regarding public health code, statutes, and the laws required to form a municipal health
agency. Therefore, staff is requesting $19,170 for those efforts, as well as a contract
contingency of $10,000 for any unexpected consultant requests like attending additional
meetings with City staff or stakeholder interviews regarding the formation of a public
health agency.
Project Item Total
HMA Contract $170,830
Contract Admin and Legal Services $19,170
Contingencies $10,000
TOTAL DELIVERY COST FOR PROJECT $200,000
FISCAL IMPACT
Funds will be available upon carry forward of the American Rescue Plan Act (ARPA) grant
funds from FY 20-21 to FY 21-22 for estimated expenditures as follows:
Fiscal
Year
Accounting Unit-
Account Fund Description Accounting Unit,
Account Description Amount
FY 21-22
(Aug.-June)18103013-various American Rescue
Plan Act (ARPA)ARPA - CMO, Various $195,140
FY 22-23
(July-Aug.)18103013-various American Rescue
Plan Act (ARPA)ARPA - CMO, Various $ 4,860
Total $200,000
EXHIBIT(S)
1. HMA Proposal
2. Agreement with HMA
Submitted By: Steven Mendoza, Assistant City Manager
Feasibility and Fiscal Evaluation for a Municipal Public Health Agency
August 17, 2021
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Approved By: Kristine Ridge, City Manager
Proposal to Provide
Feasibility and Fiscal Evaluation Services for a Municipal Public
Health Agency
Presented to:
City of Santa Ana, Community Development Agency
RFP No. 21-054
May 13, 2021
EXHIBIT 1
Table of Contents
1. Cover Letter .......................................................................................................................... 1
2. Agreement Statement .......................................................................................................... 2
3. Firm and Team Experience .................................................................................................. 3
ii. General Description of Firm ............................................................................................... 3
iii. Project Manager ................................................................................................................ 3
iv. Resumes for Key Staff....................................................................................................... 3
v. Experience in Providing Similar Services .......................................................................... 8
4. Proposed Work Plan ...........................................................................................................14
HMA’s Understanding of Scope of Services .........................................................................14
ii. Anticipated Approach to the Scope Services ....................................................................15
iii. Tasks Necessary for Successful On-Time Completion .....................................................20
iv. How HMA will Adhere to the City’s Project Timeline .........................................................21
v. Suggestions or Special Concerns .....................................................................................22
5. Cost Proposal ......................................................................................................................23
6. Certifications .......................................................................................................................24
Attachment A: .......................................................................................................................24
Attachment B: Proposer’s Statement ....................................................................................25
Attachment C: Non-Collusion Affidavit ..................................................................................26
Attachment D: Non-Lobbying Certification ............................................................................27
Attachment E: Non-Discrimination Certification .....................................................................28
7. References...........................................................................................................................30
8. Insurance .............................................................................................................................32
Conflict of Interest and Litigation Statements ......................................................................43
Conflict of Interest Statement ................................................................................................43
Litigation Statement ..............................................................................................................43
EXHIBIT 1
1. Cover Letter
May 13, 2021
Steven Mendoza
Assistant City Manager/Executive Director, Community Development
City of Santa Ana – City Manager’s Office
20 Civic Center Plaza
Santa Ana, CA 92701
Dear Mr. Mendoza:
Health Management Associates, Inc. (HMA) is pleased to submit our proposal to the City of
Santa Ana, Community Development Agency to provide Feasibility and Fiscal Evaluation
Services for a Municipal Public Health Agency in response to RFP No. 21-054.
HMA’s team is uniquely positioned to successfully complete this project given our team
members’ extensive understanding and work in public health systems and our knowledge and
experience working in Orange County and Santa Ana to improve health outcomes for its
residents. Christina Altmayer, who has worked directly in Orange County as the former
executive director of First 5 Orange County and former strategic consultant to the Santa Ana
Building Healthy Communities initiative of the California Endowment, will lead our team. We will
ground our public health analysis in the experience of three senior members of our team,
Jonathan Freedman and Michelle Parra, who held previous leadership positions in county public
health departments, and Helen DuPlessis, MD, MPH, who has a broad background in public
health, school health, health services research, and the California safety net.
We are committed to providing the City of Santa Ana with an independent, critical review of the
challenges and values associated with creating a municipal public health department and
engaging City leadership in strategic discussions of the benefits and challenges of various
options, resulting in an informed, responsive decision.
HMA is a “C” Corporation. Please contact proposals@healthmanagement.com if you have any
questions regarding this response. For contracting matters, please contact our contracts
director, Jeff DeVries, at 517-482-9236 or contracts@healthmanagement.com. As chief
administrative officer, I am authorized to bind HMA contractually with this bid.
We are excited about the prospect of working with the City of Santa Ana and are confident HMA
will provide exemplary service on this project. Thank you for the opportunity to bid on this very
important work. We look forward to your decision.
Sincerely,
Kelly Johnson
Chief Administrative Officer
EXHIBIT 1
2. Agreement Statement
Health Management Associates, Inc. is in concurrence with any and all provisions as contained
in Exhibit 1 – Standard Agreement of RFP No. 21-054.
EXHIBIT 1
3. Firm and Team Experience
ii. General Description of Firm
Health Management Associates, Inc. (HMA) is an independent, national research and
consulting firm. Founded in 1985, HMA provides technical and analytical services with a focus
on advancing the administration and delivery of public health care and social services programs.
HMA currently employs 309 total staff, of which more than 230 are consultants who provide
services to clients. We have 22 office locations in 16 states and Washington, DC, and we have
worked in all 50 states. In the key staff section below, we present five employees who will work
directly on this project; they will be supported by a research associate to be assigned once the
project begins.
HMA is a private, for-profit “C” corporation, incorporated in the State of Michigan in good
standing and legally doing business as Health Management Associates, Inc.
Dedicated to serving populations who depend on publicly funded services, we provide
policymakers, providers, health plans, foundations, and community-based organizations with
strategic guidance, technical assistance, data analysis, research and evaluation, policy
development, decision support, and implementation services.
Through the years, HMA has distinguished itself from other consulting companies by our
decades-long tradition of hiring senior-level policymakers, such as former state Medicaid
directors, mental health commissioners, budget officers, insurance directors, policy advisors,
governors and other elected officials, and former senior officers from key federal agencies, as a
complement to our many clinicians, hospital and health system leaders, and Medicaid managed
care executives. Our staff members have backgrounds in health policy and program
administration, project management and support, managed care, clinical and social services,
health information systems, health economics, health care finance and reimbursement,
pharmacy benefit design and management, and data analysis and evaluation.
iii. Project Manager
Christina Altmayer will serve as the project manager and as the primary point of contact
between the HMA team and the City. Ms. Altmayer brings more than 20 years of consulting
project management experience, including multiple projects in Santa Ana and with the Orange
County community. She worked extensively on multiple projects with the County, philanthropic
partners, and community agencies and was the former executive director of the Children and
Families Commission of Orange County (renamed to First 5 Orange County) from 2012 through
2016. As a consultant, she provided technical assistance to the community planning team to
support the launch of the Santa Ana Building Healthy Communities initiative of the California
Endowment. She also worked closely with diverse community leaders to successfully capture
input and engage diverse representatives throughout the strategic planning process.
In addition to serving as the project manager, Ms. Altmayer will directly oversee the community
needs assessment and fiscal modeling analysis of the scope of work. She may be contacted at
caltmayer@healthmanagement.com or 213-314-9104.
iv. Resumes for Key Staff
Our proposed team members are presented in Figure 1. Brief overviews of the qualifications
and experience of our proposed staff are included in Figure 2 and the resumes that follow. All
proposed personnel will be available for the full duration of the project.
EXHIBIT 1
Our key project leaders will work directly on this project and lead specific work streams. A
research associate, who will provide project support, will be assigned once the project begins. A
resume for the assigned individual will provided at that time.
FIGURE 1: HMA’S PROPOSED PERSONNEL
HMA TEAM
Christina Altmayer, MPA
Principal
Project role:
Project Manager,
Community Health and
Statutory/Regulatory Lead
Jonathan Freedman, MSPH
Vice President
Project role:
Technical Advisor
Helen DuPlessis, MD, MPH
Principal
Project role:
Technical Advisor
Michelle Parra, PhD
Principal
Project role:
Lead, Municipal Comparative Analysis
Michael Butler, MA
Senior Associate
Project role:
Lead, County Service Analysis
Our team members’ qualifications are summarized in Figure 2 below.
FIGURE 2: QUALIFICATIONS OF THE HMA TEAM
Team Member
Understanding of Santa
Ana, Orange County,
and California
Environment
Public Health
Experience
Fiscal and
Cost Analysis
Experience
Christina Altmayer, MPA
Project Manager
Jonathan Freedman, MSPH
Technical Advisor
Helen DuPlessis, MD, MPH
Technical Advisor
Michelle Parra, PhD
Lead, Municipal Comparative Analysis
Michael Butler, MA
Lead, County Service Analysis
EXHIBIT 1
Christina Altmayer, MPA | HMA Principal
Project role: Project Manager, Community Health and Statutory/Regulatory Lead
Christina Altmayer is a senior executive with vast experience and success leading public
agencies dedicated to early childhood. Her work has focused on policy and system changes to
better serve the needs of children in both the health care and early education spaces.
She joins HMA after leading high-impact efforts to implement and expand maternal and pediatric
early intervention services as the senior vice president of the Center for Children and Family
Impact for First 5 LA. In this capacity, she oversaw more than $90 million in programmatic
investments focused on family supports, community engagement, early care and education, and
health systems with a focus on policy and systems change. She developed First 5 LA’s 2020–
2028 strategic plan and pioneered innovative financing strategies to sustain priority maternal and
child interventions, including partnerships with Medi-Cal managed care organizations.
Previously, Ms. Altmayer served as executive director of First 5 Orange County where she led
the organization through a comprehensive strategic planning and implementation process and
oversaw an annual program portfolio of $35 million. She led several high-impact efforts,
including initiatives related to developmental screening and early intervention, kindergarten
readiness, and oral health and innovative financing strategies to sustain important services for
children and families. She worked closely with CalOptima, Children’s Hospital of Orange
County, and community organizations to implement innovative financing strategies to support
early childhood investments.
A seasoned consultant, she helmed her own management consulting organization helping
nonprofit, public, and private organizations with long-term financial planning, strategy
development, program design and implementation, performance management, and evaluation.
She launched her career in consulting at Ernst & Young, serving as a senior manager supporting
public and private clients. During her consulting tenure, she authored multiple articles on
performance-based management and was a frequent instructor and presenter on this topic.
Ms. Altmayer earned a bachelor’s degree in government and politics and a master’s degree in
public administration from St. John’s University in New York.
Jonathan Freedman, MSPH | HMA Vice President
Project role: Technical Advisor
Jonathan Freedman works with plans, providers, associations, and governmental and non-
governmental entities in the areas of public health, safety-net health care, and public policy. His
work focuses on strategic planning, public health improvement and transformation, and the
health care safety net. He is regularly sought after for complex strategic and operational
planning situations.
Mr. Freedman held a variety of management and leadership roles for more than 25 years with
the County of Los Angeles, including chief deputy director of the Los Angeles County
Department of Public Health (DPH). While at DPH, Mr. Freedman was directly responsible for
more than 4,000 employees and a $900 million budget encompassing the County’s delivery of
core public health services, including surveillance and assessment, communicable disease
control, clinical public health services, maternal and child health, environmental health, and
numerous other programs.
Mr. Freedman also served as the chief of strategy at L.A. Care Health Plan, the largest publicly
operated health plan in the nation. He led L.A. Care’s entry into the commercial market with the
launch of L.A. Care Covered on the California health insurance marketplace, Covered
California. He was also intimately involved with L.A. Care’s substantial growth related to the
Medicaid expansion and a dual demonstration known as CalMediConnect.
EXHIBIT 1
Mr. Freedman has led many high-profile initiatives, including the public health response to the
1994 Northridge earthquake; Los Angeles County’s Master Tobacco Settlement negotiation;
solutions to funding crises in the Los Angeles County safety net; and the 2010 H1N1 influenza
response.
He has also led many special projects on behalf of the Los Angeles County Board of
Supervisors and chief executive officer, including negotiating the County’s interests in California
Medicaid Waivers; developing revenue and tax options for local government; drafting workers’
compensation and pension reform legislation; developing a successful partnership between the
Los Angeles and the University of California to re-open the MLK Hospital in South Los Angeles;
and negotiating state-county fiscal and program realignment.
He has received outstanding leadership awards from the California State Association of
Counties and Los Angeles County. He is a lecturer at the University of California, Los Angeles
Fielding School of Public Health, and a contributor to three books on public health practice—
Public Health Leadership (Routledge Press, 2017), Public Health Practice: What Works (Oxford
Press, 2012), and Global Biosecurity: Threats and Responses (Routledge Press, 2010).
Mr. Freedman earned degrees in political science and public health from the University of
California, Los Angeles.
Helen Duplessis, MD, MPH | HMA Principal
Project role: Technical Advisor
Helen DuPlessis is an accomplished physician executive who brings wide-ranging leadership
experience and an array of knowledge about public sector health programs to HMA. Her
expertise includes involvement in health care administration for a variety of organizations as well
as in program and policy development, practice transformation, public health, maternal and child
health policy, community systems development, performance improvement, and managed care.
Prior to joining HMA, Dr. DuPlessis served as CMO of St. John’s Well Child and Family Center
where she provided executive management for integrated medical, behavioral, dental, and
pharmacy services in a large network of federally qualified health centers. She built and
upgraded key elements of the organizational infrastructure and clinical services, including
strategic business expansion; patient-centered medical home certification; electronic health
records implementation; clinical workforce recruitment, training, and development; and
performance improvement.
Other notable professional experiences include her work as senior advisor to the University of
California, Los Angeles Center for Healthier Children, Families and Communities where she
provided leadership, research, program development support, counsel, and representation to
local, state, and national efforts, and community-level systems transformation. She trained and
mentored students in various disciplines and educational levels.
Dr. DuPlessis previously served as CMO at L.A. Care during the initial rollout of Medi-Cal
managed care in California. She served as director of student medical services for the Los
Angeles Unified School District.
She has also served as an advocate of community capacity-building, staff, and professional
development drawing on her understanding and implementation of innovative and effective
health programs and performance improvement activities.
Dr. DuPlessis earned her medical degree from the University of California, San Francisco, her
master’s in public health from the University of California, Los Angeles, and her bachelor’s
degree from the University of Southern California.
EXHIBIT 1
Michelle Parra, PhD | HMA Principal
Project role: Lead, Municipal Comparative Analysis
Michelle Parra is a dedicated and experienced researcher with a diverse background in the field
of public health, health protection across the lifespan, and child and adolescent mental health.
She also has expertise in the area of health policy and government-funded programs for
disease and risk prevention.
As an evidence-based and prevention researcher, Dr. Parra also holds the title of adjunct
associate professor within the University of Southern California School of Social Work where
she has taught courses on research methods, the science of social work, and evaluation
practice for the past 13 years.
Before joining HMA, Dr. Parra served as director of the Vaccine Preventable Disease Control
Program for the Los Angeles County Department of Public Health where she led planning,
outbreak control efforts, training, intervention and evaluation programs, and services to increase
immunization coverage and reduce vaccine-preventable diseases throughout Los Angeles
County.
She also previously served as the director of Los Angeles County’s Department of Public Health
Injury and Violence Prevention Program where she oversaw local data collection from various
partners for a national violent death reporting system, analyzed projects, and administered
grants to reduce intentional and unintentional injury. She also developed evidence-based
recommendations for violence prevention programs and collaborated with community-based
organizations, policymakers, and partners to reduce injury morbidity and mortality in Los
Angeles County.
Dr. Parra has spent 25 years working in research settings with a variety of populations,
including adolescents with anxiety and depressive disorders, adolescent girls in juvenile
detention, children experiencing abuse and neglect, LGBTQ populations, chronically mentally ill
outpatients, as well as individuals at risk for sexually transmitted diseases including HIV
infection. She has extensive experience running large-scale, National Institutes of Health-
funded multisite projects, as well as expertise in secondary data analysis of large datasets and
training and using standardized psychological assessments.
Dr. Parra earned her doctorate and master’s degrees from the University of California, Los
Angeles, in psychological studies in education where she also received a bachelor’s degree in
Italian language and literature and political science.
Michael Butler, MA | HMA Senior Associate
Project role: Lead, County Service Analysis
During his career, Michael Butler has directed hundreds of program evaluations, strategic
planning, organizational development, and technical assistance projects in a wide array of
areas, including public education, college and career readiness, community health and wellness
services, and workforce development. His work is centered on accelerating equity and
demonstrating measurable impact in the social sector.
Mr. Butler comes to HMA from NPO Solutions, where he worked with decision-makers at the
local, state, and national levels to enhance accountability, measure effectiveness, disseminate
best practices, and implement research-based strategies for continuous improvement. His work
spanned a variety of sectors, including public education, workforce development, and
intervention support programs for youth and families. Increasingly, he is working in health equity
and increasing access to physical, mental, and oral health as well as the social determinants of
health as “upstream” factors affecting individual and community outcomes.
EXHIBIT 1
At NPO Solutions, he worked to embed program evaluation and key performance indicator
metrics into the firm’s strategic planning model. He is skilled at guiding organizations in
developing systems for measurement, accountability, and continuous improvement. In addition,
he provided professional development and coaching services focused on data-driven
approaches to enhance service delivery and build collaborative evaluation culture into
organizations.
He co-founded and served as vice president of Public Works, Inc., a nonprofit organization
dedicated to utilizing data to improve the effectiveness of the public and nonprofit sectors. He
also served as a consultant and researcher.
Mr. Butler earned his master’s degree in political science from the University of California, Los
Angeles, and an undergraduate degree from Occidental College. He was a research fellow at
the RAND Corporation and is a graduate of the University of Southern California’s executive
program in social innovation through the Price School of Public Policy.
v. Experience in Providing Similar Services
Figure 3 below summarizes HMA’s relevant project experience consistent with the proposed
scope of work in providing similar services for recent clients. Following the table, detailed project
descriptions are provided.
FIGURE 3: RELEVANCE OF SELECTED PROJECT EXPERIENCE
Recent Clients
Understanding of
Santa Ana, Orange
County, and California
Environment
Community/
Public Health
Assessment
Fiscal and
Cost
Analysis
Regulatory
Analysis
First 5 Orange County
Orange County Health Care
Agency
Los Angeles County Department
of Public Health
Clackamas County Public Health
Division
Oregon Health Authority
State of Mississippi
EXHIBIT 1
Prenatal to Three Strategy Update
Conditions of Children Report
Agency First 5 Orange County
Duration of Project April 2021–March 2022
Annually since 2015
Budget $225,000 (two projects)
Link to Strategic
Plan
https://www.ocgov.com/civicax/filebank/blobdload.aspx?BlobID=119236
Project Description
HMA is currently supporting First 5 Orange County in reviewing and refining its strategy to
support the youngest families in Orange County and improve outcomes for children prenatal to
age three. The approach leverages its long-time investments in home visiting through the
Bridges for Newborn networks and is focused on developing a sustainable and coordinated
system of voluntary family supports for Orange County’s youngest families. Currently, HMA is
assisting in a a landscape assessment focused on analyzing and summarizing data to present a
picture of the needs and gaps in the current system. Future phases will include supporting First
5 Orange County in partnership cultivation and developing key indicators to monitor strategy
implementation. This strategy development project involves the collaboration with multiple
community partners and stakeholders. The prenatal to three strategy will guide the
Commission’s investments to strengthen family resiliency and improve families’ access to
prevention and early intervention services by diversifying and increasing the platforms for
engagement with a specific focus on families living in targeted geographic communities.
Since 2015, HMA has been engaged by First 5 OC (formerly the Children and Families
Commission of Orange County) to support development of the Annual Report on the Conditions
of Children in Orange County. The Annual Report on the Conditions of Children in Orange
County is co-sponsored with the County of Orange through the Orange County Children’s
Partnership. The Annual Report is a critical tool providing a countywide assessment and report
of the present and emerging needs of children and their families. HMA’s scope of work includes
data collection, project management and report development. HMA has also assisted the
County in planning and facilitating community convenings around the report findings in
partnership with the County Board of Supervisor offices.
EXHIBIT 1
Technical Assistance – Mental Health Services
Agency Orange County Health Care Agency
Duration of Project September 2020–December 2020
Budget $202,000 (three projects)
Link to Strategic Plan Not applicable
Project Description
Orange County Health Care Agency (OCHCA) engaged HMA to assist with the following three
projects:
Assist school-based mental health providers and ensure the sustainability of services
during the COVID-19 pandemic. OCHCA requested HMA to provide technical support to
mental health providers as they apply to register as Medi-Cal providers. HMA provided
the following training and technical assistance:
o training materials, policies and procedures, and workflows on the Medi-Cal
provider registration process
o training sessions for school-based mental health providers to provide an overview
of the Medi-Cal provider registration process
Assess dual eligibles (Medicare and Medicaid beneficiaries) in Orange County
Analyze inpatient psychiatric services, assess how the pandemic has impacted
operations, and identify opportunities for process improvement. Our analysis included
how current processes may need to be further modified due to the COVID-19 pandemic,
including supporting virtual visits, minimizing direct patient contact, and expanding
telehealth visits and monitoring
Fiscal and Budget Support
Agency Los Angeles County Department of Public Health
Duration of Project October 2015-August 2016 and January 2019-July 2019
Budget $205,000 (two projects)
Link to Strategic Plan Not applicable
Project Description
The Los Angeles County DPH engaged HMA for two finance and budget projects.
In 2015–2016, DPH asked HMA to identify revenue opportunities. This work included a
comprehensive review of existing DPH revenues and funding streams, and HMA worked closely
with DPH management to understand their mandated functions and contractual obligations as a
local public health department. HMA pinpointed where DPH was missing revenue opportunities
and provided recommendations on how best to capture the revenues.
In 2019, DPH engaged HMA to assist in an internal reform of accounting and budgeting across
the agency’s 30 plus programs and operating divisions. DPH sought this assistance based on a
re-organization of the agency. This project entailed working closely with DPH finance staff to
properly align expenditures, funding streams, and revenues across mandated, contractual, and
discretionary programs. HMA provided DPH with tools to align budgeting, accounting, and
revenue and expenditure reporting so that program managers have greater visibility into the
finances and overall financial performance of specific programs.
EXHIBIT 1
Substance Abuse Prevention and Control Program Technical Assistance
Client Organization Los Angeles County Department of Public Health
Substance Abuse Prevention and Control (SAPC)
Contract Amount More than $500,000
Contract Year 2017–present
Link to Strategic Plan Not applicable
Detailed Description of Services Provided
Since 2017, HMA has been engaged by Substance Abuse Prevention and Control (SAPC) to
assist them in analyzing and providing technical support to implement substance abuse service
reforms. Specific projects include:
Assessing state requirements and SAPC readiness to implement Drug Medi-Cal
Organized Delivery System reforms
Reviewing and analyzing SAPC substance abuse prevention programming
Reviewing and analyzing SAPC provider contracting and identifying solutions to reduce
barriers to increase provider supply
Assessing SAPC organization and recommendations for staffing and functional unit
changes to improve performance and reduce compliance risks
Drafting internal policies and procedures
Assessing the operational and financial performance of the Antelope Valley
Rehabilitation Center, a residential program operated by the County
Oral Health Program Support
Agency Los Angeles County Department of Public Health, Oral Health Program
Duration of Project February 2018–March 2019
Budget $110,000
Link to Strategic Plan http://publichealth.lacounty.gov/ohp/docs/LACDPH_COHIP.pdf
Project Description
The Oral Health Program (OHP) of the DPH hired NPO Solutions, now a division of HMA, to
conduct a large-scale strategic planning process to develop a community oral health
improvement plan (COHIP) to cover Los Angeles County’s approximately 10 million residents.
OHP is a department dedicated to improving oral health by increasing dental health literacy,
coordinating services, educating the public, promoting water fluoridation, and emphasizing oral
health is an essential part of overall health.
NPO Solutions conducted this strategic planning process to define the vision, mission,
objectives, strategies, and action plans of the COHIP to address the region’s oral health
priorities. The COHIP development process ultimately engaged more than 150 community
stakeholders through semi-structured informant interviews, focus groups, working groups, and
leadership committees. Participants’ backgrounds ranged from academic experts and low-
income residents to leaders of community-based organizations and dental care providers. Over
the year-long process, these community stakeholders created a COHIP with six key objectives
(health literacy; access to care; coordination of care; workforce development; policy leadership;
and transparency and accountability). Within each objective, the plan included action items to
address collaboratively over the next five years by the dozens of organizations engaged during
the process. The plan also included specific measurable outcomes to track its implementation
over time and assess changes relative to baseline, cross-referenced by plan objectives.
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Three-Year Strategic Plan
Agency Clackamas County Public Health Division
Duration of Project March 2021–August 2021
Budget $50,000
Link to Strategic Plan TBD; Plan in Development
Project Description
HMA is currently assisting the Clackamas County Public Health Division (CCPHD) in
developing a three-year strategic plan. Clackamas County is the third-largest county in the
State of Oregon. CCPHD is focused on aligning strategic planning with public health
modernization and health equity. Working with a core planning team from CCPHD and in
conjunction with a larger Strategic Planning Committee, HMA is facilitating a revised vision,
mission, and values to guide the planning process. HMA is developing a theory of change to
align these with core programs and with desired measurable outcomes. To inform the process,
we have engaged internal stakeholders in reviewing organizational strengths, areas for
refinement, areas for de-emphasis, and opportunities for innovation. We are conducting an
environmental scan of the community and of the larger public health ecosystem by holding
informant interviews and focus groups with community leaders and partner agencies. These are
intended to identify and elevate key trends and drivers, as well as identify community needs
and priorities that should inform strategic planning and priorities. Through our interactions with
CCPHD, HMA is promoting coherence and alignment of the plan within Clackamas County’s
health and human service ecosystem, as well as catalyzing collaborative problem-solving
among key divisions and programmatic foci of the organization. The result will be a streamlined,
prioritized strategic plan that lends itself to implementation and ongoing use by leaders, as well
as a plan grounded within the current context, and impacts, of COVID-19, wildfires, and focus
on racism as a public health crisis.
Insurance Billing Assessment
Agency Oregon Health Authority: Insurance Billing Assessment for HIV/STD
Prevention and Care Services
Duration of Project July 2020–present
Budget $418,000
Link to Strategic Plan Not applicable
Project Description
The Oregon Health Authority (OHA) engaged HMA to assist their Public Health Division in
improving revenue recovery related to HIV and sexually transmitted infection (HIV/STI)
prevention and care services provided by the state and local public health departments. OHA is
interested in understanding and maximizing opportunities for public health agencies to bill
insurance (including Medicaid, Medicare, commercial) for public health services that are
covered services. HMA is currently working with OHA on into two major tasks: 1) Assessing the
current state of insurance billing opportunities by reviewing relevant regulations and contracts
and assessing the current state of insurance billing practices through surveying public health
agencies that are providing HIV/STI services; and 2) Developing a training program and manual
to teach public health agencies how to maximize insurance billing.
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Integrated Disease Surveillance Requirements Analysis
Agency State of Mississippi, Department of Health
Duration of Project October 2020–June 2021 (projected)
Budget $75,000
Link to Strategic Plan TBD; Plan in Development
Project Description
HMA is providing technical resources to support the State of Mississippi in procuring an
integrated disease surveillance platform. This platform will support the State in fulfilling the
responsibilities of the Offices of Communicable Diseases and the Offices of Health Data,
Operations, and Research work to pinpoint the source of disease to prevent dangerous
outbreaks. Specifically, HMA serves as the subject matter expert and is conducting the needs
assessment and developing a comprehensive set of requirements to support the release of a
request for proposals (RFP). HMA is assisting in defining all the RFP requirements that
stipulate the required functionality for all targeted programs, including data collection, data
management, data conversion and/or migration, case investigations, case management,
contact tracing, and required integrations and interfaces. The platform will transition existing
State resources into one integrated disease surveillance solution.
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4. Proposed Work Plan
HMA’s Understanding of Scope of Services
The COVID-19 pandemic and the resulting community response have elevated community and
public awareness of the role of public health departments. COVID-19 has also increased
expectations for public health departments to address persistent and significant disparities in
health outcomes. COVID-19 has not only caused examination of public health at a broad level—
California’s public health spending per capita has remained relatively flat for the last 10 years,1
but has also generated interest in reassessing existing models for public health delivery. In
Santa Ana, the experience of COVID-19 has accelerated this interest. While Santa Ana
represents approximately 10 percent of the County population, the percentage of positive
COVID-19 cases has ranged from a high of almost one-quarter of the cases (August 2020) to
approximately 17 percent of the cases in April 2021.2
Similar to many jurisdictions in California, the City of Santa Ana is evaluating whether the
existing structure of public health delivery is meeting its residents’ needs and is seeking
proposals from qualified firms to provide a feasibility and fiscal evaluation of a municipal public
health agency. Currently, all public health services for County residents, including Santa Ana,
are provided through the Orange County.
California law stipulates that municipalities 3 have responsibility for public health functions and
that they may delegate this responsibility to counties. Due to the scope of responsibility and
required infrastructure and related costs, most cities have opted to do this. The four notable
exceptions in California are Long Beach, Pasadena, Vernon, and Berkeley.
We understand that the City is interested in comprehensively exploring the operational, fiscal,
and policy implications of alternative models to public health delivery. HMA’s proposed
approach is grounded in the comprehensive experience of our team members working in public
health departments and providing an independent, factual evaluation of the options and
alternatives for the City’s consideration. We will ground our analysis in the experience of peer
municipalities and transparency in key assumptions and drivers.
Core to this project’s success is a comprehensive understanding of public health delivery
systems. Public health department services include a mix of both mandated responsibilities and
additional assumed responsibilities that vary by local context. The table below is reflective of our
understanding of the public health field and these distinctions. Additionally, county government
has broad discretion on the placement of public health within the larger county infrastructure.
County public health functions can operate as an individual county department, as in the case of
Los Angeles County, or as functions embedded within a larger health care agency, as in Orange
and Riverside Counties.
1 "State Health Compare - Per person state public health funding," SHADAC, accessed May 3, 2021,
http://statehealthcompare.shadac.org/trend/117/per-person-state-public-health-
funding#0/6/a/12,14,1,2,3,4,5,6,7,8,15,24,25,27/154.
2 The population of Orange County, California, is estimated at 3,194,332 (2020) and Santa Ana at
335,052. Source: Cal State Fullerton, Center for Demographic Research.
3 ARTICLE 4. City Health Ordinances, Boards, and Officers [101450 - 101475]
(Article 4 added by Stats. 1995, Ch. 415, Sec. 3.). Sect 101450.
The governing body of a city shall take measures necessary to preserve and protect the public health,
including the regulation of sanitary matters in the city, and including if indicated, the adoption of
ordinances, regulations and orders not in conflict with general laws.
(Added by Stats. 1995, Ch. 415, Sec. 3. Effective January 1, 1996.)
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FIGURE 4: OVERVIEW OF MANDATED RESPONSIBILITIES AND ADDITIONAL ASSUMED RESPONSIBILITIES OF
PUBLIC HEALTH DEPARTMENTS
Mandated Functions for
Local Health Departments
Contractual Programs
(Additional Assumed Responsibilities of
Public Health Departments)
Public health statistics data collection and
analysis
Health education programs
Communicable disease control
Maternal and child health services
Environmental health and sanitation services
Public health laboratory services
Nutrition service
Chronic disease prevention and/or mitigation
Occupational health promotion
Public health nursing
Additional social supports
Behavioral health
Mental health supports
Smoking cessation programs
Early care and education programs
Ambulatory care
Additional responsibilities are often based on
award of federal and state discretionary grants.
With this foundational knowledge and understanding of the complexities of public health
delivery, our consulting team will provide the City with an accurate picture of the three options
outlined in the RFP for informed policy evaluation and decision.
ii. Anticipated Approach to the Scope Services
HMA’s proposed approach to meeting the City’s objectives is outlined in Figure 5 below. The
letters correspond to the specific tasks identified in the City’s Scope of Services. We have
divided the request scope of services into four work streams, each led by a senior experienced
member of the HMA team.
FIGURE 5: APPROACH TO MEETING THE CITY’S OBJECTIVES
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The final deliverable, consistent with your RFP, will include a comparative analysis considering
operational, cost, and revenue projections for the three alternative models:
Full Service Municipal Health Agency
Limited Municipal Health Agency
Regional Health Model
Our draft report weighing the pros, cons, and considerations will inform and serve as the
foundation for the critical strategic conversations that HMA will help facilitate with City
leadership. HMA proposes to work with the City to establish a common criterion that will be
applied to all three alternative models to inform the strategic conversation with the City.
Suggested criteria may include cost, revenue potential, implementation risk, implementation
complexity and other factors identified as priorities by the City.
Staff from HMA is available to provide implementation support, pending action by the City
Council, to develop City of Santa Ana-specific health programs, policies, and plans. The cost
associated with implementation support is not included in the proposal at this time.
Proposed Work Streams
Figure 6 summarizes these four work streams cross-walked to the specific tasks outlined in the
RFP. Further descriptions of each work stream and associated tasks are detailed in Figure 7.
FIGURE 6: PROPOSED WORK STREAMS AND KEY QUESTIONS
Proposed Work Streams and Key Questions Crosswalk to the
Scope of Services
1. Regulatory and Statutory Requirements Analysis
What are legally required mandates (state and federal) of public health
departments?
What are public health regulations and what are requirements to qualify
for funding?
What are the requirements of the regional health district?
A, E, F, M
2. Community Needs Assessment
What do we know about current health conditions and issues for Santa
Ana residents?
What are the specific health issues facing Santa Ana residents and
related health priorities?
How did OCHCA’s COVID-19 response address the needs of the City of
Santa Ana?
G, H
3. Current Service Level, Cost, and Revenue Analysis
What are current in-house and contracted services provided by OCHCA
and related service levels (mandated and additional)?
What are current service levels and services to Santa Ana?
What are current costs and funding sources?
What has been OCHCA’s COVID-19 response?
What are existing OCHCA public health accreditations?
B, C, D
4. Comparative Analysis and Forecasting
What are examples of comparative municipal models – full service vs.
limited service?
What are the core public health services and related staffing, facilities,
and certification requirements?
What is the cost, service, and revenue data from these comparable
municipal models?
What are the lessons learned from these municipalities’ experience and
relevancy to Santa Ana?
I
Draft and Final Synthesis of Findings Related to the Three Models K, M, N, O, P
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Note: Given the unknowns of the selected model, we are unable to estimate the consulting hours needed
at this time for developing public health policies, plans, and programs. Work associated with J and L in
the scope of work are considered implementation support and not included in the submitted cost
proposal. Please see section on Implementation Support in Figure 7 below.
FIGURE 7: DESCRIPTIONS OF PROPOSED WORK STREAMS AND DELIVERABLES
Work Stream Description and Deliverables
1. Regulatory
and Statutory
Requirements
Analysis
This first work stream will research and document federal and state
requirements for a municipal public health function. State law and
regulation define the required functions and activities of local public health
departments (Title 17). The analysis will summarize the mandated public
health services requirements and related implications for the City’s
consideration.
Deliverable: Summary memo/presentation of local health department
regulatory and statutory requirements
2. Community
Needs
Assessment
The Community Needs Assessment is intended to provide an assessment
of the health conditions and issues facing the City of Santa Ana and its
residents. HMA will rely on existing data to support this analysis, including
publicly available reports such as those listed below, to provide an
assessment of the health issues and understand how Santa Ana
compares to County averages and peer cities on key indicators of
community health. Examples of reports that we will tap into include:
26th Annual Report on the Conditions of Children in Orange
County
Orange County Community Indicators 2020–21
An Equity Profile of Orange County, March 2019, issued by USC
Program for Environmental and Regional Equity
Orange County Health Improvement Plan
Other health need assessment reports, including those issued by
the County, Children’s Hospital of Orange County, and other
philanthropic partners such as Irvine Health Foundation, Health
Funders Partnership of Orange County, and the Health Care
Foundation for Orange County
Deliverable: Summary memo/presentation of City of Santa Ana health
needs
3. Current
Service Level,
Cost, and
Revenue
Analysis
This third component is intended to provide a comprehensive picture of the
existing public health services provided by OCHCA to the City of Santa
Ana. Specific tasks included in this work stream include:
Identifying and segregating between mandated public health
services and additional services provide to the City of Santa Ana,
including those supported through grant and discretionary funds
Determining the service level, cost, staffing, and associated
revenue for all mandated public health services provided to the City
of Santa Ana
Identifying other supports and services provide to Santa Ana and
associated costs as well as defining other benefits that may not be
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fully quantifiable. These may include certifications that the OCHCA
may hold that provide opportunities for additional funds or eligibility
for certain grant awards
Based on reviewing the County’s workload data, HMA will propose a
potential geographic catchment area for consideration under the proposed
regional health models. This proposal will consider both the potential
boundaries and the functions that may be possible under a regional health
model.
This work stream will also include a summative review of the County’s
COVID-19 response specifically focusing to what degree the County’s
approach addressed issues unique to Santa Ana and/or engaged
representatives from the City of Santa Ana. This will be based on a review
of published reports by OCHCA and interviews with key stakeholders.
Deliverables: Summary memo/presentation of current service level, cost
and revenue; summative review of OCHCA COVID-19 response
4. Comparative
Analysis and
Forecasting
The final element of the analysis will be to capture data from comparative
cities on their operation of a municipal public health development to
provide the basis for the City of Santa Ana cost, staffing, and revenue
projections. Three cities in Southern California provide examples:
Pasadena and Long Beach, which operate mandated functions, and
Vernon, which operates a limited scale public health department.
Pasadena and Long Beach directly provide services and contract with the
County, nonprofits, and other partners in fulfilling their public health
responsibilities.
Comparative data from all three cities will be captured to the degree
available to understand:
Cost and staffing levels and ratio
Revenue streams
Benefits and challenges of the municipal health department
The comparative analysis will capture both quantitative and qualitative
data. Quantitative data will be used to capture staffing and revenue
estimates such as the number of inspections, permits, and related
revenue. Qualitative data captured through interviews with key city staff in
Long Beach and Pasadena will help identify and elevate key
considerations for the City of Santa Ana.
Using the data gathered from the County and comparable municipalities,
HMA will create a forecasting model to project the staffing, costs, and
revenue related for the three models: full service; limited service, and
regional health model. This forecasting model will rely on assumptions
based on the experience of other municipalities such as ratio of staffing to
inspections, frequency of inspections, fees associated with inspections,
staffing required for core functions, and potential grant funding. The model
will provide the basis for the projections included in the draft and final
model.
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Deliverables: Summary memo/presentation of comparable municipal
public health functions and related costs; forecasting model to staffing,
costs, and revenue associated with the three proposed models
Proposed Draft
and Final
Deliverable
Throughout the process, HMA’s project manager will regularly share the
findings and analysis resulting from the four work streams with the City’s
project manager. Informed by the four work streams, HMA will produce a
draft report documenting our analysis, findings, and the results of our
review of the three alternatives identified in the RFP.
HMA will present this final deliverable as a draft to engage City leadership
in a facilitated discussion of the benefits and risks associated with the
options considered. The goal is to support City leadership in identifying a
path forward that best addresses the City’s priorities within its fiscal
constraints.
The proposed deliverables will include:
Provide recommended criterion and assessment of models against
the criterion. Criteria will consider cost, infrastructure, revenue, and
other factors determined by the:
o Full Service Municipal Health Agency
o Limited Municipal Health Agency
o Regional Health Model
Draft and final synthesis of findings, including pros/cons of a Santa
Ana Public Health Department and consideration of three
alternative models (Tasks K and M), including projected staffing
and revenue and costing for 10 years for proposed public health
functions
Develop a potential transition plan and high-level timeline for each
alternative model consideration and related milestones for each
option (Tasks N and O)
Present to the City Council on findings, alternatives, and the
timeline (Task P)
Implementation
Support
Depending on recommendations and pursuant to action by the City, HMA
will be available to support:
Developing recommendations of public health policies and plans
necessary to operate a public health agency (Task J)
Assisting in developing public health programs for the City of Santa
Ana (Task L)
Providing additional support as requested to assist with
implementing the recommended structure
Given the unknowns of the selected model, we are unable to estimate the
consulting hours needed at this time for developing public health policies,
plans, and programs. HMA has a diverse set of qualified staff in multiple
public health domains and those resources will be available to support this
project. Staff could be available on a time-and-materials basis based on
hourly fees.
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iii. Tasks Necessary for Successful On-Time Completion
HMA’s General Approach to Projects
HMA’s objective is to support our world-class professionals with the processes, frameworks, and
support infrastructure to provide meaningful value to our clients, including the City of Santa Ana.
We know that a product or service’s quality is highly influenced by the quality of the process used
to develop and maintain it. To deliver the complex products/services this project will require, we
realize the need for an integrated approach and effective resources to achieve project objectives.
HMA has the project management maturity and know-how to keep a large, multi-faceted
project on track. HMA team members have led and completed multiple complex projects
involving multiple interrelated tasks, diverse stakeholders, and complex policy and technology
issues. Our approach to project management emphasizes accountability, frequent contact with
the client project manager, early identification of project risks and constraints, and strategies for
proactively countering potential obstacles to project progress. We build and tailor mechanisms
to identify, alleviate, and resolve issues before they become barriers to successful and timely
completion of the project.
HMA knows what makes a project successful. It requires a committed and experienced team
to realize the desired outcome for our client. We apply our knowledge and experience gained
from similar projects to effectively complete the tasks. Our approach to success is simple yet is
the founding principle that our team relies on to assure we exceed our client’s expectations. As
part of providing overall management and oversight for the entire project, we will ensure the City
of Santa Ana’s designated project manager is continuously aware of the project status. We will
particularly ensure the City is aware of the top risks and issues preventing progress on the
project or threatening the success of the project. To that end, we will develop and maintain a
comprehensive Project Management Plan and provide regular updates to the City.
HMA’s Approach to Project Management
Our proposed approach consists of four primary analytical work streams that follow the key
tasks outlined in the City’s RFP, supported by a robust HMA project management piece. Every
HMA project is organized with a project manager from HMA who leads the HMA team and
works closely with the client to ensure adherence to the project schedule and budget, and that
all tasks are completed and deliverables submitted on a timely basis. HMA understands the
importance of managing a project well and is committed to appropriately applying the
professional principles of project management, including those in Figure 8.
FIGURE 8: PRINCIPLES OF PROJECT MANAGEMENT
Project planning
and status
reporting
Review, refine, and finalize the work plan at the kickoff meeting and assure all
aspects of the project are defined in scope and efficiently sequenced for timely
completion
Manage the project plan and monthly reporting of progress
Staffing, cost,
and schedule
management
Confirm that staff assigned to the project are appropriate to meet project
demands and experience requirements
Manage and adhere to the project schedule and budget as established for
each project task
Manage any issues that arise that may cause a delay or excess expenditure
Quality
management
Review and manage quality control, including review and approval of work
products as appropriate for each product
Communications
management
Assure communications between HMA and the City of Santa Ana are effective
in meeting project goals
Manage communications with key stakeholders
Coordinate with all parties as necessary to resolve any issues that may arise
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iv. How HMA will Adhere to the City’s Project Timeline
As indicated above, HMA adheres to specific project management protocols to meet timelines
and provide regular status reports to the client. For each of the work streams, we have defined a
deliverable that we will complete at each phase and present to the City’s project team for review
and feedback. This will allow the City to understand progress, provide real-time feedback
throughout the process, and allow HMA to adapt our approach to best meet the City’s needs
and timeline. We view this project as a partnership, and providing regular and open
communication will be integral to its success.
Figure 9 provides our preliminary proposed work plan and timeline. If selected, this will be
reviewed with the City’s project team at the kickoff meeting and adjusted, as necessary, to meet
the City’s timeline. In our timeline, we have taken into consideration the time required to receive
documents from the City of Santa Ana, the County, and other municipalities as well as the
amount of time to perform the analysis.
FIGURE 9: HMA’S PROPOSED WORKPLAN AND TIMELINE
Proposed Timeline/Activities 2021 2022
A S O N D J F M
Project Management
Coordinate all tasks and client management
Regulatory and Statutory Requirements
Research and confirm state and federal mandated services
Research and confirm additional public health services
Identify requirements associated with additional funding sources
Research requirements associated with Regional Health district
Produce deliverable
Community Needs Assessment
Collect and review existing community needs assessment
resources and synthesize critical issues
Conduct summative review of COVID-19 response
Produce deliverable
Current Service Level Cost and Revenue Analysis
Identify current OCHCA mandated and additional services
provided to Santa Ana
Determine service level, cost, staffing, and associated revenue
Identify other supports provided to Santa Ana
Produce deliverable
Comparative Analysis and Forecasting
Capture service, cost, and revenue data from Long Beach,
Pasadena, and Vernon
Develop a forecasting model based on inputs from OCHCA
experience and municipal experience
Develop criterion for review of all options
Produce deliverable
Prepare and Present Final Consolidated Report
Prepare consolidated draft report
Prepare for/facilitate/conduct a session with City leadership
Prepare final report and presentation
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v. Suggestions or Special Concerns
HMA has assembled a team of experienced senior consultants to lead this important project for
the City of Santa Ana. We recognize the results of this analysis are likely to have visibility
throughout Orange County and the State. Therefore, it’s critical the analysis is credible,
defensible, and grounded in knowledge of public health systems. All of our team members have
worked with public health departments and several have held senior leadership positions,
bringing in-depth knowledge and personal experience to this project.
We also recognize this project requires significant financial investment on the City’s part. As
indicated above, we will be in regular communication with the City and providing interim
deliverables. This will allow the City to review progress and understand implications and early
considerations based on our research and analysis and adjust the project scope, within reason,
as appropriate. If a clear direction becomes apparent early, we will work with the City to
evaluate the best path forward.
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5. Cost Proposal
HMA is proposing a total not-to-exceed cost of $170,830. Project fees will not be incurred
beyond this amount without your prior approval and a written amendment to this agreement
signed by both parties. Included within this amount is the complete cost of doing business with
HMA, including indirect costs such as overhead, general, and administrative costs. HMA does
not anticipate any non-labor expenses such as travel, meals, or incidental costs. Our cost
breakdown is included in Figure 10.
The services described in this proposal will be billed on a time-and-materials basis. Professional
hourly rates will be billed as indicated in the table below. We will submit invoices monthly for
services provided in the previous month, and the anticipated payment schedule will align with
the anticipated project timeline presented in Figure 9. Invoices will be payable upon receipt.
FIGURE 10: COST BREAKDOWN
HMA Labor
Employee Labor Category Hourly Rate Hours Total
Christina Altmayer, MPA Principal $385 160 $61,600
Jonathan Freedman, MSPH Principal $385 6 $2,310
Helen Duplessis, MD, MPH Physician Principal $440 16 $7,040
Michelle Parra, PhD Principal $385 92 $35,420
Michael Butler, MA Senior Associate $330 116 $38,280
TBD Research Associate $170 154 $26,180
Total 544 $170,830
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6. Certifications
Attachment A:
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Attachment B: Proposer’s Statement
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Attachment C: Non-Collusion Affidavit
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Attachment D: Non-Lobbying Certification
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Attachment E: Non-Discrimination Certification
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7. References
The following references are also included on Attachment A.
Prenatal to Three Strategy/Conditions of Children Report
Client Organization First 5 OC
Address 1505 East 17th Street, Suite 230
Santa Ana, CA 92705
Contact Name Kimberly Goll, Executive Director
Contact Telephone 714-567-0152
Contact Email kim.goll@cfcoc.ocgov.com
Contract Amount $225,000 (Two Projects)
Contract Year 2020–2021
Detailed Description of Services Provided
HMA is currently supporting First 5 Orange County in reviewing and refining its strategy to
support the youngest families in Orange County to improve outcomes for children prenatal to
age three. Additionally, since 2015 HMA has supported First 5 OC in the development,
release and community engagement on the annual Conditions of Children Report.
Policy and Operations Analysis
Client Organization County of Santa Clara
Santa Clara Valley Health & Hospital System
Address 2325 Enborg Lane, Suite 320
San Jose, CA 95128
Contact Name Rene G. Santiago, Director
Contact Telephone 408-885-6868
Contact Email rene.santiago@ceo.sccgov.org
Contract Amount Two agreements; each $200,000 to $250,000
Contract Year 2017–present
Detailed Description of Services Provided
Since 2017, HMA has been engaged by Santa Clara County (SCC) to assist them with a
range of policy, organization, and operational issues. Specific projects include:
Analyzing state and federal reform policies affecting the Medicaid program
Developing policy and finance options that SCC could employ to provide a locally
supported public option for health care coverage
Developing policy and operational reforms to improve the functioning and alignment of
SCC-supported behavioral health programs
Organizing and providing technical support to improve quality, information technology,
utilization management, and claims functions of the SCC Valley Health Plan and the
SCC Behavioral Health Services Department
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Substance Abuse Prevention and Control Program Technical Assistance
Client Organization County of Los Angeles
Department of Public Health
Substance Abuse Prevention and Control (SAPC)
Address 1000 S. Fremont Ave.; Bldg. A-9 East, 3rd Floor
Alhambra, CA 91803
Contact Name Gary Tsai, MD, Director
Contact Telephone 626-299-4101 (office)
Contact Email gtsai@ph.lacounty.gov
Contract Amount More than $500,000
Contract Year 2017–present
Detailed Description of Services Provided
Since 2017, HMA has been engaged by Substance Abuse Prevention and Control (SAPC) to
assist them in analyzing and providing technical support to implement substance abuse
service reforms. Specific projects include:
Assessing state requirements and SAPC readiness to implement Drug Medi-Cal
Organized Delivery System reforms
Reviewing and analyzing SAPC substance abuse prevention programming
Reviewing and analyzing SAPC provider contracting and identif ying solutions to
reduce barriers to increase provider supply
Assessing SAPC organization and recommendations for staffing and functional unit
changes to improve performance and reduce compliance risks
Drafting internal policies and procedures
Assessing the operational and financial performance of the Antelope Valley
Rehabilitation Center, a residential program operated by the County
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8. Insurance
HMA’s evidence of insurance is included on this page and the following pages.
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Conflict of Interest and Litigation Statements
Conflict of Interest Statement
Prior to proposing on or agreeing to any engagement, we perform a detailed query of our
business intelligence system to determine whether there are any potential conflicts of interest.
This is a multilayered inquiry based on client, client type, scope of work, and geographic
coverage. HMA performed a conflict check for this engagement, and did not identify any
conflicts with this work. Should a potential conflict be identified in the future, we will take the
appropriate steps to address and manage it.
HMA takes the responsibility of avoiding conflicts of interest very seriously. HMA often serves
multiple clients within a certain industry or market, including those with potentially opposing
interests, and HMA’s relationship with the city will not be an exclusive relationship. In all such
situations, HMA is committed to maintaining the confidentiality of each client’s information and
ensuring that your interests, proprietary and otherwise, are protected. To that end, HMA strictly
adheres to our Policy and Guidelines Related to Conflicts of Interest and Proprietary
Information, which contains nondisclosure procedures (such as firewall protocols and other
safeguards) to maintain each client’s confidential information and ensure your interests are
protected.
Litigation Statement
HMA does not have any significant prior or ongoing contract failures or any civil or criminal
litigation or investigation pending that involves HMA or in which HMA has been judged guilty or
liable.
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CONSULTANT AGREEMENT
CITY OF SANTA ANA
THIS AGREEMENT is made and entered into on this 18th day of August, 2021, by and between
Health Management Associates, Inc., a Michigan corporation (“Consultant”), and the City of Santa
Ana, a charter city and municipal corporation organized and existing under the Constitution and
laws of the State of California (“City”).
RECITALS
A.On April 13, 2021, the City issued Request for Proposal 21-054 (“RFP”) seeking proposals
from qualified vendors having special skill and knowledge in the field of feasibility and
fiscal evaluation services for a municipal public health agency for the City.
B.A total of 191 professional consultants were notified of the RFP and Consultant was the
sole respondent to timely submit a responsive proposal, which was selected by the City.
Consultant represents that it is able and willing to provide such services to the City as
described in the RFP and Consultant’s proposal, which are incorporated by reference as
though fully attached hereto.
C.In undertaking the performance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services performed by Consultant under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional consulting firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
terms and conditions hereinafter set forth, the parties agree as follows:
1.SCOPE OF SERVICES
Consultant shall perform during the term of this Agreement, the tasks and obligations
including all labor, materials, tools, equipment, and incidental customary work required to fully
and adequately complete the services described and set forth in the Scope of Services attached
hereto as Exhibit A.
2.COMPENSATION
a.City agrees to pay, and Consultant agrees to accept as total payment for its services for
City, the rates and charges identified in the Budget attached hereto as Exhibit B. The
total sum to be expended under this Agreement shall not exceed One Hundred and
Eighty Thousand Eight Hundred and Thirty Dollars ($180,830.00), which includes Ten
Thousand Dollars ($10,000.00) in contingency, during the Term of this Agreement.
b.Payment by City shall be made within forty-five (45) days following receipt of proper
invoice evidencing work performed, subject to City accounting procedures. Payment
need not be made for work which fails to meet the standards of performance set forth
in the Recitals which may reasonably be expected by City.
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3. TERM
This Agreement shall commence on August 18, 2021, and terminate on August 18, 2022,
in accordance with the Timeline attached hereto as Exhibit C, unless terminated earlier in
accordance with Section 15, below. The term of this Agreement may be extended upon a writing
executed by the City Manager and the City Attorney.
4. INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee of the City. This Agreement is not intended nor shall
it be construed to create an employer-employee relationship, a joint venture relationship, or to
allow the City to exercise discretion or control over the professional manner in which Consultant
performs the services which are the subject matter of this Agreement; however, the services to be
provided by Consultant shall be provided in a manner consistent with all applicable standards and
regulations governing such services. Consultant shall pay all salaries and wages, employer's social
security taxes, unemployment insurance and similar taxes relating to employees and shall be
responsible for all applicable withholding taxes.
5. OWNERSHIP OF MATERIALS
This Agreement creates a non-exclusive and perpetual license for City to copy, use,
modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property
embodied in plans, specifications, studies, drawings, estimates, and other documents or works of
authorship fixed in any tangible medium of expression, including but not limited to, physical
drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or
caused to be prepared by Consultant under this Agreement (“Documents & Data”). Consultant
shall require all subcontractors to agree in writing that City is granted a non-exclusive and
perpetual license for any Documents & Data the subcontractor prepares under this Agreement.
Consultant represents and warrants that Consultant has the legal right to license any and all
Documents & Data. Consultant makes no such representation and warranty in regard to
Documents & Data which were provided to Consultant by the City. City shall not be limited in
any way in its use of the Documents and Data at any time, provided that any such use not within
the purposes intended by this Agreement shall be at City’s sole risk.
6. INSURANCE
Consultant shall procure and maintain for the duration of the contract insurance against
claims for injuries to persons or damages to property which may arise from or in connection with
the performance of the work hereunder by the Consultant, its agents, representatives, or employees.
a. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad
as:
1. Commercial General Liability (CGL): Insurance Services Office Form CG 00
01 covering CGL on an “occurrence” basis, including products and completed
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operations, property damage, bodily injury and personal & advertising injury
with limits no less than $1,000,000 per occurrence. If a general aggregate limit
applies, either the general aggregate limit shall apply separately to this
project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be
twice the required occurrence limit.
2. Automobile Liability: Insurance Services Office Form Number CA 0001
covering, Code 1 (any auto), or if Consultant has no owned autos, Code 8
(hired) and 9 (non-owned), with limit no less than $1,000,000 per accident for
bodily injury and property damage.
3. Workers’ Compensation: insurance as required by the State of California, with
Statutory Limits, and Employer’s Liability Insurance with limit of no less than
$1,000,000 per accident for bodily injury or disease (Not required if consultant
provides written verification it has no employees).
4. Professional Liability (Errors and Omissions): Insurance appropriate to the
Consultant’s profession, with limit no less than $2,000,000 per occurrence or
claim, $2,000,000 aggregate.
5. If the Consultant maintains broader coverage and/or higher limits than the
minimums shown above, the City requires and shall be entitled to the broader
coverage and/or the higher limits maintained by the Consultant. Any available
insurance proceeds in excess of the specified minimum limits of insurance and
coverage shall be available to the City.
b. Other Insurance Provisions – The insurance policies are to contain, or be endorsed to
contain, the following provisions:
1. Additional Insured Status: The Cit y, its officers, officials, employees, and
volunteers are to be covered as additional insureds on the CGL policy with
respect to liability arising out of work or operations performed by or on behalf
of the Consultant including materials, parts, or equipment furnished in
connection with such work or operations. General liability coverage can be
provided in the form of an endorsement to the Consultant’s insurance (at least
as broad as ISO Form CG 20 10 11 85 or both CG 20 10, CG 20 26, CG 20 33,
or CG 20 38; and CG 20 37 forms if later revisions used).
2. Primary Coverage: For any claims related to this contract, the Consultant’s
insurance coverage shall be primary coverage at least as broad as ISO CG 20
01 04 13 as respects the City, its officers, officials, employees, and volunteers.
Any insurance or self-insurance maintained by the City, its officers, officials,
employees, or volunteers shall be excess of the Consultant’s insurance and shall
not contribute with it.
3. Notice of Cancellation: Each insurance policy required above shall state that
coverage shall not be canceled, except with notice to the City.
4. Waiver of Subrogation: Consultant hereby grants to City a waiver of any right
to subrogation which any insurer of said Consultant may acquire against the
City by virtue of the payment of any loss under such insurance. Consultant
agrees to obtain any endorsement that may be necessary to affect this waiver of
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subrogation, but this provision applies regardless of whether or not the City has
received a waiver of subrogation endorsement from the insurer.
5. Self-Insured Retentions: Self-insured retentions must be declared to and
approved by the City. The City may require the Consultant to purchase coverage
with a lower retention or provide proof of ability to pay losses and related
investigations, claim administration, and defense expenses within the retention.
The policy language shall provide, or be endorsed to provide, that the self-
insured retention may be satisfied by either the named insured or City.
6. Acceptability of Insurers: Insurance is to be placed with insurers authorized to
conduct business in the state with a current A.M. Best’s rating of no less than
A:VII, unless otherwise acceptable to the City.
7. Claims Made Policies: If any of the required policies provide coverage on a
claims-made basis:
1. The Retroactive Date must be shown and must be before the date of the
contract or the beginning of contract work.
2. Insurance must be maintained and evidence of insurance must be
provided for at least five (5) years after completion of the contract of
work.
3. If coverage is canceled or non-renewed, and not replaced with another
claims-made policy form with a Retroactive Date prior to the contract
effective date, the Consultant must purchase “extended reporting”
coverage for a minimum of five (5) years after completion of contract
work.
8. Verification of Coverage: Consultant shall furnish the City with original
Certificates of Insurance including all required amendatory endorsements (or
copies of the applicable policy language effecting coverage required by this
clause) and a copy of the Declarations and Endorsement Page of the CGL policy
listing all policy endorsements to City before work begins. However, failure to
obtain the required documents prior to the work beginning shall not waive the
Consultant’s obligation to provide them. The City reserves the right to require
complete, certified copies of all required insurance policies, including
endorsements required by these specifications, at any time.
9. Subcontractors: Consultant shall require and verify that all subcontractors
maintain insurance meeting all the requirements stated herein, and Consultant
shall ensure that City is an additional insured on insurance required from
subcontractors.
10. Special Risks or Circumstances: City reserves the right to modify these
requirements, including limits, based on the nature of the risk, prior experience,
insurer, coverage, or other special circumstances.
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7. INDEMNIFICATION
Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers,
agents, employees, contractors, special counsel, and representatives from liability: (1) for personal
injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for
personal injury, including death, and claims for property damage, which may arise from the
negligent operations of the Consultant, its subcontractors, agents, employees, or other persons
acting on its behalf which relates to the services described in section 1 of this Agreement; and (2)
from any claim that personal injury, damages, just compensation, restitution, judicial or equitable
relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and
hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial
or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in
this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant
further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including
fees and costs for special counsel to be selected by the City, regarding any action by a third party
challenging the validity of this Agreement, or asserting that personal injury, damages, just
compensation, restitution, judicial or equitable relief due to personal or property rights arises by
reason of the terms of, or effects arising from this Agreement. City may make all reasonable
decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing,
to the extent Consultant’s services are subject to Civil Code Section 2782.8, the above indemnity
shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of,
pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant.
8. INTELLECTUAL PROPERTY INDEMNIFICATION
Consultant shall defend and indemnify the City, its officers, agents, representatives, and
employees against any and all liability, including cost s, for infringement of any United States’
letters patent, trademark, or copyright infringement, including costs, contained in the work product
or documents provided by Consultant to the City pursuant to this Agreement.
9. RECORDS
Consultant shall keep records and invoices in connection with the work to be performed
under this Agreement. Consultant shall maintain complete and accurate records with respect to
the costs incurred under this Agreement and any services, expenditures, and disbursements
charged to the City for a minimum period of three (3) years, or for any longer period required by
law, from the date of final payment to Consultant under this Agreement. All such records and
invoices shall be clearly identifiable. Consultant shall allow a representative of the City to
examine, audit, and make transcripts or copies of such records and any other documents created
pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all
work, data, documents, proceedings, and activities related to this Agreement for a period of three
(3) years from the date of final payment to Consultant under this Agreement.
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10. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant agrees that
it shall not use or disclose such information except in the performance of this Agreement, and
further agrees to exercise the same degree of care it uses to protect its own information of like
importance, but in no event less than reasonable care. “Confidential Information” shall include all
nonpublic information. Confidential information includes not only written information, but also
information transferred orally, visually, electronically, or by other means. Confidential
information disclosed to either party by any subsidiary and/or agent of the other party is covered
by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any
information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the
Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant
without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e)
is independently developed by the Consultant without reference to information disclosed by the
City.
11. CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct
or indirect, which would conflict in any manner with performance of services specified under this
Agreement.
12. NON-DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital status,
sexual orientation, gender identity, gender expression, gender, medical conditions, genetic
information, or military and veteran status, age, national origin, ancestry, o r disability, as defined
and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization,
promotion, termination or other employment related activities or any services provided under this
Agreement. Consultant affirms that it is an equal opportunity employer and shall comply with all
applicable federal, state and local laws and regulations.
13. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Consultant, and supersedes any and all other agreements, oral or written, between the parties. In
the event of a conflict between the terms of this Agreement and any attachments hereto, the terms
of this Agreement shall prevail. This Agreement may not be modified except by written instrument
signed by the City and by an authorized representative of Consultant. The parties agree that any
terms or conditions of any purchase order or other instrument that are inconsistent with, or in
addition to, the terms and conditions hereof, shall not bind or obligate Consultant or the City. Each
party to this Agreement acknowledges that no representations, inducements, promises or
agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any
party, which is not embodied herein.
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14. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Consultant,
Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior
written consent of the City and any such assignment, transfer, delegation or subcontract without
the City's prior written consent shall be considered null and void. Nothing in this Agreement shall
be construed to limit the City’s ability to have any of the services which are the subject to this
Agreement performed by City personnel or by other contractors retained by City.
15. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days written notice of
termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant
compensation for all services performed by Consultant prior to receipt of such notice of
termination, subject to the following conditions:
a. As a condition of such payment, the Executive Director may require Consultant to
deliver to the City all work product(s) completed as of such date, and in such case
such work product shall be the property of the City unless prohibited by law, and
Consultant consents to the City's use thereof for such purposes as the City deems
appropriate.
b. Payment need not be made for work which fails to meet the standard of
performance specified in the Recitals of this Agreement.
16. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or
granted by the provisions of this Agreement shall be effective unless it is in writing and signed by
the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or
remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not
similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies.
17. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the validity,
interpretation, performance, and enforcement of any of the clauses of this Agreement shall be
determined and governed by the laws of the State of California. Both parties further agree that
Orange County, California, shall be the venue for any action or proceeding that may be brought or
arise out of, in connection with or by reason of this Agreement.
18. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder
and required by the laws and regulations of the United States, the State of California, the City of
Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and
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in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and
exemptions. Said inability shall be cause for termination of this Agreement.
19. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this Agreement
shall be in writing and shall be deemed to be properly given if delivered in person or mailed by
first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in
the manner provided in this Section, to the following persons:
To City:
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax: 714- 647-6956
With courtesy copies to:
Executive Director
Community Development Agency
City of Santa Ana
20 Civic Center Plaza (M-xx)
P.O. Box 1988
Santa Ana, California 92702
To Consultant:
A party may change its address by giving notice in writing to the other party. Thereafter,
any communication shall be addressed and transmitted to the new address. If sent by mail,
communication shall be effective or deemed to have been given three (3) days after it has been
deposited in the United States mail, duly registered or certified, with postage prepaid, and
addressed as set forth above. If sent by fax, communication shall be effective or deemed to have
been given twenty-four (24) hours after the time set forth on the transmission report issued by the
transmitting facsimile machine, addressed as set forth above. For purposes of calculating these
time frames, weekends, federal, state, County or City holidays shall be excluded.
Kelly Johnson
Chief Administrative Officer
Health Management Associates, Inc.
120 North Washington Square, Suite 705
Lansing, MI, 48933
Fax – 517-482-0920
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20. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature herein below has the
power, authority and right to bind their respective parties to each of the terms of
this Agreement, and shall indemnify City fully, including reasonable costs and
attorney’s fees, for any injuries or damages to City in the event that such authority
or power is not, in fact, held by the signatory or is withdrawn.
b. The Agreement is the final and complete agreement and any prior or
contemporaneous agreements for similar services between the parties is superseded
by this Agreement. This shall not apply where the Parties are currently engaged
and Consultant is providing services not contemplated by this Agreement
c. All Exhibits referenced herein and attached hereto shall be incorporated as if fully
set forth in the body of this Agreement.
{Signatures on following page}
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first
above written.
ATTEST: CITY OF SANTA ANA
Daisy Gomez Kristine Ridge
Clerk of the Council City Manager
APPROVED AS TO FORM:
SONIA R. CARVALHO CONSULTANT:
City Attorney
By:
Ryan O. Hodge
Assistant City Attorney (title)
Tax ID#
RECOMMENDED FOR APPROVAL:
Steven Mendoza, Executive Director
Community Development Agency
Kelly Johnson
Chief Administrative Officer
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EXHIBIT A
SCOPE OF SERVICES
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FIGURE 4: OVERVIEW OF MANDATED RESPONSIBILITIES AND ADDITIONAL ASSUMED RESPONSIBILITIES OF
PUBLIC HEALTH DEPARTMENTS
Mandated Functions for
Local Health Departments
Contractual Programs
(Additional Assumed Responsibilities of
Public Health Departments)
Public health statistics data collection and
analysis
Health education programs
Communicable disease control
Maternal and child health services
Environmental health and sanitation services
Public health laboratory services
Nutrition service
Chronic disease prevention and/or mitigation
Occupational health promotion
Public health nursing
Additional social supports
Behavioral health
Mental health supports
Smoking cessation programs
Early care and education programs
Ambulatory care
Additional responsibilities are often based on
award of federal and state discretionary grants.
With this foundational knowledge and understanding of the complexities of public health
delivery, our consulting team will provide the City with an accurate picture of the three options
outlined in the RFP for informed policy evaluation and decision.
ii. Anticipated Approach to the Scope Services
HMA’s proposed approach to meeting the City’s objectives is outlined in Figure 5 below. The
letters correspond to the specific tasks identified in the City’s Scope of Services. We have
divided the request scope of services into four work streams, each led by a senior experienced
member of the HMA team.
FIGURE 5: APPROACH TO MEETING THE CITY’S OBJECTIVES
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The final deliverable, consistent with your RFP, will include a comparative analysis considering
operational, cost, and revenue projections for the three alternative models:
Full Service Municipal Health Agency
Limited Municipal Health Agency
Regional Health Model
Our draft report weighing the pros, cons, and considerations will inform and serve as the
foundation for the critical strategic conversations that HMA will help facilitate with City
leadership. HMA proposes to work with the City to establish a common criterion that will be
applied to all three alternative models to inform the strategic conversation with the City.
Suggested criteria may include cost, revenue potential, implementation risk, implementation
complexity and other factors identified as priorities by the City.
Staff from HMA is available to provide implementation support, pending action by the City
Council, to develop City of Santa Ana-specific health programs, policies, and plans. The cost
associated with implementation support is not included in the proposal at this time.
Proposed Work Streams
Figure 6 summarizes these four work streams cross-walked to the specific tasks outlined in the
RFP. Further descriptions of each work stream and associated tasks are detailed in Figure 7.
FIGURE 6: PROPOSED WORK STREAMS AND KEY QUESTIONS
Proposed Work Streams and Key Questions Crosswalk to the
Scope of Services
1. Regulatory and Statutory Requirements Analysis
What are legally required mandates (state and federal) of public health
departments?
What are public health regulations and what are requirements to qualify
for funding?
What are the requirements of the regional health district?
A, E, F, M
2. Community Needs Assessment
What do we know about current health conditions and issues for Santa
Ana residents?
What are the specific health issues facing Santa Ana residents and
related health priorities?
How did OCHCA’s COVID-19 response address the needs of the City of
Santa Ana?
G, H
3. Current Service Level, Cost, and Revenue Analysis
What are current in-house and contracted services provided by OCHCA
and related service levels (mandated and additional)?
What are current service levels and services to Santa Ana?
What are current costs and funding sources?
What has been OCHCA’s COVID-19 response?
What are existing OCHCA public health accreditations?
B, C, D
4. Comparative Analysis and Forecasting
What are examples of comparative municipal models – full service vs.
limited service?
What are the core public health services and related staffing, facilities,
and certification requirements?
What is the cost, service, and revenue data from these comparable
municipal models?
What are the lessons learned from these municipalities’ experience and
relevancy to Santa Ana?
I
Draft and Final Synthesis of Findings Related to the Three Models K, M, N, O, P
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Note: Given the unknowns of the selected model, we are unable to estimate the consulting hours needed
at this time for developing public health policies, plans, and programs. Work associated with J and L in
the scope of work are considered implementation support and not included in the submitted cost
proposal. Please see section on Implementation Support in Figure 7 below.
FIGURE 7: DESCRIPTIONS OF PROPOSED WORK STREAMS AND DELIVERABLES
Work Stream Description and Deliverables
1. Regulatory
and Statutory
Requirements
Analysis
This first work stream will research and document federal and state
requirements for a municipal public health function. State law and
regulation define the required functions and activities of local public health
departments (Title 17). The analysis will summarize the mandated public
health services requirements and related implications for the City’s
consideration.
Deliverable: Summary memo/presentation of local health department
regulatory and statutory requirements
2. Community
Needs
Assessment
The Community Needs Assessment is intended to provide an assessment
of the health conditions and issues facing the City of Santa Ana and its
residents. HMA will rely on existing data to support this analysis, including
publicly available reports such as those listed below, to provide an
assessment of the health issues and understand how Santa Ana
compares to County averages and peer cities on key indicators of
community health. Examples of reports that we will tap into include:
26th Annual Report on the Conditions of Children in Orange
County
Orange County Community Indicators 2020–21
An Equity Profile of Orange County, March 2019, issued by USC
Program for Environmental and Regional Equity
Orange County Health Improvement Plan
Other health need assessment reports, including those issued by
the County, Children’s Hospital of Orange County, and other
philanthropic partners such as Irvine Health Foundation, Health
Funders Partnership of Orange County, and the Health Care
Foundation for Orange County
Deliverable: Summary memo/presentation of City of Santa Ana health
needs
3. Current
Service Level,
Cost, and
Revenue
Analysis
This third component is intended to provide a comprehensive picture of the
existing public health services provided by OCHCA to the City of Santa
Ana. Specific tasks included in this work stream include:
Identifying and segregating between mandated public health
services and additional services provide to the City of Santa Ana,
including those supported through grant and discretionary funds
Determining the service level, cost, staffing, and associated
revenue for all mandated public health services provided to the City
of Santa Ana
Identifying other supports and services provide to Santa Ana and
associated costs as well as defining other benefits that may not be
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fully quantifiable. These may include certifications that the OCHCA
may hold that provide opportunities for additional funds or eligibility
for certain grant awards
Based on reviewing the County’s workload data, HMA will propose a
potential geographic catchment area for consideration under the proposed
regional health models. This proposal will consider both the potential
boundaries and the functions that may be possible under a regional health
model.
This work stream will also include a summative review of the County’s
COVID-19 response specifically focusing to what degree the County’s
approach addressed issues unique to Santa Ana and/or engaged
representatives from the City of Santa Ana. This will be based on a review
of published reports by OCHCA and interviews with key stakeholders.
Deliverables: Summary memo/presentation of current service level, cost
and revenue; summative review of OCHCA COVID-19 response
4. Comparative
Analysis and
Forecasting
The final element of the analysis will be to capture data from comparative
cities on their operation of a municipal public health development to
provide the basis for the City of Santa Ana cost, staffing, and revenue
projections. Three cities in Southern California provide examples:
Pasadena and Long Beach, which operate mandated functions, and
Vernon, which operates a limited scale public health department.
Pasadena and Long Beach directly provide services and contract with the
County, nonprofits, and other partners in fulfilling their public health
responsibilities.
Comparative data from all three cities will be captured to the degree
available to understand:
Cost and staffing levels and ratio
Revenue streams
Benefits and challenges of the municipal health department
The comparative analysis will capture both quantitative and qualitative
data. Quantitative data will be used to capture staffing and revenue
estimates such as the number of inspections, permits, and related
revenue. Qualitative data captured through interviews with key city staff in
Long Beach and Pasadena will help identify and elevate key
considerations for the City of Santa Ana.
Using the data gathered from the County and comparable municipalities,
HMA will create a forecasting model to project the staffing, costs, and
revenue related for the three models: full service; limited service, and
regional health model. This forecasting model will rely on assumptions
based on the experience of other municipalities such as ratio of staffing to
inspections, frequency of inspections, fees associated with inspections,
staffing required for core functions, and potential grant funding. The model
will provide the basis for the projections included in the draft and final
model.
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Deliverables: Summary memo/presentation of comparable municipal
public health functions and related costs; forecasting model to staffing,
costs, and revenue associated with the three proposed models
Proposed Draft
and Final
Deliverable
Throughout the process, HMA’s project manager will regularly share the
findings and analysis resulting from the four work streams with the City’s
project manager. Informed by the four work streams, HMA will produce a
draft report documenting our analysis, findings, and the results of our
review of the three alternatives identified in the RFP.
HMA will present this final deliverable as a draft to engage City leadership
in a facilitated discussion of the benefits and risks associated with the
options considered. The goal is to support City leadership in identifying a
path forward that best addresses the City’s priorities within its fiscal
constraints.
The proposed deliverables will include:
Provide recommended criterion and assessment of models against
the criterion. Criteria will consider cost, infrastructure, revenue, and
other factors determined by the:
o Full Service Municipal Health Agency
o Limited Municipal Health Agency
o Regional Health Model
Draft and final synthesis of findings, including pros/cons of a Santa
Ana Public Health Department and consideration of three
alternative models (Tasks K and M), including projected staffing
and revenue and costing for 10 years for proposed public health
functions
Develop a potential transition plan and high-level timeline for each
alternative model consideration and related milestones for each
option (Tasks N and O)
Present to the City Council on findings, alternatives, and the
timeline (Task P)
Implementation
Support
Depending on recommendations and pursuant to action by the City, HMA
will be available to support:
Developing recommendations of public health policies and plans
necessary to operate a public health agency (Task J)
Assisting in developing public health programs for the City of Santa
Ana (Task L)
Providing additional support as requested to assist with
implementing the recommended structure
Given the unknowns of the selected model, we are unable to estimate the
consulting hours needed at this time for developing public health policies,
plans, and programs. HMA has a diverse set of qualified staff in multiple
public health domains and those resources will be available to support this
project. Staff could be available on a time-and-materials basis based on
hourly fees.
EXHIBIT 2
EXHIBIT B
BUDGET
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Feasibility and Fiscal Evaluation Services for a Municipal Public Health Agency
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5. Cost Proposal
HMA is proposing a total not-to-exceed cost of $170,830. Project fees will not be incurred
beyond this amount without your prior approval and a written amendment to this agreement
signed by both parties. Included within this amount is the complete cost of doing business with
HMA, including indirect costs such as overhead, general, and administrative costs. HMA does
not anticipate any non-labor expenses such as travel, meals, or incidental costs. Our cost
breakdown is included in Figure 10.
The services described in this proposal will be billed on a time-and-materials basis. Professional
hourly rates will be billed as indicated in the table below. We will submit invoices monthly for
services provided in the previous month, and the anticipated payment schedule will align with
the anticipated project timeline presented in Figure 9. Invoices will be payable upon receipt.
FIGURE 10: COST BREAKDOWN
HMA Labor
Employee Labor Category Hourly Rate Hours Total
Christina Altmayer, MPA Principal $385 160 $61,600
Jonathan Freedman, MSPH Principal $385 6 $2,310
Helen Duplessis, MD, MPH Physician Principal $440 16 $7,040
Michelle Parra, PhD Principal $385 92 $35,420
Michael Butler, MA Senior Associate $330 116 $38,280
TBD Research Associate $170 154 $26,180
Total 544 $170,830
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EXHIBIT C
TIMELINE
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iv. How HMA will Adhere to the City’s Project Timeline
As indicated above, HMA adheres to specific project management protocols to meet timelines
and provide regular status reports to the client. For each of the work streams, we have defined a
deliverable that we will complete at each phase and present to the City’s project team for review
and feedback. This will allow the City to understand progress, provide real-time feedback
throughout the process, and allow HMA to adapt our approach to best meet the City’s needs
and timeline. We view this project as a partnership, and providing regular and open
communication will be integral to its success.
Figure 9 provides our preliminary proposed work plan and timeline. If selected, this will be
reviewed with the City’s project team at the kickoff meeting and adjusted, as necessary, to meet
the City’s timeline. In our timeline, we have taken into consideration the time required to receive
documents from the City of Santa Ana, the County, and other municipalities as well as the
amount of time to perform the analysis.
FIGURE 9: HMA’S PROPOSED WORKPLAN AND TIMELINE
Proposed Timeline/Activities 2021 2022
A S O N D J F M
Project Management
Coordinate all tasks and client management
Regulatory and Statutory Requirements
Research and confirm state and federal mandated services
Research and confirm additional public health services
Identify requirements associated with additional funding sources
Research requirements associated with Regional Health district
Produce deliverable
Community Needs Assessment
Collect and review existing community needs assessment
resources and synthesize critical issues
Conduct summative review of COVID-19 response
Produce deliverable
Current Service Level Cost and Revenue Analysis
Identify current OCHCA mandated and additional services
provided to Santa Ana
Determine service level, cost, staffing, and associated revenue
Identify other supports provided to Santa Ana
Produce deliverable
Comparative Analysis and Forecasting
Capture service, cost, and revenue data from Long Beach,
Pasadena, and Vernon
Develop a forecasting model based on inputs from OCHCA
experience and municipal experience
Develop criterion for review of all options
Produce deliverable
Prepare and Present Final Consolidated Report
Prepare consolidated draft report
Prepare for/facilitate/conduct a session with City leadership
Prepare final report and presentation
EXHIBIT 2