REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
September 23, 2025
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Contract with The Joxel Group, LLC for Consulting and Technical Support Services
End
RECOMMENDATION(S)
Recommendation
Approve Contract with The Joxel Group, LLC, for the provision of Consulting and Technical Support Services for the myAvatar Electronic Health Record system in an amount not to exceed $1,200,000 for the period of October 1, 2025, through the earlier of September 30, 2029, or utilization of 8,000 hours of services.
(Presenter: Georgina Yoshioka, Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Promote the Countywide Vision.
Operate in a Fiscally-Responsible and Business-Like Manner.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The recommended contract in an amount not to exceed $1,200,000 is funded through the Mental Health Services Act. Adequate appropriation and revenue have been included in the Department of Behavioral Health (DBH) 2025-26 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
DBH is responsible for providing mental health and substance use disorder (SUD) services to county residents experiencing severe mental illness and/or SUD. To meet the needs of such residents and comply with state and federal requirements, DBH implemented a Behavioral Health Management Information System through a contracted partnership with Netsmart Technologies (Netsmart) in 2017. In 2019, as a subcontractor to Netsmart, The Joxel Group, LLC (Joxel) began to provide consultation and system development services in support of DBH’s electronic health record, myAvatar (EHR). Given the county’s extensive geographic size, complying with the federal and state regulations, including federal network adequacy standards and California Advancing and Innovating Medi-Cal (CalAIM) initiatives presents a unique challenge in maintaining an extensive and progressive EHR. Joxel’s expertise allows the County to address these unique needs through strategic EHR system configurations and tailored consultation services.
DBH was introduced to Joxel’s services through their subcontract with Netsmart. While DBH has an existing contract with Netsmart that provides the EHR platform and similar services to that of Joxel, Netsmart lacks the capabilities to fully integrate the development and configuration of the EHR. Joxel was closely involved in the customization of the EHR to meet DBH and State requirements in providing consulting and technical support services that seamlessly integrate into the framework of the EHR. These services are unique to this organization as they specialize in supporting Netsmart products with focused expertise in operational understandings and insights into diverse organizational cultures, healthcare practices, regulatory requirements and innovative solutions. Consulting and technical support services as it relates to DBH’s EHR include, but are not limited to (1) form, report, and widget development, (2) training and assistance, (3) configuration assignments as requested by DBH, and (4) continued technical support for all issues related to the EHR.
A continued partnership with Joxel is essential to comply with CalAIM initiatives such as Payment Reform, which supports both counties and healthcare providers in delivering value-based care and improving the quality of life for County Medi-Cal beneficiaries. Joxel’s specialized expertise ensures DBH’s EHR is adaptable to meet the evolving regulatory requirements and optimizes an advanced billing process to ensure efficient, timely, and accurate Medi-Cal claim submissions. In addition, Joxel’s technological proficiencies and ability to develop in-depth forms and customized reports are essential to the effective and efficient operation of DBH’s EHR and allow DBH to improve data accuracy and system efficiency and optimize staffing resources.
DBH will implement mechanisms to regularly review consultant invoices administratively and programmatically to ensure the utilization of contractual hours is accurate prior to payment processing.
PROCUREMENT
The Purchasing Department supports the non-competitive procurement of Consulting and Supportive Services for EHR based on specialized expertise and unique knowledge. The Joxel Group, LLC was subcontracted by NetSmart and directly involved in customizing DBH’s system to meet State and departmental requirements, making them uniquely qualified to provide ongoing consulting, configuration, and support services necessary to ensure continuity, compliance, and operational efficiency.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Marianna Martinez, Administrative Supervisor II, 383-3940) on August 21, 2025; County Counsel (Charles Phan, Supervising Deputy County Counsel, 387-5455) on August 25, 2025; Purchasing (Joni Yang, Buyer III, 387-2463) on August 25, 2025; Innovation and Technology Department (Lynn Fyhrlund, Chief Information Officer, 388-5501) on August 28, 2025; and County Finance and Administration (Paul Garcia, Administrative Analyst, 386-8392) on September 8, 2025.