REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
July 13, 2021
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Amendment to Agreement with Experian Health, Inc. For Software Modules and Secure Card Transactions
End
RECOMMENDATION(S)
Recommendation
Approve Amendment No. 1 to Contract No. 19-721 with Experian Health, Inc., increasing the not to exceed amount by $448,200, from $2,304,000 to $2,752,200, with no change to the contract period of November 5, 2019, through November 4, 2024, for the additional software modules needed to ensure compatibility with the new Electronic Health Record system.
(Presenter: William L. Gilbert, Director, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Improve County Government Operations.
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies and Stakeholders.
FINANCIAL IMPACT
Approval of the recommendation with Experian Health, Inc. (Experian) will not result in the use of Discretionary General Funding (Net County Cost). The additional cost of $448,200 is funded by State Medi-Cal, Federal Medicare, private insurances, and other departmental revenue. Funding sources may change in the future pending any legislative activity related to the repeal and/or replacement of the Affordable Care Act. Sufficient appropriation and revenue are included in the Arrowhead Regional Medical Center (ARMC) 2021-22 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
On November 5, 2019 (Item No. 8), the Board of Supervisors approved Agreement No. 19-721 with Experian in an amount not to exceed of $2,304,000, for the five-year period beginning November 5, 2019, through November 4, 2024, for the conversion of Experian software and licensing of additional third-party software. This conversion ensures compatibility with both the existing MediTech Electronic Health Record and the new EPIC Electronic Health Record (EHR) system, anticipated to be implemented by February 2022. The recommended amendment to this contract will add software modules that are necessary for successful conversion to the new EPIC EHR.
Experian is supporting ARMC’s current MediTech legacy system functions and will support EPIC applications as ARMC transitions from MediTech to EPIC. The Experian system interfaces with the existing ARMC electronic systems to automate real-time patient eligibility information and verify covered insurance benefits. Availability of this information in real-time promotes continuity of care for each patient and positively impacts healthcare maintenance, chronic disease management, preventative care, and overall health. Use of this patient software system provides for the safety, health, and social service needs of County residents by ensuring that patients have insurance to cover necessary care, as well as identifying patients who do not have coverage and creating opportunities to assist them with access to other insurance coverage programs.
The recommended amendment adds additional software modules necessary for integration with the new EPIC EHR that will give ARMC the ability to verify insurance claim status as quickly as possible with intelligence retrieved directly from the insurance websites and will send electronic attachments to payers and facilitate automated updates to data within EPIC. This Experian software along with EPIC tools will ensure appropriate capturing of electronic responses for payers necessary for follow-up of billed claims, without adding additional staffing.
The software contributes to ARMC's goals of improving the patient experience, data capture, improves of insurance capture, and allows ARMC to manage the claim submission functions allowing us to maximize the claiming of net patient revenue.
PROCUREMENT
Procurement of the insurance eligibility software license is non-competitive based on functional specification, as the Experian patient eligibility software is already integrated into ARMC’s current
Electronic Health Record provider, MediTech, with real-time eligibility, so no additional integration software is needed. Of the vendors offering the eligibility functionality required by ARMC, only Experian can deliver real-time eligibility. County Purchasing recognizes functional specification as a valid non-competitive justification and supports procurement of this software license from Experian.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Bonnie Uphold, Deputy County Counsel, 387-5455) on June 17, 2021; Purchasing Department (Ariel Gill, Buyer, 777-0722) on June 18, 2021; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on June 18, 2021; Finance (Yael Verduzco, Administrative Analyst, 387-5285) on June 28, 2021; and County Finance and Administration (Matthew Erickson, County Chief Financial Officer, 387-5423) on June 28, 2021.