Merced County EMS Ambulance Request for Proposal RFP

Merced County EMS Ambulance Request for Proposal (RFP) Advisory Committee Meeting March 2019 Presented by: The Abaris Group Walnut Creek, CA www. abarisgroup. com

Agenda Discuss Committee Confidentiality Review RFP Timeline History of Merced EMS Next Gen Task Force Results Consultant Recommendations RFP Scope of Work Confidential 2

Confidentiality RFP development is a confidential process Ensures equality for all potential bidders No discussions outside of these meetings Refer stakeholders with questions to Jim Perceived conflict? Share with Jim! Confidential 3

Ambulance RFP Timeline, completed Meet with County EMS Agency Collect & review available reports, data, contracts, etc. Conduct interviews with all stakeholders Research current ambulance and first responder input Evaluate the industry best practices and trends Develop EMS system financial analysis Complete strategic planning process Confidential 4

Ambulance RFP Timeline, pending Conduct town hall meeting Develop RFP document Obtain County/State RFP approval Release RFP Facilitate bidders’ conference Support bidder selection Assist contract negotiations Confidential 5

History of Merced County EMS

History High-Performance EMS contract Two ALS ambulance providers BLS first responders Includes interfacility transports Includes CCT Confidential 7

Next Gen Task Force

Next Gen Task Force, results 1. High system user diversion 2. Outcome-based measures 3. Resource triage at dispatch 4. Health information exchange 5. Nurse triage at dispatch Confidential 9

Next Gen Task Force, results Remaining Medi. Cal payer partnership Hospital readmissions Hospice revocation Community paramedicine Consolidated dispatch Confidential 10

Next Gen Task Force, rec’s 1. Clinical Outcomes 2. Resource Triage 3. High System User Diversion 4. Community Paramedicine 5. Health Information Exchange Remaining best practices should be encouraged through innovation section of RFP Confidential 11

Scope of Work

Scope of Work, approach Working document only. . . nothing set in stone Input needed and encouraged Confidential 13

Scope of Work, components Fiscally viable Incumbent work force First response coordination Mutual aid/standbys Vehicle requirements Service levels Surge capacity Response times Dispatch Performance standards Outcome-driven service Confidential 14

Scope, fiscally viable Ensure contract compliance without fiscally compromising the service Determine reasonable number of response zones Simplify financial statement requirements Confidential 15

Scope, EOA Current Includes Westside through subcontract Future Continue existing EOA? Exclude Westside? Confidential 16

Scope, incumbent work force Maintain existing field staff Offer interviews to existing supervisors and managers Confidential 17

Scope, first response coordination Provide joint training regularly Participate in County training (e. g. , MCI) Resupply first responders “one-for-one” Support future standardized of EMS equipment with first responders Confidential 18

Scope, mutual aid/standbys Best effort to respond to mutual-aid requests of neighboring counties Provide ALS standby (ambulance or first responder) services as requested for Working fires, hazardous material events, law enforcement incidents, etc. Confidential 19

Scope, vehicle requirements Type (e. g. , van, sprinter, modular) Safety standard (e. g. , KKK, NFPA, CAAS) Stock/maintain ambulance and first response units to County standards Approved vehicle markings e. g. , logo, text, color No maximum mileage Confidential 20

Scope, service levels Current ALS & BLS 9 -1 -1 ALS interfacility BLS interfacility CCT interfacility Future ALS & BLS 9 -1 -1… yes ALS interfacility… maybe BLS interfacility… maybe CCT interfacility… no Confidential 21

Scope, surge capacity Current Westside Ambulance Neighboring counties Future Require call back policy Confidential 22

Scope, response times Current Emergency Non-emergency IFT Future Emergency… yes (outlier penalty only) Non-emergency calls… none IFT… none Consider more reasonable response zones Confidential 23

Scope, performance standards Current Penalties for response time non-compliance per call and monthly Possible Outliers only Minimal exemptions Credit for meeting outcome-driven metrics Continued failure to comply, results in default and loss of contract Confidential 24

Scope, dispatch Current Independent center for ambulance No CAD-2 -CAD link Future Consolidate? Resource Management Right resources to right patient in right time… E. G. , first response to healthcare facility? Confidential 25

Scope, outcome-driven Confidential 26

Scope, outcome-driven Benchmark categories Cardiac arrest STEMI Stroke Pain management Respiratory distress Hypoglycemia Trauma Sepsis Seizures Efficiency Patient Safety Confidential 27

Scope, outcome-driven Independent patient satisfaction scoring Communication by 9‐ 1‐ 1 call taker Communication by firefighters Communication by medics (patient and family) Timeliness of ambulance response Pain control Cleanliness of ambulance Ride of the ambulance Communication by business office staff Hospital visit within 24 hours? (for AMA calls) Confidential 28

Scope, outcome-driven Cardiac Arrest Response interval < 5 minutes for CPR/AED Bystander CPR rate Bystander AED rate Appropriate airway management End-tidal CO 2 monitored Pit crew/focused CPR Post resuscitation care Therapeutic hypothermia Aggressive BP goals STEMI recognition Transport to “Resuscitation Center” ROSC percentage Survival to discharge (e. g. , overall, Utstein) Confidential 29

Scope, outcome-driven STEMI Recognition ASA administration NTG administration Appropriate analgesia given Two pain scores recorded Sp. O 2 recorded EKG acquired within X minutes (e. g. , 5 -10) 12 L acquired 12 L transmitted Limited scene time (e. g. , < 10 minutes) Transport to STEMI center rate EMS access to PCI time (“ 911 -to-balloon time”) Confidential 30

Scope, outcome-driven Stroke Time last seen normal Use of a prehospital stroke scale e. g. , NHS, FAST, MEND, CPSS, LAPSS, MASS Blood glucose documented Blood pressure documented Appropriate O 2/airway management Limited scene time (e. g. , < 10 minutes) Transport to a stroke – capable facility Confidential 31

Scope, outcome-driven Respiratory Distress (e. g. , asthma) Mental status Resp. rate, Sp. O 2, PEFR recorded B 4 treatment Oxygen administered (if appropriate) Bronchodilators for pediatrics with wheezing Beta 2 agonist administration for adults Endotracheal intubation success rate End-tidal CO 2 performed on any successful ET intubation Improvement after treatment Confidential 32

Scope, outcome-driven Trauma Over-triage rate Dispatched – enroute to hospital interval Pain Management Offered pain meds prior to movement Pain score decreased Sepsis Protocol completed Confidential 33

Scope, outcome-driven Hypoglycemia Glucose recorded B 4 treatment Glucose recorded after treatment Correct disposition (e. g. , transport, referral, home) Seizure Glucose recorded Sp 02 recorded Anticonvulsant administration (febrile) Temperature management (febrile) Received intervention as appropriate Confidential 34

Scope, outcome-driven Efficiency Domain Cost per patient contact Cost per transport Cost per unit hour Employee turnover rate Confidential 35

Scope, outcome-driven Patient Safety Drops per 1, 000 patient contacts AMA to hospital within X hours (e. g. , 24 -72) Mission failures per X responses/miles Ambulance crashes per X responses/miles Chart Review (random, manager, MD) Protocol compliance rate Confidential 36

Input/Questions?

Bill Bullard, MBA Senior Vice President 707. 823. 0350 bbullard@abarisgroup. com The Abaris Group Walnut Creek, CA 888. EMS. 0911 Thank You