Wellpath_Contract_with_Addendums

Palm Beach County Sheriff’s Office West Palm Beach, Florida Technical and Cost Proposal January 25, 2019 Respectfully Submitted to: Ric Bradshaw, Sheriff 3228 Gun Club Rd. West Palm Beach FL 33406-3001 561-688-4400 Submitted by: Wellpath 1283 Murfreesboro Road, Suite 500 Nashville, TN 37217 800-592-2974 Tax ID# 32-0092573 Points of Contact: Zela Guirola Vice President of Partnership Development 561-569-5084 [email protected] Kip Hallman President 858-283-8619 [email protected] This submission includes the following required copies: Technical and Cost Proposal – 1 original and 3 copies as well as 1 electronic submittal. Palm Beach County, Florida Transmittal Letter Dear Sheriff Bradshaw: Wellpath appreciates the opportunity to submit our proposal for Inmate Health Care Services. We are enthusiastic about telling you our story and introducing our capabilities and our culture by a simple code: Always Do the Right Thing! Throughout this proposal, we will demonstrate our experience and our commitment to providing a comprehensive, high-quality program while ensuring community connectivity, creating program efficiencies, and reducing risk for the Palm Beach Sheriff’s Office (PBSO). We have tailored our proposal to address your current challenges and goals for the future. Working with Wellpath, inmates will be thoroughly screened upon booking by Registered Nurses to identify chronic care patients, detox, and mental health issues. This early intervention approach will support the inmate’s overall health while potentially decreasing safety issues and the risks associated with transporting patients outside the facility to the emergency room or to other community programs. Wellpath will collaborate with as many resources as possible to enable discharged patients to continue their treatment plans in the community after release with the goal of enhancing their state of health and reducing the likelihood of recidivism. In 2018, Wellpath was born out of the joining of two great companies – Correct Care Solutions and Correctional Medical Group Companies. These two organizations recognized the importance of putting patients first and providing high-quality care to an often overlooked and underserved population. Wellpath delivers medical and behavioral health care services to nearly 300,000 adult and juvenile patients each day through a family of local and state providers in correctional facilities, state psychiatric hospitals, forensic treatment facilities, and civil commitment centers. We have over 35 years of nationwide experience in medical and behavioral health care working with local, state, federal, and community partners. And we understand how to provide excellent patient care in the state of Florida. Wellpath currently provides medical and mental health services in the State of Florida to the Pasco Sheriff’s Office Detention Center, Broward County Sheriff’s Office Detention Center, Sumter County Sheriff’s Office Detention Center, Lee County Sheriff’s Office Detention Center, the Monroe County Sheriff’s Office Jail and Detention Centers, the Nassau County Jail and Detention Center, the South Florida State Hospital, the South Florida Evaluation and Treatment Center, the Treasure Coast Forensic Treatment Center, the Florida Civil Commitment Center, as well as two Federal Bureau of Prisons. Our Mission Our mission is to be the premier public health solutions provider for governmental agencies and the premier provider of effective and efficient health care to specialized populations. Wellpath has identified opportunities for program enhancement and community partnerships, including several of your current providers, for various service improvements for your inmate population. The information our proposal clearly demonstrates that our vision of goal alignment and our focus on improving clinical results will translate into a cost-efficient healthcare program that will deliver excellent patient care. There are several reasons why Wellpath is the right choice for Palm Beach County: Palm Beach County, Florida Transition Experts A well designed and executed transition is key for a successful long-term program. We have developed a comprehensive implementation plan that is orderly, procedural, systematic, and proven to be effective. The Monroe County Florida HSA, who Wellpath promoted and retained from the incumbent provider, recently remarked, “CCS (now Wellpath) has a lot more to offer on their training,” and “the support from CCS (now Wellpath) versus [the previous provider] has been phenomenal…I’m more confident in the care we provide.” We hire and keep great people Year after year, our staff turnover is low, and our team satisfaction is high. We hire well, train well and treat our people well. We regard our people like family and make sure to provide relief for nurses working in what is often a high-stress job. Our compassionate, engaged, and stable health-care teams produce better care, higher inmate satisfaction, fewer grievances, and less risk. We are determined to maintain full staffing at all times This isn’t just a goal, but a mission that we fulfill time and time again. In fact, we are committed to covering every shift, every day. Unlike many of our competitors, we build a significant Relief Factor into our planning and staff budgets. We never leave a position empty because a key person is on vacation or sick. We also build a solid, qualified PRN pool and we almost never use temporary agency staffing on an ongoing basis. We’re accessible and reliable This means that any member of our team can be in Palm Beach County in a matter of hours. We have a keen understanding of Palm Beach County’s needs and recognize what it takes to bring a quality program to the Palm Beach County Detention Centers for the long-term. With our team, you can be sure that you won’t have to go through multiple levels of corporate bureaucracy or wait days for important answers or solutions to critical health care. For us, an ounce of prevention truly is worth a pound of cure, which means we instill and support a proactive culture that seeks to prevent issues before they arise. Enhanced Behavioral Health Services Wellpath understands Palm Beach County is focused on serving the needs of the underserved mentally ill population through creative programming. We are prepared to provide an advanced on-site behavioral health program, including our Seven Minutes to SAVE campaign, increased suicide prevention programming with PAMM assistance, referrals for forensic placement competency restoration, and powerful security staff training. We can leverage our nearby Treasure Coast hospitals to provide support to Palm Beach County, including staff training and other specialized clinical support. Leading experts on protocols for alcohol and Opiate abuse Wellpath has used proven, evidence-based withdrawal protocols, aligned with ACA standards and ASAM protocols, which address detoxification from all commonly abused substances found in jail populations. Our proven withdrawal protocols deliver improved and safer withdrawal care. Palm Beach County, Florida One Patient. One Team We believe it is time to reconnect the head with the body, and eliminate the silos that exist between medical and behavioral healthcare. So we pioneered OneCare: Collaborative Correctional Care℠, integrated medical and behavioral care that aligns the right resources to match the need. Our OneCare solution includes evidence-based treatment protocols that step￾down care for mental and behavioral health patients as well as discharge planning services to help inmates get out and stay out. Specialty Care Expertise thru e-consults To support the evidence-based clinical work done by the Collaborative Care Team, we have over 140 medical and mental health specialists available via InmateCare+ that span approximately 40 different specialty areas of medicine. The onsite psychiatry team is also integral to supporting this collaborative approach to inmate patient care. InmateCare+, reduces unnecessary off-site care and optimizes on￾site care. InmateCare+ e-Consult allows our on-site provider to consult with a panel of medical specialists, who are available to help manage care on-site, reducing the need for off-site specialist appointments. Turnaround time for an e-Consult is only six hours, compared to wait times to see community specialists, which can stretch to weeks. Our use of InmateCare+ has helped us achieve a nearly 20% reduction in off-site specialist referrals, reducing off￾site costs, risk to community, and liability. In-depth look upon intake One of our key focus areas includes delivering detailed intake screenings to provide better assessments for both medical and mental health needs from the beginning of the intake process. We will complete more in-depth intakes, which not only improves the quality of care, but can also correlate to a significant decrease in offsite visits while providing better health outcomes to our patients. Proven Success Managing Offsite Care Wellpath has successfully established many on-site programs and specialty care clinics for our current clients. Our continued focus on the identification, referral, and treatment of patients with chronic conditions allows Wellpath to manage the health care needs of our patients before they escalate and require offsite consultation or result in grievances or litigation. Accreditation Experience Wellpath has enjoyed unparalleled success in our accreditation experience. Many Wellpath sites have been named 100% compliant during their accreditation surveys. Furthermore, we carry the distinction of counting 18 Triple Crown sites among our clients so we will ensure your health program is executed to ensure continued accreditation. “The service which your team has been providing has been nothing short of spectacular and has met or exceeded all of our expectations. It is clear to me, as well as members of our staff, that you and your company have become an integral part of our family.” Richard Lucia, Undersheriff Alameda County, California Palm Beach County, Florida Florida Experience and Resources Wellpath currently provides services in 25 facilities within the State of Florida. With over 2,000 employees caring for almost 20,000 patients within the state, our company knowledge, best practices, and resources are readily available to support the success of the PBSO program. Community Connectivity Like the PBSO, we are dedicated to establishing relationships within the communities we serve, and we partner with local organizations to maximize continuity of care for each patient. We will have partnerships in place with local Florida educational entities to implement training programs for nursing, social work, psychology, and psychiatry students; we find by engaging students, we have an opportunity to introduce the benefits to a career in correctional medical and behavioral health care. As part of our due diligence for the Palm Beach County Detention Centers’ medical program, we have contacted and connected with many area providers to establish partnerships that will enhance the continuity of care and reintegration processes for your inmate population. EHR Experience Wellpath has the broadest experience and deepest knowledge of electronic medical systems in corrections, with over 150 of our facilities using an electronic medical record. We are the largest user of jail based correctional Electronic Health Records software in the Country. We Deliver on our Commitments Like you, we are taxpayers, and we are sensitive to the County’s desire to spend your taxpayer dollars wisely. We know that our delivery of care, with consistent, full coverage, quality staffing, costs more. This is how we’ve delivered outstanding services for 35 years. It’s effective; it works; and it’s the only way we know. We know that we could reduce our cost to you by cutting corners; by paying less than competitive pay rates (leading to high staff turnover); by not training our staff; or not committing to 100% full staffing. But that isn’t what our customers want or expect, and we don’t think it is what Palm Beach County wants or expects. Throughout this proposal, you will notice the blue icon to the right of a paragraph. This icon is a way for us to highlight innovative solutions and other differentiators that are unique to a partnership with Wellpath. You will also encounter the green icon to the right of a paragraph, which clearly identifies areas within our proposal where cost savings advantages are to be gained by partnering with Wellpath. We are Wellpath. We are the right people, striving to Always Do the Right Thing! We are committed to continuously improving our services and program offerings for each and every client we serve. We consider our clients to be true partners and encourage you to call our current partners and let them tell you exactly what we have done for them, and what we can do for you! We welcome the opportunity to present to you, discuss this proposal in person, and to demonstrate our passion and commitment to exceeding your expectations. Palm Beach County, Florida We look forward to beginning a partnership with the PBSO. Please contact us with any questions you may have. Sincerely, Zela Guirola Vice President of Partnership Development 561-569-5084 [email protected] Kip Hallman President 858-283-8619 [email protected] This proposal remains valid for 90 days. Palm Beach County, Florida Table of Contents 1 Wellpath Experience .......................................................................................................................1 1.1 Leadership Team................................................................................................................................1 1.2 Experience of Key Staff ......................................................................................................................6 1.3 Florida Experience..............................................................................................................................8 1.4 Juvenile Health Care Experience........................................................................................................8 1.5 Home Office Support .........................................................................................................................9 1.6 Accreditation Experience .................................................................................................................10 2 Scope of Work...............................................................................................................................13 2.1 Written Health Care Plan .................................................................................................................13 2.2 Humane Treatment..........................................................................................................................13 2.3 Nursing Services...............................................................................................................................13 2.4 Intake Screening...............................................................................................................................14 2.4.1 Receiving Screening Guidelines.................................................................................................14 2.4.2 Admission Deferrals...................................................................................................................14 2.4.3 Communicable Disease Reporting.............................................................................................15 2.4.4 Access to Care............................................................................................................................15 2.4.5 Medication Verification.............................................................................................................15 2.5 Health Assessment...........................................................................................................................16 2.6 Periodic Health Assessment.............................................................................................................17 2.7 Sick Call.............................................................................................................................................18 2.8 Patient Referrals ..............................................................................................................................19 2.9 Hospital and Other Outpatient Services..........................................................................................19 2.9.1 Hospital Care .............................................................................................................................26 2.9.2 Emergency Care.........................................................................................................................30 2.9.3 Specialty Care and Referrals......................................................................................................32 2.9.4 Medication-Assisted Treatment (MAT) .....................................................................................32 2.10 Chronic Care Patients.....................................................................................................................33 2.10.1 Special Needs Screening ..........................................................................................................33 2.10.2 Classification and Housing ......................................................................................................34 2.10.3 Individualized Treatment Plans...............................................................................................34 2.10.4 Specialty Referrals...................................................................................................................34 2.10.5 Chronic Care Tracking..............................................................................................................35 2.10.6 Chronic Care Guidelines...........................................................................................................35 2.11 Dialysis Services .............................................................................................................................36 2.12 Dental Care.....................................................................................................................................36 2.13 Ancillary Services............................................................................................................................36 2.14 Obstetrical Care .............................................................................................................................37 2.15 X-Ray Services................................................................................................................................40 2.16 Laboratory Services........................................................................................................................41 2.17 Pharmacy Services .........................................................................................................................42 2.18 Mental Health ................................................................................................................................51 2.18.1 Program Oversight ..................................................................................................................51 2.18.2 Multidisciplinary Communications..........................................................................................52 2.18.3 Correctional Officer Training ...................................................................................................53 Palm Beach County, Florida 2.18.4 Goals of the Wellpath Mental Health Program.......................................................................53 2.18.5 Initial Mental Health Screening...............................................................................................54 2.18.6 Mental Health Evaluation........................................................................................................54 2.18.7 Triage of Mental Health Referrals...........................................................................................55 2.18.8 Crisis Management..................................................................................................................55 2.18.9 Placement and Housing...........................................................................................................57 2.18.10 Treatment Planning...............................................................................................................57 2.18.11 Counseling Services ...............................................................................................................58 2.18.12 Protocol for Psychotropic Medications..................................................................................60 2.18.13 Restraint Protocols................................................................................................................61 2.18.14 Segregation ...........................................................................................................................62 2.19 Telemedicine and Medical Videoconferencing..............................................................................63 2.20 Detoxification and Withdrawal Protocol .......................................................................................66 2.21 Discharge Planning.........................................................................................................................71 2.22 OneCare: Collaborative Correctional Care℠.................................................................................73 2.23 Health Education of Inmates..........................................................................................................79 2.24 Services to Correctional Staff.........................................................................................................85 2.25 Medical Records.............................................................................................................................86 2.26 Administrative Meetings and Reports...........................................................................................89 2.27 Inmate Grievances and Complaints...............................................................................................90 3 Administrative Functions...............................................................................................................93 3.1.1 Policies and Procedures.............................................................................................................93 3.1.2 Disaster Plan..............................................................................................................................93 3.2 Periodic Reviews and Committees...................................................................................................96 3.2.1 Utilization Review......................................................................................................................96 3.2.2 Statistical Data ..........................................................................................................................96 3.2.3 Continuous Quality Improvement Committee...........................................................................97 3.2.4 Medical Audit Committee........................................................................................................100 3.2.5 Risk Management and Mortality Review................................................................................101 3.2.6 Pharmacy and Therapeutics....................................................................................................102 3.2.7 Infection Control......................................................................................................................103 4 Proposed Staffing........................................................................................................................105 4.1 Personnel Services.........................................................................................................................112 4.1.1 On-Call Responsibility..............................................................................................................113 4.1.2 Credentialing ...........................................................................................................................113 4.1.3 Recruitment.............................................................................................................................113 4.1.4 Employee Benefits...................................................................................................................118 4.1.5 Employee Training and Orientation ........................................................................................121 5 Contract Transition......................................................................................................................130 6 Fees Proposal..............................................................................................................................137 Tabbed Attachments Sample Transition Plan CONFIDENTIAL ........................................................................................................A Palm Beach County, Florida 1 1 Wellpath Experience Wellpath will provide a full range of professional management services to support the Palm Beach County Detention Centers’ health care program. Our program will be directly supported by the Wellpath Home Office in Nashville, Tennessee, and our Regional Management Team. The Wellpath Executive Team has more than 400 years of combined correctional health care experience, and the entire team will be fully engaged in the operation of programs and services for the PBSO. Strengthening communication and operational workflows in the Wellpath program will be our Regional Management Team, containing comprised of experienced individuals who are familiar with State of Florida requirements and who will work to ensure a compliant program that meets or exceeds the PBSO needs and expectations. Wellpath takes pride in being a large company with the ability to offer volume-based buying power and resources to our partners, while still keeping our homegrown, family culture and hands-on approach to client service. Our program is designed to ensure that no Wellpath site will ever feel as though it is unsupported or operating in a vacuum. Wellpath is a truly hands-on provider; our Regional Vice President, Bill Kissel or our Regional Manager, Stephanie Peskowitz, will be on-site monthly to evaluate the medical processes and to meet with the PBSO administration. Our Vice President of Partnership Development, Zela Guirola will serve as the Wellpath client liaison to the PBSO for all aspects of the contract to ensure that the PBSO is satisfied with our service. This is our corporate pledge to the PBSO as your medical provider. 1.1 Leadership Team Our leadership team will ensure that our programming follows the tenets of the contract between the PBSO and Wellpath, as well as Wellpath protocols and industry standards. Clinical oversight will be provided by the Wellpath Medical Director, who will report directly to Regional Medical Director, Karla Dunbar. Regional Behavioral Health Manager, Bridgette DaBiere, will oversee our mental health program. Operational oversight will be the responsibility of Regional Manager, Stephanie Peskowitz, and Senior Regional Vice President, Bill Kissel, who reports directly to the Chief Operating Officer of the Wellpath Local Detention Division, Cindy Watson. We have provided an overview of the qualifications of key leadership staff who will be involved with the implementation of Wellpath health services in Palm Beach County and the subsequent management of operations. These are more than just names in a proposal, but rather faces you will see walking the hallways of the Palm Beach County Detention Centers supporting our program. “We set out to find a partner rather than a vendor, and your extraordinary care and attention to the patients, our staff, and your own team demonstrates a shared passion and approach which is beyond encouraging as we look to the years ahead. The level of service and communication we have received thus far has proven we made the right choice." Colonel Tom Eberhardt Lee County, Florida Palm Beach County, Florida 2 Jerry Boyle Founder & Executive Chairman of the Board Mr. Boyle founded Correct Care Solutions (CCS) in 2003 and now serves as Chairman of the Board for Wellpath. He has more than 35 years’ experience in key leadership positions working with justice￾involved clients in correctional, behavioral, and residential settings. His corrections career started at the Massachusetts Department of Correction where he worked 15 years. For the past 25 years, he has had increased roles in operations, business development, and mergers and acquisitions. His blend of public and private service has helped forge a vision for Wellpath that is focused on service excellence: service to patients, clients, and team members. Mr. Boyle received his bachelor’s degree in human services from Fitchburg State College. His management philosophy is well known throughout the company and is based on what he calls The Five Hs, which emphasize the qualities of Hard Work, Hunger, Honesty, Humility, and Humor in Wellpath and its employees. Jorge Dominicis Chief Executive Officer Mr. Dominicis serves as the Chief Executive Officer for Wellpath. His role is to ensure operational excellence and to drive the organization’s strategic focus. Before joining Wellpath, Mr. Dominicis served for 10 years as President of GEO Care, during which time GEO Care increased revenue six-fold. Prior to that, he served 14 years as Vice President of Corporate Affairs at Florida Crystals Corporation, where he was responsible for all governmental and public affairs activity at the local, state, and federal level, as well as for the coordination of community outreach and charitable involvement. Mr. Dominicis also served in various public and government policy positions in Florida, including the St. Mary’s Medical Center Governing Board and the Criminal Justice Commission. He holds a bachelor’s degree in business administration, finance, and international business from Florida International University. Kip Hallman President Mr. Hallman became President of Wellpath in October 2018, following the combination of CCS and CMGC, where he served as CEO. He brings more than 30 years of diverse experience, including co-founding and growing a large national health care services company and leading the successful turnaround of a leading national diagnostic imaging company. As President, he is responsible for ensuring we exceed the expectations of our customers. Mr. Hallman has a passion for leading our team to achieve great results for our people, our patients, and our client partners. Palm Beach County, Florida 3 Juan Perez Chief Financial Officer Mr. Perez is a highly capable executive with extensive accounting and finance experience, including public accounting, as well as public and private equity-sponsored companies. He joined Wellpath in April 2016 with a solid background in mergers, acquisitions, and divestitures. Mr. Perez’s industry experience includes high tech, manufacturing, resort, health care, real estate, telecom, financial services, and ISPs. He is an excellent leader with proven experience leading and assembling large finance organizations while increasing productivity. Mr. Perez is a licensed CPA. Cindy Watson Chief Operating Officer, Local Government Division Ms. Watson brings more than 25 years of health care experience to her role as Chief Operating Officer for the Local Government Division. Her background includes a diverse blend of leadership operations, client services, technology, marketing, product management, sales, and business development. Ms. Watson has provided start-up direction, turn-around management, strategic business development, integration of acquisitions, and has driven organic growth. She combines exceptional communication skills at the executive and board level with team building, problem-solving, and the successfully balancing of strategic vision and tactical execution to achieve outcomes. Carl Keldie, MD Chief Clinical Officer Dr. Keldie joined Wellpath as Chief Clinical Officer in 2015. His primary responsibility is ensuring that Wellpath provides our patients with quality health care. Dr. Keldie also works as a liaison between medical staff and administration to support positive channels of communication while ensuring appropriate care to all patients. He comes to Wellpath with over three decades of clinical and administrative experience. Dr. Keldie’s previous responsibilities include providing direct patient care in primary care, urgent care, and emergency medicine in civilian, Department of Defense, and correctional medicine settings. His professional memberships include the American Medical Association, Society of Correctional Physicians, American Correctional Association, and the National Commission on Correctional Health Care. Dr. Keldie earned a bachelor’s degree in biology from the University of South Florida and a doctor of medicine degree from the University of South Florida College of Medicine. He is a fellow of the American College of Emergency Medicine and is board certified by the American Board of Emergency Medicine. Palm Beach County, Florida 4 William Ruby, DO, CCHP Associate Chief Clinical Officer Dr. Ruby has practiced in multiple areas of medicine, including community-based clinics, public health agencies, academic institutions, and correctional medicine. His passion for treating patients began immediately after training when he was the Director of Primary Care for the Center for AIDS Research and Education. Dr. Ruby furthered his reach of patients and administrative duties as the Medical Director for the New York State Department of Corrections. He was then recruited to The Johns Hopkins University School of Medicine as Assistant Professor of Medicine in the Infectious Diseases Division, where he developed the first telemedicine program, which remains active today, and concurrently held the position of Deputy Director of Clinical Services for the Maryland Department of Public Safety and Correctional Services. In order to better the treatment of HIV disease, he was recruited to a major pharmaceutical company where he was the National Medical Director for the Community, Corrections, Managed Care, and Governmental Affairs markets, where he was instrumental in bringing HIV and HCV medications to market. Dr. Ruby joined Wellpath in 2011. Judd Bazzel, MD Patient Safety Officer Dr. Judd Bazzel joined Wellpath in 2005. He received his Medical Doctorate from the University of South Alabama College of Medicine in Mobile, Alabama, and completed a residency in Family Medicine at the University of South Alabama Medical Center. Dr. Bazzel began working in correctional settings during his time as Chief Resident, and dedicated himself to the practice of correctional medicine in 2004. He is a member of the Society of Correctional Physicians and the Academy of Correctional Health Professionals. Dr. Bazzel has special interests in the management of withdrawal from substances of abuse. He assists in leading our clinical team and provides a hands-on management style when assisting our nurses and on-site medical practitioners. Dr. Bazzel is another home grown talent for Wellpath: he began as our Medical Director in Nashville, TN, giving him hands￾on experience with large jails. Palm Beach County, Florida 5 Cassandra Newkirk, MD Chief Psychiatric Officer Dr. Newkirk joined Correct Care Recovery Solutions (CCRS) in 2005. Her career spans over 32 years in forensic psychiatry and correctional mental health services administration. Having previously served as Chief Medical Officer for CCRS, Dr. Newkirk is now the Chief Psychiatric Officer for Wellpath, making her the psychiatric leader for CCRS clinical activities while adding oversight duties for Wellpath psychiatric correctional programs. Immediately prior to joining CCRS, she was the Director of Mental Health at Rikers Island in New York. Dr. Newkirk practiced general and forensic psychiatry in Atlanta with faculty appointments at Emory University and Morehouse Schools of Medicine, and currently holds a voluntary faculty position at Florida International University. She also served as Deputy Commissioner and Chief Psychiatrist for the Georgia Department of Corrections. Dr. Newkirk has held a variety of positions on professional-related organizations, including the American Correctional Health Services Association, Florida Psychiatry Society, and the Georgia Psychiatric Physicians Association. She received her bachelor’s degree from Duke University, her doctor of medicine degree from the University of North Carolina at Chapel Hill, and a master’s degree in business administration with emphasis in health care management from Regis University. Dr. Newkirk completed her residency in psychiatry at Emory University School of Medicine and is board certified in general and forensic psychiatry. Uduakobong Ikpe-Welch, PhD, JD Director of Behavioral Health for Local Government Division Dr. Ikpe-Welch joined Wellpath in 2012 as Clinical Supervisor at the Lansing Correctional Facility in Kansas, then was later promoted to Regional Behavioral Health Manager, and now Director of Behavioral Health for the Local Government Division. Born and raised in Miami, Florida, she attended the Gulliver Preparatory School and later obtained her Bachelor’s degree in psychology from Johns Hopkins University. From there, she took a year off from school with plans to travel, but instead, began a job finding housing placements for individuals with serious mental illness who were being released from incarceration. She knew then she had a passion for helping people involved in the justice system who also had mental illness, and has worked in corrections ever since. Dr. Ikpe-Welch went on to receive her PhD in clinical psychology from Nova Southeastern University in Fort Lauderdale, Florida, with a concentration in forensic psychology. She then earned her law degree from the University of Miami, became a member of the Florida Bar, and practiced immigration and criminal law briefly. She also held a position as a post-doctoral fellow in Lubbock, Texas, which afforded her the opportunity to work with the Lubbock County court system. Palm Beach County, Florida 6 1.2 Experience of Key Staff Following is an overview of the qualifications of key leadership staff who will be involved with the implementation of Wellpath services in Palm Beach County and the subsequent management of operations. Bill Kissel, CCHP Senior Regional Vice President Mr. Kissel joined Wellpath as a Regional Vice President in 2013. He has 28 years of combined correctional health care experience serving the Georgia Department of Corrections (GDC) and private correctional health care companies. Mr. Kissel has a master’s degree in Mental Health Counseling, and he has served as a Mental Health Counselor, Mental Health Director, and State Director of Mental Health for the GDC. He is a Certified Correctional Health Professional (CCHP) and an NCCHC Accreditation Surveyor. Mr. Kissel is a member and former president of the Georgia Chapter of the Board of the National Alliance on Mental Illness, and is a member of the American Correctional Association and the American Jail Association. Stephanie Peskowitz, RN, BSN Regional Manager Ms. Peskowitz has over 20 years of nursing experience, with 17 of those years spent in a correctional setting. She has experience as a Nurse Manager, Director of Nursing, Health Services Administrator, Assistant Program Manager, and a Regional Manager. Ms. Peskowitz currently serves as a Regional Manager for Wellpath, overseeing our juvenile and adult facilities in Florida. She will be a resource to Wellpath health care staff for juvenile policy, procedural, and operational matters. Ms. Peskowitz resides in Florida. Brigette DaBiere, LCSW, CCHP Regional Mental Health Director Ms. DaBiere began her correctional career with the Albany County Department of Mental Health in 2000 as a forensic mental health clinician in the Albany County Correctional Facility. In 2006, she became a Mental Health Program Director. She also worked with the Mobile Crisis Team providing crisis intervention services. During this time, Ms. DaBiere taught suicide prevention and basic mental health services to officers in the jail. She also taught a 40-hour quarterly Mental Health training module for the New York State Troopers at their Academy in Albany, NY. Ms. DaBiere relocated to Fort Myers, FL in 2014 where she began working at the Lee County Jail as a Mental Health Clinician. In 2016, Ms. DaBiere was promoted to Health Services Administrator. During that time, she became proficient in NCCH standards for medical care. Ms. DaBiere took a position with 2018 as the Regional Mental Health Director for Southwest and Southeast Regions. Palm Beach County, Florida 7 Karla Dunbar, MD Regional Medical Director Dr. Dunbar received her Doctor of Medicine degree at Emory University School of Medicine and finished training in Internal Medicine at New Hanover Regional Medical Center. After a successful career as a hospitalist and in private practice, she decided to pursue a career in corrections in 2009. Dr. Dunbar joined the medical staff at the DeKalb County Sherriff’s Office in Decatur, Georgia, in 2009 as a staff physician to provide treatment for chronic care patients and to oversee the Diabetic Clinic. She joined Wellpath in 2011 and was promoted to site Medical Director in 2012, overseeing all clinical aspects of care, including fine-tuning policies and procedures, reviewing CQI studies and improvement plans, monitoring offsite medical visits, monitoring pharmacy use, participating in direct patient care, and working closely with medical staff and other vendors to ensure quality patient care. In 2015, Dr. Dunbar was promoted to Regional Medical Director for Wellpath sites in Georgia, Florida, Tennessee, South Carolina, and Louisiana. She is passionate about health care and was named Clinician of the Year. Zela Guirola, CCHP Vice President of Partnership Development Ms. Guirola is an experienced Business Development executive with nearly a decade in correctional health care, and is a Certified Correctional Health care Professional (CCHP). During her career, Ms. Guirola has been responsible for offering and providing numerous facilities with successful medical, behavioral, and dental solutions. Ms. Guirola is all about the details, and is passionate about helping partners craft custom solutions to their health care challenges. At Wellpath, Zela brings her successful mix of industry insights and strategic thinking to key territories. She will be the primary Wellpath contact for Palm Beach County. Palm Beach County, Florida 8 1.3 Florida Experience As a result of our experience in the State of Florida, Wellpath is fully aware of all requirements to satisfy the standards of the Florida Correctional Accreditation Commission (FCAC) and the Florida Model Jail Standards (FMJS), the guidelines of the Florida Administrative Code, and the Florida Department of Health and Rehabilitative Services. We are knowledgeable of the medical and nursing nuances specific to Florida, and state and local laws, rules, and regulations. Wellpath is the industry leader in designing and operating health care programs in facilities similar to the Palm Beach County Detention Centers. The significant difference with Wellpath is that we have a proven history of success with similar sites.  Facilities of Similar Size and Complexity Nationwide: Many of our clients are the same size or larger than the Palm Beach County Detention Centers. Of our 500 client contracts, we provide services at more than 50 county, municipal, and regional jails and detention centers that have an average daily population (ADP) above 1,000 inmates.  State of Florida Experience Wellpath currently serves clients in 36 states, and understanding the regional differences from state-to-state gives Wellpath a competitive edge. With Wellpath actively providing services to 25 facilities in the State of Florida and caring for nearly 20,000 adult and juvenile patients within the state, company knowledge, best practices, and resources are readily available to support the success of the Palm Beach County Detention Centers health care program.  Accreditation Experience: Wellpath operates all of our programs at a level of care in conjunction with the standards of the National Commission on Correctional Health Care (NCCHC) and the American Correctional Association (ACA). Our program for Palm Beach County will meet or exceed these standards and will continue to maintain compliance with all state laws, regulations and guidelines. Wellpath has never failed to obtain nor lost accreditation status at any of our client facilities.  In addition, Wellpath is experienced in providing care for U.S. Marshals as well as U.S. Immigration and Customs Enforcement (ICE) Experience: Wellpath currently provides services to facilities that have 287(g) programs housing ICE detainees, and we provide all our health care services in compliance with the National Detention Standards (NDS) for Immigration and Customs Enforcement. Wellpath has a 100% record of passing all ICE audits and inspections. Wellpath currently provides care for more than 8,000 ICE detainees nationwide. 1.4 Juvenile Health Care Experience Wellpath manages combined adult and juvenile programs, as well as standalone juvenile programs, at many of our client sites across the country. We have been providing comprehensive juvenile health care services for more than 20 years. We serve 4,718 juveniles in 112 facilities for 59 clients in 24 states. Among these are statewide juvenile systems in Louisiana, Arkansas, and Illinois. ADPs range from 1 to 900. We know from experience that young patients have distinctive medical needs. They are still developing and growing, both physically and mentally. Wellpath knows how to identify, understand, and treat residents in this challenging situation. Palm Beach County, Florida 9 Wellpath will provides primary and preventative care, sick call and episodic care, acute and chronic medical treatment, and follow-up care for juveniles in our care at the Palm Beach Detention Center. Our programs will be based on documented policies and procedures addressing the provision of health services, including assessment and evaluation, suicide prevention, special needs treatment plans, referrals for care, ongoing care, and discharge planning from Day One. We develop customized policies and procedures for each of our contracted juvenile facilities to meet the specific needs of their individual populations. Wellpath has two dedicated Juvenile Specialists, Stephanie Peskowitz, RN, BSN, and Pam Poole, RN, who oversee our juvenile facilities. Ms. Peskowitz brings more than 16 years of correctional health care experience working with juveniles and adults in county and statewide settings, while Ms. Poole has 14 years of nursing experience in adult, juvenile, and federal correctional facilities. They will both serve as valuable resources to Wellpath staff at the Palm Beach Detention Center for juvenile policy and procedural matters, juvenile-specific education and programming, and orientation focused on our juvenile patients. 1.5 Home Office Support The Wellpath Home Office in Nashville, Tennessee, will directly support our on-site medical and administrative staff at the Palm Beach County Detention Centers. Our Home Office support includes a staff of Human Resource professionals to guide all recruiting and hiring, as well as Leadership Development and Clinical Education teams to train new and retained staff members. Our Finance and Accounting teams will provide regular, thorough reporting for the PBSO. Our Information Technology department will ensure that all technology meets your needs and requires minimal resources. In addition to the proposed on-site staff, and the Wellpath Executive and Regional Teams, the Palm Beach County medical program will also be supported by the following Home Office personnel: Wellpath Home Office Resources HR Manager Stephanie Popp 24/7 HR Support Line 615-324-5706 [email protected] 866-673-6176 Employee Benefits Tanya Blake 615-324-5709 [email protected] Employee Relations Joy Arsenault 615-324-5722 [email protected] Physician/Provider Recruiter Mary Wyatt 954-354-8772 [email protected] Nurse Recruiter Tammy Lamb [email protected] 615-870-2580 IT & Network Development Support Richard Lee 24/7 IT Support Line, Helpdesk 615-844-5400 [email protected] 866-631-0051 Legal Counsel Lori Schwartzmiller 615-844-5517 [email protected] Designated Case Manager Michelle Wray 615-708-9273 [email protected] Palm Beach County, Florida 10 Technical Support Wellpath offers the highest level of technical support programs in the industry. Our IT specialists are available 24/7 to troubleshoot any software or hardware problems that occur at our client sites. Our IT department provides a helpdesk hotline for employee technical support during normal business hours; after-hours emergency support is provided through a voicemail call-back process. Human Resources Hotline Wellpath offers a 24/7 Human Resources hotline for employees who need guidance regarding an issue outside of regular business hours. 1.6 Accreditation Experience The Wellpath program for Palm Beach County will meet or exceed community standards of care, as well as standards established by the National Commission on Correctional Health Care (NCCHC) and American Correctional Association (ACA). We have extensive experience maintaining NCCHC and ACA accreditation, and we will ensure that the medical program maintains Triple Crown status for the duration of the contract. Wellpath operates all of our programs at an appropriate level of care consistent with standards established by the NCCHC and ACA. Our accreditation history is well-documented: We have never failed to obtain nor lost accreditation status at any of our client facilities, and we have never been denied for continued accreditation. We conduct mock accreditation surveys at each of our facilities prior to the actual on-site audit, and we discuss our findings and recommendations with the on-site staff. Additionally, our internal quality improvement programs ensure that our client facilities meet and maintain the applicable standards. Praise for Wellpath NCCHC Audit “I wanted to take the opportunity to let you know what a great job Beth [Frederick, HSA] did in preparing for and handling the recent NCCHC audit! Both during my personal interview and during the exit interview, both of the auditors had nothing but the highest praise for Beth and her staff and the medical services your company provides. While this facility has maintained that accreditation for over 30 years, we have never partnered with better company than yours. It takes me back to the day we interviewed you for the initial RFP and the pledge Jerry [Boyle, Founder & Executive Chairman] made and you stood by ever since. Thank you.” Michael Giese, Jail Administrator Waukesha County Sheriff’s Dept., WI Palm Beach County, Florida 11 Client Accreditation Status Wellpath currently provides health care services in 211 facilities accredited by the NCCHC, ACA, and/or CALEA. The following table shows a summary of our current accreditation status. Wellpath Accreditations by the Numbers Accrediting Agency Number of Facilities NCCHC, ACA & CALEA (Triple Crown) 18 NCCHC & ACA 18 NCCHC Only 47 ACA Only 128 TOTAL 211 Wellpath has enjoyed unparalleled success in our accreditation experience. Many Wellpath sites have been named 100% compliant during their accreditation surveys. Furthermore, we carry the distinction of counting 18 Triple Crown sites among our clients. The National Sheriffs’ Association (NSA) presents its prestigious Triple Crown Award to correctional facilities that achieve accreditation by the NCCHC, ACA, and CALEA. According to the NSA, “Achieving these accreditations individually is a daunting task. Acquiring all three at the same time is an extraordinary feat. In fact, the Triple Crown distinction is so rare, that since the establishment of the award in 1993, fewer than 100 sheriffs' offices have qualified.” Wellpath is proud to manage Triple Crown facilities in:  Alameda County, CA  Alexandria, VA  Arapahoe County, CO  Augusta-Richmond County, GA  Broward County, FL (five Triple Crown facilities)  DeKalb County, GA  Elkhart County, IN  Jefferson County, CO  Marion County, IN  McHenry County, IL  Monroe County, FL  Orange County, NY  Shelby County, TN (two Triple Crown facilities) NCCHC Awards (2017 & 2012) Each year, the NCCHC presents their Program of the Year Award to one standout program among the thousands provided by accredited jails, prisons, and juvenile facilities. In 2017, the Community Oriented Re-Entry (C.O.R.E.) Program at our Westchester County Correctional Facility in New York received this prestigious award. Palm Beach County, Florida 12 In Valhalla, New York, Wellpath HSA Dr. Alexis Gendell and her team had a vision to provide additional services to our mental health patients within the Westchester County Correctional Facility. The Wellpath team worked directly with the Westchester County Department of Correction and community providers to make this vision a reality. The resulting Community Oriented Re-Entry (C.O.R.E.) Program was recognized by the NCCHC as their 2017 Program of the Year. The NCCHC also presents a Facility of the Year Award to one facility selected from among the nearly 500 jails, prisons, and juvenile facilities accredited by the NCCHC. A Wellpath site was named Facility of the Year in 2012, when the NCCHC recognized the professional delivery of health care services at the Chittenden Regional Correctional Facility in Vermont, whose health care program was managed by Wellpath. Unique Accreditation Perspective Wellpath has strong connections to the NCCHC and ACA. Jon Bosch, who led our compliance and accreditation department until transitioning into a new roll within the company, is the former Director of Accreditation for the NCCHC. Wellpath has a unique perspective into the accreditation process due to our employees’ participation in the following NCCHC activities:  Standards development  Standards interpretation  Conducting on-site accreditation surveys  Training NCCHC lead surveyors  Hosting and conducting Certified Correctional Health Professional (CCHP) exams to encourage advancement and professional certification of our employees Wellpath personnel have participated in NCCHC standards development and interpretation; on-site accreditation surveys; and training of lead surveyors. We typically send over 50 staff members to the annual NCCHC conference each year for training. Wellpath staff members regularly serve as presenters and educational session leaders at the conference. Wellpath hosts CCHP examinations at our Home Office in Nashville, Tennessee and in various locations throughout the U.S. to make it convenient for our employees to take the exam. Encouraging this certification, we provide CCHP examination opportunities for our employees on a regularly scheduled basis. Wellpath is also proud to include ACA Past Presidents Michael Wade (Sheriff for Henrico County, Virginia) and Daron Hall (Sheriff for Davidson County, Tennessee) among our clients. ACA Past President Endorses Wellpath “As advertised, your organization has been extremely responsive to our needs and the proactive manner in which you operate is in stark contrast to our previous provider…While I have been extremely impressed with [your] responsiveness, I have been even more impressed with the level of excitement and enthusiasm which has been instilled in your line staff. This is refreshing! It gives me great comfort to know that your staff respects your organization and its commitment to quality.” Sheriff Daron Hall, ACA Past President Davidson County, TN Palm Beach County, Florida 13 2 Scope of Work Wellpath will provide a health care delivery system that is specifically tailored to the PBSO needs. We will implement a managed care system that will promote efficiency and improve health care services, reduce offsite risk on transportation, and encouraging preventive health measures in the inmate population. Wellpath will be responsible for identifying all inmate health care needs and scheduling appropriate treatment, as well as coordinating all emergency and non-emergency on-site and offsite medical services. 2.1 Written Health Care Plan Wellpath will implement a written health care plan with clear objectives and site-specific policies and procedures for the Palm Beach County Detention Centers. Our goal will be to reduce risk for the PBSO, avoid unnecessary transportation and security risk for offsite care, and lower litigation claims and grievances while improving patient care. Our significant experience in these areas will help Wellpath achieve these benchmarks in Palm Beach County. Standards of Care Wellpath will perform our obligations hereunder in compliance with all applicable local, state, or federal laws, rules, regulations, and orders. The Wellpath program for the Palm Beach County Detention Centers will meet or exceed community standards of care, as well as standards established by the National Commission on Correctional Health Care (NCCHC), the American Correctional Association (ACA), the Florida Correctional Accreditation Commission (FCAC) and the Florida Model Jails (FMJ). Wellpath operates all of our programs at an appropriate level of care consistent with national standards for correctional health care. Our internal quality improvement programs guarantee that all Wellpath clients meet or exceed these standards. 2.2 Humane Treatment Wellpath will provide inmates with health care services that are consistent with care available in the community. Our focus is operating a humane, legally defensible health care program for the Palm Beach County Detention Centers. While acknowledging our responsibility to avoid unnecessary costs, Wellpath also ensures that patients receive the most appropriate care. We believe each decision related to a patient’s care should include asking ourselves, “What if this were my family member?” Wellpath will strive to provide care consistent with an inmate’s rights under the U.S. Constitution and the PBSO philosophy related to the care of incarcerated individuals, specifically that:  Inmates have a right to access health care services  Inmates have a right to professional medical judgment  Inmates have the right to care that has been ordered Wellpath stresses humane and respectful patient treatment in everything we do. Our employee handbook describes our company values, including “treating our people with respect and dignity.” 2.3 Nursing Services Wellpath will provide appropriate coverage to ensure comprehensive nursing services at the Palm Beach County Detention Centers, including receiving screenings, health assessments, medication Palm Beach County, Florida 14 administration, sick call triage and follow-up, emergency response, physician assistance, and other health care functions for the inmate population. Health care services will be provided by persons who are fully qualified and appropriately licensed, certified, or registered in the State of Florida. 2.4 Intake Screening Wellpath Registered Nursing staff will perform a receiving screening on any inmate who answers “yes” to a question on the Prescreening Questionnaire completed by custody staff. Nursing Intakes will be completed within the required eight hour Florida standard and to ensure that emergent and urgent health needs are met; our standard is to ensure screenings are completed within four hours. Wellpath receiving screenings emphasize the identification, referral, and treatment of inmates with acute and chronic health care conditions, including behavioral health disorders, suicide risk, detoxification, and dental issues, as well as inmates who require medication, isolation, or close observation. The receiving screening sets the course for the inmate’s medical care throughout their entire stay; early identification of problems using a systematic intake evaluation prevents more serious and costly problems from developing later. Wellpath understands the importance of maintaining a timely and proper booking and admission screening process to ensure the well-being of all inmates and of the overall facility operations. We will ensure adequate staffing to allow for the timely evaluation of intake orders and inmates in need of further evaluation so those with medical and mental health issues can be stabilized as quickly as possible and medications can be initiated. Wellpath will conduct receiving screenings 24 hours a day, seven days a week, including holidays to complete the intake screenings within eight hours of a patient being booked into the Jail. Juvenile intakes will be completed per NCCHC standards. Nursing staff will be available to assist for emergencies in the Breathalyzer Room until Emergency Medical Services staff arrive. 2.4.1 Receiving Screening Guidelines Wellpath has established physician-approved Receiving Screening guidelines to guide the assessment, treatment, and referral process of inmates admitted with health care needs. Wellpath nurses follow these guidelines to determine the appropriate intervention based on various conditions presented at intake. Health care staff will be trained by the responsible physician or designee in the early recognition of medical or mental health conditions requiring clinical attention. Training will include instructions on completing the Receiving Screening form and when to contact medical staff to determine appropriate disposition of the patient. 2.4.2 Admission Deferrals Admission to the Palm Beach County Detention Centers will be dependent upon clearance for any injuries or medical problems. Health care staff performing the receiving screening may identify inmates whose clinical status suggests a need for immediate health services beyond the scope of care initially available at the Jail. In such cases, patients will be referred immediately for care to a local emergency Palm Beach County, Florida 15 room or approved hospital. The inmate’s subsequent admission to the Palm Beach County Detention Centers will be predicated on written medical clearance from the hospital. Most jurisdictions have established a practice of requiring medical clearance from an outside agency when such patients are identified. Reasons for admission deferrals include but are not limited to:  Trauma/injury upon arrest  Excessive bleeding  Chest pain  Unconscious, semiconscious, or severe confusion  Active convulsions  Respiratory distress  Active labor Wellpath will perform Quality Improvement reviews on all admission deferrals to identify any additional staff training needs, as well as a utilization review on all emergency room and hospital-direct admissions/pre-booking injuries/illnesses, to ensure that inmates return to the Jail as soon as clinically indicated. 2.4.3 Communicable Disease Reporting Wellpath will immediately report all highly infectious communicable diseases to the Health Department, in accordance with local regulations. We will work with the Health Department concerning communicable disease screening, continuing medical surveillance, case management, reporting, and inmate referral in the community. The HSA will be responsible for reporting incidents to public health officials; however, all Wellpath staff will be trained on the notification process to ensure timely reporting in cases of unexpected absence or scheduled time off. These inmates will be isolated based on facility accommodations. 2.4.4 Access to Care During the receiving screening process, Wellpath staff will advise all inmates of their right to access care and the process for requesting health care services. Information regarding access to health care will be communicated both verbally and in writing in a language the inmate comprehends upon arrival at the Palm Beach County Detention Centers. Provisions will be made to ensure that non-English speaking inmates understand how to obtain health care. 2.4.5 Medication Verification Wellpath will provide adequate staffing to allow for the timely evaluation of intake orders and inmates in need of further evaluation so that inmates with medical and mental health issues can be stabilized as quickly as possible and medications can be initiated. Prescription medications will only be prescribed by licensed physicians, physician’s assistants, or nurse practitioners within the scope of their licensure. If there is an immediate need to initiate medication not currently on-site, the medication will be obtained from the backup pharmacy. Medications for life-threatening or serious chronic diseases will not be delayed upon admission. Palm Beach County, Florida 16 When it is determined that an inmate received medical or mental health care prior to incarceration, nursing staff will attempt to obtain treatment information and verify medications from community providers to facilitate continuity of care. Individuals who report psychotropic medication use at intake are asked to complete a Release of Information (ROI) so that the medication verification process can begin. Medications that are verified are reviewed by a prescribing clinician and continued as clinically indicated. If the medication verified is not considered a formulary medication, the medication order will be bridged for up to 30 days to ensure no break in care while allowing time for a clinician to review the clinical necessity of the medication. Typically, given the nature of jails as short-stay facilities, verified medications (whether formulary or not) are continued throughout the duration of an individual’s placement unless the individual reports side effects, poor response to the regimen, or a different medication is considered more clinically appropriate for the individual’s current symptom constellation. If a non-formulary medication is to be continued after the initial bridge order, the prescribing clinician will request continuation of the medication, to include a brief clinical rationale for the medication, through the Wellpath process. 2.5 Health Assessment Wellpath will conduct a comprehensive health assessment, including a complete medical history and physical examination, for all inmates prior to their being in custody for 10 calendar days. We typically target day 10 for health assessments to ensure their completion within the 14-day period required by NCCHC standards. For those newly committed and housed on the Orientation Dorm, the H&P will be completed by Day 3, consistent with current practice. This allows health care staff to identify any medical needs or conditions the inmate may have failed to disclose during the intake screening, and to initiate timely and appropriate treatment that may avoid a later need for emergent treatment or hospitalization. Wellpath staff will record the number of inmates who refuse physicals, as well as the reasons for refusal. A physician, a mid-level provider, or a properly trained Registered Nurse (RN) will conduct the health assessment in accordance with local regulations. Prior to performing health assessments, RNs must complete physical exam training provided or approved by the responsible physician or designee. The RN must pass a written test and successfully demonstrate an exam for the physician, who will sign off on the RN’s competency to complete the task. The training is documented in the RN’s training record and is repeated annually. A Wellpath physician will review, sign, and date any assessments completed by RNs and any abnormal assessments completed by the mid-level provider. Any abnormal results of the health assessment will be reviewed by a physician or mid-level provider for appropriate disposition. The comprehensive health assessment will minimally include:  A review of the receiving screening  Recording of vital signs, height, and weight  Immunization history and initiation of any needed immunizations and therapy  PPD test for tuberculosis (if not previously administered) Palm Beach County, Florida 17  Laboratory and/or diagnostic tests when clinically indicated or judicially mandated  Vision and hearing screenings  Physical examination (including breast, rectal, and testicular exams as indicated by the patient’s gender, age, and risk factors)  Pap testing for female inmates as medically indicated  Dental screening and hygiene education  Mental health assessment, including suicide potential screening and psychiatric screening  Review of health history and gathering of any additional data needed to complete the medical, dental, and mental health histories  Documentation of allergies  Other tests and examinations as appropriate, required, and indicated (diagnostic panel, urinalysis, EKG, etc.) The health care professional conducting the health assessment will record findings on a form approved by the PBSO, which will also include the individual’s title and signature, as well as the date and time of the assessment. The health appraisal will be included in the inmate’s health record. Juvenile Comprehensive Health Assessment In accordance with NCCHC Standards for Health Services in Juvenile Detention and Confinement Facilities, a Wellpath Health Care Practitioner will conduct a comprehensive assessment, including a complete medical history and physical, for all youth prior to their being in custody for seven calendar days. When clinically indicated, the comprehensive physical assessment will be completed within 24 hours from arrival to accommodate youth with significant health conditions and those on maintenance prescription drug regimens. Determination of significant health conditions will be made by a qualified medical professional in accordance with Wellpath policies and procedures. Following the assessment, a Wellpath physician will review, sign, and date the assessment findings, which will then be entered into the youth’s medical record. Wellpath staff will record the number of youth who refuse physicals, as well as the reasons for refusal. Follow-up for Identified Health Problems Wellpath will provide for all necessary follow-up for any health problem identified during the physical examination and/or any test. A physician will review this follow-up for appropriate disposition and plan of care. Inmates referred for treatment as a result of the physical examination will be seen the following day unless the provider making the referral orders the inmate to physician sick call on another day (exceptions will be made for life-threatening discoveries). 2.6 Periodic Health Assessment Wellpath will provide health maintenance exams for inmates who are under the jurisdiction of the PBSO for over one year to manage any existing conditions and identify any new conditions or illnesses that may develop. This managed care approach allows us to keep down costs for medical services while improving the overall health of our patients. For inmates undergoing prolonged incarceration, a health maintenance visit takes place upon the anniversary of their incarceration. Health maintenance exams are repeated at reasonable intervals thereafter as determined by the treating physician based on the age, gender, and health of the patient. Palm Beach County, Florida 18 The responsible physician, based on the current community standard of care, determines the specific components of the examination. 2.7 Sick Call A responsible Nursing Triage/Sick Call program is one of several critical operating systems designed to adequately and expeditiously care for patients with onset of acute or semi-chronic symptoms, other than those requiring emergency care. The Wellpath sick call process ensures that inmates have access to medically necessary health care services seven days per week, and uses a combination of nurses, mid￾level providers, and physicians for sick call services as defined within their scope of practice. Wellpath will allocate sufficient health care staff for the sick call process to allow all inmates to be seen in a timely manner in accordance with NCCHC and ACA standards. The sick call triage room will be used to complete timely sick call. During the receiving screening process, Wellpath staff will advise all inmates of their right to access care and the process for requesting health care services. Information regarding access to health care will be communicated to inmates both verbally and in writing in a language the inmate comprehends. Provisions will be made to ensure that non-English speaking inmates understand how to obtain health care. Inmates will have immediate access to sick call request forms that meet all standards and guidelines. Correctional staff can also make referrals if they have concerns for the health status of an inmate. All medical complaints will be recorded, along with a recommended intervention and referral to appropriate health care staff. Should the County begin to use the Securus kiosks for sick call, Wellpath will convert to that system for sick call request triage. Inmates will have unimpeded access to both emergency and routine care, regardless of their location, custody level, or status, at all times. If an inmate is unable to attend a sick call session due to custody status (e.g., segregated inmates) or as a result of physical condition, Wellpath will arrange to conduct sick call services at the inmate’s cell. Nurse Triage and Treatment Qualified nursing personnel will conduct sick call triage at least once daily, seven days a week, including holidays. Sick call requests will be assigned a disposition of Urgent, Priority, or Routine, and will be addressed within 24 hours. Following the collection and triage of health service request forms, inmates will receive a face-to-face consultation at the next scheduled nurse sick call. Nurse sick call will take place seven days per week. Should the need arise outside the scheduled sick call, inmates who require urgent or emergent medical attention will be seen on the same day they request such services. At the time of triage, the nurse will initiate referrals for patients in need of consultation with the medical provider. If multiple areas of interest (i.e., medical, dental, and/or mental health) are requested, additional referrals will be sent to the area of request. The nurse will document the area of interest on the request form and will sign, date, and time the form. Palm Beach County, Florida 19 Nursing Documentation Pathways Wellpath nurses conduct sick call using Nursing Documentation Pathways (NDPs), which represent a standard of care to be provided to patients in a variety of situations. The NDPs were developed by Wellpath physicians to assist nurses with diagnoses and to ensure consistency of care. The NDPs provide a consistent structure for patient care, justification for actions, and a set of interventions specific to the patient’s presenting condition. Their purpose is to provide facts and information regarding specific health conditions or complaints and, thereby, facilitate the nurse's ability to draw logical conclusions from observations, then provide appropriate intervention and follow-up for a particular health condition. In its simplest form, a Nursing Documentation Pathway is a decision-tree process for nurses to follow, which also improves ease of training and maximizes practitioners’ time. All Wellpath nursing staff are trained in the use of the NDPs. The Wellpath Nursing Documentation Pathways manual for the Palm Beach County Detention Centers will be subject to approval by the PBSO. The manual will be reviewed annually by the site Medical Director and will be updated as required by the Wellpath Nursing Department. As part of the annual review process, the HSA and/or DON will instruct all nursing staff on revised NDPs as applicable. 2.8 Patient Referrals Patients referred for provider consultation will be seen during the next scheduled provider clinic. Provider clinics will be conducted by a physician or mid-level provider and scheduled with a frequency and duration sufficient to meet the health needs of the patient population. A physician or mid-level provider will also be available on call 24/7 for emergencies. The medical provider will assess the patient and provide the appropriate treatment and follow-up. Wellpath practitioners use evidence-based practices to make clinical decisions regarding patient treatment. Wellpath has developed Clinical Monographs that represent best practices our practitioners should use when treating both episodic and chronic medical needs. Wellpath practitioners also receive training from the Wellpath Clinical Department on clinical decision making in the correctional environment. 2.9 Hospital and Other Outpatient Services Wellpath will make arrangements with offsite providers for the treatment of inmates with health care problems beyond the scope of primary care provided on-site. If an inmate requires hospitalization or specialty services that cannot be provided on-site, Wellpath will authorize, schedule, and coordinate the provision of all outpatient services, including but not limited to, outpatient surgery, diagnostic testing (e.g., MRI, CT scan, etc.), and ER ambulance services. Wellpath will coordinate with the Palm Beach County Detention Centers to arrange security for all offsite specialty care. Inmates will not be informed of scheduled appointment dates, times, or the location of outside providers. Palm Beach County, Florida 20 Wellpath Care Management System Wellpath will implement our web-based Care Management system at the Palm Beach County Detention Centers to be operational on Day One of the contract at no cost to the PBSO. The Wellpath Care Management System creates more clinical control and cost efficiencies for offsite care by allowing us to track offsite care, ensure timely return from offsite visits, manage claims, and provide reports to assist with cost containment and budget preparation. Wellpath staff will use the Care Management system to initiate referrals for offsite treatment, which will be limited to the chief complaint(s) indicated through a referral form and/or medical consultation. Referrals will be approved based on appropriateness and necessity. Palm Beach County, Florida 21 Offsite Service Referral Form – Care Management System Submitted Requests View – Care Management System Palm Beach County, Florida 22 The Care Management system will function alongside the Jail’s Jail Management System (JMS), IMAX, to ensure accurate reports for the PBSO. The Corrections Division Manager or designee will be given login information for the Care Management system in order to access management information and monitor offsite scheduling and inpatient status. With our robust Care Management system, Wellpath can offer the PBSO a level of automation and accuracy in reporting that none of our competitors can match. Following is a summary of the Wellpath Care Management process. 1. When an on-site provider determines that an inmate may need community-based services, the provider uses the Care Management system to document and communicate the Consultation Request. 2. Our Corporate and/or Regional Medical Director will access the Care Management system daily to review requests and take one of the following actions: o Authorize a specific diagnostic or therapeutic modality o Recommend an alternative treatment plan o Request additional information 3. If it is determined that the requested service is medically necessary, the request is approved and an authorization number is established in the Care Management system, which automatically sends the authorization number to the site and to the Wellpath claims department. 4. Once the site receives an authorization number, an appointment can be scheduled within the system. Authorization numbers are only valid for a specific period. Wellpath will communicate service approval to the community provider and will require pre-approval in order to assume financial responsibility for services rendered. Wellpath also verifies that all invoiced charges are appropriate. Since the system sends the authorization number to our claims department, they are able to review every invoice to ensure that the PBSO is only billed for the approved services. 5. If an inmate is released from custody prior to a scheduled appointment, Wellpath will notify the community provider that the PBSO is no longer financially responsible, and Wellpath will remove the pending appointment from the system. 6. The Wellpath Medical Director will review and address discharge summaries and medical recommendations that the community provider makes. Prospective Review (Prior Authorization) Wellpath requires prior review and authorization of all non-urgent or non-emergent care of our patients. Wellpath clinicians follow NCCHC standards and correctional guidelines to review and approve services. The Wellpath Medical Director will initiate a second review if standards are not clearly met. Alternative treatment is only at the discretion and direction of a physician. Wellpath provides clients with complete access to our easy￾to-use Care Management system, including real-time utilization reporting. We are fully transparent in our Care Management process, assuring our clients that only necessary off-site trips are being made. Palm Beach County, Florida 23 Appointment Scheduling Once the offsite referral is approved, Wellpath staff will schedule an appointment through the Wellpath Care Management system, which allows health care personnel to easily schedule appointments for offsite specialty services. Appointment scheduling through the Care Management system is a valuable tool for medical staff as they prioritize specialty appointments. This powerful scheduling function makes our Care Management system an integral tool in the provision of care. Features include:  Recurring appointments (ideal for chronic care patients)  Cancellation of appointments for patients who have been released  Rescheduling of pending appointments for patients who are re-admitted to the Palm Beach County Detention Centers  Easy-to-view daily/weekly/monthly calendars for staff review  Queues show missed appointments (due to security, court appearances, etc.) and allow for rescheduling Appointment Scheduling – Care Management System Palm Beach County, Florida 24 Sample Scheduled Appointments List (On-site) Palm Beach County, Florida 25 Sample Scheduled Appointments List (Off Site) Palm Beach County, Florida 26 2.9.1 Hospital Care In the event that a patient requires hospitalization, Wellpath will authorize, schedule, and coordinate the provision of all inpatient services. Wellpath staff will make referrals for inpatient care through the Care Management system. Any hospitalizations will be authorized by the Wellpath Medical Director. Wellpath will coordinate inpatient care with local hospitals, including Wellington Regional Hospital (for OB and deliveries), JFK Hospital, and St. Mary’s Hospital for the Main Detention Center. Lakeside Medical Center will provide hospital services for the West Detention Center when an acute care setting is deemed necessary or in emergency situations. We will utilize local hospitals whenever possible for inpatient care, and we will coordinate and collaborate with hospital administrations as needed. Emergency Room and Inpatient Referral Form – Care Management System Palm Beach County, Florida 27 ER Trips Report – Care Management System Wellpath will provide the Corrections Division Manager or designee with a daily inpatient report, which can be accessed directly through the Wellpath Care Management system. We will communicate frequently with the PBSO to provide the most complete evaluation and treatment of your patient population. Concurrent Review Wellpath will assign a Regional UM Nurse Care Manager to manage all offsite, inpatient care on a daily basis through contact with the hospital. The Wellpath Care Management team is notified of inpatient admissions at the time of admission. Wellpath Regional Care Managers and Regional Medical Directors follow NCCHC standards, InterQual Criteria, and correctional guidelines to review inpatient services daily. The Wellpath Medical Director of Care Management holds clinical rounds via telephone twice weekly to ensure inpatient stays are appropriate and meet national guidelines (InterQual Criteria) for continued inpatient stay. The Wellpath Medical Director, Regional Medical Director, and Regional UM Nurse Care Manager attend the clinical rounds discussion. As a result InterQual Criteria provide evidence-based clinical decision support guidelines to ensure that care is provided in the most appropriate setting. InterQual helps providers determine the most appropriate level of care based on severity of illness and intensity of care required. Palm Beach County, Florida 28 of this multidisciplinary approach, Wellpath ensures that inpatient stays are well-managed and appropriate transitions of care are completed with improved accuracy. Inpatient Census Report – Care Management System Retrospective Review The Care Management department and site leadership retrospectively review emergency care. Wellpath uses a retrospective review process to resolve claims issues, determine appropriateness of care post￾delivery, and perform focused reviews. Additionally, Wellpath will perform focused reviews at the request of the provider. Discharge Planning Wellpath believes that discharge planning must start on Day One to be effective, and we have policies in place regarding discharge planning for released inmates. During initial contact with the clinical provider, inmates will be informed about community resources available upon discharge. Wellpath will work with local providers to develop processes to ensure continuity of care for discharged patients, especially those with dual diagnoses of mental illnesses and substance abuse. We will strive to enhance these patients’ state of health and reduce the likelihood of recidivism by providing them with as many resources as possible to continue their treatment plans. When an inmate is discharged from the Palm Beach County Detention Centers, Wellpath will assist in creating discharge plans that detail the needed post-release care. We will medically clear inmates for discharge and secure a medical necessity form signed by the practitioner for any discharge medications. Within 48 hours of notification of an inmate’s pending release into the community, Wellpath staff will Palm Beach County, Florida 29 perform a discharge screening to determine the need for post-release medications and medical assistance. Wellpath will make post-release referrals as necessary for continuing care. If immediate post-release care is needed, Wellpath will coordinate with the PBSO to secure post-release placement. We will also assess the need for medical assistance, and will assist with the completion of necessary paperwork. Access to Health Care During incarceration, Wellpath works hard to provide each inmate with the medical care needed to live a healthy life. Outside of jail, obtaining quality health care services can be daunting for offenders. Wellpath understands this and works with each inmate to ensure that continuity of care from jail to community is intact and that no medical needs go unaddressed. Through private or public health care services, we help to build a plan with each patient and provide the right tools for them to obtain health care benefits, including Medicaid enrollment. Our discharge planning will include connectivity to services in the community to address medical and mental health care, substance use treatment, and housing needs for released inmates. Linkage for inmates with serious mental illness (SMI), substance use disorder (SUD), and/or significant medical health issues typically includes housing assistance, scheduling appointments, transportation arrangements, and the exchange/release of health-relevant information, when release date is known. Mental Health Referrals Mental health presents a challenge for most jails and a great opportunity to make a significant impact on the community. Wellpath mental health professionals will assist with discharge planning and reintegration services to bridge the gap in care when re-entering the community. Most patients require long-term or repeated episodes of care to achieve sustained abstinence and recovery. Therefore, establishing community connections is an integral component to the Wellpath Mental Health Program. Wellpath will coordinate with community providers to arrange post-release treatment to enhance continuity of care and reduce recidivism. Substance Abuse Services Substance abuse treatment is another integral component for many released patients. Because addiction is typically a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives. Attempting to navigate free world demands while also attempting to maintain sobriety in the absence of community treatment resources is not likely to be successful. Therefore, Wellpath will coordinate with Another Way and community providers to ensure appropriate substance abuse treatment services upon release. Linkage to Community Resources An effective discharge planning process begins at intake and extends continuity of care for our patients by helping to connect them with community resources. Most offenders are under our care for a limited time, so they must be made aware of available services and know how to access them for support long after they are released from custody. Our goal is to educate inmates about all resources available to them to help meet the challenges faced in sustaining a healthy and crime-free lifestyle. Wellpath works hard to provide as many community resources as possible to enable discharged patients to continue Palm Beach County, Florida 30 their treatment plans, with the goal of enhancing their physical and mental health and reducing the likelihood of recidivism. Linkage to community services is a critical component of any re-entry plan. Wellpath has a long history of establishing connections with local resources so they are ready and willing to accept clients re￾entering the community from incarcerated settings. Connectivity with community providers greatly enhances the discharge planning services offered to our clients. Wellpath also offers a group curriculum dedicated to educating inmates on identifying, navigating, and applying for community services upon release. Wellpath will develop resource guides listing community-based resources to assist in continuity of care for inmates. We will place special focus on continuity of care for those with mental health issues and chronic diseases. Many of our patients at the Treasure Coast Forensic Treatment Center are transferred from the Palm Beach Detention Center. Treasure Coast Forensic Treatment Center (TCFTC): TCFTC is a secure 224-bed forensic psychiatric facility in Indiantown, Florida. TCFTC is Joint Commission accredited and provides mental health treatment to residents found incompetent to stand trial or declared not guilty by reason of insanity. Wellpath Recovery Solutions (WRS) opened TCFTC in an abandoned state building in 2007, alleviating a statewide forensic bed shortage. WRS provides all programmatic elements to individuals found incompetent to proceed and not guilty by reason of insanity, including assessment, treatment planning, psychiatric services, competency restoration, court reports, court testimony, psychosocial rehabilitation, discharge planning, medical care, pharmacy, food/nutrition, facility maintenance, transportation, and safety/security. Forensic services provide individualized, professional, and quality care to those with psychiatric illness and substance use disorders whose needs cannot be met in the community. Documentation and Follow-up Wellpath staff will see patients returning from an offsite medical appointment or hospital stay for follow-up during the next provider sick call clinic, and will document the follow-up in the inmate’s health record. All information and documentation returned with the inmate from an offsite provider will be made part of the inmate’s health record. This will include a disposition and instruction sheet to indicate actions taken, orders written, findings from consults, treatments performed, and a detailed discharge summary for patients returning from an inpatient hospitalization. 2.9.2 Emergency Care Wellpath will provide emergency medical services 24 hours a day for any person accepted into the custody of the Palm Beach County Detention Centers pursuant to Florida State law. Correctional health care personnel are trained to respond to emergencies within four minutes. A Wellpath staff member will respond to all emergencies upon notification by reporting to the area of the emergency with necessary emergency equipment and supplies. The patient will be stabilized on-site, then transferred to an appropriate medical facility if necessary. Wellpath has established physician/mid-level provider "call back" schedules at other client facilities, allowing urgent but non-emergent services such as suturing to be provided on-site during off hours. We will analyze the feasibility of establishing this type of schedule at the Palm Beach County Detention Palm Beach County, Florida 31 Centers. By training our nurses in emergency response and offering call back physician services, Wellpath is able to reduce unnecessary offsite/ER trips and hospital stays for our clients. Wellpath staff will determine if a patient needs to be transported to a local emergency room for treatment. We will coordinate with local hospitals, including Wellington Regional Hospital (for OB and deliveries), JFK Hospital and St. Mary’s Hospital for the Main Detention Center. Lakeside Medical Center will provide hospital services for the West Detention Center as appropriate in emergency situations, and will coordinate emergency transport and ambulance services with correctional staff as needed. On-site health care staff may make emergency offsite referrals based on established guidelines and their professional interpretation of a patient’s need. The on-call physician will be notified as soon as the situation allows. The Wellpath Medical Director will conduct a retrospective review following an ER referral to ensure that the action was appropriate and to identify any additional staff training needed. Retrospective Review Form for Emergency Services – Care Management System Wellpath will customize monthly reports of emergency room visits, with data including each patient’s name and identification number, the date of emergency service, the patient’s disposition, and the emergency treatment received. Transportation and Security Wellpath will coordinate with correctional staff to arrange emergency transport and ambulance services when needed. Health care staff will work cooperatively with correctional staff to ensure that transportation services are provided in a timely and safe manner. Emergency Treatment for Visitors and Staff Wellpath will provide emergency medical treatment and first aid to stabilize any staff, visitors, employees, or subcontractors of the Palm Beach County Detention Centers who become ill or injured Palm Beach County, Florida 32 and require emergency care while on the premises. Once the individual’s condition is stabilized, he or she will be referred to a personal physician or to a local hospital. Wellpath will document any services provided. 2.9.3 Specialty Care and Referrals Wellpath understands our role as a steward of the taxpayers’ dollars, and we are dedicated to reducing unnecessary costs and community risk associated with offsite care by providing adequate care onsite. We will provide as many on-site medical services as possible to limit the number of patients who must be transported off site, while ensuring that inmates receive medically necessary health care services in the most appropriate setting. Our continued focus on the identification, referral, and treatment of inmates with chronic conditions allows us to manage our patients’ needs before they escalate and require offsite consultation, or result in grievances or litigation. Wellpath has successfully established many on-site programs and specialty care clinics for our current clients. If awarded the contract with the PBSO, we will evaluate statistics regarding offsite specialist consultations and determine what services could be more cost effectively provided on-site. Services brought on-site would typically result in cost savings for the PBSO as a result of clinic (rather than per patient) rates and decreased officer transportation expenditures. We will ensure communication with the current Dialysis, Ortho and Physical Therapy providers to continue on-site services, and Wellpath will continuously evaluate the potential benefits of the following on-site clinics and will implement them as appropriate.  OB/GYN  Cardiology  Ophthalmology  Oral Surgery  Dermatology  ENT  General Surgery  Urology  Other services as needed 2.9.4 Medication-Assisted Treatment (MAT) Wellpath will use a non-methadone method for withdrawal of heroin abusers, except in special circumstances that may require methadone maintenance (e.g., pregnant women), and as clinically determined by the Medical Director. All methadone treatment services for inmates will be in conformance with state and federal regulations. Management of chemically dependent pregnant female inmates includes education and counseling, as well as coordination with community-based medication assisted treatment (MAT) programs. Prevention of opiate withdrawal during pregnancy can be accomplished by using specific opiate substitution medications, such as Methadone or Suboxone. The National Institute on Drug Abuse has determined that Suboxone is a better alternative for a woman expecting a baby and that it is a safe alternative to Methadone. Wellpath recommends Suboxone as the preferred treatment for opioid-dependent pregnant patients. However, if a pregnant patient has been receiving Methadone at the time of her arrest, Wellpath will ensure continuation of Methadone treatment. Palm Beach County, Florida 33 Vivitrol Programming Wellpath has established Vivitrol release programs at several of our client sites. We have proven success collaborating with Alkermes, the manufacture of Vivitrol, in providing this program to our clients. When an inmate is released from custody, they will be sent into the community with a comprehensive recovery plan. As part of our discharge planning services, we will work with a community provider to establish a program should it be desired by the PBSO. We will work with local treatment centers to improve continuity of care for our patients upon release. Referrals of potential candidates will be communicated to the medical department through a variety of sources, including Wellpath staff, community substance abuse treatment providers, community mental health providers, adult probation officers, public defenders, drug court personnel, and direct patient request. Our medical staff will provide program-specific education and counseling on Vivitrol prior to an inmate’s acceptance into the program. The site Medical Director will be ultimately responsible for deciding which candidates meet the established requirements for acceptance into the Vivitrol program. 2.10 Chronic Care Patients Wellpath recognizes that many inmates with special health care needs require ongoing medical supervision and/or multidisciplinary care. We have established a Special Needs Program focused on the identification, referral, and treatment of inmates with special needs, including chronic conditions (e.g., diabetes, hypertension, asthma, seizures, etc.) and communicable diseases (e.g., HIV, tuberculosis, etc.). Special needs patients include those that are mentally ill and/or developmentally disabled. Wellpath considers any patient with long-term health care needs related to chronic conditions or acute medical and/or mental health problems to be a special needs patient. It is our goal to provide special needs patients with services that promote health maintenance and health improvement. The Wellpath Special Needs Program also emphasizes patient education to encourage compliance with treatment plans both during and following incarceration. 2.10.1 Special Needs Screening Wellpath staff will perform a special needs screening during the initial intake process and again during the health assessment. The screening will address housing, monitoring, and follow-up for special needs patients. The results of the special needs screening will be documented on a Chronic Care Referral form, which will be placed in the inmate’s medical record. Wellpath staff receive focused training and guidance regarding appropriate interventions based on the special needs screening. If it is determined that an inmate requires ongoing care, Wellpath staff will make recommendations for specialty health care services, appropriate housing, work assignments, and program participation. Patients with special needs may also be identified through self-report, during a provider encounter, or by correctional staff. Self-reported conditions will be entered in the patient’s medical record and verified by the medical provider. Referrals from correctional staff will be managed in the same manner as if the report had been made directly to medical or mental health staff by the inmate. Palm Beach County, Florida 34 2.10.2 Classification and Housing Wellpath receiving screening guidelines address housing for inmates with special health care needs, those who require monitoring, and those who may be in danger of harming themselves or others. Wellpath staff will make a recommendation for housing best equipped to meet the individual’s special needs, and will inform correctional staff of inmates with special needs that affect classification and housing. In the event that an inmate requires enhanced monitoring, the HSA or Medical Director will be contacted. 2.10.3 Individualized Treatment Plans Wellpath staff will coordinate with the Medical Director to establish individualized treatment plans for special needs patients based on their medical history and physical examination findings. Special needs treatment plans act as a reference for health care personnel involved in the inmate’s care by providing instructions regarding diagnostic and therapeutic interventions, special diets, pharmaceutical therapy, and patient education. They also include short- and long-term goals and the methods by which the goals will be pursued. Special needs treatment plans include information regarding the patient’s disposition, pharmaceutical therapy, scheduled appointments, therapeutic diet, diagnostic testing, housing assignment, ability to function in general population, impact on programming, and frequency of follow-up indicated. Wellpath will share these plans with the PBSO as needed to facilitate housing in the appropriate area of the Palm Beach County Detention Centers and to ensure proper treatment of inmates with long-term and individualized health care needs. Special needs patients will typically be reviewed by a mid-level provider or physician every 90 days, or at other intervals when medically indicated. This consultation will be documented in the patient’s medical record and will contain the date and time of the consultation, the provider’s name and title, and any new orders for the patient’s treatment. When feasible, treatment plans maintain connections between inmates and the community agencies that have been or will be serving them. Our company has a long history of establishing connections with local resources so there are providers ready and willing to accept patients from incarcerated settings. 2.10.4 Specialty Referrals Wellpath will ensure appropriate and timely access to specialty care, and will schedule referrals for specialty care providers according to clinical priority. We will strive to ensure that specialty services with urgent priorities occur as quickly as possible within 7 days of referral; routine specialty services will occur as soon as possible within 30 days of referral. If services do not occur within this timeframe, the medical practitioner will re-evaluate the patient to determine and document the level of need. Wellpath staff will schedule appointments for specialty services through our powerful Care Management system, which allows us to track and prioritize specialty appointments to ensure they take place within the required timeframe. In the event that a patient requires specialty services that cannot be provided on-site, Wellpath will authorize, schedule, and coordinate the provision of such services with local providers. Palm Beach County, Florida 35 2.10.5 Chronic Care Tracking Wellpath will track all inmates with chronic illnesses on a chronic care roster and will report these inmates to the PBSO monthly. We will maintain a list of chronic care patients that includes the date of intake, date referred to the chronic care program, date of most recent visit, and date of next scheduled visit. Monthly Medical Audit Committee (MAC) meetings will include discussion of statistics such as number of patients by chronic care diagnosis and number of chronic care patients seen in the clinic by the providers. The frequency of chronic care visits will be determined by the medical provider based on the patient’s condition(s). Wellpath clinicians will consult the Wellpath Minimum Standards for Care of Chronic Disease, which include recommendations for chronic care visit periodicity. 2.10.6 Chronic Care Guidelines Wellpath practitioners follow disease-specific, evidence-based clinical decision support protocols to ensure continuity of disease management at the initial and follow-up patient encounters. Practitioners also use a set of established Minimum Standards for Care of Chronic Disease, based on recommendations from professional organizations, to guide their treatment decisions. Wellpath has developed Clinical Monographs that represent best practices our practitioners should use when treating specific conditions. The purpose of the Clinical Monographs is to reduce variability in the care provided to groups of patients with similar health care needs. Topics include:  Asthma  Benzodiazepine Use  Cataracts  Cirrhosis  COPD  Diabetes  Emergency Contraception  GERD  HIV  Hyperlipidemia  Hypertension  Kidney Disease  Measles  Seizures  Sickle Cell Anemia  Thyroid Disease  Tuberculosis  URI  Withdrawal from Alcohol and Benzodiazepines  Wound Closure The Wellpath Continuous Quality Improvement Program (CQIP) includes CQI screens such as Continuity of Care – Chronic Disease, Patients with Special Health Needs, and Special Needs Treatment Planning to ensure that appropriate chronic care guidelines are followed at all Wellpath sites. Wellpath also offers access to UpToDate® Clinical Knowledgebase and Support Tools, an online medical resource for provider evidence-based clinical reference and patient education materials. UpToDate includes treatment recommendations based on the latest and best medical evidence. Recommendations are kept current as new studies are released and practices change. Palm Beach County, Florida 36 2.11 Dialysis Services Wellpath can continue to provide on-site dialysis services through Physician’s Dialysis Corp. We also have national contracts with Fresinius and CharDonnay Dialysis, Inc. to provide a full-range of on-site hemodialysis services. Both specialize in providing dialysis services to correctional institutions throughout the country. By working with the PBSO to analyze the current services, Wellpath can provide the most comprehensive and cost effective dialysis solution. On-site services will include initial assessment, individualized care plans, and monthly follow-ups. Individualized care plans will be based on an evaluation of the nature of the inmate’s illness and the treatment modality prescribed. These care plans will address each patient’s physical, medical, dietary, psychological, functional, and rehabilitation needs. Inmates undergoing dialysis will receive education to help them understand all aspects of their treatment. We will ensure that dialysis services are documented in the patient’s medical record. 2.12 Dental Care Wellpath will provide dental services to satisfy the dental care needs of the Palm Beach County Detention Centers’ inmate population in accordance with NCCHC and ACA standards. We take the dental needs of our patients seriously, as dental health can have a serious impact on the overall physical health of a patient. Neglect of dental needs can lead to serious infection, affecting both the health of the patient and cost of treatment. Consistent with the Wellpath care philosophy, services will be provided on-site to the extent possible. Dental services, including but not limited to exams and treatment (e.g., emergency fillings and extractions), will be provided by dental personnel licensed to practice in the State of Florida. 2.13 Ancillary Services Wellpath will authorize, schedule, and coordinate necessary ancillary services, including phlebotomy, X￾ray, EKG, and ultrasound services. Health care staff will make referrals for diagnostic services and prioritize tasks for appointment scheduling through the Wellpath Care Management system. Wellpath will provide the necessary follow-up care for health problems identified by any health screenings or diagnostic tests. Consistent with the Wellpath care philosophy, laboratory and radiology services will be provided on-site to the extent possible. Wellpath will ensure that the Palm Beach County Detention Centers have the necessary staff and supplies to provide on-site care and treatment of the inmate population, including but not limited to laboratory, radiology, medical, and dental supplies. We have par level ordering guidelines and will order the supplies necessary to ensure the continuation of proper care at the Palm Beach County Detention Centers. Infirmary Care Infirmary care is an important part of Wellpath services. Through appropriate infirmary operations, we are often able to reduce unnecessary hospital days. Wellpath will maximize use of the Main Detention Center’s West infirmary for the treatment of inmates requiring close observation and monitoring. We will operate the infirmary in accordance with NCCHC guidelines and policies and procedures of PBSO. A manual of infirmary-specific nursing care procedures will be developed and updated annually. Palm Beach County, Florida 37 Wellpath will ensure that the MDC’s West infirmary has the necessary staff and supplies to provide both routine and emergency ancillary services on site. Scope of the infirmary will include detoxification, convalescent care, skilled nursing care, pre- and post-surgical management, and limited acute care. The infirmary will also be used as a protective environment for inmates exhibiting symptoms or behavior serious enough to require notification of medical or mental health staff. Wellpath will staff the infirmary appropriately to provide 24/7 coverage for the care and observation of infirmary patients. We will utilize a combination of RNs, LPNs, and Medical Assistants for the provision of care; a dedicated supervising RN will be on duty 24/7, and a physician will be on call 24/7. An initial nursing assessment for all infirmary admissions will be completed by an RN. Nursing staff will conduct rounds daily, with a nursing note at least once per shift or more often as indicated by the patient’s condition. Our medical and mental health staff will meet daily with detention staff to share relevant information, to review the status of inmates under constant observation, and to make determinations regarding continued observation or return of inmates to general population. Wellpath staff will use the Whiteboard Method to review the status of patients in medical housing. The Wellpath physician will approve each inmate’s return to general population when recovered. More information about the Wellpath Whiteboard Communication meetings can be reviewed in Section 2.18.2 Multidisciplinary Communications. 2.14 Obstetrical Care Pregnancies among female inmates are often unplanned and high-risk, and compromised by a lack of prenatal care, poor nutrition, domestic violence, mental illness, and drug and alcohol abuse. Therefore, Wellpath will ensure adequate prenatal care, effective education, and discharge planning that emphasizes the importance of continued care upon release and where to access it. Upon determining that a female inmate is pregnant, Wellpath staff will ensure that she receives family planning counseling and discussion of options with regard to the outcome of the pregnancy. Pregnant inmates will receive comprehensive counseling and assistance based on their expressed desires regarding their pregnancy, whether planning to keep their child, considering adoption, or seeking Wellpath Infirmary Creates Cost Savings in NC Through our determination and creativity in increasing the level and quality of on-site services, we helped stabilize healthcare costs for the Durham County, NC Health Department by reducing off-site trips and thereby overall program costs. We expanded nursing services and opened an infirmary, significantly decreasing off-site trips and hospital stays. In addition, we were able to improve by 50% the discount the County had with the local hospital provider. Overall, we have reduced the County’s per inmate per day costs below what they were paying prior to our partnership, and they have stayed that way for six consecutive years under our management. “CCS was able to creatively structure a contract that managed skyrocketing inmate healthcare costs in a manner that was consistent with our philosophy of care. This was an amazing feat…I recommend CCS (now Wellpath) as a service provider without reservations.” Gayle Harris, Director Durham County Health Department, NC Palm Beach County, Florida 38 abortion services. Wellpath will ensure each patient fully understands all of her options so she can make the most informed decision possible. Pregnant patients will receive timely and appropriate prenatal care, specialized obstetrical services, and postpartum care when indicated. These services will be provided through a scheduled on-site clinic whenever possible (typically through the first 24 weeks of an uncomplicated pregnancy and after delivery). The Wellpath physician will act as the patient’s primary provider, coordinating care with an obstetrical specialist as appropriate. Care of pregnant inmates will include but not be limited to:  Routine and high-risk care, including monitoring fetal growth and heart tones  Comprehensive counseling and assistance  Identification and management of chemically dependent pregnant female patients, including education and counseling  Appropriate housing  Counseling on appropriate levels of activity and safety precautions  Prenatal vitamins  Nutritional counseling and diet plan (diet and vitamins will be planned in accordance with recommendations from the American Congress of Obstetricians and Gynecologists and Registered Dieticians)  Laboratory and diagnostic tests, including testing for gestational diabetes, HIV, and other testing as recommended by the American College of Obstetricians and Gynecologists  Observation for signs of toxemia, including urine testing for proteins and ketones  Coordination of comprehensive counseling and assistance to pregnant patients planning to keep their child, considering adoption, or seeking termination services  On-site obstetrical care when it can reasonably be provided  Postpartum care, including but not limited to lactation, monitoring for postpartum depression, contraception, and education  Education on infant care  Counseling regarding future pregnancies  Family planning services prior to release High-risk Pregnancies High-risk pregnancies and pregnancies past 24 weeks will be managed by an experienced obstetrical specialist. Pregnancy and delivery services will be provided through Wellington Regional Hospital. Wellpath will continue to facilitate testing that can be performed on-site. Patients with high-risk pregnancies will be monitored regularly and hospitalized when needed. A pregnancy is considered high risk if the patient:  Has diabetes, cancer, high blood pressure, kidney disease, or epilepsy  Has a history of tobacco, alcohol, or drug use  Is younger than 17 or older than 35 Palm Beach County, Florida 39  Is pregnant with more than one baby  Has had three or more miscarriages  Had pre-term labor, preeclampsia, or seizures (eclampsia), or gave birth to a baby with a genetic condition (such as Down Syndrome) during a past pregnancy  Has an infection such as HIV, Hepatitis C, cytomegalovirus (CMV), chicken pox, rubella, toxoplasmosis, or syphilis  Is taking certain medications such as lithium, phenytoin (e.g., Dilantin), valproic acid (e.g., Depakene), or carbamazepine (e.g., Tegretol) Perinatal Care Perinatal care (immediately prior to, during, and after delivery) will be provided in accordance with specialists’ recommendations and will usually take place in the hospital setting. Obstetrical services will be provided in the hospital setting in accordance with the Emergency Medical Treatment and Labor Act (EMTALA). Wellpath staff will ensure the provision of postpartum care, including accommodation for lactation. Patients released back to the Palm Beach County Detention Centers will be reviewed immediately by health care personnel and placed under medical observation for a minimum of 23 hours. Since separation from a child can trigger self-harming behavior, mental health staff will evaluate the patient’s emotional status. Wellpath staff will monitor patients for perinatal mood and anxiety disorders and will refer patients to licensed mental health staff as needed. Palm Beach County, Florida 40 2.15 X-Ray Services Wellpath will identify the most cost-effective and comprehensive radiology program in consultation with PBSO. We have a national contract with MobilexUSA to provide on￾site radiology services. Mobilex is the country’s leading provider of mobile X-ray and ultrasound services, serving more than 6,000 facilities nationwide. We will work with either Portable Medical Diagnostics or Mobilex and the PBSO to establish a routine schedule for on-site radiology services, including:  Mobile X-ray services  Ultrasounds  Sonograms  Doppler studies  Holter monitor studies Results can be received electronically, via fax, or manually on paper. We will maintain a log to document the type and number of X-rays completed and the results received. Medical personnel will review the log on daily to determine if any test results are outstanding. This process will ensure that test results are reported in a timely manner. All X-rays and radiology special studies will be read by a board-certified radiologist, who will provide a typed and/or automated report within 24 hours. The radiologist will call the institution if a report necessitates immediate intervention. The site Medical Director or physician/mid-level designee will be notified of all abnormal radiology results and will review, initial, and date all X-ray reports within five working days. Wellpath staff will document and store digital images and radiology reports in the patient’s electronic medical record. The site Medical Director or physician/mid-level designee will meet with the patient to discuss their results and will establish a plan of care as appropriate. Any follow-up with the patient will be noted in the medical record. Palm Beach County, Florida 41 2.16 Laboratory Services Wellpath will provide on-site laboratory services through our national contract with Laboratory Corporation of America (LabCorp). With more than 35 years of experience serving physicians and their patients, LabCorp operates a sophisticated laboratory network, performing more than one million tests on more than 370,000 specimens each day. The laboratory program for the Jail will include necessary supplies and a dedicated printer, timely pickup and delivery, and accurate reporting within 24 hours on most labs. We will ensure that all qualified health care personnel are trained in the collection and preparation of laboratory specimens. The majority of all phlebotomy and lab services will be processed on-site, including but not limited to:  Dipstick urinalysis  Finger-stick blood glucose  Pregnancy testing  Stool blood testing A medical provider will review and sign off on all laboratory results, which will be reported via a dedicated printer (unless an ERMA® interface is established in the future). If test results indicate a critical value, the provider will also receive an alert via telephone. All laboratory results will be reviewed within 24-48 hours (72 hours for weekends and holidays); the provider will be notified immediately to review all STAT lab reports and any abnormal test results. Where preliminary results are available, they will also be presented for medical review. The laboratory program for the PBSO will comply with all standards set forth by the American College of Pathology and all Florida requirements for medical pathology, specimen handling, testing, and reporting. On-site services will be performed in accordance with the Clinical Laboratories Inspection Act (CLIA) and will comply with the Clinical Laboratory Improvement Amendments of 1988. We will train all on-site staff on our laboratory policies and will provide a diagnostic procedure manual that includes reporting on STAT and critical values. All diagnostic laboratory reports and any resulting plans for follow-up care will be made part of the patient’s medical record. Lab Formulary Wellpath and LabCorp have established a lab formulary to manage laboratory costs. As part of our agreement with LabCorp, we receive discounted pricing for lab tests that we renegotiate to ensure savings for our clients. The lab formulary includes the most commonly required tests, which allows Wellpath staff to expedite the ordering process by easily selecting the appropriate tests. Should a medical provider recommend a test outside the approved lab formulary, a non-formulary request must be approved before the test can be completed. Wellpath staff will complete non￾formulary requests through our Care Management system. The non-formulary request will be reviewed by the Regional Medical Director, who will either approve the lab test or suggest an alternative plan. Palm Beach County, Florida 42 2.17 Pharmacy Services Wellpath will provide pharmaceutical services in accordance with all applicable laws, guidelines, policies and procedures, and accepted community standards. Our pharmaceutical management program includes formulary and non-formulary oversight; prescribing, filling, and administering of medications; record keeping; appropriate licensure; DEA management; and the secure and proper storage of all medications. Pharmacy Provider Wellpath plans to continue to subcontract the Palm Beach County Detention Centers’ pharmaceutical services to Diamond Pharmacy Services. As our pharmacy vendor, Diamond will maintain all pharmaceutical licenses in accordance with state and federal regulations. Diamond is the nation’s largest correctional pharmacy provider, efficiently and accurately filling prescriptions for approximately 640,000 inmates (or 30% of U.S. inmates). With 47 years of experience, Diamond currently services more than 1,500 correctional facilities in 44 states. This experience gives Diamond a comprehensive understanding of all federal, state, and local laws and statutes, as well as State Board of Pharmacy rules and regulations. Diamond offers professional comprehensive pharmaceutical services for all prescription, non￾prescription, and intravenous solutions as ordered by all prescribers, as well as clinical management and technology solutions. Diamond will ensure:  Continuity of patient care  No disruption to current service  Technicians and support personnel that have established relationships with Jail staff  A reliable delivery model  The commitment to work hard every day to greatly exceed your expectations Pharmacy Savings Wellpath and Diamond work together to provide medication for tens of thousands of patients in jail, prison, and detention facilities nationwide. In fact, Wellpath is Diamond’s largest client. Our strong partnership with Diamond allows us to receive and pass on to the PBSO the industry’s most cost￾effective and competitive pricing for pharmaceutical services. Due to our national buying power, Wellpath receives the deepest discounts in the industry from Diamond—savings we will pass on to the PBSO. Diamond offers low acquisition costs for medications (for many, the lowest in the industry) due to their tremendous size and buying power. Wellpath occasionally works with other pharmacy vendors, and we have found that Diamond’s acquisition costs are 3-4% lower compared with national competitors and are an average of 12% lower compared with local and regional providers. With 80-90% of your pharmacy bill related directly to medication costs, the difference in acquisition costs will have a significant effect. Additionally, the Wellpath program with Diamond offers the ability to receive credit on returns. Palm Beach County, Florida 43 Emergency Medications Medications for life-threatening or mental illnesses, or serious chronic diseases, will not be delayed upon admission. We have established a list of “no-miss” medications to facilitate this process. All efforts are made to verify and administer these medications prior to the next scheduled dose once the medical staff is aware, and within 24 hours for all other medications. If there is an immediate need to initiate medication, the medication will be obtained from the backup pharmacy (CVS) as quickly as possible. We will use local pharmacies to supply emergency prescription medications and as backup for pharmacy services. Due to Diamond’s size and volume, the company has aggressive national contracts with most chain pharmacies and is willing to negotiate with any pharmacy that is not in their network. Stock Medications Wellpath will only use in-house stock medications as appropriate and as allowable within state guidelines. Currently, Diamond is the only correctional pharmaceutical supplier with Joint Commission and Verified-Accredited Wholesale Distributor (VAWD) accreditation in the provision of stock medication. This allows Wellpath and Diamond to provide the highest levels of service in accordance with the standards established by these accrediting bodies. These accreditations are available to others in the correctional pharmacy industry, but only Diamond has voluntarily sought and gained accreditation. With the very large volume of stock provided to correctional facilities, we feel this differentiation between Diamond and other providers is significant. Diamond realizes that receiving emergency medications in a timely fashion is important, and they do everything in their power to expedite processing, filling, and delivery. They also realize that emergencies are costly in terms of the patient’s well-being and the expense of providing emergency care. Consequently, Diamond will continually collaborate with the site Medical Director to determine which medications need to be added to the emergency stock supply list to help minimize future emergency orders. Emergency medications not found in the emergency medication kit or the starter packs and unavailable from Diamond in sufficient time will be provided in a minimum quantity by a backup pharmacy. Over-the-Counter Medications Wellpath will establish a protocol to provide OTC medications to inmates upon consultation with the site Medical Director and PBSO. When inmates have non-prescription medications available outside of health services, the items and access to them will be approved jointly by the site Medical Director and PBSO. These items will be reviewed annually. KOP Medications A KOP program allows patients to have immediate access to necessary medications in the event of an urgent medical need; it also typically reduces the amount of health care professional time devoted to medication administration. Wellpath has established a spectrum of KOP programs intended to assist in educating inmates about their medications and to promote inmate responsibility for their own continuing state of health. We will work with PBSO to establish an effective KOP program if desired, and with approval by the county and the site Medical Director. KOP medications are limited to those that may be safely self-administered with the proper education, such as inhalers or nitroglycerine. The list of allowed KOP medications is subject to approval by facility Palm Beach County, Florida 44 administration. Inmates are only given KOP medications if they need immediate access to them at all times based on their chronic care treatment plan (e.g., inhalers for those with severe COPD or severe, persistent asthma). Inmates are instructed regarding the use of the KOP medication and must sign an informed consent statement acknowledging that the medication is only to be used as clinically directed, must be kept on person at all times, and must be presented for inspection to any officer or health care employee who requests to see it. Inmates found to be using KOP medications improperly or abusing the privilege may have their KOP privileges limited or rescinded, based on a physician’s review. Medication Renewals Wellpath will maintain a system for medication renewals to ensure that required medications are continuously available for all patients who require them. The evaluation and re-order will be documented in the inmate’s health record. Patients in need of psychotropic medications should be evaluated by the psychiatric provider prior to their renewal. Formulary Management Wellpath will introduce a formulary to better manage pharmaceutical costs for the PBSO. In a correctional facility, formulary usage with strict compliance is shown to significantly decrease total monthly pharmacy invoices. Diamond’s formulary experts combine decades of correctional pharmacy experience with clinical expertise that simply is unavailable from other providers in the industry. The formulary for the Palm Beach Detention Centers can be customized based on review of usage and cost efficiency. The Wellpath formulary is continually reviewed and modified as needed through addenda and memoranda to reflect any changes to the paper copy or electronic format. Immediate changes, with the approval of the site Medical Director and PBSO, will be incorporated with the release of new medications, when clinical information identifies previously unknown safety concerns, and when generic products become available. Utilization is important for formulary management and development. Diamond will review and provide evidence-based literature review articles specific to areas that may affect utilization and the cost￾effectiveness of medications. Pricing increases and decreases also are monitored daily. To assist in this effort, Diamond’s pharmacists receive daily price-change reports for review, as well as weekly information from Diamond's wholesaler when new medications are expected to receive generic approval and pricing. This information will be provided to the site Medical Director for review when assessing a medication’s formulary status. Pharmacy and Therapeutics (P&T) Committee Wellpath will establish a Pharmacy and Therapeutics (P&T) Committee to monitor pharmaceutical processes and utilization practices. The P&T Committee will be responsible for managing the formulary and will help balance efficacy, safety, and cost of certain medications by requiring prior approval. The site Medical Director will chair the P&T Committee, which will be multidisciplinary and will meet quarterly. Copies of P&T Committee meeting minutes and related reports will be provided to the Corrections Division Manager or designee. Palm Beach County, Florida 45 Formulary Exceptions As part of the receiving screening process, Wellpath staff will attempt to obtain treatment information from community providers and verify medications to facilitate continuity of care. During the receiving screening, Wellpath staff will ask each inmate about preferred providers and medical, dental, or mental health treatment in progress. They will also ask the inmate to complete a Release of Information (ROI) in order to request and obtain medical and/or mental health information. The ROI also allows Wellpath staff to begin the medication verification process. Medications that are verified will be reviewed by a prescribing clinician and continued as clinically indicated. If the medication verified is not considered a formulary medication, the medication order will be bridged for up to 30 days to ensure no break in care while allowing time for a clinician to review the clinical necessity of the medication. If a non-formulary medication is to be continued after the initial bridge order, the prescribing clinician will request continuation of the medication (to include a brief clinical rationale for the medication) through the Wellpath Non￾Formulary Medication Request process. The Regional Medical Director will review non-formulary requests on a daily basis. The HSA will be notified if a non-formulary medication is ordered without the appropriate use of a non-formulary request form. Given the nature of jails as short-stay facilities, verified medications (whether formulary or not) are typically continued throughout the duration of an individual’s placement unless they report side effects, have a poor response to the regimen, or a different medication is considered more clinically appropriate for the person’s current symptom constellation. Non-Formulary Reviews Diamond enforces formulary compliance on behalf of Wellpath and provides proactive first-line pharmacist reviews of non-formulary medication requests that are communicated back to Wellpath providers and Regional Medical Directors. Diamond’s drug information center and non-formulary process screens for daily orders that are non-formulary and provides our prescribers with email, fax, or phone consultation on formulary alternatives that best meet our clinical and cost-containment goals. The program works as follows:  Diamond receives an electronic notification that the facility submitted an order for a non￾formulary medication.  One of Diamond’s clinical formulary specialists reviews the patient profile and determines if any formulary alternatives can be substituted without compromising patient care.  The pharmacist’s review is sent to our providers with a recommendation for a formulary alternative, a request for additional information, or a recommendation to submit the non￾formulary request in accordance with our policy. Palm Beach County, Florida 46 Wellpath and Diamond can provide a Formulary Management Report (FMR) on a monthly basis. FMRs are a modular combination of Excel spreadsheets and charts that illustrate monthly expenditures, usage, prescribing habits, and trends. Wellpath and Diamond also provide a formulary exception report listing all non-formulary medications prescribed during a particular period and sorted by prescriber, medication name, and patient. The report contains the medication’s name and strength, dispense date, inmate name and number, prescriber, cost per prescription, order stop date, primary therapeutic class, secondary therapeutic class, formulary status indicator, and total cost per medication dispensed. Generics, Narcotics, and Off-Label Use Wellpath will prescribe generic medications whenever possible unless the clinician provides justification for a brand name request. We will track the percentage of generic versus non-generic use and will provide statistical reports on all areas of pharmaceutical management. In accordance with Wellpath policy, providers will be instructed to use sleep and pain medications only when clinically indicated. Only non-narcotic medications will be ordered in general population. Inmates that may require narcotic medications for a short-term purpose or otherwise shall be housed in the appropriate non-general population for the period that the medications are prescribed and will have the appropriate oversight by medical personnel. Wellpath policy discourages the dispensing of medication (prescription or OTC) for any off-label use. Electronic Ordering System Diamond offers unsurpassed flexibility in ordering medications. Health care staff can order medications electronically or by phone/fax using Diamond’s toll-free number 24/7/365. When the need arises for an emergency prescription, health care staff can easily fax or electronically submit the prescription using Diamond’s STAT LINE, which is staffed and available 24/7/365. Upon order receipt, Diamond will contact the backup pharmacy and arrange for the emergency prescription. Medication Administration Wellpath will provide written systems and processes for the delivery and administration of medications. We will evaluate the layout and procedures at the Palm Beach Detention Centers to determine the best method for administering medications. We will tailor medication pass for each facility to ensure the timeliness and accuracy of the process, coordinating with security staffing and meal times to ensure accurate and effective medication administration. All medications, including over-the-counter medications, will be administered by personnel appropriately licensed in the State of Florida. Our proposed staffing plan includes nursing coverage to conduct medication pass, per physician’s orders, at least twice daily for inmates in general population, and more frequently as needed for inmates in medical housing or observation, or as medically indicated. Medications will be administered within 24 hours by trained health care personnel following the ordering of the pharmacotherapy by the responsible clinician. Wellpath staff will educate patients on prescribed pharmacotherapy at the time the therapy is ordered; this education will be documented in the inmate’s medical record. Palm Beach County, Florida 47 Wellpath staff will receive orientation training in addition to a mandatory CEU regarding medication administration and the prevention of medication errors. Wellpath does not permit pre-pouring of medications and will monitor the medication delivery process to ensure this is not occurring. Nursing staff will observe patients taking medications, especially when Direct Observation Therapy is required by physician’s order. Wellpath staff are also trained to provide Direct Observation Therapy for medications subject to abuse, psychotropic medications, and those related to the treatment of communicable and infectious diseases. Health care staff will document medication administration and missed doses in an inmate-specific Medication Administration Record (MAR). These records will become a permanent part of the inmate’s medical record. All information relative to a patient’s prescription will be recorded in the MAR, which includes instructions, injection site codes, and result codes, as well as non-administered medication reason codes. In the event that an inmate misses or refuses doses on three consecutive days, or if a pattern is noted, the inmate will be referred to the prescribing clinician and each medication refusal will be documented. Administering and Tracking Medications Wellpath recognizes the importance of pharmacy controls within the correctional environment. Wellpath staff will use the electronic Medication Administration Record (eMAR) in CorrecTek. Discharge Medications When an inmate is discharged from the Detention Centers, Wellpath will assist in creating discharge plans that detail the needed post-release care. We will medically clear inmates for discharge and secure a medical necessity form signed by the practitioner for any discharge medications. Within 48 hours of notification of an inmate’s pending release into the community, Wellpath staff will perform a discharge screening to determine the need for post-release medications and medical assistance. Wellpath will make post-release referrals as necessary for continuing care. If immediate post-release care is needed, Wellpath will coordinate with the PBSO to secure post-release placement. We will also assess the need for medical assistance, and will assist with the completion of necessary paperwork. Working in conjunction with an agency called InMedRx, Wellpath has developed a method for providing discharge medications that can be implemented at the Detention Centers. Inmates in need of discharge medications will be given a prescription and a pharmacy card, specific to their individual medications and for one-time use only. The InMedRx plan allows filling of up to a 30-day prescription at any pharmacy, increasing the number of patients who are able to obtain discharge medications and improving continuity of care. Wellpath will provide a prescription card for all inmates in need of discharge medications, including those in need of psychotropic medications. When a prescription is filled, Wellpath will absorb the costs, which will be included in the pricing for our Wellpath pharmacy program. Palm Beach County, Florida 48 340B Medication Cost Programming We are exploring a 340B program on behalf of the PBSO to control costs for HIV medication for patients who are HIV positive. We will make arrangements with specialists for HIV disease management. Concept/Contract Goals  HIV disease management  Improve standardization of services  Optimize Telemedicine Scope of Services  HIV specialists to provide scheduled and episodic services to manage the HIV population.  HIV specialists will order medications and ancillary services to include agreed upon lab panels, basic imaging and immunizations directly related to HIV disease.  HIV specialists will maintain separate medical records and documentation in compliance with 340B covered entity status. 340B Pricing  Accessed to offset additional cost of providing this enhanced services delivery model  Will enhance coordinated reentry efforts into the community Because multiple entities are involved, Wellpath, the Eligible Entity, and the Contracted Pharmacy, timelines are often determined by the time for legal review of the contracts between the entities. Any delays created by the review process, will affect our timeline to put a 340B program in place during 2019. In order for the jail to benefit from 340B medication cost savings, all HIV prescriptions must be written by the “Eligible Entity.” Because of the importance of medication adherence in the treatment of HIV, it is imperative that prescriptions be continued at intake. This means medications prescribed at intake would not be eligible for 340B discounts. The saving would be based on how quickly a patient is seen by the eligible entity and how long the patient stays at the facility after that encounter. In jails, the cost of the referral to the eligible entity and the loss of returns credit for 340B drugs may negate any 340B drug savings. Wellpath will work with the PBSO to analyze the options and determine the most cost effective solution. Inventory Control Storage and Security Medications and pharmaceutical supplies will be stored in a secure, locked area, to be determined in consultation with PBSO. Bulk supplies will be kept separate and inventoried weekly and when accessed. Records will be maintained to ensure adequate control. Palm Beach County, Florida 49 Wellpath staff will be responsible for ensuring that all medications are kept secure. The medication room and all cabinets will be locked at all times when health care staff are not present. No inmate will have access to any medication other than those administered by a qualified staff member. Controlled Substances A limited supply of controlled drugs will be kept at the Palm Beach County Detention Centers under the control of the responsible physician. These medications will be monitored and accounted for by the HSA or Division Commander. All controlled substances must be signed out to the inmate receiving them at the time they are administered. As an additional level of control, Wellpath treats certain medications that are not controlled but have the potential for misuse or abuse as controlled substances. All Wellpath nurses will be trained on the proper procedures for administering, storing, counting, and logging controlled substances. Class II, III, and IV drugs will be counted at the end of every shift by one staff member going off duty and one coming on duty. Any discrepancies in the count must be reported immediately and resolved prior to the present staff going off duty. Emphasis will be placed on maintaining a clear “paper trail” that complies with DEA guidelines for accountability and record keeping. Counts will be tracked in the Controlled Substance Log Book (also known as “the red book”), a spiral￾bound log book with an index and numbered pages to ensure a perpetual inventory and usage record. Red books must be retained on￾site for five years. Sharps and Supplies During orientation, each employee will receive instruction on how to handle sharp instruments, utensils, and supplies. Needles, syringes, and other high-risk items will be stored in locked areas and signed out when they are in use; they should never be left in any area when not in use. Sharps will be inventoried at each change of shift, and each employee will be responsible for ensuring that the sharps count is correct. Employees will be instructed to never take the word of co-workers when conducting sharps counts. Used sharps are considered biomedical waste, and will be discarded directly into leak-proof, puncture resistant containers that have been designed for this purpose. Palm Beach County, Florida 50 Example of a Sharps Inventory Sheet Disposal Medications that cannot be returned to Diamond (e.g., non-unit-dose medications, medications refused by the inmate, and/or medications left by inmates upon discharge) will be destroyed. Wellpath will make every reasonable accommodation to minimize the amount of pharmaceuticals that must be destroyed. Regular audits will be conducted to remove discontinued or expired medications. Diamond can email the facility a daily Excel report to alert staff of medications approaching their expiration date. They can also set a trigger to alert staff when there are “X” number of days (e.g., 1 week, 10 days, 2 weeks, etc.) prior to a medication expiring. Wellpath will dispose of pharmaceutical waste in compliance with federal, state, and local laws and regulations. The HSA will be responsible for overseeing, monitoring, and ensuring compliance with the pharmaceutical waste disposal policy. Wellpath staff will place pharmaceutical waste inside of an approved collection container as soon as is practically possible from the time the medication becomes waste and will fill out the appropriate disposal form. Wellpath will ensure the availability of RX Destroyer products for these purposes. The RX Destroyer container will remain locked in the medication room cabinet. Wellpath staff will ensure that pharmaceutical waste is kept in a secure location and, if controlled, is counted until disposal. All controlled substances will be retained in a double-locked area with restricted access and continued counts at each shift until they can be destroyed by authorized individuals. This will be tracked in the controlled substances log book. Date Patient Name Nurse Signature Time Insulin Syringe TB Syringe 21g Butterfly 23g Butterfly 21g Vacudraw 22g Vacudraw 18g Intracath 20g Intracath 22g Intracath 24g Intracath Huber Needle 3cc syringe 25g X 5/8" 3cc syringe 22g X 1-1/2" 18g 1" Needle 20g 1" Needle 23g 1"Needle Razors #10 Scalpel #11 Scalpel #12 Scalpel Suture Removal Kit Staple Removal Kit Sharps Inventory Sheet Palm Beach County, Florida 51 2.18 Mental Health Wellpath believes in taking a proactive approach to the mental health needs of our client populations. Mental health issues are a growing concern for all correctional facilities and a key focus in Wellpath sites. Our evidence-based mental health programming is targeted to specific presenting issues and designed to address recidivism risk factors. The Wellpath Mental Health Program, which emphasizes identification, referral, and treatment, is based on established policies, procedures, and protocols that provide consistency of care for each patient. These policies and procedures address the provision of mental health services, including inmate assessment and evaluation, suicide prevention, special needs treatment plans, referrals for care, ongoing care, and discharge planning. Wellpath will identify inmates with serious mental health issues that may impact their ability to function independently while incarcerated. Our mental health professionals are trained to work with inmates entering the system who present as naïve to the correctional environment or particularly vulnerable based on stature, mental illness, or developmental disability. They will provide assessments, treatment, education, case management, and discharge planning services for these individuals. Inmates with serious mental health issues will receive an individualized treatment plan and appropriate mental health services designed to achieve stability as quickly as possible. As part of the Wellpath Mental Health Program, Wellpath staff will obtain community records, verify psychotropic medication regimens, and ensure continuity of care. They will initiate referrals for the appropriate services identified as part of the mental health evaluation, which can include psychiatry services, Special Needs Program enrollment, placement in identified mental health units, group programming (including substance abuse treatment services as indicated), discharge planning services, or transfer to more intensive mental health programs if the individual presents with mental health issues beyond what can be safely addressed in a correctional setting. 2.18.1 Program Oversight The Wellpath Mental Health Program will be overseen by Chief Psychiatric Officer, Cassandra Newkirk, MD, and Director of Behavioral Health for Local Detention, Uduakobong Ikpe-Welch, PhD, JD, and Regional Behavioral Health Manager, Brigette DaBiere, who will work directly with the on-site mental health and psychiatric staff at the Palm Beach County Detention Centers. The entire Wellpath team will be tasked with building a collegial communication structure in the care of all patients. Our corporate and regional mental health teams will coordinate with local providers to deliver a mental health program that is fully standards compliant and designed to meet the specific needs of the Jail. The Wellpath mental health team will regularly convene to discuss common issues and problems with the goal of developing joint solutions and providing the best possible proactive care for the Palm Beach County Detention Centers’ inmate population. The Wellpath Mental Health Program will include on-site visits and structured conference calls to discuss and improve established policies. Wellpath will clearly define what is required to trigger a cross-team communication event, and we will hold our team accountable for ensuring this happens whenever necessary. Palm Beach County, Florida 52 2.18.2 Multidisciplinary Communications An important initiative in total patient care is cooperation and coordination between medical and mental health teams, which Wellpath emphasizes in our mental health programs. Wellpath will ensure open communication between nursing, mental health, and correctional staff. Integrating patient information in an accessible health record will promote and enhance this effort by allowing medical and mental health staff to make decisions based on all available data and information. Wellpath will maintain current and accurate health records, service delivery logs, and other reports related to mental health services. We will also participate in periodic, scheduled administrative meetings and Continuous Quality Improvement Program (CQIP) meetings regarding mental health services. The Wellpath Whiteboard Method Wellpath will liaise with PBSO administration regarding all contract matters, including but not limited to project coordination, status meetings, and status reports. We have developed a “whiteboard method” for the management of health care services that we will use at the jail. The Wellpath whiteboard method essentially maintains a real-time HSA Command Center that provides an interactive communication system for all stakeholders at the facility. Wellpath staff are charged with advocating for our patients, executing policy and procedure, and representing our clients’ needs, while simultaneously weighing potential liability and risk to all involved. The whiteboard is a means of enhancing organization and streamlining information-sharing, with the provision of excellent patient care as the driving force. The whiteboard method promotes the philosophy that every facet of our complex system is a known entity. The whiteboard is a reporting tool that demonstrates a global awareness of overall facility operations. It provides an accurate snapshot of the site’s responsibilities for that day, that month, and that year, from high-priority medical cases and infection control statistics to site expenditures and upcoming events. The whiteboard is divided into categories that serve as the foundation of operational and clinical discussions that take place during daily morning briefings at our sites, which will include the Corrections Division Manager or his designee. This visual map serves as an outline that provides shape and structure to the focused review of salient topics. Whiteboard categories are site-specific and may include pregnant patients, inpatient status, appointments, medical housing, special needs housing, mental health housing, screening exceptions, withdrawal protocols, and/or high-acuity patients. All teams will be aware of the whiteboard’s importance in guiding daily activities at the jail, and all staff will participate in daily whiteboard meetings. Relevant data from daily briefings will be translated onto the board by leaders who are assigned to update specific areas. Every employee will be empowered to “own the board” since its contents include pertinent items communicated via email, in-person conversation, or reported in a log. No information sharing is considered too small or insignificant. Palm Beach County, Florida 53 2.18.3 Correctional Officer Training Wellpath routinely trains correctional officers on responding to potential emergency situations, on handling life-threatening situations, and on their responsibility for the early detection of illness and injury, including recognizing the signs of mental illness. We also offer suicide prevention training to correctional officers in order to recognize when an inmate is in need of emergency mental health care, based on questions asked during booking and any warning signs of self-harming behavior. Wellpath has a powerful correctional officer training curriculum that focuses on:  Legal aspects of correctional mental health care and the issues we face  An overview of the most prevalent mental health diagnoses  Review of common medications and their potential side effects  Detox and withdrawal  Communication between health care and correctional staff  Intense focus on suicide prevention and team work between health care and correctional staff 2.18.4 Goals of the Wellpath Mental Health Program There are several important goals for any jail-based behavioral health program. First and foremost is the safety of the incarcerated population. Mental health efforts must focus on ensuring that all individuals are assessed at intake and monitored throughout their incarceration for risk of self-harm. While risk of self-harm is certainly higher around the time of intake and during episodes of substance withdrawal (which occur together in a correctional environment), an individual’s risk is related to a number of internal and external factors that can fluctuate throughout their incarceration. Therefore, proactive approaches to training, referral, intervention, treatment services, and CQI studies are hallmarks of the Wellpath Suicide Prevention Program. Palm Beach County, Florida 54 In addition to safety, another important goal is the identification of those individuals who have mental health issues that may interfere with their functioning, the functioning of the facility, or both. The Wellpath Special Needs Program focuses on maintaining stability for those individuals who present to the facility with stable mental health conditions, as well as achieving stability as quickly as possible for those individuals who present to the facility with active symptomology. The Wellpath intake process affords quick identification of such conditions, with rapid referral for a more in-depth evaluation of mental health needs. 2.18.5 Initial Mental Health Screening As part of the receiving screening, Wellpath staff will perform an initial mental health screening on all inmates on arrival at the Palm Beach County Detention Centers to ensure that emergent and urgent mental health needs are met, per NCCHC guidelines. Early identification of mental health issues is a hallmark of the Wellpath Behavioral Health Program. All parties benefit when a proactive plan of care is started as soon as possible after admission to a facility, but the most benefit is for the patient. Admission to a correctional setting can be an overwhelming and distressing event. Establishing contact and rapport with a mental health provider quickly can serve to assuage many concerns and fears while helping the patient realize there are caring providers who will work with them to establish and/or maintain stability throughout the duration of their incarceration. To begin the early identification process, Wellpath staff will use a standardized mental health screening tool to screen inmates for mental health issues. The screening form will include a question regarding any history of mental health problems or treatment, hospitalizations, and/or current previous thoughts of self-harm. The Wellpath mental health screening tool complies with current NCCHC Mental Health Standards and contains an enhanced suicide risk assessment component. Inmates having suicidal ideation or appearing to be in crisis will receive an urgent referral to mental health staff. The need for securing Release of Information (ROI) documentation is also determined as part of the initial mental health screening, particularly related to self-reports of current treatment involvement, as these records are an invaluable asset to continuity of care efforts. When it is determined that a patient received mental health care prior to incarceration, nursing staff will attempt obtain treatment information and verify medications from community providers to facilitate continuity of care. Based on the results of the initial mental health screening, inmates currently prescribed psychotropic medications, receiving mental health treatment, and having a history of mental illness or self-harm will be referred for further evaluation and appropriate care. 2.18.6 Mental Health Evaluation Wellpath staff will perform an initial mental health assessment on all inmates, in accordance with current practice and NCCHC guidelines. The Medical History and Physical Assessment form used during the comprehensive health assessment includes a behavioral health component with questions regarding suicide potential, mental status, history of inpatient and outpatient psychiatric treatment, history of substance use and treatment, history of sex offenses or violent behavior, and history of victimization. Mental health evaluations will follow current NCCHC Mental Health Standards for Mental Health Assessment and Evaluation and will include more in-depth questions regarding: Palm Beach County, Florida 55  History of outpatient and inpatient mental health treatment  Current psychotropic medication  Suicidal risk, including history of suicidal behavior  Emotional response to incarceration  History of substance use and treatment  Educational, employment, military, legal, and social history  Availability of family/social support  History of violent behavior  History of sexual offenses  History of victimization  History of cerebral trauma or seizures During the evaluation, mental health staff will also complete a mental status exam and will assess the inmate’s risk level. For inmates determined to be at risk of self-harm, mental health staff will complete a Suicide Watch Initial Assessment and start suicide precautions. If the mental health evaluation indicates that ongoing evaluation and treatment are required, mental health staff will establish a treatment plan, schedule the inmate’s next session, and make the appropriate referral if a medical or psychiatric provider’s services are required. 2.18.7 Triage of Mental Health Referrals Mental health referrals can occur at any time during the inmate’s incarceration. Wellpath mental health staff will review and triage referrals daily and will respond to them in accordance with clinical judgment and NCCHC standards. Wellpath will provide adequate staffing to allow for timely mental health evaluations so that inmates with mental health issues can be stabilized as quickly as possible and medications can be initiated. Urgent referrals will be managed by mental health staff without delay, with follow-up by the Wellpath psychiatric provider as needed. Medical staff will address urgent referrals received after hours and contact the on-call psychiatrist as needed. 2.18.8 Crisis Management Wellpath will play an active role in managing mental health emergencies. Inmates demonstrating self￾injurious behaviors and increased suicide risk will be placed on constant observation until a comprehensive mental health evaluation can be completed and an appropriate disposition determined. Designated mental health housing will be used as a protective environment for inmates exhibiting behaviors that require close monitoring. When inmates are in crisis, they will receive regular visits from mental health staff in order to provide support and evaluate their risk. Providing supportive and diagnostic services to inmates when they are in crisis will:  Provide needed support to the inmate  Manage utilization of medical services (research has demonstrated that many people in crisis seek medical attention when their needs are more psychological) and provide a point of collaboration with the psychiatric provider if a medication adjustment or re-assessment is needed Palm Beach County, Florida 56 Mental health staff will perform scheduled rounds and evaluations when inmates are placed in observation or isolation. Inmates will be cleared from close observation and suicide watch only by qualified mental health professionals. Mental health staff will meet daily with correctional staff to share relevant information, to review the status of inmates on constant observation, and to make determinations regarding continued observation or return of inmates to general population. The psychiatrist will determine when an inmate can be returned to general population, with documentation in the inmate’s health record regarding the decision. Patients who require one-to-one observation will be monitored in an observation cell or transferred to the Infirmary and patient checks will be completed and documented in the Advanced Patient Monitoring System (PAMM) system. Advanced Patient Monitoring System The staff at many of our facilities use our exclusive Patient Activity Monitoring Management (PAMM) system to complete patient observations. PAMM is a computer tablet and application developed by Wellpath. We welcome the opportunity to give an on-site demonstration of the PAMM system and its capabilities to the PBSO Administration. If PAMM is used without ERMA, it is a stand-alone process and does not upload results into a health record. PAMM has been custom-built to interface with our Electronic Record Management Application (ERMA), which sends patient information and observation orders to PAMM; PAMM then sends completed patient check information back to ERMA. Certain ERMA functions interface with PAMM and directly impact its usage, including:  Patient Status  Patient Location  Precautions  Patient Observations (including activity and behaviors) Medical, mental health, or correctional staff will see the Patient Countdown Timer screen, which displays the time left before the next patient check is due. Staff then swipe the screen to complete a patient observation. The PAMM application is color-coded. A red screen indicates an observation should be done immediately. Green indicates no observation is due for at least 5 minutes. Yellow indicates that an observation is due within 2-5 minutes. Palm Beach County, Florida 57 The Patient Observation List displays all patients that are scheduled for an observation, starting from the observations closest to their scheduled time. Each patient is displayed on a “card.” The elements of a card include:  Time: Displays the time remaining until the next due observation  Observation Interval: Displays the interval at which the patient should be observed (Q15, Q30, or Q60 refer to observations needed every 15, 30, or 60 minutes)  Last Observation: Displays when the last observation was performed and any associated information on that activity The patient’s location is synced to PAMM directly from ERMA; PAMM then operates without the need for Wi-Fi during the observation rounds. At the time of the observation, the patient’s picture is captured directly on the tablet and the patient’s activity and behavior are documented. A note about the patient’s activity at the time of observation may also be included. PAMM observation data is available via a performance dashboard, giving facility administration accurate observation compliance statistics at all times. 2.18.9 Placement and Housing An essential component in the process of developing a care plan for inmates suffering from mental illness is determining proper placement. If an inmate with serious mental illness will not participate in treatment protocols, mental health staff will determine whether they are being housed appropriately. Consideration will be given as to whether the patient needs to be monitored more closely and placed in alternative housing, when applicable. Wellpath staff will screen all patients diagnosed with mental illness prior to their being placed in alternative housing to ensure the placement will not exacerbate their mental illness. Involuntary Commitment If a mental health patient exhibits a grave disability that cannot be safely and appropriately managed in a specialized correctional environment, mental health and psychiatric staff, in consultation with the Wellpath Director of Psychiatric Services, will consider the need and appropriateness for pursuit of involuntary commitment proceedings and will work to facilitate proper placement. Forensic Court Ordered Evaluations A third party will continue to provide Court-Ordered Evaluations. 2.18.10 Treatment Planning Once safety and stability issues have been addressed, the focus of the Mental Health Program can shift to treatment planning and programming designed to move beyond maintenance and address risk factors for recidivism. Key elements to address include cognitive thinking patterns that are supportive of Palm Beach County, Florida 58 criminal behavior, trauma histories, and lack of adequate community support (e.g., housing and other resources). Wellpath uses an individualized approach to treatment planning to ensure that each patient’s needs are addressed in the most effective manner possible during their incarceration. Treatment plans will include the care to be provided, the roles of the members of the treatment team, and discharge planning as needed. Wellpath understands the importance of proactive treatment planning and has learned that the delivery of proactive patient care in the correctional setting produces several long-term benefits, including:  Fostering patient trust: Wellpath patients will feel important and heard. The Wellpath team will provide care with the respect and understanding that these patients deserve. This includes knowledge of each patient’s specific situation and needs, including communication with previous care providers as necessary to ensure the continuation of patient-specific treatment programs that provide the best possible care while fostering patient trust.  Reducing patient emergencies: Wellpath will understand our patients. We will not wait for an emergency to occur. Instead, we will actively treat each patient to ensure that their needs are understood and met. Proactive treatment planning and care will reduce emergencies that typically result from the provision of reactive patient care.  Identifying relevant trends: Wellpath will implement CQI audits to evaluate our programs and to help us anticipate issues before they occur. We systematically review the quality of our mental health services throughout the year and take actions to improve processes and outcomes based on these reviews.  Improving the level of services being offered: Wellpath will work closely with the PBSO to develop site-specific improvements where possible. 2.18.11 Counseling Services Wellpath may refer inmates to a program of individual and/or group counseling services designed to address the mental health needs of the inmate population. As part of the health assessment process, inmates identified as having significant mental health needs are evaluated by a member of the mental health staff for enrollment in individual or group counseling services. Group Therapy Wellpath offers several evidence-based programs for patients with mental health issues, which we can implement at the Palm Beach County Detention Centers in consultation with the PBSO. We will also consult with the PBSO regarding the continuation of any groups currently offered at the Jail. Wellpath group therapy programs are offered in addition to the other fundamental aspects of the Wellpath Mental Health Program, including crisis management, special needs programming, intake evaluations, and suicide prevention. Group programs are open-ended to allow individuals to join at any point during their incarceration. Wellpath views incarceration as an opportunity for individuals to pursue life skills development and sobriety. Various group topics may include: Life Skills; Self Esteem Building; Identifying Stressors; Anger De-escalation; Goal Setting; Communication and Problem Solving; and psycho-educational groups on Palm Beach County, Florida 59 Managing Anxiety, Sleep Hygiene, Coping with Depression, Coping with Bipolar, and Coping with ADHD. We also offer a curriculum dedicated to educating inmates on identifying, navigating, and applying for community services upon release. Safe Group Interaction Wellpath is very selective about who can participate in group therapy. Mental health staff will monitor patients’ interactions with others and compliance with rules when selecting group participants to support a safe environment. To enable safe group interaction among inmates who pose a danger to self or others, Wellpath mental health staff will work with the Palm Beach County Detention Centers administration to establish general rules for group participants. Enhanced Behavioral Health Programs Wellpath offers several cutting-edge behavioral health programs, two of which (“Changing Lives, Changing Outcomes” and “Escaping the Cage”) were developed exclusively for Wellpath, making them a unique benefit of a Wellpath partnership. We look forward to discussing these and other options with the PBSO to ensure our behavioral health programming meets the needs of the Palm Beach County Detention Centers’ inmate population. Coping Skills The “Coping Skills” program provides materials for skill-building groups with patients who have significant problems related to mental illness. Program content includes Focusing on Our Strengths; Understanding Mental Illness; Reducing Stress; Connecting with People; Expressing Our Positive Feelings; Getting Closer to People; Standing Up for Ourselves in a Positive Way; Managing Anger; Using Our Time Well; and Avoiding Problems with Alcohol and Drugs. Seeking Safety “Seeking Safety” is an evidence-based, present-focused counseling model to help patients attain safety from trauma and/or substance abuse. It directly addresses both trauma and addiction, but without requiring individuals to delve into the trauma narrative (the detailed account of disturbing trauma memories), thus making it relevant to a very broad range of patients and easy to implement. Changing Lives, Changing Outcomes Developed exclusively for Wellpath, “Changing Lives, Changing Outcomes” is an evidence-based program targeting patients with serious mental health issues who are at high risk for criminal recidivism. The program is most effectively implemented in a group format, meeting for three sessions per week for approximately 90 minutes per session. This approach to treatment is built on the Risk￾Needs-Responsivity model for recidivism risk reduction. Changing Lives, Changing Outcomes was developed by Dr. Robert Morgan, a consultant with Wellpath who holds the John G. Skelton, Jr. Regents Endowed Professor Chair in the Department of Psychology at Texas Tech University. Dr. Morgan’s research has been funded by the National Institute of Mental Health (NIMH), the National Institute of Justice (NIJ), and the Center for Behavioral Health Services and Criminal Justice Research. The program uses a bi-adaptive model of intervention by targeting mental illness and criminalness to improve functional outcomes for justice-involved persons with mental illness. This intervention includes Palm Beach County, Florida 60 a three-part treatment protocol: Part I includes Mental Illness and Criminal Awareness, Medication Adherence, and Coping with Mental Illness and Criminalness; Part II focuses on Problematic Thoughts and Attitudes, Emotions Management, and Problematic Associates; Part III addresses Preparing for Change, Skill Development, and Substance Abuse. Escaping the Cage Developed exclusively for Wellpath, “Escaping the Cage” is a mental health treatment program for individuals in disciplinary housing who cannot access other groups. Escaping the Cage, which was provided directly to Wellpath by the program’s developers, specifically targets a population that has become a “hot button” for correctional agencies to manage—patients with serious mental illness (SMI) who are housed in segregation units. Escaping the Cage targets mental health issues, along with behavioral, emotional, and attitude skills development, to assist patients in coping with their current placement in segregation. The program also helps patients make the changes necessary to function adequately within the correctional environment, decreasing their risk for future segregation placements. It is designed to be implemented with both in￾cell and out-of-cell programming offered by Wellpath mental health professionals. Escaping the Cage uses a bi-adaptive intervention model to address both mental illness and criminal patterns with a goal of improving psychiatric and behavioral outcomes for segregated inmates with SMI. Treatment modules for the program include: Understanding, Changing, and Making It Happen; Surviving Solitary; Suicide and Self-Injurious Behavior; Understanding My Emotions; Exploring My Mental Illness and Criminalness; Seeking Supportive Allies; Integrating “Us” and “Them”; and Road Map to Recovery. 2.18.12 Protocol for Psychotropic Medications Wellpath will order and administer psychotropic medications when appropriate, in accordance with all state and federal laws. We will staff psychiatric providers to conduct medication evaluation, administration, and monitoring. Psychiatric providers will coordinate all services with mental health and medical staff. Wellpath emphasizes high standards of psychiatric care by providing quality treatment, including psychotropic medication, to those patients with serious mental health issues. We have developed written policies, procedures, and clinical letters for psychiatric services that address treatment plans, laboratory studies, informed consent, non-compliance, and management of various conditions. Inmates will only be prescribed psychotropic therapy as clinically indicated and will be monitored for medication compliance and drug toxicity. Prior to prescribing psychotropic medications, the psychiatric provider will conduct a medical record review, obtain informed consent from the patient, and educate the patient on treatment with the prescribed medications. A medical evaluation, routine lab work, and regular blood pressure monitoring will be performed as indicated on inmates requiring psychotropic medications. The results of all such monitoring will be documented in the inmate’s medical record. Medication Education Education will be provided at the time of the medication order regarding the risks and benefits associated with each prescribed medication and will be documented in the inmate’s medical record. Education will consist of informed consent, verbal information, and (where available) written Palm Beach County, Florida 61 information related to contraindications. Informed consent will be obtained and documented in the inmate’s medical record prior to the initiation of psychotropic medication. Female inmates will be specifically educated regarding the risks of taking medication while pregnant. All female inmates will be tested for pregnancy prior to orders being written for medications, if a pregnancy test has not already been provided. Emergency Medication Protocol The right to refuse mental health treatment is inherent in informed consent; however, psychiatric emergencies do occur. Wellpath has developed an emergency psychotropic medication protocol for patients determined by a physician to be dangerous to themselves or others due to acute psychiatric symptoms. The emergency administration process complies with NCCHC standards, as well as applicable laws and regulations governing emergency use of forced psychotropic medications. Emergency psychotropic medications are prescribed only when clinically indicated, and are not used for disciplinary reasons or for the management of negative behaviors associated with personality disorders. Wellpath has a Quality Improvement process for monitoring emergency administration of psychotropic medications that will be completed after such an event occurs. When an emergency medication is administered, the patient will be placed on continuous observation for no less than one hour to monitor vital signs, including respiratory status. The patient must then remain on continuous observation watch until a mental health staff member, through a face-to-face evaluation and consultation with a psychiatric provider, determines that the patient no longer poses an imminent threat to self or others. If a second dose of emergency psychotropic medication is considered, the psychiatrist must reconsider the entire course of care during the immediate event. In no case may a psychiatrist order a third dose of emergency psychotropic medication without a face-to-face evaluation of the patient. Additionally in these cases, the psychiatrist will consider the need to petition for commitment to an inpatient psychiatric unit if the patient is determined to present a need for this level of care. 2.18.13 Restraint Protocols Health care staff will not order the use of restraints unless a patient is exhibiting behavior dangerous to self or others as a result of medical or mental illness. Medical restraints are only used when a patient’s safety and welfare cannot be protected by less restrictive means. A physician’s order (verbal or written) must be obtained, along with completing a Special Consideration Form and requesting final approval from the Corrections Division Manager or designee prior to initiating restraints, except in emergency situations. The least restrictive interventions possible will be used. Wellpath recommends that orders for restraint not exceed two hours if the therapeutic restraint is to occur in a restraint chair versus an approved restraint bed; use of the restraint bed shall not exceed six hours before the order must be renewed. Wellpath does not participate in custody-ordered restraints outside of notifying Jail staff of any medical contraindications for restraint and conducting health monitoring while a patient is in custody-ordered fixed restraints. Health care staff will not participate in the restraint of patients ordered by Jail staff, except to monitor a patient’s health status. A qualified health care professional under the supervision of an RN will take all necessary measures to maintain proper peripheral circulation during the use of restraints ensuring to document vital signs, Palm Beach County, Florida 62 mental status and sensation of limbs within the first hour of placement and every 60 minutes thereafter. Patients placed on special watch will be observed every 15 minutes, with a documented evaluation by mental health staff on a daily basis. If not already involved in the case assessment, the site psychiatrist or Psychiatry Nurse Practitioner will be contacted for consultation as soon as possible. If the psychiatrist is on-site, the psychiatrist will conduct a face-to-face evaluation with the patient as soon as possible after the initiation of the seclusion status. If not on-site, the psychiatrist will conduct a face-to-face evaluation with the patient when next at the Jail. 2.18.14 Segregation Upon notification that an inmate will be placed in segregation, a qualified health care professional will review the inmate’s health record to determine whether existing medical, dental, or mental health needs contraindicate the placement or require accommodation. If contraindications or accommodations are noted, the health care professional will inform the Corrections Division Manager or designee and provide a full explanation. The review and any subsequent notification will be documented in the inmate’s health record. This review also allows health care staff to plan for continued service delivery for inmates placed in segregation. Mental health staff will be notified when an inmate is placed in segregated housing, and will be available to participate in the ongoing monitoring of the inmate’s progress. Segregation Rounds Medical and mental health staff will conduct segregation rounds on a schedule agreed upon by Wellpath and the PBSO. The frequency of segregation rounds may be determined based on facility policy, accreditation standards, or degree of isolation. Typically, segregation rounds are conducted weekly by mental health staff and at least three times per week by medical staff. Segregation rounds will be documented on individual logs, to include the date and time of contact and signature or initials of the staff member making rounds. Wellpath staff will document any significant findings in the inmate’s health record and will make any needed referrals for care. We will promptly inform the Palm Beach County Detention Centers administration of inmates who are physically or psychologically deteriorating, and those exhibiting other signs or symptoms of failing health. Mental Health Concerns When a patient with serious mental illness is placed in segregation, the patient’s treatment plan should be updated to reflect the changed environment, given the documented impact of isolation on symptoms of mental illness. Experience has demonstrated that patients are at elevated risk for suicide when placed in isolated settings. Therefore, it is Wellpath best practice to provide additional mental health screening during this high-risk period, beyond the chart review completed by health care staff upon the patient’s placement in segregation. Where possible, Wellpath mental health staff should provide screening for suicide risk during the first two-to-three business days following a patient’s placement in segregation, to be followed by weekly rounds. Palm Beach County, Florida 63 2.19 Telemedicine and Medical Videoconferencing Wellpath has embraced telehealth in many of our health care programs. Wellpath performed more than 50,000 telehealth encounters in 2018. Wellpath will analyze existing telehealth clinics and intends to expand telehealth services. Telehealth will not replace face-to-face patient encounters, but augment service delivery. Based on patient volume, technological accessibility, and facility work flow, Wellpath can implement the following specialty clinics via tele-health:  Wound Care  Gastroenterology  Dermatology  Infectious Disease  Urology  Neurology  Nephrology Platform: Our client base has access to a broad array of telehealth services. From this platform, Wellpath anticipates sustained results in improved patient safety, clinical effectiveness and cost savings. Tele-Mentoring: Teleconferencing tools are used to increase clinical collaboration and communication. Wellpath clinical leadership provides structured clinical onboarding of new practitioners, ongoing collaboration, mentoring, and PEER review using this technology. Scheduled Telemedicine: Scheduled encounters via synchronous audio and video to conduct clinics in a variety of specialties. Benefits include: increased access to services and specialties, reduced time to fill open positions and reduced offsite transportation. Specialty eConsult: Utilization of HIPAA compliant and secure platform connecting providers to national network of specialty providers. eConsult response time is under 24 hours (typically 8 hours) for 30+ specialties and access to 200+ specialty clinical checklists. Behavioral Health/Telepsychiatry: Wellpath utilizes telepsychiatry as an effective solution to the nationwide shortage of mental health professionals and uses teleconferencing solutions to connect onsite behavioral health programs for increased access to care. Wellpath has developed an internal teleprovider network with national behavioral health telemedicine providers like Regroup and MindCare Solutions (MCS) to supplement our internal resources. These partners have correctional experience, and like Wellpath, believe that combining physical health with behavioral health, early and appropriately, will yield better overall health outcomes and reduced costs. These companies combine technology with a staff of psychiatrists and advanced practice nurses who regularly collaborate with other specialists to treat medically complex patients. Tele-behavioral health partners deliver documentation back to the facility or utilize the facilities’ EHR and provide monthly metrics to the Wellpath Telemedicine Department. Cross-Facility Tele-Behavioral Health: A variety of behavioral health applications are possible through telehealth beyond remote telepsychiatry. Synchronous audio and visual teleconferencing between facilities can enhance existing programs. Teleconferencing technology can connect patients at different Palm Beach County, Florida 64 locations for remote group therapy. Additionally, telehealth can facilitate patient access and enable participation in specialized programs hosted at other facilities. Wellpath will evaluate opportunities to leverage telehealth potential to the benefit of the entire behavioral health program. Wound Care: Wellpath provides telehealth-supported wound care through our clinical partner MyWoundDoctor® (MWD), which helps significantly reduce the overall cost of wound care treatment for both emergency and chronic wounds, and more importantly prevents the likelihood that patients will have serious wound infections and exacerbated wounds that lead to amputations. Using a secure mobile application and a clinical console, MWD works in collaboration with on-site clinicians to review images of each patient’s wound and provide clinical consultation services 24/7 using evidence-based wound care treatment protocols to inform the clinician regarding a recommended treatment plan for each patient. Follow-up images of the patient’s wounds are reviewed by MWD clinicians to evaluate the healing rate of the wound and to communicate any additional clinical suggestions to the on-site clinicians. MWD’s HIPAA compliant platform supports the ongoing care of patients, both during incarceration and during the re-entry process. The MWD app is available from the Apple or Google Play application stores if the patients want to pursue transitional care during re-entry directly from MWD. The benefits of using MWD include the reduction in both transportation and security costs for the ECSD when a patient is cared for using telehealth support, as well as the reduction in overall costs of acute care services that might not be required based on the clinical consultation of credentialed physicians and certified wound care nurses on staff at MWD. In addition, MWD offers MWD Supply Paks™. These are wound care supply packages prepared in advance using clinical wound care supply formularies specifically bundled by the patient’s wound profile and used by the onsite Wellpath clinicians to support healing the patient’s wound efficiently and effectively. The use of the MWD Supply Paks™ is optional based on the Wellpath medical supply contracts. MWD provides Wellpath monthly wound care image documentation for each treated patient as well as access to all clinical wound care suggestions to the Wellpath onsite clinicians for any compliance audit requirements. Policy: Appropriate use of telemedicine requires a thorough understanding of relevant laws, requirements and guidelines that govern topics, including but not limited to the following:  Telehealth provision  Confidentiality  Protected health information  Appropriate technology services to support a telehealth platform  Selection and onboarding of health care providers  Obtaining informed consent that addresses issues specific to telehealth It is Wellpath policy to conduct telehealth encounters that comply with all state and federal laws, including those relating to the licensing of health care providers and the privacy of patient information. Wellpath tracks the evolving telehealth regulatory landscape and works with sites to establish and maintain compliance. Wellpath also enforces corporate telehealth policies that establish expectations for the quality of telehealth care delivery, technology performance and the patient experience. Palm Beach County, Florida 65 Technology: A variety of technology solutions are available and in use for telemedicine encounters based on the clinical requirements of the specialty and the needs and preferences of our clients. All solutions ensure data security and HIPPA compliance and all solutions are dependent upon a stable network with adequate bandwidth. Wellpath utilizes the end-to-end secure and HIPAA compliant web-based teleconferencing software Zoom that can be used with a standard All-In-One PC, laptop or Toughbook with webcam and audio capabilities; wound care evaluation software enabled cellular devices; solutions that seamlessly connect with existing client investments in Polycom, Sony, and Cisco hardware. Accessory options include remote pan and tilt cameras, mobile carts, dual monitor options, echo cancellation mics, speakers and headphones, as well as telemedicine capable high resolution USB clinical peripherals. Wellpath Telehealth Department works with each facility to design, test, and implement a telemedicine technology solution that suits their unique needs, physical space, budget, network and existing hardware. Implementation: Wellpath Telehealth Department leads and facilitates the implementation of telehealth services at our client facilities. Utilizing an established telemedicine implementation approach, the team will customize the plan to address the unique needs and work collaboratively with the ECSD’s IT team and site leadership as well as Wellpath IT, Operations, and Clinical leadership to ensure success. Our implementation process will focus on the following areas of activity. Project Initiation: Wellpath will schedule a kickoff call that focuses on defining project scope, collaboration, and setting expectations. This will include:  Setting project roles and points of contact  Discussing facility challenges and needs  Establishing criteria for telehealth success  Reviewing preliminary technical and staffing information  Discussing budget considerations  Reviewing provider resource options Palm Beach County, Florida 66 Policies and Procedures: Wellpath will work with the facility project team regarding relevant regulatory telehealth requirements or guidelines. This will include:  Providing information on the Wellpath Telehealth Policy  Researching and providing information on state and federal regulations  Recommending workflow adjustments or additional forms to comply with regulatory requirements Coordination and Workflow: Wellpath will establish a clearly defined coordination and workflow process to support telehealth delivery of care. This will include:  Establishing a clinic schedule based  Defining documentation workflow between the facility and provider  Establishing a clinic workflow that optimizes efficiency and productivity with consideration for staff involvement Staffing and Training: Wellpath will provide training to key participating staff and providers to support the success of the telehealth initiative. This will include:  Sharing relevant policy and regulatory information  Discussing the telehealth workflow for the facility  Training each participant to use the selected telehealth equipment, software, accessories and peripherals relevant to their role  Providing information on how to get help should a technical issue arise. 2.20 Detoxification and Withdrawal Protocol Wellpath will manage detoxification services in the Orientation Dorm, (unless infirmary placement is indicated) for patients withdrawing from drugs and/or alcohol in a cell that allows for frequent monitoring and observation by both custody and medical staff. Wellpath takes the management of drug and alcohol withdrawal very seriously. We understand the high-risk nature of this medical issue and continually review and revise our policies and protocols as advances are made to this area of medicine. Individuals booked into the facility who are intoxicated, a threat to their own safety or the safety of others and are placed in the protective environment of a sobering cell will be under close observation by custody and health services staff. Withdrawal from alcohol and drug intoxication will be done under medical supervision in accordance with direct orders from the responsible medical provider and/or approved protocols/standardized procedures. All protocols were developed using the work of experts in the field of addiction medicine. We provide continuing observation and assessment at a minimum of every four hours, documented on the custody monitoring log and the Wellpath Alcohol Withdrawal Syndrome Assessment (CIWA) or Clinical Opiate Withdrawal Scale (COWS) assessment tools for alcohol and opioid withdrawal. Inmates remaining in sobering cells longer than four hours will be seen by the MD or mid-level provider during regularly scheduled sick call and at any time when requested by custody staff. Palm Beach County, Florida 67 Wellpath will provide medically supervised on-site withdrawal management services in accordance with all applicable standards of treatment. When medically indicated, patients will undergo a complete withdrawal management program, minimizing risk of adverse symptoms and the need for offsite treatment. The responsible provider will be called and/or the inmate sent to the local Emergency Department for all inmates meeting the following criteria:  non-improving CIWA/COWS scores in response to medication after six hours  seizures  severe, profound confusion  and/or temperature greater than 101° Wellpath will ensure that all health care and correctional staff are trained to recognize the signs and symptoms of withdrawal and to take the proper next steps to safely manage patients experiencing these symptoms. We also provide correctional staff with Quick Facts for Intoxication and Withdrawal designed as a quick reference to help them identify inmates in need of medical intervention. The Wellpath Withdrawal Management Program incorporates the following steps:  Receiving Screening  Observation and Monitoring  Treatment Receiving Screening: Many individuals arrive in the correctional setting under the influence of drugs or alcohol. Significant histories of substance abuse increase the possibility that they will experience some degree of withdrawal. Therefore, the Wellpath receiving screening includes questions regarding types of substances used, time of last usage, frequency and amount of usage, length of time using, and side effects experienced when ceasing use in the past. During the receiving screening, Wellpath staff will use a standardized form to evaluate all inmates for signs and symptoms of withdrawal, including:  Anxiety and agitation  Disorientation  Visual and auditory disturbances  Nausea and headache  Tremors  Paroxysmal sweats  Elevated pulse, respiratory rate, and blood pressure Inmates who report alcohol and/or drug dependence or who are identified as being at risk for withdrawal will receive a more in-depth assessment. Wellpath staff will complete this assessment using the Addiction Research Foundation Clinical Institute Withdrawal Assessment – Alcohol (CIWA-Ar) and/or the Clinical Opioid Withdrawal Scale (COWS). Palm Beach County, Florida 68 These tools have been researched and shown to be viable methods for assessing the severity of withdrawal symptoms based on observation of the inmate’s/detainee’s behavior or response to questioning. Wellpath medical personnel also use the CIWA-Ar/COWS tools to determine the responses of our patients to medications given to ameliorate withdrawal. Please see examples of our CIWA and COWS Assessment Tools on the following pages. Palm Beach County, Florida 69 Palm Beach County, Florida 70 Palm Beach County, Florida 71 Observation and Monitoring: Inmates determined to be at risk for alcohol or drug withdrawal will undergo withdrawal monitoring. Nursing staff will contact the physician/mid-level provider on duty or on call when inmates are identified as high risk for withdrawal. Based on the clinical presentation of the inmate, the provider may recommend placing them in observation. Inmates experiencing withdrawal from alcohol, opiates, or benzodiazepines will be monitored for at least five days or longer if deemed necessary by the provider. Inmates undergoing withdrawal monitoring will be assessed by medical personnel three times daily and anytime requested by facility staff. During each assessment, the Inmate will undergo a short mental health screen that assesses current thoughts of suicidality, hopelessness, or recent bad news. A positive answer to any of these questions will result in the Inmate being placed on suicide watch and the mental health provider will be called. Withdrawal can be uncomfortable and is a risk factor for suicides and suicide attempts, so Wellpath prefers to take this proactive approach. Treatment: Wellpath establishes a physician treatment plan as soon as we assess the potential for withdrawal from alcohol or sedative-hypnotics. The Regional Medical Director will orient clinicians regarding effective management of care based on specific criteria. Medical personnel will establish an individualized treatment plan based on their assessment of the patient’s condition. The treatment plan may include prescribed pharmaceutical therapy, as indicated. Wellpath has established a best practice for determining the medications to be used, the frequency of use, and the starting dose of these medications. This best practice has been translated into an order sheet used by practitioners to manage and treat the symptoms of withdrawal. This document dictates the minimum amount of medication that should be used to treat patients going through withdrawal, thus allowing for immediate use for most patients. Individual treatment plans are developed for those who do not respond as expected. 2.21 Discharge Planning We believe that discharge planning must start on Day One in order to be effective, and we have policies in place regarding discharge planning for released inmates. During initial contact with the clinical provider, inmates will be informed about community resources available upon discharge. Wellpath will work with local providers to develop processes to ensure continuity of care for discharged patients, especially those with dual diagnoses of mental illnesses and substance abuse. We will strive to enhance these patients’ state of health and reduce the likelihood of recidivism by providing them with as many resources as possible to continue their treatment plans. When an inmate is discharged from the Palm Beach Detention Centers, Wellpath will assist in creating discharge plans that detail the needed post-release care. We will medically clear inmates for discharge and secure a medical necessity form signed by the practitioner for any discharge medications. Within 48 hours of notification of an inmate’s pending release into the community, our staff will perform a discharge screening to determine the need for post-release medications and medical assistance. Wellpath will make post-release referrals as necessary for continuing care. If immediate post-release care is needed, we will coordinate with the PBSO to secure post-release placement. We will also assess the need for medical assistance, and will assist with the completion of necessary paperwork. Palm Beach County, Florida 72 Access to Health Care During incarceration, Wellpath works hard to provide each inmate with the medical care needed to live a healthy life. Outside of jail, obtaining quality health care services can be daunting for offenders. Wellpath understands this and works with each inmate to ensure that continuity of care from jail to community is intact and that no medical needs go unaddressed. Through private or public health care services, we help to build a plan with each patient and provide the right tools for them to obtain health care benefits. Our discharge planning will include connectivity to services in the community to address medical and mental health care, substance use treatment, and housing needs for released inmates. Linkage for inmates with serious mental illness (SMI), substance use disorder (SUD), and/or significant medical health issues typically includes housing assistance, scheduling appointments, transportation arrangements, and the exchange/release of health-relevant information, when release date is known. Mental Health Referrals Mental health presents a challenge for most jails and a great opportunity to make a significant impact on the community. Wellpath mental health professionals will assist with discharge planning and reintegration services in order to bridge the gap in care when re-entering the community. Most patients require long-term or repeated episodes of care to achieve sustained abstinence and recovery. Therefore, establishing community connections is an integral component to the Wellpath Mental Health Program. We will coordinate with community providers to arrange post-release treatment to enhance continuity of care and reduce recidivism. Substance Abuse Services Substance abuse treatment is another integral component for many released patients. Because addiction is typically a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives. Attempting to navigate free world demands while also attempting to maintain sobriety in the absence of community treatment resources is not likely to be successful. Therefore, we will coordinate with Another Way and community providers to ensure appropriate substance abuse treatment services upon release. Linkage to Community Resources An effective discharge planning process begins at intake and extends continuity of care for our patients by helping to connect them with community resources. Most offenders are under our care for a limited time, so they must be made aware of available services, and know how to access them for support long after they are released from custody. Our goal is to educate inmates about all resources available to them to help meet the challenges faced in sustaining a healthy and crime-free lifestyle. Wellpath works hard to provide as many community resources as possible to enable discharged patients to continue their treatment plans, with the goal of enhancing their physical and mental health and reducing the likelihood of recidivism. Linkage to community services is a critical component of any re-entry plan. Wellpath has a long history of establishing connections with local resources so they are ready and willing to accept clients re￾entering the community from incarcerated settings. Connectivity with community providers greatly Palm Beach County, Florida 73 enhances the discharge planning services offered to our clients. We also offer a group curriculum dedicated to educating inmates on identifying, navigating, and applying for community services upon release. Wellpath will develop resource guides listing community-based resources to assist in continuity of care for inmates. We will place special focus on continuity of care for those with mental health issues and chronic diseases. 2.22 OneCare: Collaborative Correctional Care℠ Behavioral health issues are the most significant challenges faced by county jails across the country, with more than 60% of inmates having some degree of situational mood disorder, substance use disorder, or psychiatric illness. In most jails, the care of patients with mental or behavioral health issues is restricted to a small group of psychiatric providers and licensed behavioral health professionals. They often lack the time and resources to adequately meet the growing behavioral health needs of the inmate population, a situation exacerbated by a worsening shortage of psychiatrists. We developed OneCare: Collaborative Correctional Care℠ as our solution to this problem. OneCare is based on the Collaborative Care model developed by the University of Washington’s Advancing Integrated Mental Health Solutions (AIMS) Center. Collaborative Care brings mental health care to primary care clinics. Its strength lies in treating persistent mental health conditions like depression and anxiety that require systematic follow-up for patients to get better. Over the past two decades, the AIMS Center has worked with over 1,000 organizations and trained more than 6,000 clinicians around the world to implement Collaborative Care. Studies have demonstrated that Collaborative Care provides better access, lower costs and better outcomes. OneCare: Collaborative Correctional Care℠ is Collaborative Care modified and optimized for the correctional environment. The OneCare model of care expands and enhances the care available to patients with mental and/or behavioral problems by integrating medical and mental health care. As part of implementing this model, Wellpath is expanding the training of all of its primary care staff, from nurses to providers, to include mental health and One Patient. One Team. We believe it is time to reconnect the head with the body, and eliminate the silos that exist between medical and behavioral healthcare. Palm Beach County, Florida 74 substance use training. Now, instead of a very limited number of staff devoted to the care of patients with mental or behavioral concerns, we have an entire care team with the training to screen, assess, and intervene to help this large subsection of our jail population. The OneCare model can also improve the care of all chronic health conditions. There is often a link between mood disorders and chronic medical conditions, and care improves when this link is understood and addressed. When care is “siloed” into medical or mental health, rather than addressed collaboratively, care and the patient suffer. One Patient. One Team. OneCare: Collaborative Correctional Care℠ reconnects the head with the body, eliminating the silos between medical and behavioral health care. OneCare is integrated medical and behavioral care that aligns the right resources to match the need. Designed to treat patients with chronic care needs, situational depression and anxiety, significant and persistent mental Illness (SPMI) and substance use disorders, OneCare: Collaborative Correctional Care℠ is evidence-based care that uses early identification, engagement and treatment to execute a shared care plan. We are excited and proud to be the first national correctional health care provider to bring the benefits of Collaborative Care to county jails and juvenile facilities. OneCare: Community Another key facet of OneCare is how it reaches beyond the facility walls, and into the community. We call these efforts OneCare: Community. A primary goal of ours in developing OneCare was a belief that collaborative care can have an impact on recidivism. For example, when it comes to patients with substance use disorder, proper assessment, intervention, treatment, discharge planning, re-entry and ongoing sober living are all critical to the spectrum of care needed. As a result, a key to OneCare’s success is not only to provide great care while the patient is with us, but also to know they have a place to go to continue their healthy journey once they are released. This means relationships with community programs is an absolute necessity in our solution of care. From drug and alcohol, to housing, to job and life skills, OneCare includes the building of bridges to successful community programs that maintain the continuity of care, and help our patients get well, get out, and get on the right track. The Principles of OneCare: Collaborative Correctional Care℠ OneCare: Collaborative Correctional Care℠ is a patient-centered model in which primary care staff and providers, behavioral health specialists, and a Care Manager form the Care Team. This Care Team works collaboratively to assess the patient’s care needs, enter the patient into the right care protocol, and monitor care progress and outcomes during the entire length of incarceration. Discharge planning ensures a successful “hand off” of care to community providers to help reduce community health care costs and recidivism. OneCare: Collaborative Correctional Care℠ follows five core principles: 1. Inmate-Patient Centered Care Team - Primary care and behavioral health providers collaborate effectively using shared care plans that incorporate patient goals. Palm Beach County, Florida 75 2. Population-Based Care – The care team shares a defined group of patients with a variety of diagnoses tracked in an electronic tracking registry to ensure no one falls through the cracks. 3. Measurement-Based Treatment to Target - Each patient’s treatment plan clearly articulates personal goals and clinical outcomes that are routinely measured by evidence-based tools like the PHQ-9, GAD-7, and clinical indicators such as blood pressure trends and HbgA1C trends. 4. Evidence-Based Care – All care guidelines are evidence-based and match community best-practice standards. Behavioral interventions will be part of the tools used by the care team. 5. Accountable Care - Providers are accountable for quality of care and clinical outcomes, not just the volume of care provided. OneCare: A Staffing Force Multiplier With so many patients suffering with mental and behavioral health issues, a key challenge is how to match the resources with the need. At first glance, the solution is to hire more mental health professionals, but this quickly increases costs and keeps medical and mental health care in silos. OneCare is a force multiplier that converts a disparate group of health care professionals into an integrated medical, mental and behavioral care team. With OneCare, everyone on the medical team receives specialized training so they can provide routine mental and behavioral care, reducing the burden on overtaxed behavioral and mental health professionals. At a time when the question is how to handle so many, the answer is not entirely about adding more people. The answer is doing more with the people you already have. The answer is OneCare. The OneCare Structure The structure of OneCare: Collaborative Correctional Care℠ focuses on the key care areas found in a correctional setting: Chronic Care, Situational Depression and Anxiety, Serious and Persistent Mental Illness (SPMI) and Substance Use Disorder (SUD). This care is built on a clinical philosophy and foundation of Care Management, Evidence based Treatment Protocols, and Outcomes. We include here more information about each of these core aspects of this comprehensive, effective and efficient solution. Palm Beach County, Florida 76 Four Core Focus Areas of Care Chronic Care refers to the care of an illness or condition that affects an individual’s well-being for an extended interval, usually at least six months or more, and generally is not curable. The goal in managing a chronic condition is to provide optimum functioning within any limitations the condition imposes on the individual (NCCHC Standards). OneCare: Collaborative Correctional Care℠ derives its effectiveness in treating patients with chronic conditions through a team approach, using the knowledge and expertise of a variety of providers. It is widely known that chronic care improves when mood and thought disorders are concurrently and collaboratively addressed by medical and mental health practitioners. For many people, the experience of entering or returning to jail will stretch the limits of their normal ability to cope and continue daily routines. The correctional environment can often overwhelm normal coping mechanisms, especially when patients haven’t yet adapted to the environment. Situational Depression and Anxiety are caused by new situations, changing events and events that make that individual uncomfortable. Most inmate-patients with situational depression or anxiety develop symptoms within roughly 90 days following intake. Depending on the individual, symptoms of situational depression can include listlessness, feelings of hopelessness, sleeping difficulties, sadness, recurring bouts of crying, unfocused anxiety, unfocused worry, loss of concentration, withdrawal from normal activities and withdrawal from peers, friends and family. Some people also develop suicidal thoughts. Symptoms of situational anxiety can include panic attacks or extreme anxiety. A situation that causes one individual to experience anxiety may not affect another individual at all. A smaller percentage of inmate patients present with Serious and Persistent Mental Illness requiring specific treatment. In the case of SPMI inmates, care is typically directed by the psychiatrist. As defined by the California Legislature, Serious and Persistent Mental Illness or Serious Mental Disorder means a mental disorder that is severe in degree and persistent in duration, which impairs behaviors, thoughts, and/or emotions. Without treatment, support and rehabilitation, SPMI may interfere with the ability to manage activities of daily living, function independently, maintain personal or community safety, achieve emotional or cognitive stability, and develop positive relationships. Serious mental disorders include, but are not limited to, schizophrenia, bipolar disorder, post-traumatic stress disorder, as well as major affective disorders or other severely disabling mental disorders. 60% to 80% of jail inmates suffer from a SUD. OneCare: Collaborative Correctional Care℠ aims to address the substance use epidemic in corrections by implementing effective, evidence-based treatment programs designed to support patients from detox to abstinence. The process to identify and begin needed treatment starts on intake. To properly identify and treat inmates with SUD, staff and providers are trained to understand and address its medical and mental health effects. Every inmate arriving in the jail is screened for SUD and, when identified as being at risk for withdrawal complications, is started on an evidence-based withdrawal protocol to ensure a safe detoxification. Beyond detox, as part of the 14-day health assessment, the Chronic Care Situational Depression and Anxiety Seriously and Persistently Mentally Ill (SPMI) Substance Use Disorders Palm Beach County, Florida 77 Care Manager assesses inmates for the existence and severity of any SUD, and the inmate patient’s willingness to change. Appropriate individuals are directed to programs that can guide them toward a healthy life in recovery. Substance Use Disorder patients typically require medication treatment, psychotherapy and drug and alcohol programs. The Foundation of Care Care Management and the Care Manager are a foundation of OneCare. Care Managers coordinate the overall effort of the group and ensure effective communication among team members. Care Managers will be registered nurses with specific mental and behavioral health training. Care Managers support the Care Team by coordinating treatment, providing proactive follow-up of treatment response, alerting the Care Team providers when the patient is not improving, supporting medication management, and facilitating communication with the psychiatric team members regarding treatment changes. They may also offer brief counseling (using evidence-based techniques such as motivational interviewing, behavioral activation, and problem-solving treatment) and help facilitate changes in treatment if patients are not improving as expected. Unlike the more traditional correctional healthcare model where inmates are treated as medical or mental health patients, OneCare provides a consistent point person for care who:  Directs the patient to the right professional, for the right issue, at the right time  Is an added health care resource for the team, when indicated by the treatment plan  Tracks effectiveness of treatment, and advocates for adjustments and modifications when needed  Unites the team around the patient, offering patient-centered, integrated care  Optimizes provider time  Begins discharge planning during the first engagement with the patient and Care Team. Evidence-based care is one of the core principles of OneCare: Collaborative Correctional Care℠. Patients are offered treatments with credible research evidence to support their efficacy in treating the target condition. In addition to NCCHC and community standard medical guidelines for the treatment of chronic medical conditions (e.g. Asthma, Diabetes, hypertension, etc.) we have developed evidence-based care guidelines for situational depression, anxiety/PTSD, and SUD. The therapies used to treat behavioral conditions, such as Moral Reconation Therapy (MRT), Problem Solving Therapy (PST), Behavioral Activation (BA) and Cognitive Behavioral Therapy (CBT), are all evidence-based and are widely used within the correctional environment. Collaborative Care has a substantial evidence base for its effectiveness, one of the few integrated care models that does. To support the evidence-based clinical work done by the Collaborative Care Team, we have over 140 medical and mental health specialists available via InmateCare+ and covering approximately 40 different specialty areas of medicine. The onsite psychiatry team is also integral to supporting this collaborative approach to inmate patient care. Care Management Evidence-based Treatment Protocols Palm Beach County, Florida 78 OneCare: Collaborative Correctional Care℠ is designed with a singular focus to improve outcomes. Studies show that this integrated team approach with care management and evidence-based treatments, yields less depression and anxiety, better functioning, higher quality of life, greater patient and provider satisfaction, and lower costs. To date more than 75 randomized trials have confirmed the effectiveness of Collaborative Care, including the IMPACT Study (Improving Mood Providing Access to Collaborative Treatment for Depression). The IMPACT study is the largest randomized control study to date that tested this model of treatment of depression in primary care settings. In the IMPACT trial, from 1998-2003, 1,801 depressed adults were studied in 8 clinics in 5 states. The study compared outcomes of patients treated with Collaborative Care versus those treated in a more traditional medical model. The study found that patients treated with Collaborative Care experienced significantly less depression and physical pain than those treated for just medical issues. In addition, the clinics realized a reduction in patient health care costs of nearly 10%, especially in the area of inpatient care. Sample flow of OneCare for a patient presenting with situational depression: The Next Evolution in Correctional Healthcare We are excited for the opportunity to bring this effective, efficient, integrated and proven approach to your facility. With OneCare, together we can use evidence-based treatment to address and change the landscape of mental and behavioral health issues facing our inmate patients. It is time to reconnect the head with body. It is time for one integrated team to surround the patient. It is time for us to treat problems and not just symptoms. It is time for OneCare: Collaborative Correctional Care℠. Outcomes Palm Beach County, Florida 79 2.23 Health Education of Inmates Wellpath emphasizes the importance of patient education at all of our client sites. It is imperative that inmates receive basic, and often critical, knowledge about common health care needs, issues, and diseases. Therefore, Wellpath staff will provide inmates with complete education information upon orientation and admittance to the Palm Beach County Detention Centers and additional information during any health care encounter as determined by the provider in the course of his or her examination. Wellpath will provide detailed information on health issues that assist inmates in self-care strategies, including but not limited to personal hygiene, healthy lifestyle choices, getting better sleep, and ways to maintain optimal health. Health education can also be provided through group sessions when applicable for more widespread issues such as MRSA, smoking cessation, fitness, and the flu. Inmates with chronic conditions such as asthma or diabetes will receive additional health education stressing the importance of proper health management and nutrition. Wellpath staff will educate inmates on their conditions, their role in the treatment plan, and the importance of adherence to the plan. Education will also include recommendations for lifestyle modifications and information regarding continuity of care upon release. The education will be documented in the inmate’s health record. Educational Materials Wellpath will collaborate with the PBSO in developing a comprehensive health education program for the Palm Beach County Detention Centers. We offer a variety of health education programs that can be customized to meet the specific needs of the Jail’s inmate population, including but not limited to chronic diseases prevalent in Palm Beach County. One such program was developed to address a common problem in correctional facilities—trouble sleeping. Wellpath provides patient health education through multiple means, including verbal instructions at times of service delivery and written information through the use of brochures, pamphlets, orientation packets, and instructional posters. Educational materials are available in areas easily accessible to patients, including clinic areas. Juvenile Specific Health Education Wellpath emphasizes the importance of patient education at all of our client sites. We also understand the unique needs of the juvenile population in consideration of their ongoing growth and development. We offer a variety of health education programs that can be customized to meet the specific needs of the County’s resident population. In our Louisiana Office of Juvenile Justice (OJJ) sites, where we have provided state-wide comprehensive juvenile health care services since 2010, Wellpath has implemented health education programs that have proven to be extremely effective preventative tools with the youth population. Wellpath nurses coordinate with the Louisiana OJJ teachers to conduct youth education in the classroom setting, which has created a significant increase in youth participation in this important area. We welcome the opportunity to collaborate with the County to develop a comprehensive health education program for the Palm Beach County Juvenile Health Program. It is imperative that residents receive basic, and often critical, knowledge about common health care needs, issues, and diseases. Therefore, Wellpath provides complete education information upon orientation and admittance to the facility, and additional information during any health care encounter Palm Beach County, Florida 80 as determined by the provider in the course of his or her examination. Detailed information is provided on health issues that assist residents in self-care strategies, including but not limited to personal hygiene, healthy lifestyle choices, getting better sleep, and ways to maintain optimal health. Youth with chronic conditions such as asthma or diabetes will receive additional health education stressing the importance of proper health management and nutrition. Health education can also be provided through group sessions when applicable for more widespread issues such as MRSA, smoking cessation, fitness, and the flu. Wellpath will provide resident health education through multiple means, including oral instructions at times of service delivery and written information through the use of brochures, pamphlets, orientation packets, and instructional posters. Informational pamphlets will be available in areas easily accessible to residents, including clinic areas. Residents will receive brief, easy-to-understand handouts that offer educational information on topics ranging from personal hygiene and exercise to stress management and adolescent development. All patient education materials are available in both English and Spanish and can be translated into other languages as needed. Samples of Youth Health Education materials are included on the following pages. Palm Beach County, Florida 81 Palm Beach County, Florida 82 Palm Beach County, Florida 83 Palm Beach County, Florida 84 Medical Reference Library Wellpath maintains a comprehensive library of course content for preventive health education that can be customized for a readily available training agenda and scheduled delivery to meet the needs of the entire inmate population. We will provide a medical reference library accessible at all times by health care personnel, with basic reference texts related to diagnosis and treatment in a primary care setting. UpToDate Wellpath also offers access to UpToDate® Clinical Knowledgebase and Support Tools, an online medical resource for provider evidence-based clinical reference and patient education materials. All users are given single-click access to these valuable medical reference and client-specific patient education materials on multiple topics. UpToDate helps to increase the quality of patient care by allowing providers to print patient education materials and discuss them with the patient while they are together. UpToDate covers more than 10,000 topics in 22 medical specialties and includes more than 9,000 graded recommendations; 27,000 graphics; and 380,000 Medline abstracts, as well as references and a drug database. Content is reviewed and edited continuously with content updated within UpToDate every weekday. UpToDate includes treatment recommendations based on the latest and best medical evidence. Recommendations are kept current as new studies are released and practices change. Topics available within medical specialties in UpToDate include:  Medical Calculators  Adult Primary Care  Allergy and Immunology  Cardiology  Critical Care  Drug Information  Emergency Medicine  Endocrinology  Gastroenterology  Nephrology  Neurology  Hematology  Hepatology  Infectious Diseases  Oncology  Pulmonology  Rheumatology  Surgery  Internal Medicine  Geriatrics  Psychiatry  Dermatology  Palliative Care Palm Beach County, Florida 85 UpToDate is evidence-based and uses a literature-driven updating system. More than 450 journals are monitored by more than 5,700 doctors, editors and authors, and anytime something of importance is published, it is incorporated into the program. The key word is “incorporated”—UpToDate is not a journal watch. New studies are not simply added, but rather they are placed in the context of what has already been published in that field. This instant availability of continuously updated, evidence-based health care information, accessible from inside the patient record, will aid medical staff in providing the highest quality of care. UpToDate also includes a Continuing Education feature that allows physicians and nurses to utilize and credit their time in the program for credit of AMA PRA Category 1 CME/CEU credits toward maintaining their licenses and applicable certifications. In one study, 90% of UpToDate users reported that UpToDate makes them a better doctor. UpToDate is recognized as an official educational tool by multiple medical organizations, including:  The Society of General Internal Medicine  The American College of Rheumatology  The American Gastroenterological Association  The American Thoracic Society  The Endocrine Society and the Hormone Foundation 2.24 Services to Correctional Staff In addition to educating patients, Wellpath will train correctional staff in medical issues as requested by the PBSO. We routinely educate correctional staff on the importance of recognizing and responding to specific medical and mental health concerns. Correctional staff are a vital part of the process for delivering health care to inmates. Because correctional officers are often the first to respond to problems, Wellpath offers training for correctional staff on responding to potential emergency situations, handling life-threatening situations, and their responsibility for the early detection of illness and injury. Wellpath has developed a Health Training for Correctional Officers manual that complies with the requirements of NCCHC Standard J￾C-04. The manual can be offered as a supplement to facility￾provided education. It is comprised of 16 training modules addressing the essential information that correctional staff must understand when presented with potentially urgent or emergent situations. Each training module includes a topic-specific slideshow presentation, a curriculum outline for the presenter/trainer, and handouts for correctional staff. Wellpath health care staff will present the training topics, which are based on our 7 Minutes to Save Rapid Response Series and are designed to be presented in a brief amount of time (average 7-15 minutes). Palm Beach County, Florida 86 Training topics for detention staff include:  Alcohol and Benzodiazepine Withdrawal  Altered Mental Status  Basic First Aid  Chest Pain  Diabetes  Head Trauma  Health Associated Infections  Heat Related Illness  Ingestions  Opiate Withdrawal  Recognizing Signs of Mental Illness  Respiratory Distress  Rhabdomyolysis  Seizures  Serious Medication Reactions  Suicide Prevention Wellpath can collaborate with the PBSO to develop additional training topics specific to the Palm Beach County Detention Centers as needed. The frequency of training is typically based on accreditation standards and/or facility policy; however, Wellpath recommends a minimum of monthly training. Training sessions will be scheduled in coordination with the PBSO, and the HSA or Corrections Division Manager will maintain documentation of completed training sessions. 2.25 Medical Records Wellpath will maintain up-to-date medical records at all times, consistent with NCCHC and ACA standards; the PBSO policies and procedures; community standards of practice; and all federal, state, and local laws. Wellpath has the broadest experience and deepest knowledge of electronic medical systems in corrections. Wellpath provides medical services in more than 200 sites utilizing an electronic health record. Many of our sites use Electronic Record Management Application (ERMA), our in-house electronic health record system; however, due to the scale of our clients, we have significant experience with systems that are not Wellpath-owned, including:  CorEMR  Catalyst  CorrecTek  eCW  EOMIS  GE Centricity  HealthSecure  Netsmart  NextGen  Quest  Sapphire Wellpath is experienced in the use of CorrecTek and we will support this platform at the Palm Beach Detention Centers should PBSO wish to continue the use of CorrecTek. We are familiar with CorrecTek’s platform, interface, and reporting capabilities from several of our other sites, including Monroe County, Florida. Wellpath will insure all staff members are well-trained to use the CorrecTek system. We will use our experience with CorrectTek to integrate of our clinical and operational programs into the County’s system. Palm Beach County, Florida 87 Many of our sites use Electronic Record Management Application (ERMA), our in-house electronic health record system. Should Palm Beach wish to explore the use of ERMA, Wellpath would be pleased to provide an on-site demonstration or facilitate a visit to one of our partner sites to see the advantages ERMA brings to their health care program. The cost of an electronic medical record transition may seem daunting. Wellpath is open to discussions and may be able to provide ERMA at a very attractive cost. One of the most beneficial aspects of using ERMA is the advanced technology that can be implemented with it. For instance, when administering medications, nursing staff can use an off-network laptop—the Point of Care Companion (POCC) system—with their medication cart, marking and electronically signing off on the administration of medications is ERMA is used as the Electronic Medical Record solution. Point of Care Companion – used with ERMA If a patient does not receive his or her medication for any reason, this is noted in the system during the medication pass. Once the nurse returns to the medical unit, the laptop is docked and the information from the medication pass is synced within ERMA so administration records are immediately up-to-date. The ability to synchronize data provides increased flexibility for nursing staff by allowing them to use the system in facilities where Wi-Fi or mobile internet connectivity is unavailable. This also allows medication passes to continue even if the facility loses internet connectivity, and since the laptop is battery-powered, loss of power will not affect its use. The features and benefits of ordering through this user￾friendly software include:  The ability to order (or reorder) prescriptions or stock orders quickly, through use of drop-down screens or order refill buttons  Increased accuracy by reducing transcribing errors and clarity issues that may result from faxed order sheets  Improved formulary compliance—If a medication is not on the approved list, a non-formulary alert is automatically sent to the prescribing clinician’s queue, where the clinician can easily complete the non-formulary request process online; once the non-formulary request is approved, the order is automatically forwarded to the pharmaceutical provider to facilitate expedited ordering  OTCs, stock and emergency medications are all easily initiated and documented as profile meds on the electronic Medication Administration record  Time savings through the elimination of paper physician’s order sheets, which are no longer needed  The ability to view patient profiles and determine when a medication was last filled prior to transmitting the order Point of Care Companion Palm Beach County, Florida 88  Password-protected access for approved staff to patient profiles, medication orders and history from any web-based computer located on or off site  Tracking and documentation of patient allergies and/or drug interactions  Exceptions are immediately noted in the patient’s health record: missed doses, refusals, complications Transfer of Medical Information Pertinent medical information will be prepared to accompany all inmates when traveling off site to a specialty appointment or emergency room, or when transferring to another detention/correctional facility. Upon transfer to another facility, a medical transfer form will accompany the inmate. The form will contain all necessary information required for the continuation of treatment. Supplies and Equipment Wellpath will ensure that the Palm Beach County Detention Centers have the necessary staff and supplies to provide on-site care and treatment of the inmate population, including but not limited to laboratory, radiology, medical, and dental supplies. We have par level ordering guidelines and will order the supplies necessary to ensure the continuation of proper care at the Jail. All materials and equipment will comply with standards promulgated by the American National Standards Institute (ANSI) or with the rules of the Food and Drug Administration under the Safe Medical Devices Act. As part of our transition process, we will evaluate and assure that all supplies and equipment currently in place are maintained in good working order. As equipment fails or reaches the end of its useful life, Wellpath will replace items at our cost, with approval as necessary by the Sheriff’s Office or designee. We understand what it takes to operate correctional health and pharmacy programs and will maintain all supplies and equipment necessary to support them. We will conduct a verifiable annual inventory of medical and dental equipment, with documentation provided to the Sheriff’s Office or designee. We understand that upon termination of our agreement with the County, all remaining supplies and equipment shall become the property of the Sheriff’s office, with no consideration of remuneration. We will be responsible for all associated office and medical equipment required for the efficient operation of the PBSO health care program. We will work with the PBSO to ensure that all necessary equipment is available for start-up, and we will maintain adequate equipment to perform all services required under our contract with the PBSO. Repair and Maintenance Wellpath will be responsible for the repair and maintenance of existing medical equipment. Should such equipment become non-serviceable due to routine use, Wellpath will coordinate with the PBSO for its replacement. Wellpath personnel will only use the property and equipment made available for their use under the contract. We will ensure that all medical personnel are properly trained in the use of medical equipment before operating it. Wellpath will bear responsibility for any loss or damage to any property or equipment resulting from negligence or carelessness on the part of Wellpath employees or subcontractors. Palm Beach County, Florida 89 Network and Telephone Requirements Wellpath understands that the PBSO will give Wellpath staff full use of the Jail’s medical unit, and will be responsible for all utilities and general structural maintenance for this area. The PBSO will also be responsible for the costs of any special wiring, outlets, or other electrical work reasonably necessary for the provision of services required under the contract. 2.26 Administrative Meetings and Reports Wellpath will coordinate with the PBSO to facilitate monthly administrative meetings for the purpose of evaluating statistics, program needs, problems, and coordination between correctional, medical, and mental health staff. Wellpath believes that active, open, and honest communication is an essential component to a successful health care program. The HSA for the Palm Beach County Detention Center will focus on maintaining open communication and a good working relationship with the PBSO administration, Wellpath employees, correctional staff, contracted providers, and outside agencies. As part of this focus, the HSA will serve as a liaison between health care and correctional staff, and will hold interdisciplinary meetings to facilitate continued communication and cooperation between custody and care providers. Wellpath will provide a full set of operational reports that can be customized to meet the specific needs of the PBSO. We will deliver detailed monthly statistical reports and daily operational reports for the PBSO’s review. Wellpath will use these reports to continually review the effectiveness of our program and to improve overall program quality and efficiencies. We will provide monthly and daily statistical reports regarding the operation of the health care program, staffing fill rates to demonstrate compliance with the contracted staffing plan, and financial reports to aid the PBSO with future budgeting efforts. Daily Reports Wellpath will provide a daily narrative report for the previous 24 hours to the designated PBSO authority (Saturday and Sunday reports may be submitted Monday morning). The daily report will outline important events of both day and night shifts, including but not limited to:  Transfers to offsite hospital emergency departments  Communicable disease reporting  Suicide data (i.e., attempts and precautions taken)  Report of status of inmates in local hospitals and infirmaries  Staffing roster changes  Completed medical incident report copies  Completed medical grievance report copies  Receiving screenings performed  Health assessment status report Monthly Reports Wellpath will provide a customized monthly report package that best fits the Palm Beach County Detention Centers’ specific needs. Reports will delineate the status of the health care program, including potential problems and suggested resolutions. Wellpath will also provide reports on monthly paid and project costs, as well as monthly aggregate and projected aggregate costs. Palm Beach County, Florida 90 Wellpath will submit the report package to the designated PBSO authority on a mutually agreed-upon day each month. The customized monthly reports for the PBSO will reflect the previous month/term workload, with data including but not limited to:  Inmates’ requests for various services  Inmates seen at sick call  Inmates seen by physician  Inmates seen by dentist  Inmates seen by psychiatrist/psychologist  Infirmary admissions, patient days, and average length of stay  Offsite hospital and emergency room admissions and cost  Medical specialty consultation referrals and cost  Intake medical screenings  14-day history and physical examinations  Diagnostic studies  Report of third-party reimbursement, pursuit, and recovery  Percentage of inmate population administered medication  Inmates testing positive for TB, STDs, HIV, or HIV antibodies  Inmate mortality  Number of hours worked by entire medical staff and staffing compliance to contract staffing levels  Other data deemed appropriate by the designated PBSO authority Annual Reports Wellpath will provide a comprehensive annual report based on the contract year, giving a comprehensive review of the monthly statistical and program reports and examining significant trends and issues. We will submit the annual report to the Corrections Division Manager no later than 60 days after the end of each contract year. The report will include utilization statistics and a narrative summary of our accomplishments for the year, as well as recommendations for desirable changes in medical procedures and/or protocols. 2.27 Inmate Grievances and Complaints Wellpath recognizes our first responsibility is to our patients, to allow them access to care and treatment sufficient to meet their medical needs. We train and expect our staff to operate efficiently and appropriately while respecting those needs. Our excellent litigation history and our record of reduced grievances are indicative of the exemplary care Wellpath team members provide. All Wellpath personnel receive grievance resolution training, which teaches them to address concerns at the point of contact prior to the inmate initiating a grievance. Palm Beach County, Florida 91 The Wellpath grievance process will be consistent with national standards and with the PBSO policies. Wellpath staff will respond to grievances, complaints, and inquiries as soon as is practical, generally within 72 hours of receipt. Resolution and Review All Wellpath health care staff will be available to attend to medical grievances, which include complaints such as not being seen in a timely manner for a sick call request, medications not being started in a timely manner, and conduct of health care staff. The Wellpath Medical Director or designee will resolve urgent grievances, which are defined as those complaints that involve an immediate need on the part of the inmate for health care services. Wellpath will resolve concerns and grievances in collaboration with the HSA and mental health, dental, pharmacy, or other appropriate service providers. The HSA or appropriate designee will work with the PBSO in the investigation, follow-up, and resolution of complaints in accordance with the PBSO policies, and will implement the PBSO recommendations. When necessary, Wellpath will conduct a face-to-face interview with the inmate and participate as a part of the grievance committee. Our Quality Improvement Committee (QIC) and Medical Administration Committee (MAC) will review and categorize grievances to identify potential issues and to determine if patterns exist or develop. Grievance Reporting Wellpath will establish a mechanism to report monthly on the volume of grievances received, the nature of the grievances, the resolution status, corresponding timeframes, and whether or not the grievance is substantiated. We will maintain a daily log of all grievances that will include the name of the person filing the grievance and the date and nature of the complaint. If the grievance process substantiates a grievance, then the HSA or designee will develop and implement a corrective action plan for that grievance. Wellpath will categorize complaints and grievances and will report specifics as a part of the medical services monthly statistical report. This report will contain a description of the grievance or complaint, an explanation of the circumstances surrounding the grievance, and all actions taken to investigate and resolve the grievance. Wellpath will submit a monthly report identifying inmate grievances, along with copies of all medical grievance requests and their resolutions, to the Corrections Division Manager or designee. Palm Beach County, Florida 92 Sample Grievance Log Palm Beach County, Florida 93 3 Administrative Functions 3.1.1 Policies and Procedures Within 60 days of on-site startup, following a discovery period, Wellpath will develop a facility specific Policies and Procedures Manual tailored to health care services provided at the Palm Beach County Detention Center sand subject to approval by the PBSO. The Wellpath Policies and Procedures Manual will meet or exceed NCCHC and ACA standards. We anticipate that certain policies will undergo some revision within the first 120 days of the contract. The manual will subsequently be reviewed and revised as Wellpath and/or the PBSO policies are modified, no less than once per year. 3.1.2 Disaster Plan Wellpath prides itself on being a solutions-oriented company that considers all aspects of our clients’ needs. We have an effective disaster plan for our contracted facilities with detailed procedures for handling emergency situations. Our team members jump into action and do what needs to be done for our valued partners in the face of a disaster or impending disaster. Following is an example of how Wellpath stepped up to help our valued partner, the Richland County Sheriff’s Department, during the devastating flooding in South Carolina in early October 2015. Wellpath continually strengthens our emergency plan to address such disasters faced by our client facilities. Emergency Preparedness Wellpath will work collaboratively with the PBSO to define the roles of health care staff in the event of a disaster. We have established contingency and emergency procedures to ensure continuity of care during unexpected events, disruptions, and natural or man-made disasters. Wellpath will act quickly throughout and following the transition period to develop a comprehensive plan that addresses all aspects of these possible emergencies. Photograph compliments of the MCSO Columbia, South Carolina 2015 When we learned that our client facility, the Alvin S. Glenn Detention Center in Columbia, South Carolina, was without drinking water as a result of severe flooding, Senior Regional Vice President, Bill Kissel, borrowed a truck and labor from the Mecklenburg County Sheriff’s Office, our valued partner in Charlotte, North Carolina, and purchased every bottle of water in stock at the local Walmart. He and the Mecklenburg Deputy transported the water the 90 miles to Columbia, where the flooding had crippled the city. Palm Beach County, Florida 94 Wellpath will develop a cooperative Emergency Preparedness Plan to ensure proper staff recall and allocation, patient movement to designated safe areas, and presence of emergency equipment and supplies. We will coordinate with Palm Beach County Detention Centers administration to incorporate our Wellpath Emergency Preparedness Plan into the overall emergency plan for the Jail. The Wellpath Emergency Preparedness Plan, which will comply with NCCHC and ACA standards, will be thoroughly outlined in the Wellpath Policies and Procedures Manual developed for the Jail within 60 days of contract award. The Emergency Preparedness Plan will be approved by the PBSO and will minimally include:  Establishment of a command post  Responsibilities of health staff during an emergency  Triage procedures  Use of emergency equipment and supplies  Establishment of primary and secondary triage areas and sites for care  Continuity of care and safety of patients  Prevention of interruption in medication  Contingency pharmacy and medical supplies plan  The protection and accessibility of patient care data at predetermined locations  Training modules  Disaster bag/mobile equipment contents, breakaway seal system  Crash cart equipment  Contact list for recall of key health care staff and community emergency response system  Evacuation procedures in coordination with security personnel  Evacuation routes and means of transport out of the institution for injured, ill, disabled, or restrained individuals  Emergency treatment documentation  Medical staff participation in facility emergency procedure drills  Procedure for conducting man down and emergency drills  Backup assignments for each of the contingency elements Wellpath recognizes unique problems and situations, including severe weather and other adverse conditions. The Wellpath Emergency Response Plan will cover the four major phases of emergency preparedness management—Mitigation, Preparedness, Response, and Recovery—as illustrated in the following graphic. Wellpath Staff’s Commitment during Disaster “Your staff during Hurricane Harvey was stellar during the challenging circumstances they faced during this event. Your staff had to work under very uncomfortable conditions, mostly related to the loss of electrical power and even the loss of generator power. Your staff under the very competent leadership of [HSA] Mr. Jason Rankin is to be commended for providing the best medical care to the inmates of the Nueces County Jail.” Asst. Chief Deputy Abel B. Carreon Nueces County Sheriff’s Office, TX Palm Beach County, Florida 95 All Wellpath personnel will be aware of and familiar with the Wellpath Emergency Preparedness Plan, which will also cover “man down” incidents, fires, and hostage situations. New employees will be trained on the health aspects of the plan during orientation, and all health care staff will review the plan annually. A health emergency “man down” drill will be practiced once a year on each shift where Wellpath personnel are regularly assigned in accordance with applicable standards. Wellpath will also participate in disaster drill planning programs as requested by the PBSO and will perform a critique of the drills on an annual basis. Wellpath is committed to ensuring all personnel are adequately trained to respond to a crisis situation. Correctional health care personnel are trained to respond to emergencies within four minutes. We offer periodic proficiency training for medical personnel on emergency response and other integral components of our program using established Core Competency Checklists. Core Competency is assessed at least annually dependent upon an individual’s needs or responsibilities. Staff members are also trained on the implementation of an Incident Command System (ICS). Wellpath uses the START (Simple Triage and Rapid Treatment) system, established by the Hoag Hospital and Newport Beach Fire Department, to train Wellpath staff on the process for handling multi-casualty events. The triage portion of START, which is the focus of our training program, allows for rapid assessment of every patient, identifying those who have life-threatening injuries, and assigning each patient to one of four categories so that when rescuers arrive at the scene, they can immediately be directed to those patients with the best chance of surviving. Palm Beach County, Florida 96 3.2 Periodic Reviews and Committees 3.2.1 Utilization Review Wellpath uses an established review process to ensure that offsite referrals are medically necessary, that the length of stay is medically indicated, and that payments made are appropriate. We will coordinate, validate, and track offsite care and invoicing through the Care Management system, which generates reports that allow us to analyze the utilization of offsite services on behalf of our clients. Wellpath uses this data to assess the need for additional on-site and offsite services, as well as the potential impact that systems such as telemedicine may have. We will continuously evaluate both the number of cases as well as the costs associated with transporting inmates in determining which clinics are held on-site. Constant evaluation of specialty services will ensure the most cost-effective solution for clinics. 3.2.2 Statistical Data The Wellpath Care Management system can produce reports containing detailed cost data for purposes of cost analysis and cost containment. These reports include information related to all medical, dental, and mental health services and associated costs, including laboratory, radiology, and other ancillary services; specialty services; pharmaceuticals; and medical supplies. Wellpath will analyze utilization statistics and continuously evaluate the potential benefits of establishing on-site clinics. Services brought on-site would typically result in cost savings for the PBSO as a result of clinic (rather than per patient) rates and decreased officer transportation expenditures. Wellpath has had marked success in reducing offsite medical and security costs for our clients by ensuring the provision of cost-effective, medically necessary health care services to our contracted populations. The Care Management system is a powerful tool for tracking, analyzing, and trending data through visual dashboards. Care Management Dashboards will allow the PBSO to compare historical data and analyze, trend, and compare data. Operational and outcome trending can be provided on:  Admits per 100/1000  Admits by diagnosis  Re-admission rates  ER visits per 100/1000  ER visits by diagnosis  ER conversion rates  Infection rates  Non-formulary utilization trends  Non-formulary lab trends  Prior authorization turnaround times  Prior authorization outcome rates  Standard vs. expedited authorization requests Palm Beach County, Florida 97 Sample Dashboards – Offsite Referrals and Inpatient Events 3.2.3 Continuous Quality Improvement Committee Wellpath will introduce proven performance monitoring techniques at the Palm Beach County Detention Centers, including our Continuous Quality Improvement Program (CQIP), which includes audit and medical chart review procedures to ensure compliance with contract requirements, as well as NCCHC and ACA standards. We will also conduct Medical Audit Committee (MAC) meetings and peer reviews to evaluate the Jail’s health care program. Palm Beach County, Florida 98 Wellpath is dedicated to continuously improving our services and program offerings for the clients we serve. We use established techniques like electronic CQI screens and advanced technology to make our programs even better. Continuous Quality Improvement Program Wellpath continually focuses on maintaining a high quality of care for our patients. We have established policies and procedures and a data-driven Continuous Quality Improvement Program (CQIP) to ensure the continued quality of our medical programs. The goal of the CQIP, which operates under the authority of Wellpath Chief Clinical Officer, Carl Keldie, MD, is to ensure systems and programs guarantee that our patients receive quality health care services. The Wellpath CQIP will ensure that clinical care delivery at the Palm Beach County Detention Centers is conducted in accordance with our high expectations, as well as NCCHC and ACA standards. Within 90 days of contract implementation, Wellpath will develop a site-specific Quality Improvement (QI) plan for the Palm Beach County Detention Centers based on the scope of care provided. The QI plan will address health care services provided both on and off site for quality, appropriateness, and continuity. Wellpath will use the QI plan to review and define the scope of care provided within the system, as well as the QI review process and meeting format. We will coordinate with the PBSO to integrate our program with any quality assurance initiatives currently in place at the Jail. Scope of CQIP Wellpath will conduct CQI studies to ensure that all services at the Palm Beach County Detention Centers meet established minimum thresholds. Wellpath will be responsible for monitoring relevant areas for quality improvement, including accreditations, credentialing, environmental inspections, emergency drills, nursing, intake, medication management, special housing, and ancillary services. Routine CQI studies will examine areas where overlap or hand-off occurs, as well as other problem￾prone, high frequency/volume, and risk management processes, including but not limited to: Receiving Screenings, Screening and Evaluation at Health Assessment, Special Needs, Segregation, Treatment Planning, Suicide Prevention, Medication Administration, Initiating Medication at Intake, as well as processes exclusive to the Jail. Wellpath will complete monthly CQI screens as outlined in the Wellpath CQI Calendar, plus at least one ad hoc screen per quarter to evaluate a site-specific issue presenting challenges. Examples of ad hoc screens include:  Missed Medication (investigative study)  TB Screening  Health Assessment – Periodic  Grievances  Communication with Custody  Initiating Essential Medications – Return from Hospital  Prenatal and Postpartum Care – HEDIS and Outcome Study Please see the following sample CQI Calendar, with monthly CQI screens broken out by responsible party. Palm Beach County, Florida 99 Sample CQI Calendar Month Nursing Site Medical Director Mental Health Jan. 1. Continuity of Care 2. Pregnancy Care Feb. 1. Site-specific Study 2. CQI Meeting 1. Scheduled & Unscheduled Offsite Care 1. Suicide Prevention March 1. Medication Administration 2. Copy of Narcotics Logs April 1. Alcohol/Benzodiazepine Withdrawal 2. Opiate Withdrawal 1. Segregation May 1. CQI Meeting 2. Patient Safety (review Q1) 1. Physician Chart Review 1. Suicide Prevention June 1. Emergency Services 2. Sick Call July 1. Receiving Screen & Med Verification 1. HIV 1. Psychiatric Services Aug. 1. Site-specific Study 2. CQI Meeting Sept. 1. Ancillary Services 2. Dental Care 3. Dietary Services 1. Suicide Prevention Oct. 1. Alcohol/Benzodiazepine Withdrawal 2. Diabetes–HEDIS 1. MH Special Needs & Treatment Planning Nov. 1. CQI Meeting 2. Patient Safety (review Q2 & Q3) 1. Infirmary Care Dec. 1. Annual Review of CQI Program 1. Suicide Prevention Quality Improvement Committee A multidisciplinary Quality Improvement Committee (QIC) will direct all Quality Improvement activities. The QIC will be led by the Wellpath Medical Director and will include the site’s designated mental health representative, dentist, HSA, site Safety Coordinator, and appropriate PBSO representative(s). The QIC will typically meet quarterly to review significant issues and changes and provide feedback for the purpose of improving processes or correcting any deficiencies. The QIC will be responsible for performing monitoring activities, discussing the results, and implementing corrective actions as indicated. The QIC will review significant issues or changes and will provide feedback for the purpose of correcting any deficiencies or improving processes. Wellpath marks all CQIP activity records as confidential; discussions, data collection, meeting minutes, problem Palm Beach County, Florida 100 monitoring, peer review, and information collected as a result of the CQIP are not for duplication or outside review. The CQI team from the Wellpath Home Office, led by CQI Director Dawn Ducote, will conduct monthly conference calls with the sites and will ensure site-specific issues or concerns are studied and resolved using the appropriate methodology (process or outcome studies). Following are examples of typical CQI conference call topics: High-risk Items The Wellpath CQIP addresses many forms of risk management, including clinical and environmental risk management tools that work to identify and reduce variability, as well as reducing liability when adverse events occur. The QIC addresses the following risk management items:  Critical Clinical Event (CCE) Reviews: The QIC monitors, reviews, and reports on the health staff’s response to critical incidents. The committee uses the root cause analysis problem solving methodology to review the CCE.  Emergency Drill Reviews: The QIC monitors, reviews, and reports on the health staff’s response to emergency drills.  Environmental Inspection Reports: Wellpath participates in monthly facility environmental inspections to ensure that inmates live, work, recreate, and eat in a safe and healthy environment.  Resolution Tracking: The QIC tracks deficiencies identified during routine environmental inspections through resolution.  Utilization Management: Wellpath monitors the provision of care to ensure that medically necessary health care services are provided in the most appropriate setting.  Grievances: The Wellpath grievance process is consistent with national standards and internal client policies. The QIC reviews and categorizes grievances to identify potential issues and determine if patterns exist or develop. Patient satisfaction surveys are completed on topics relevant to the inmate population.  Pharmacy: Wellpath ensures quality pharmacy programming through regularly scheduled on￾site inspections performed by a consulting state-licensed pharmacist. We document inspection reports and maintain them on file, and the consulting pharmacist reports a summary of these discussions and actions to the QIC.  Pharmacy Reports: Wellpath uses pharmacy reports to identify outliers and trends, then evaluates and addresses all outliers. The Regional Medical Director typically reviews pharmacy utilization data on a regular basis. 3.2.4 Medical Audit Committee Wellpath will establish a Medical Audit Committee (MAC) to oversee all health care functions at the Palm Beach County Detention Centers. The MAC will meet on a regular basis (typically each quarter) with distributed agendas. The purpose of the MAC meeting is to evaluate the health care program, ensuring that high-quality medical, dental, and mental health services are available to the entire inmate population. Palm Beach County, Florida 101 Discussions will include monthly health services statistics by category of care, current status of the health care program, costs of services, coordination between security and health services, and identified issues and program needs. The MAC will also review and categorize grievances to identify potential issues and to determine whether patterns exist or develop. Wellpath will conduct MAC meetings in coordination with the PBSO administration to discuss health care services. Meeting minutes will be documented, distributed to attendees and the PBSO administration, and maintained for reference. Wellpath will provide the PBSO with monthly and quarterly reports regarding the clinical operation of the health care program, in accordance with NCCHC and ACA standards. We will regularly confer with the PBSO regarding any issues deemed appropriate, including existing procedures and any proposed changes to procedure. The MAC will typically include:  Health Services Administrator (HSA)  Director of Nursing (DON)  Medical Director  Dentist  Psychiatrist and/or mental health representative  Designated Palm Beach County Detention Centers representative(s) 3.2.5 Risk Management and Mortality Review Wellpath is committed to ensuring that our client populations live, work, recreate, and eat in a safe and healthy environment. We will abide by all Palm Beach County Detention Centers rules, regulations, policies, and procedures regarding risk management, and will work with all other health care contractors to ensure the safety of patients, contractors, and Palm Beach County Detention Centers staff. Critical Clinical Events The HSA for the Palm Beach County Detention Center will promote patient safety by instituting systems to prevent adverse and near-miss clinical events. This will be achieved through the Continuous Quality Improvement Program (CQIP) and the Wellpath Safety Program. The HSA, in conjunction with the CQIP, will establish an error reporting system for health staff to voluntarily report, in a non-punitive environment, errors that affect patient safety. Additionally, the HSA or Medical Director can recommend a review of an adverse or near-miss clinical event. A critical clinical event (CCE) is an occurrence involving death or serious physical or psychological injury, or risk thereof. CCE reviews are conducted on clinical occurrences that are considered a patient safety issue, including but not limited to:  Medication errors resulting in negative clinical outcome  Suicide attempts  Hospitalizations resulting from delayed care or inappropriate treatment  Potential serious occurrences that were identified prior to an adverse patient outcome  All deaths (expected, unexpected, and suicides)  Inmate-on-inmate sexual assault  All transgender patients Palm Beach County, Florida 102  Hospital readmission for the same diagnosis or secondary diagnosis within a three-day period  Hospitalizations as a result of detoxification progressing to delirium tremens  Hunger strikes that last more than 72 hours  Use of therapeutic restraints on a patient  Any significant variance from expected clinical norms at the facility At the conclusion of the CCE review process (to include if cause is due to failure of policy or procedure), a corrective action plan will be maintained on-site, along with a record that the CCE review was discussed in the CQI committee meeting. Additionally, the Wellpath Risk Manager will retain at the Wellpath Home Office a full record of the CCE review and recommendations, a full record of Root Cause Analysis (if one was performed), and supporting documentation as deemed necessary by the Risk Manager. Mortality Review In the event of an inmate’s death, the Wellpath Medical Director, HSA, and appropriate correctional personnel will be notified; in the event of a suicide, homicide, accidental, or suspicious death, the medical examiner and appropriate law enforcement officials will also be notified. Wellpath will participate in conjunction with the County Attorney or designee to conduct a mortality review consistent with NCCHC and ACA standards, as well as state and federal law. The HSA will notify the Wellpath Regional Manager, electronically report the event directly to the Director of CQI, and assist in providing information to Jail administration, who will then communicate with the patient’s next-of-kin and request an autopsy. A copy of the autopsy report and death certificate will be filed in the inmate’s closed medical record. The Charge RN on duty at the time of the inmate’s death will ensure that documentation on the progress notes is performed regarding the witnessed facts concerning the death. Documentation will include time of death, circumstances surrounding death, nature of death, treatment(s) rendered, and persons notified of death and by whom. The site QI Committee will review the death to determine the appropriateness of clinical care, ascertain whether corrective action in the policies and procedures is warranted, and identify trends that define future studies. Wellpath will report all deaths in accordance with pertinent regulations and timeframes. The report will include a narrative medical history covering the period 90 days prior to the death, the deceased’s primary medical or psychiatric diagnosis and therapy provided, and a narrative description of the terminal event. If additional facts or critical information are discovered about a submitted incident, Wellpath will submit a follow-up report within 14 days of such a discovery. Wellpath will notify the County Attorney and designated PBSO representative(s) in writing of any inmate-related litigation we receive involving correctional health care. We will not settle any inmate litigation without first contacting the County Attorney. 3.2.6 Pharmacy and Therapeutics Wellpath will establish a Pharmacy and Therapeutics (P&T) Committee to monitor pharmaceutical processes and utilization practices. The P&T Committee will be responsible for managing the formulary and will help balance efficacy, safety, and cost of certain medications by requiring prior approval. Palm Beach County, Florida 103 Further, the committee will review use and prescribing practices in regards to psychotropic medications and those in the KOP approved medication program. The Wellpath Medical Director will chair the P&T Committee, which will be multidisciplinary and will meet quarterly. Copies of P&T Committee meeting minutes and related reports will be provided to the Corrections Division Manager or designee. 3.2.7 Infection Control Wellpath has a written infection control policy that will promote the creation and maintenance of a safe and healthy environment for the inmates, staff, and visitors of the Palm Beach County Detention Centers. The primary drivers of effective infection control policies, procedures, and guidelines include: Identification, Prevention, Diagnosis, and Treatment. The Wellpath Infection Control Program aims to effectively control the occurrence and spread of communicable diseases by maintaining compliance with universal precaution procedures. The program ensures the provision of appropriate cleaning and personal protective equipment, and includes training on general sanitation issues and preventing the transmission of blood borne pathogens. The goals of the Wellpath Infection Control Program are:  To identify those individuals who are at risk for infectious diseases  To monitor and report the incidence of infectious diseases among staff and inmates  To promote a safe and healthy environment through the use of regular inspections, education, communication, and role modeling  To survey patients from the time of their entry into the facility  To provide timely, effective treatment when an infectious disease is identified  To administer vaccinations to minimize the spread of infectious diseases  To protect the health and safety of staff and inmates by use of appropriate isolation precautions  To establish effective decontamination techniques for cleaning of medical equipment and contaminated reusable items  To provide safe means of disposing of biohazardous waste and used needles and sharps  To implement and use strict Standard Precautions to minimize the risk of exposure to blood and bodily fluids  To file required reports in a manner that is consistent with local, state, and federal laws and regulations  To establish and maintain a good working relationship with the Health Department, the community, and the facility in matters that relate to the prevention of infectious diseases  To train staff during their orientation and on an ongoing basis regarding each facet of the Infection Control Program  To monitor the effectiveness of the Infection Control Program through ongoing Quality Improvement data collection and statistical reporting It is our expectation to reach these goals through a commitment to early identification from surveillance of potential and actual occurrences of infectious disease. As part of the receiving screening process, Wellpath staff routinely inquire into any past history of infectious or communicable diseases. Patients at risk for spreading a communicable disease are segregated from the general population. Palm Beach County, Florida 104 Communicable Disease Reporting Wellpath will immediately report all highly infectious communicable diseases to the Health Department, in accordance with local regulations. We will work with the Health Department concerning communicable disease screening, continuing medical surveillance, case management, reporting, and inmate referral in the community. The HSA will be responsible for reporting incidents to public health officials; however, all Wellpath staff will be trained on the notification process to ensure timely reporting in cases of unexpected absence or scheduled time off. Wellpath will use our Care Management system to customize a monthly report of all inmates diagnosed with an infectious disease for the PBSO. Data will include each patient’s name and identification number, the date of service, the patient’s disposition, and the infectious disease diagnosis. All clinic logs and statistical data will be maintained by the DON and stored electronically on the Wellpath intranet. All appointments will be scheduled and completed in the Care Management system through the DON. Our on-site health care team will closely monitor and promptly transmit to the PBSO, the Health Department, and necessary outside hospitals and health care delivery facilities information regarding the presence or incidence of communicable diseases in a patient that was recently treated or will be treated at their location. The Wellpath DON, in conjunction with the HSA, will be responsible for managing, reporting, and recording these cases and implementing appropriate educational programs to prevent future occurrences of these incidents. Palm Beach County, Florida 105 4 Proposed Staffing Wellpath takes staffing and coverage by licensed healthcare professionals seriously, as evidenced by our low staff turnover rate, and our track record of committing to fill every shift. This is a reflection of our firm commitment to deliver for our customers; our passionate belief that the core requirement for any successful correctional healthcare program is to have the right people, properly trained, who share our passion for delivering great care; and the financial commitment to hiring, training, and retaining a great team. This means that we don’t cut corners when it comes to staffing. We pay people fairly, provide excellent benefits, and treat our people well. We never put an untrained person into a new situation, which can lead to unhappy staff, poorly served inmates, and a dangerous level of inconsistency. We provide at least two weeks of training to all new staff before they ever “fly solo,” and we provide ample ongoing staff training. Unlike many of our competitors, we always build a Relief Factor into our planning and staff budgets. Leave no shift unfilled is one of our core principles, reflecting a commitment to never leave a position vacant when a member of our team is sick, on vacation, in training or otherwise absent. We build a solid, qualified PRN pool so that we do not have to rely on temporary agency staffing to cover vacations, staff training, or unplanned absences. While we have often entered new contracts where agency staffing has been the norm, we rarely use temporary agency staffing on an ongoing basis. All of this costs a little more. We know that we could reduce our cost to you by cutting corners…by not training our staff, and by not committing to 100% full staffing. But we know that isn’t what Palm Beach County wants or expects. We will spend your money wisely, and we guarantee that you will be satisfied with the results. Wellpath will staff the Main and West Detention Centers appropriately to ensure the timely provision of healthcare in accordance with National and State of Florida FCAC and FMJ Standards and the Wellpath OneCare Collaborative Care Model. We have reviewed the current staffing and propose an enhanced staffing plan that is based on our significant medical and behavioral health experience in detention settings, a review of the contract requirements, a review of the layout of the facility, a desire to ensure enhanced staff supervision and mental health services, and 24/7 intake coverage by Registered Nurses, and the desire to ensure comprehensive quality care while being cognizant of cost and efficiencies. The programs will be managed administratively by the Wellpath Health Services Administrator supported by the Directors of Nursing. The Wellpath program will be managed clinically by the Medical Director. The Wellpath proposed staffing plan allows for: Charge RN Coverage Under the supervision of the Director of Nursing and ADON at the Main Detention Center, the Wellpath plan includes two (2) Charge RN’s on each shift that administrative staff are not scheduled, to oversee staff activity and patient care. The Charge RN’s will support the RN’s assigned to oversee intake and the infirmary and provide supervision and oversite to the LPN’s and ancillary personnel in the clinic, and pharmacy. In addition, during hours that the Director of Nursing is not on-site, the Charge RN’s ensure assignments are adjusted as needed so that all sick call, intake/transfers and clinic services are seamlessly provided to Standards of Care. At the West Detention Center, the staff will be supervised 24/7 by the Charge RN, under the direction of the Director of Nursing. Palm Beach County, Florida 106 24/7/365 RN Intake Staffing Wellpath is dedicated to ensuring the provision of care to newly committed inmates is timely, and that issues that may require urgent care are identified early in the screening process. By ensuring that medical and mental health issues are assessed and appropriately triaged, our experience has been a better stabilized population and fewer off-site transportation needs. The Wellpath plan for the PBSO includes Registered Nurses in intake 24/7, supported by LPN’s and Medical Assistants as needed. Registered Nurses have the education, training and skills to provide an enhanced level of assessment and observation for the chronically and mentally ill, and those at risk for substance abuse detox. During times of increased volume, additional staff will be dispatched to intake to assist. Wellpath has an automated process to track timeliness of intake screenings on a daily basis and will ensure that urgent medical and mental health needs are proactively identified and addressed. Comprehensive Nursing Staff Coverage The Wellpath Staffing plan ensures sufficient staff to manage Sick Call, Transfers and all Clinic Services. Registered Nurses conduct sick call and H&Ps. Support services are provided by the Administrative Assistants, Unit Clerks and Certified Medical Assistants. The Medical Assistants will support the clinical staff during sick call clinic, intake and infirmary care, and conduct treatments and phlebotomy. Health Care Practitioners On-site Seven Days per Week Under the direction of the Medical Director, the Wellpath staffing plan provides Physician and Nurse Practitioner/Physician Assistant coverage seven (7) days a week. Staffing schedules can be staggered in order to allow for expanded coverage throughout the day. A Health Care Practitioner will be on call 24 hours a day/7 days a week. Medication Distribution Medication distribution will be conducted utilizing a combination of Registered and Licensed Practical Nurses. Wellpath designates a dedicated Pharmacy Technician to ensure general organization of the pharmacy and that medications are ordered and returned in a timely manner. This will ensure efficiencies and maximum financial return on behalf of the PBSO. Pharmacist Consultation Services The Wellpath partnership with Diamond includes the consultative services of a pharmacist. A consulting pharmacist will review the on-site pharmaceutical program on a quarterly basis. The pharmacist’s review will be documented and a report will be provided to the Wellpath Medical Director and the PVCSO designee. The Quality Improvement Committee (QIC) will review the report and establish action plans for identified problem areas. The consulting pharmacist will perform the following duties:  On-site audits consistent with NCCHC and ACA guidelines  Quality assurance reviews on a quarterly basis  Written reports identifying any areas of concern and/or recommendations for improving pharmacy services  Quarterly inspections of stock medication storage areas  Assure that all medications are stored under proper conditions  Remove and replace all compromised or expired medications  Participate in quarterly meetings of the Pharmacy and Therapeutics Committee Palm Beach County, Florida 107 Behavioral Health Services On-site Seven Days per Week The Wellpath Behavioral Health program is supervised by the Psychiatric Director and Mental Health Director. Wellpath recommends an increase in the number of Mental Health Professional hours at the Main Detention Center to provide for seven (7) day a week coverage to ensure that newly committed inmates with mental health issues and med management are proactively evaluated. In addition, we have included Mental Health Professional/Substance Abuse Counselor hours for implementation of the Wellpath OneCare Collaborative Care Model and to ensure the needs of the population at the West Detention Center can be addressed. Staffing schedules can be staggered in order to allow for expanded coverage throughout the day. The MHPs/SACs are responsible for assessments and treatment planning, segregation and suicide watch rounds, individual and group therapy and discharge planning activities. In addition, the Mental Health units will be covered by Mental Health Technicians and Psych RNs 24/7. A Psychiatric Practitioner will be on call 24 hours a day/ 7 days a week. The OneCare model of care expands and enhances the care available to patients with mental and/or behavioral problems by integrating medical and mental health care. As part of implementing this model, Wellpath is expanding the training of all of its primary care staff, from nurses to providers, to include mental health and substance use training. Now, instead of a very limited number of staff devoted to the care of patients with mental or behavioral concerns, we have an entire care team with the training to screen, assess, and intervene to help this large subsection of our jail population. Care Managers The Wellpath staffing plan includes three (3) Care Managers. Care Management and the Care Manager are a foundation of OneCare. Care Managers coordinate the overall effort of the group and ensure effective communication among team members. Care Managers will be registered nurses with specific mental and behavioral health training. Care Managers support the Care Team by coordinating treatment, providing proactive follow-up of treatment response, alerting the Care Team providers when the patient is not improving, supporting medication management, and facilitating communication with the psychiatric team members regarding treatment changes. They may also offer brief counseling (using evidence-based techniques such as motivational interviewing, behavioral activation, and problem￾solving treatment) and help facilitate changes in treatment if patients are not improving as expected. Re-Entry and Discharge Planning Services The enhanced staffing plan for the PBSO includes a full-time discharge planner for assessment and re￾entry services to ensure discharged inmates are connected with community providers as needed for medical, mental health and substance abuse follow-up. The Discharge Planner would be responsible for:  Coordination with the appropriate contact regarding referrals to community based providers; including HIV, Housing, Vocational Education and other re-entry support service providers  Communication with the Salvation Army, MHMR and Probation and Parole  Initiating (when appropriate) and attending community-based case management meetings which may include representatives of mental health, family support or other specialized service agencies  Assisting inmates with completion of discharge paperwork and applications for Medicaid, social security and veterans benefits when applicable Palm Beach County, Florida 108 Dental Services Dental services are provided utilizing a combination of Dentist and Dental Assistant hours. The Dental Assistant ensures adequate preparation of tools and clinic schedules so that the Dental Practitioner’s time on-site can be maximized. The Wellpath plan ensures all Standards of Care are met. Proposed Staffing Plan We have utilized our extensive experience in developing this plan, but knowing that each site is individual, Wellpath would welcome a further detailed discussion on staffing; your insight and knowledge of the Jail would be invaluable for us to ensure the best possible utilization of resources. Although our proposed staffing plan results in slightly fewer FTEs, the level of care will be improved with the addition of enhanced RN and MH coverage. We are confident our systems and processes will improve staffing efficiencies and our recruitment and retention excellence will ensure decreased staffing vacancies and turnover. Palm Beach County, Florida 109 Main Detention Center 1400 ADP TITLE Mon Tues Wed Thur Fri Sat Sun Week FTEs Days Health Services Administrator 8 8 8 8 8 40 1.00 Medical Director 8 8 8 8 8 40 1.00 Staff Physician 8 8 8 8 8 8 8 56 1.40 Mid-level 8 16 8 16 8 56 1.40 Director of Nursing 8 8 8 8 8 40 1.00 Assistant DON 8 8 8 8 8 40 1.00 Charge RN 8 8 8 8 8 16 16 72 1.80 RN: Infection Control 8 8 8 8 8 40 1.00 RN: H&P 8 16 8 16 8 8 8 72 1.80 RN: Intake 8 8 8 8 8 8 8 56 1.40 RN 24 24 24 24 24 24 24 168 4.20 LPN 56 56 56 56 56 56 56 392 9.80 Medical Assistant 24 24 24 24 24 16 16 152 3.80 Nurse Educator 8 8 8 8 8 40 1.00 Medical Records Supervisor 8 8 8 8 8 40 1.00 Medical Records Clerk 12 12 12 12 12 12 12 84 2.10 Unit Clerk 8 8 8 8 8 40 1.00 Pharmacy Technician 8 8 8 8 8 8 8 56 1.40 Administrative Assistant 16 16 16 16 16 80 2.00 Discharge Planner 8 8 8 8 8 40 1.00 Psychiatrist 8 8 8 8 8 40 1.00 Psychiatrist 8 4 8 4 8 32 0.80 Psychologist 16 16 16 16 16 80 2.00 Mental Health Director 8 8 8 8 8 40 1.00 MHP/Substance Abuse Counselor 20 20 20 20 20 12 12 124 3.10 Mental Health Technician 24 24 24 24 24 24 24 168 4.20 Mental Health Secretary 8 8 8 8 8 40 1.00 Care Manager 16 16 16 16 16 80 2.00 Mental Health RN 16 16 16 16 16 16 16 112 2.80 Dentist 8 8 8 8 32 0.80 Dental Assistant 8 8 8 8 32 0.80 Subtotal 2,384 59.60 Evenings Charge RN 16 16 16 16 16 16 16 112 2.80 RN: Intake 8 8 8 8 8 8 8 56 1.40 RN 16 16 16 16 16 16 16 112 2.80 LPN 56 56 56 56 56 56 56 392 9.80 Medical Records Clerk 12 12 12 12 12 12 12 84 2.10 Medical Assistant 16 16 16 16 16 16 16 112 2.80 Palm Beach County, Florida 110 Mental Health Technician 24 24 24 24 24 24 24 168 4.20 Mental Health RN 16 16 16 16 16 16 16 112 2.80 Subtotal 1,148 28.70 Nights Charge RN 16 16 16 16 16 16 16 112 2.80 RN: Intake 8 8 8 8 8 8 8 56 1.40 LPN 32 32 32 32 32 32 32 224 5.60 Medical Assistant 16 16 16 16 16 16 16 112 2.80 Mental Health Technician 24 24 24 24 24 24 24 168 4.20 Mental Health RN 16 16 16 16 16 16 16 112 2.80 Subtotal 784 19.60 TOTAL 4,316 107.90 *May substitute one hour of physician time for two hours of mid-level practitioner time, or two hours of mid-level practitioner time for one hour of physician time, as necessary and with client approval. West Detention Center ADP 600 TITLE Mon Tues Wed Thur Fri Sat Sun Week FTEs Days Staff Physician 8 8 16 0.40 Mid-level 8 8 8 24 0.60 Director of Nursing 8 8 8 8 8 40 1.00 Charge RN 12 12 12 12 12 12 12 84 2.10 LPN 24 24 24 24 24 24 24 168 4.20 Medical Assistant 8 8 8 8 8 40 1.00 Medical Records Clerk 8 8 8 8 8 40 1.00 Administrative Assistant 8 8 8 8 8 40 1.00 Psychiatrist 4 4 8 0.20 MHP/Substance Abuse Counselor 8 8 8 8 8 40 1.00 Care Manager 8 8 8 8 8 40 1.00 Dentist 8 8 0.20 Dental Assistant 8 8 0.20 Subtotal 556 13.90 Nights Charge RN 12 12 12 12 12 12 12 84 2.10 LPN 12 12 12 12 12 12 12 84 2.10 Medical Assistant 12 12 12 12 12 12 12 84 2.10 Subtotal 252 6.30 TOTAL 808 20.20 *May substitute one hour of physician time for two hours of mid-level practitioner time, or two hours of mid-level practitioner time for one hour of physician time, as necessary and with client approval. Palm Beach County, Florida 111 The Wellpath staffing variances are detailed here. Wellpath OneCare Model Current Staffing FTE Variance Title FTE(s) FTE(s) Health Services Administrator 1.00 1.00 0.00 Medical Director 1.00 1.00 0.00 Staff Physician 1.80 1.80 0.00 PA/NP 2.00 2.00 0.00 Director of Nursing 2.00 2.00 0.00 Assistant DON 1.00 1.00 0.00 Charge RN 11.60 4.20 7.40 RN 13.00 15.80 -2.80 RN Infection Control 1.00 1.00 0.00 LPN 31.50 35.60 -4.10 Nurse Educator 1.00 1.00 0.00 Discharge Planner 1.00 0.80 0.20 Medical Records Supervisor 1.00 1.00 0.00 Medical Records Clerk 5.20 8.50 -3.30 Medical Assistant 12.50 12.50 0.00 Pharmacy Technician 1.40 1.40 0.00 Administrative Assistant 3.00 3.00 0.00 Unit Clerk 1.00 3.00 -2.00 Psychiatric Director 1.00 1.00 0.00 Psychiatrist 1.00 1.00 0.00 Psychologist 2.00 2.00 0.00 Mental Health Director 1.00 1.00 0.00 MHP 4.10 2.00 2.10 Mental Health Technician 12.60 12.60 0.00 Mental Health Clerk 0.00 1.00 -1.00 Mental Health Secretary 1.00 1.00 0.00 Care Manager 3.00 0.00 3.00 Mental Health RN 8.40 8.40 0.00 Dentist 1.00 1.00 0.00 Dental Assistant 1.00 1.00 0.00 Total 128.10 128.60 -0.50 Palm Beach County, Florida 112 4.1 Personnel Services Wellpath ensures the same staff category coverage during periods of planned or unplanned absence. The Wellpath staffing plan and relief factor calculations ensure adequate coverage for holidays, weekends, vacation and sick days, emergencies, and any other extenuating circumstances that may arise. Wellpath uses part-time and per diem personnel to provide coverage for scheduled absences and to supplement full-time staffing needs. Wellpath maintains a PRN pool to ensure that backfill and relief coverage are available when needed and available within three (3) hours. PRN pool employees are staff members who are committed to several shifts per month and open to working when full-time staff members are absent. Our PRN staff completes orientation and ongoing training consistent with our full-time team members to ensure they are capable and ready to serve. Wellpath reacts swiftly to vacancies and other potential staffing crises to avoid long-term staffing holes. We use PRN, locum tenens, or overtime coverage as temporary solutions until permanent positions are filled, for a period not to exceed 30 days. Documentation of Staffing Wellpath realizes the importance of delivering what we promise, especially regarding on-site staffing. We work to keep staffing costs as low as possible and track and report all staff hours worked, as well as hours not provided. To demonstrate compliance with the contracted staffing plan, Wellpath provides the PBSO with a monthly statistical report showing staffing fill rates. Each month, we provide accounting of actual days/hours worked by the entire medical staff to the PBSO in an FTE report. These reports, which are compiled by pay period, provide true transparency and allow for auditing down to the individual and shift. Because these reports are automatic, historical reports can be searched, queried, and drilled down in moments. Our automated FTE reporting system allows for 100% auditable reporting of contract versus worked staffing reports. Palm Beach County, Florida 113 4.1.1 On-Call Responsibility We will provide a physician/mid-level provider, as well as a psychiatrist, on-call twenty-four (24) hours per day, seven (7) days per week. A dentist is provided as needed; however, should an emergent situation arise, we have protocols in place for the inmates. The on-call physician will be able to respond within two (2) hours when required to do so. 4.1.2 Credentialing Wellpath has a credentialing process to ensure all personnel are up to date on state licensure requirements. The Wellpath Risk Management Department oversees credentialing activities. All health care practitioners (i.e., employees, subcontractors, and locum tenens) providing on-site service for Wellpath must complete the credentialing process before starting work. The credentialing process (described below) begins as soon as Wellpath decides to make an offer of employment to the candidate. 4.1.3 Recruitment To consistently recruit and retain highly qualified employees, Wellpath has developed industry-leading talent acquisition and employee retention programs. Our initiatives include strategic talent acquisition plans, competitive benefits programs, opportunities for professional development, and structured onboarding programs to educate new employees and welcome them to the Wellpath team. Wellpath continually researches rates of pay in different areas to ensure that our salary ranges remain competitive. By showing our employees that they are a valued part of our company, Wellpath is able to Palm Beach County, Florida 114 save our clients unnecessary operational expense and added costs created by turnover. The Jail will have a hard copy of all personnel files on-site. Talent Acquisition Wellpath provides on-site support to our clients through our skilled HR department, which facilitates the recruitment, development, and retention of health care professionals in our client communities. Our dedicated talent acquisition team of Physician Recruiters, Nurse Recruiters, Managers, and Coordinators actively source high-potential candidates, screen applicants, and conduct interviews. Using competency￾based behavioral interview questions and partnering with our clinical and operational specialists enables us to make informed hiring decisions. We perform primary source verification of credentials and licensure concurrently during the interviewing and screening process. We will also use the Department of Homeland Security E-Verify to confirm employment eligibility. We then select the best candidates based on qualifications and credentials, experience, references, interview results, and other information. All potential candidates for the Jail will have an on-site visit. Local, regional, and national recruitment campaigns keep a constant flow of qualified candidates within reach to discuss opportunities. Our recruiting team begins with our extensive candidate database, and concurrently sources through our broad resources for qualified candidates. Our first focus is recruiting locally and then, if circumstances merit, employing a nationwide search. National recruitment efforts focus on geographic locations where health care professionals are more plentiful and unemployment is higher, which increases the likelihood that candidates will be willing to relocate. Wellpath uses the iCIMS Applicant Tracking System (ATS) to maximize our talent acquisition processes. Hiring managers work with a dedicated recruiter and the Wellpath recruiting team to post open positions in the ATS. iCIMS helps us leverage mobile, social, and video technologies to manage our talent acquisition lifecycle. It also helps us build talent pools, in addition to automating our recruitment marketing, applicant screening, and onboarding processes. The talent acquisition process is illustrated in the following figure. The Wellpath Talent Acquisition Process Palm Beach County, Florida 115 National Recruiting and Sourcing Tools With the continuing challenges of lower unemployment rates for health care professionals, Wellpath is vigilant in our constant search for talent. We continually look for cutting-edge ways to source and communicate with candidates while also using tried-and-true strategies, like calling a candidate directly. Wellpath uses a variety of national recruiting tools that provide ongoing access to health care professionals throughout the country. Wellpath also uses resources that share job postings and information across dozens of other recruiting databases and job sites through a single source. Our strategic use of various databases ensures a continuous feed of the newest resumes and candidates into the Applicant Tracking System that our recruiters use to find the best candidates in the shortest amount of time. Internal Recruiting We post all job openings internally and externally. We give internal applicants first consideration for opportunities, to promote career advance. Wellpath employees in good standing can apply for internal opportunities after completing six months in their current role. Team members interested in transferring to another position and/or location, as part of the internal application process, must validate that they have informed their manager of their interest in another position or site. Hiring managers or regional staff members typically conduct interviews. Wellpath also welcomes input from clients during the interview process for key positions. College and University On-site Recruiting A key part of the Wellpath recruitment plan includes reaching out to local nursing schools and residency programs to attract health care professionals to a career in corrections. We have developed programs for nursing students in many of our client facilities and are expanding our outreach to residency programs. We find that by increasing community interest and education regarding corrections, we are able to attract and recruit health care providers who may have otherwise overlooked a career in our industry. Metrics and Technology Wellpath is strongly invested in technology to promote our open positions and provide us with robust analytics to help us understand the growing needs in staffing, as well as the outcomes of our efforts. Equal Employment Opportunities Wellpath is an Equal Employment Opportunity (EEO) employer. We have a thorough diversity policy to appropriately guide our recruiting and hiring processes. We comply with all provisions of federal, state, and local regulations to ensure that no employee or applicant for employment is discriminated against because of race, religion, color, gender, sexual preference, marital status, age, disability, or national origin. Palm Beach County, Florida 116 Employee Retention Wellpath understands the importance, for continuity of care, of ensuring the majority of our employees are full-time employees. Consistent staffing improves the quality of patient care and minimizes issues that can lead to grievances and lawsuits. Wellpath focuses on prudent staff deployment to promote high efficiency, fewer mistakes, and improved morale. As a result, we have an excellent retention rate with low turnover. Wellpath offers benefit-related incentives to entice those who may be looking at a slightly higher rate of pay as per diem staff to commit to full-time employment with our company. We are proud to say that over 96% of all Wellpath jail positions are filled with permanent employees (any open positions are temporarily filled through overtime and PRN staffing pools). We attribute our retention success and low turnover to maintaining competitive salary and benefits packages, embracing diversity, rewarding superior performance, and providing meaningful work in a friendly environment. Commitment to People Development Wellpath created our People Development program to invest in our employees’ long-term professional satisfaction and well-being. Our dedication to People Development creates lower employee turnover, reduces costs due to replacement and training, and strengthens team spirit through mutual respect and recognition of each employee’s contributions. Wellpath believes that a successful operation begins with motivated employees who are equipped to satisfy the needs of our clients. We begin with the identification, validation, and recruitment of the very best people and orient them to our Wellpath culture and operations through an established onboarding process. Wellpath offers a full range of opportunities for our employees’ continued professional development, including training programs, continuing education, clinical exposure, promotion preparation, succession planning, and peer reviews. Nurse Outreach and Support Wellpath has adopted several outreach techniques for our valued nursing professionals, including advanced training opportunities and open communication through the Nurse Channel, an online resource for Wellpath nursing professionals. In addition to providing useful information, the Nurse Channel also recognizes Wellpath nurses that are upholding our high standards for patient care. Employee Survey Responses “Working for and with Wellpath has been a great opportunity for me. I enjoy everything the company does for the sites as a whole as well as on an individual basis. They continue to help us grow and develop as a group through effective communication, patience, and understanding.” “When I started in corrections, I worked for [a competitor]…I know Wellpath has a vested interest in my success and personal well-being. I have the tools needed to do my job, and through CORE and startups I have been able to expand my knowledge and believe my opinion and talents are important. This is the company I want to retire from.” Wellpath is constantly taking action to improve employee retention rates for all of our locations. Over 96% of all Wellpath jail positions are filled with permanent employees. Palm Beach County, Florida 117 Professional Development Wellpath encourages employees to take advantage of opportunities for advancement and professional growth. The Wellpath education and training program facilitates professional development and provides tuition assistance to employees for skills and career advancement. Each year, Wellpath employees and their children who have graduated high school are encouraged to apply for Wellpath-sponsored college scholarships. In 2018, Wellpath awarded four $2,500 scholarships to children of Wellpath employees who had graduated high school. Employee Recognition Wellpath attracts and retains skilled and competent personnel through a number of employee incentives. However, incentives alone do not build loyalty; a friendly company culture ensures the long￾term satisfaction of our employees. Wellpath understands that the primary reason for dissatisfaction in the health care field is feeling undervalued. From the recruiting process through the life of their career, each employee is treated with respect, incentivized and rewarded for dedication and performance, and viewed as a valuable asset of our team. We also have a formal Employee Recognition Program based on our company slogan: “The Right People Doing the Right Things Right.” The program, known as “R3 Recognition,” rewards employees for outstanding performance and exemplary service. The purpose of the program is to motivate positive job behavior and build a sense of pride in each employee. By recognizing our top performing employees, we are able to increase employee morale, as well as increase quality of care. Each Wellpath location incorporates “R3 Recognition” into its local operations. The primary program is the 5H Award, which represents the values by which Wellpath strives to exist: Hunger, Honesty, Hard Work, Humility, and Humor. Wellpath encourages the use of the 5H Program to continuously recognize employees whose contributions echo these values. To recognize a particular staff member, each Wellpath location or territory has its own R 3 Recognition Committee and celebrates recognized employees each month and quarter. Wellpath presents monthly and quarterly recognition awards based on attendance, customer service, teamwork, and overall performance. Each year, the leadership team of each Wellpath business unit selects one individual from each of the quarterly 5H Award Winners to be nominated for the President’s Award. All nominees for the quarterly award, Quarterly Award Winners, and President’s Award Winners are recognized on the Wellpath website and eligible to receive a monetary award, certificate of recognition, and a gift. Flexible Scheduling When possible, Wellpath allows flexible scheduling to meet the needs of our employees. We employ part-time and per diem personnel to provide coverage for scheduled absences and to supplement any full-time staffing needs. Wellness Program Wellpath places a great deal of importance on the health and well-being of our staff. We encourage employees to participate in the Wellpath Wellness Program, which offers exercise programs, healthy eating tips, and other initiatives that promote a healthy lifestyle. Various Wellpath sites offer incentives or contests to encourage employee participation in programs that create a healthier staff, including smoking cessation and weight control programs. Palm Beach County, Florida 118 Employee Assistance Program Wellpath offers an Employee Assistance Program (EAP) through Aetna. All Wellpath employees and their household dependents have 24/7 access to a range of free services and educational materials to help with a variety of life/work challenges and crisis management. Assistance is available through a confidential phone call or referral to a specialist for up to three sessions of in-person support. The Aetna EAP also gives employees access to a variety of discounted services and programs designed to promote health and wellness. Dare to Care Wellpath established our Dare to Care Employee Assistance Fund to support our valued team members when they need it most. Wellpath employees and their eligible dependents can apply for economic assistance to help meet their needs in the event of unexpected economic hardship. Employees may be eligible for assistance if they experience extreme or catastrophic circumstances beyond their control, including loss of property due to natural disaster; life-threatening illness or injury; or the loss of a family member. Wellpath started Dare to Care in 2010 in response to the flooding that devastated the City of Nashville. Since then, the Dare to Care fund has provided nearly $785,000 in financial assistance to more than 500 Wellpath employees and their families in need. Most recently, we assisted our fellow employees impacted by hurricanes in Texas and Florida by donating tens of thousands of dollars to Dare to Care. Wellpath partners with the Community Foundation of Middle Tennessee to manage all funds and award gifts, which keeps the application process private and ensures that requests for assistance are reviewed by an impartial and experienced third party. Dare to Care is funded through employee donations and matching contributions from Wellpath. 4.1.4 Employee Benefits Our goal is to retain all qualified, properly credentialed individuals who have the attributes to succeed as a part of our team, with your input and approval. We compensate these employees at a rate equivalent to what they are currently receiving. This includes full benefits on Day One for those who qualify for full benefits in their current position. Wellpath offers competitive salaries and benefits to attract and retain qualified staff. We conduct local due diligence and salary surveys to ensure that our proposed rates are competitive within the surrounding area. Our benefits program exceeds market standards and is designed to attract and retain health care staff, while recognizing the diverse needs and goals of our workforce. Wellpath also promotes retention through:  Retention bonuses  Referral bonuses for hard-to-fill positions Palm Beach County, Florida 119  Incremental increases of benefits such as vacation and 401k vesting based on length of employment  Annual salary increases based on performance and qualifications  Monetary assistance and time off for CMU/CEU programs related to specific skill sets  Employer Tuition Reimbursement Program, which can be used for licensure renewal  Malpractice insurance coverage for practitioners  Company-sponsored gatherings  Discounted offerings for theme parks, restaurants, movie theaters, and other activities Employee Benefits Program Our comprehensive and flexible benefits program focuses on the overall health and well-being of our staff. We offer three medical plan options with a robust pharmacy program, two dental plan options, vision, and company-paid life insurance, as well as additional insurance options for employees, spouses, and children. We also offer short- and long-term disability plans to offset income loss in case of an emergency, as well as various supplemental insurance programs that pay staff directly for illness or accidental injury. Additionally, we offer numerous incentives for employees who take steps toward healthier lifestyles, rewarding them for making healthy choices; a wellness incentive program is an important part of our commitment to healthy living at Wellpath. Wellpath encourages employees to use the benefits we offer to improve their health and well-being. As part of our wellness initiatives, our MedEncentive program awards employees for learning information that improves health. MedEncentive helps employees, in consultation with their doctor, better understand and self-manage their health. Members also gain the peace of mind that comes from knowing their doctor’s care is consistent with “best practices” as published by credible, independent sources. When members visit their physician, they receive an invitation to complete an Information Therapy prescription. Completion is easy, and members earn a $15 reward each time they complete one. Preventive care is important to maintaining well-being and a high quality of life. Simply by obtaining or maintaining an annual physical on file (within the last year), employees receive a $50 per-paycheck discount off their medical plan premium. Wellpath also offers a Health Savings Account option with an annual employer contribution that allows employees to make pre-tax contributions to pay for doctor’s visits, medications, and other health services. Affordability is top priority for our benefits program. Wellpath works with vendors to ensure that we provide competitive benefit plans at affordable rates. To do this, we subsidize the majority of the total cost of health care and tier the out-of-pocket bi-weekly premiums so that staff with lower income pays less than staff who earn higher wages. All new hires, transitioning employees, and current staff can enroll in Wellpath benefits through our online and mobile enrollment system, which streamlines communications, education, forms, and all other benefit-related options. Financial wellness is an important aspect of employee retention, and Wellpath offers multiple retirement and other saving options for our staff. In addition to a traditional 401k with a company match, Wellpath offers a Roth IRA, 409A deferred compensation plan, college tuition reimbursement, Palm Beach County, Florida 120 and a 529 College Savings Plan. Wellpath employees also have the opportunity to meet, at no cost, with a licensed financial advisor knowledgeable about our company-sponsored benefits. Wellpath offers a competitive paid time-off program as well as paid holidays throughout the year. Please see the following summary of Wellpath benefits programs for 2019. Wellpath Benefits Summary Benefit Eligibility Amount/Coverage Paid Time Off Accrual begins immediately; eligible for use after 90 days of employment Year one = 15 days Holidays Immediately eligible 6 company-paid holidays per year, plus 3 floating holidays Pregnancy Disability Leave Full-time employees who have one year of completed service and have received medical certification under FMLA Up to 2 weeks of paid leave during pregnancy or after giving birth Military Leave Immediately 2 weeks paid per year/difference between military pay and base salary Funeral Leave Immediately Company pays for 3 days off for immediate family member Jury Leave Immediately Company pays the difference between jury pay and regular pay if scheduled work days are missed FMLA/LOA Service date with prior company will drive FMLA date; also offer 30-day personal leave of absence Up to 12 weeks in a rolling 12-month period for FMLA Long-Term Disability Immediately (see probation period); pre-ex applies Pays 60% of monthly salary up to max of $15,000; benefits begin 180 days after covered injury or sickness Short-Term Disability Immediately (see probation period); pre-ex applies Pays 60% of weekly salary up to max of $2500; benefits begin after 8 days of injury or sickness Medical/Health Insurance Immediately for retained employees during acquisition Multiple options through Aetna and Health Cost Solutions, including PPO, HSA, and HMO plans; provided for employees and dependents Prescription Benefits Immediately for retained employees during acquisition Envision Rx; offer a retail and mail order pharmacy benefit Dental Insurance Immediately for retained employees during acquisition Aetna Dental; provided for employees and dependents Vision Insurance Immediately for retained employees during acquisition Aetna Vision; provided for employees and dependents Basic Life and AD&D Immediately for retained employees during acquisition 1x annual salary up to max of $500,000 Voluntary Life Immediately for retained employees during acquisition Can elect up to 5x annual salary up to max of $1,000,000 Palm Beach County, Florida 121 Wellpath Benefits Summary Benefit Eligibility Amount/Coverage Family Life Immediately for retained employees during acquisition Available with Voluntary Life; benefit cannot exceed 50% of coverage; spouse benefit in $5,000 increments up to max of $250,000; dependent benefit of $10,000 Tuition Assistance After 6 months of service Company will pay up to $2,000 in rolling 12 months Employee Assistance Program Available immediately Through Aetna Other Benefits 1) Wellness Program; 2) Flex plan for health and dependent care reimbursement; 3) Legal and Identity Theft Program Retirement/Pension, 401K, Employer Contribution Eligibility is 1st of the quarter following date of hire or date of acquisition Traditional 401k plan or Roth 401k through Mass Mutual 4.1.5 Employee Training and Orientation The lives and health of our patients depend on the knowledge, practical skills, and competencies of the professionals who care for them. Caring for and respecting patients in correctional facilities requires hiring ethical and competent professionals, and then building upon their skills through continued training initiatives. Wellpath will provide appropriate orientation and training for all health care personnel. Additionally, we will extend appropriate educational offerings to the PBSO personnel and will train correctional staff in medical issues as requested. Orientation Wellpath provides a comprehensive three-phase training program for our employees. New staff members go through the Wellpath Onboarding process, and all employees receive ongoing skills/knowledge assessment through our Performance Enhancement and Leadership Development programs. All Wellpath staff members are required to participate in each phase of training. The frequency and focus of each training phase will be determined by the position and learning capacity of individual employees. Phase 1: Onboarding Critical to the future success of any new employee is his or her initial experience with the organization. To start the employee off on the right foot and to ensure a smooth transition, Wellpath offers a three￾part onboarding process: Orientation, On-the-Job Training, and Follow-up. Palm Beach County, Florida 122 Onboarding Step 1: Orientation Each new hire is scheduled to participate in a learning experience (the physician orientation program has additional requirements), where they are introduced to the Wellpath clinical skills, lab techniques, culture, policies, and procedures. The program is designed to clearly establish expectations and to involve new employees in the success of the company. Onboarding Step 2: On-the-Job Training (OJT) On-the-Job Training is guided by standards, detailed checklists, and a qualified preceptor. While there are time schedules with expected milestones, the preceptors will work with the new employees to ensure that the expected knowledge is transferred. This portion will not be considered complete until the new employee feels capable of performing the job. Onboarding Step 3: Follow-up Follow-up is the last component of the onboarding process. During this component, the new employee has an opportunity to provide feedback about his or her experience with the Health Services Administrator (HSA). During this discussion, the HSA also shares information about his or her leadership style and performance expectations. Phase 2: Performance Enhancement Performance Enhancement training consists of skills labs and webinars. On a scheduled basis, the medical team will participate in online training, as well as in-service learning opportunities such as “Lunch and Learn” sessions. In addition, webinars and DVDs that interface with a variety of Subject Matter Experts (SMEs) will be offered to staff members as applicable for their roles. Phase 3: Leadership Development Wellpath uses Leadership Development training to invest in the continued growth of our employees in order to develop leaders from within. Each training session varies in delivery and duration, and is designed to strengthen the leadership competencies of all of our staff members. The Leadership Development training sessions are a collaborative effort between our Home Office and on-site leaders. Wellpath Leadership Boot Camp Wellpath Leadership Boot Camp, held at our Home Office in Nashville, gives our new leaders the opportunity to learn about Wellpath values, policies, practices, and culture. Boot Camp is a three-day interactive experience focusing on People Skills, Patient Care, Processes and Procedures, Partnering with our clients, and operations. Wellpath will ensure that the HSA and DON for the Palm Beach County Detention Centers have the opportunity to attend our Boot Camp program. Time Topic Presenter Key Focus Location 1:00 - 1:30 Welcome, Introductions, and Objectives Angela Lewis Manager, Learning & Development Welcome to CCS Getting To Know You Program Expectations 1st Floor Training Room 1:30 - 2:00 Culture Frankie Allen Senior Leadership Development Consultant Who We Are 1st Floor Training Room 2:00 - 2:30 Understanding Your Contract Colton Cline Lori Schwartzmiller Review of Contract Q & A 1st Floor Training Room 2:30 - 2:45 Dare-To-Care Bob Martin, SVP Chief Information Officer Caring for our People 1st Floor Training Room 2:45 - 3:30 1st Floor Training Room 3:30 - 4:00 HR - Benefits Tanya Blake Tom Penn Kim Kilmon Process Insurance Tuition Reimbursement 1st Floor Training Room 4:00 - 4:30 Telemedicine CJ Whitfield Director, Telemedicine Patients Process 1st Floor Training Room 4:30 - 5:00 CCS Executive Moments Jorge Dominicis Chief Executive Officer Inspired to Lead 1st Floor Training Room 5:00 - 5:30 CCS Executive Moments Kip Hallman President Inspired to Lead 1st Floor Training Room H S A Boot Camp - Day One Agenda: Monday, January 28, 2019 Break and Tour of Building HSA-New Leader Boot Camp Palm Beach County, Florida 123 New Practitioner Orientation New Wellpath practitioners (physicians and mid-level providers) undergo a structured New Practitioner Orientation process focused on critical thinking and clinical decision making in the correctional environment. The training is presented by Wellpath Chief Clinical Officer, Carl Keldie, MD, or designee. New practitioners receive an orientation manual that also serves as a reference tool for information related to their daily work in corrections. Over the first 12 months of their employment with Wellpath, practitioners work with an assigned coach/mentor to ensure a thorough onboarding and to provide them with resources for their clinical work in correctional health care. At the end of the first 120 days of employment, practitioners participate in a focused clinical review, and at the end of their first year, they participate in a peer review with their mentor or Regional Medical Director. Wellpath practitioners receive ongoing training and clinical decision support from the Wellpath Clinical Department. Our Associate Chief Clinical Officer and Regional Medical Directors mentor and coach our on-site providers. Regional Medical Directors are available to our on-site medical staff for knowledge sharing and clinical decision support. The Wellpath Clinical Department conducts webinar events to train practitioners on timely and relevant correctional health care issues. Palm Beach County, Florida 124 Qualified Mental Health Professional Orientation Each mental health staff member receives an Onboarding Manual specifically designed for our behavioral health personnel. Additionally, each mental health staff member is assigned a mentor who works directly with them throughout the 60-day onboarding process to ensure they are well-prepared for success in their new position. Administrative/Support Personnel Orientation The Operations Support team provides in-person training for administrative personnel at the site level and quarterly training at our Nashville Home Office. The team also provides remote operational support and assistance by phone and email on a daily basis. Wellpath offers a quarterly three-day Administrative Assistant (AA) training program at our Home Office. The program provides in-depth information on all departmental processes and procedures necessary for the AA to be successful in their role. Representatives from each Home Office department cover their respective processes, allowing administrative staff receive information directly from and establish a relationship with all departments. Wellpath also conducts a monthly administrative conference call for all HSAs and AAs covering an array of topics such as human resources, workers’ comp, ERMA, payroll, and more. Attendees have an opportunity to ask questions or discuss challenges, and to offer information regarding Best Practices during this call. Ongoing Training Wellpath routinely offers continuing development and training opportunities for our employees, and we will work with the PBSO to ensure that on-site personnel receive corrections-specific training opportunities. We offer both in-house and community opportunities for continuing education programs applicable to a career in correctional health care. By encouraging our employees to take advantage of these opportunities, Wellpath is building an even stronger, more professional staff equipped to meet our clients’ diverse needs. In-Service Training Wellpath maintains a video library and other reference materials that facilities can use to build site￾specific training programs. The Wellpath Training Department also offers self-study continuing education and training programs, which can be tailored to meet the specific needs of the Palm Beach County Detention Centers. The self-study programs are available electronically and the Wellpath Training Department is available for assistance as needed. Time Topic Presenter Key Learning Points Location 8:30 - 9:15 Introductions Operations Services Team Meet & Greet Program Expectations Housekeeping Welcome to CCS 4th Floor Training Room 9:15 - 9:45 Wellpath Guest Speaker Terri Campbell Operations AA / HSA Relationships Moving Forward 4th Floor Training Room 9:45 - 10:00 10:00 - 10:30 Grab Bag Topics Tracy Matthews Tabitha White Drug Tests & Team Member Manuals 4th Floor Training Room 10:30 - 11:00 Helpdesk Richard Lee Mark Vancil Overview 4th Floor Training Room 11:00 - 11:30 CCS Executive Speaker Patrick Cummiskey CCS Vision 4th Floor Training Room 11:30 - 12:00 4th Floor Café 12:00 - 2:00 ERMA Care Management Ops Specialists Overview UM Queues Event Detail Off Site Claims 4th Floor Training Room 2:00 - 2:30 ERMA Care Management Hands-On Group Activity Ops Specialists Referral Entry Scheduling & Updating Appointments 4th Floor Training Room 2:30 - 3:00 Care Management Marge Trevathan Daily CM Log / IP Tracking 4th Floor Training Room 3:00 -3:30 Claims Kenya Adams Tammy Adams Claims Process Customer Service Info 4th Floor Training Room 3:30 - 3:45 3:45 - 4:30 Legal Hannah Bernard Litigation / Insurance Medical Records 4th Floor Training Room 4:30 -5:00 Policy Center and CCSMGR Daniel Black Policies & Procedures CCSMGR 4th Floor Training Room Break Day One: Downtown (Optional) Dinner Travel to Dinner Break Lunch Palm Beach County, Florida 125 The self-study training programs build on the foundation established during the orientation process and are conducted in accordance with professional and legal standards. For example, Wellpath ensures that all staff members are trained on PREA standards by providing education, testing their knowledge, and providing certification based on demonstrated competency; Suicide Prevention training is a mandatory part of Wellpath new employee orientation and is also required annually for all Wellpath employees and subcontractors. The HSA will be responsible for ensuring that health care personnel receive regular training on topics specific to the Palm Beach County Detention Centers. Wellpath identifies new topics on an ongoing basis through the Continuous Quality Improvement Program (CQIP). Additional training may be requested through a Clinical Training Request submitted to the Regional Manager. The HSA will maintain documentation of completed training in an individualized training record for each employee. Wellpath Academy Learning Center Wellpath has partnered with HealthStream to create the Wellpath Academy Learning Center, which Wellpath uses to deliver, track, and manage training content, including E-learning courses, classroom courses, other learning events, certifications and licenses, and more. Staff simply log in and are taken to the To Do tab, which shows all assigned training courses with due dates. When new trainings are added to each individual’s To Do list, they will receive an email notifying them of the new training required to complete. Mandatory courses for all Wellpath employees include, but are not limited to: HIPAA, Sexual Harassment, Bloodborne Pathogens, and Hazard Communication. Site-specific courses can also be added to the Learning Center. Palm Beach County, Florida 126 Once staff have completed all assigned courses, the To Do list tab will show that they are up to date, along with a button that says “Find an Elective in the Catalog,” which allows them to select additional, non-mandatory courses to further their professional development. Employees can also add information regarding certifications, licenses, resuscitation cards, and more to their personal profile. Future plans for the Learning Center include coursework for nursing CEUs, which will auto-populate based on training needed to maintain certifications and licenses. Staff can also view and print a list of completed courses by clicking the Completed tab. If an employee takes a course outside of Wellpath, he or she can add it to their completed courses transcript using the “Add a Learning Event” option. The course information will then be maintained in the employee’s transcript. 7 Minutes to Save Wellpath understands we have to be both resourceful and respectful of the time requirements for providing guidance and education to both health care and detention staff. With this in mind, Wellpath developed our 7 Minutes to Save campaign, which presents topics vital to the management of urgent and emergent issues encountered within a correctional setting in short, easy-to-comprehend training sessions. 7 Minutes to Save is a Rapid Response Series designed to standardize our approach to trauma evaluation. The program addresses many topics, including suicide prevention, pregnancy, trauma, and optimized care for patients experiencing alcohol and drug withdrawal. Training topics for health care staff include:  Abdominal Pain  Alcohol and Benzodiazepine Withdrawal  Altered Mental Status  Chest Pain  Ingestions  Opiate Withdrawal  Primary and Secondary Trauma Survey  Seizure  Respiratory Distress  Suicide Prevention  Use of Force Palm Beach County, Florida 127 In addition to our Rapid Response Series, the Wellpath Clinical Department has developed a 7 Minutes to Save series focused on Patient Care. The goal of the Patient Care Series is to equip our clinicians with up-to-date information to guide their recommendations for diagnostic and therapeutic interventions. The training series emphasizes intentional concern for patient needs based on the STEEEP principle, which dictates that patient care should be Safe, Timely, Effective, Efficient, Equitable, and Patient Centered:  SAFE – Avoids injuries to patients from care that is intended to help them  TIMELY – Reduces waits and delays for both those who receive care and those who give care  EFFECTIVE – Based on scientific knowledge, extended to all likely to benefit, while avoiding underuse and overuse  EQUITABLE – Provides consistent quality, without regard to personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status  EFFICIENT – Avoids waste, including waste of equipment, supplies, ideas, and energy  PATIENT-CENTERED – Respects and responds to individual patient preferences, needs, and values, ensuring that patient values guide all clinical decisions Specialized Nurse Education Wellpath has established a Nursing Services Department whose mission is to promote correctional nursing care focused on patients, formed in a collaborative and supportive environment, and grounded in evidence-based competencies and practice. The Wellpath Nursing Services Department is leading the charge in making Wellpath the leader in health care delivery through excellence in nursing practice. Nursing Services’ primary focus is the development and delivery of nursing education through an assortment of training initiatives, including Continuing Nurse Education (CNE), independent/self-study, in-person clinical education, distance education (webinars, conference calls, etc.), corrections-specific video training, and a Train the Trainer (T3) program. In addition to our cutting-edge training programs, Wellpath has developed educational materials that can be placed conspicuously in our sites to remind nurses of basic protocols, like SBAR communication (Situation, Background, Applicable nursing data, Request/Recommendation). Palm Beach County, Florida 128 Continuing Education While employees are ultimately responsible for their own development, it is our philosophy to provide Wellpath team members with the proper tools to build on their knowledge and further their success. Wellpath maintains a Continuing Nurse Education (CNE) provider license that allows us to offer continuing education credits to nursing personnel as an employee benefit. Employees have the opportunity to complete a variety of CNE modules focused on topics commonly seen in the corrections environment. Core Competency Training and Evaluation Wellpath offers regular nurse training opportunities to ensure that our nurses keep their skills sharp and stay on top of the latest developments in clinical practice. The Wellpath Nursing Services Department distributes an Annual Clinical Training Calendar with monthly training assignments focused on a variety of Core Knowledge topics, such as Patient Evaluation, Emergency Response, Suicide Prevention, and Withdrawal Management. Each monthly training assignment includes a Clinical Skill Competency (CSC) component designed to provide technique refreshers and verification of clinical skills. The Clinical Skill Competency modules are part of the Clinical Skill Competency Evaluation Manual developed by the Wellpath Nursing Services Department to ensure that our nurses are well￾equipped to care for our patients. The purpose of the Clinical Skill Competency Evaluation Manual is to identify competent clinical practice, areas requiring additional training, and opportunity to improve skill sets through practice and re￾evaluation. The manual presents nursing professionals with a variety of scenarios to assess their clinical competency and decision-making ability. Wellpath nurses must successfully demonstrate the clinical skill covered in each CSC module in order to pass their evaluation. Nurses are trained and evaluated on clinical skills essential for the effective and efficient delivery of health care in the correctional environment, including but not limited to conducting intake screenings, health assessments, and sick call. The CSC evaluations are developed by the Corporate Director of Nursing in collaboration with the Patient Safety Officer, based on current evidence and peer-reviewed nursing resources. The manual is reviewed and approved annually and updated as needed. DON Training Wellpath presents quarterly three-day onboarding training for all new Directors of Nursing (DONs) at our Home Office. This intensive educational event provides hands-on skills training and advanced correctional nursing instruction, equipping our DONs with additional skills and resources they can take back to their sites and their staff. The Wellpath Nursing Services Department has also established a Nursing Services Hotline for DONs to call and ask questions related to nursing practice, training questions, or resource needs. The Nursing Palm Beach County, Florida 129 Services Hotline is answered during regular business hours by a Registered Nurse who is knowledgeable about state-specific scope of practice and Wellpath clinical policies, resources, and processes. Medical Reference Library Wellpath will maintain a comprehensive library of course content for preventive health education that can be customized for a readily available training agenda and scheduled delivery to meet the needs of the entire inmate population. We will provide a medical reference library accessible at all times by health care personnel, with basic reference texts related to diagnosis and treatment in a primary care setting. Palm Beach County, Florida 130 5 Contract Transition Wellpath is prepared to implement a comprehensive turnkey program for the PBSO. We have the necessary experience, capabilities, and resources for a successful partnership with the PBSO, and we are confident that our business plan will ensure a smooth transition and will meet or exceed your program objectives and requirements. Once we receive notification of intent to award the contract, we will immediately begin the transition process. Wellpath will develop a detailed transition plan to ensure proper delegation of responsibility and to ensure that our program meets all tenets of the contract. We will use this transition plan to communicate responsibilities and to ensure the completion of all required tasks. Continuous communication helps minimize surprises and ensures a mutual understanding of decisions and protocols. Wellpath will not make change for the sake of change, nor will we accept the status quo where improvements can be made that will benefit patient care or provide cost savings for the PBSO. We will work cooperatively with on-site staff, the PBSO-contracted providers, and the PBSO administration to encourage a fully integrated program that is seen as a success throughout the State of Florida. Transition Team Accomplishing a successful transition and implementation means looking beyond the tasks themselves and placing experienced Wellpath team members on-site, working hand-in-hand with our new staff. The members of our Regional Management team will become familiar faces as they provide guidance and insight to the Palm Beach County Detention Centers’ medical and mental health teams. The Wellpath Executive Team will also be closely involved with the implementation and operation of services for the PBSO. Wellpath has assembled a strong leadership team to manage the start-up and implementation process at the Palm Beach County Detention Centers. The following individuals will support the transition and operation of the PBSO medical program:  Senior Regional Vice President: Bill Kissel  Regional Manager: Stephanie Peskowitz  Regional Medical Director: Karla Dunbar  Regional Behavioral Health Manager: Bridgette DaBiere  Director of Behavioral Health for Local Detention: Uduakobong Ikpe-Welch, PhD, JD  Chief Psychiatric Officer: Cassandra Newkirk, MD  Chief Psychiatrist for Corrections: Johannes Dalmasy, MD  Chief Clinical Officer: Carl Keldie, MD  Chief Operating Officer: Cindy Watson  Operations Support Manager: Terri Campbell  VP Transitions, Local Detention Division: Wanda Streeter  Transition Coordinator: Zela Guiroloa Each of these team members will be responsible for ensuring that programming follows the tenets of the contract between Wellpath and the PBSO, as well as Wellpath protocols and industry standards. Palm Beach County, Florida 131 Wellpath also has more than 200 additional Home Office team members prepared to support the PBSO medical program. Immediate Steps To ease the transition of services, Wellpath prefers to meet with new clients and valued medical personnel within 72 hours of notice of contract award. We will provide informational sessions to medical personnel and distribute applications and paperwork to all on-site staff. Wellpath uses an automated process to make the transition easier for current employees. We will distribute a “How to Apply” document that will guide them through the application process in six easy steps. Immediately upon notification of award, we will set up a “startup portal” website for the Palm Beach County Detention Centers employees that will be the repository for all information related to the hiring, orientation, and transition process. An example web address would be: http://newWellpath.recruiting.com/PalmBeach. Current Employees Upon notification of award, Wellpath will work closely with the PBSO to retain all valued current members of your health care team. Wellpath will conduct meetings with the PBSO command staff to identify valued health care staff and to ensure a clear understanding of expectations and channels of communication. Wellpath will ensure the compensation offered to these employees is at least equivalent to what they are currently receiving—no one will go backwards in pay. We will also provide full benefits on Day One for employees who qualify in their current position. Our goal is to retain all qualified, properly credentialed individuals who have the attributes to succeed as a part of our team, with the PBSO’s input. Prior to contract start-up, our team will personally meet with current staff to address any questions and concerns. We believe this respect and consideration initiates a positive relationship to sustain a long￾term commitment in a productive environment. Transition Plan On the day we assume responsibility, we take a very different approach than any of our competitors, one that is made possible by our high concentration of active county customers and clinical staff in close proximity to Palm Beach County. From the first day we assume responsibility for care in Palm Beach County, we will have a transition team of clinical, management and operations people on-site, to work side-by-side with our new on-site care team to make sure every member of the team is fully trained on the Wellpath Way. Your transition will be smooth, organized, timely, and successful, due to a total commitment of our executive team and the local management team we already have in place to support your program. This total commitment and our “roll up our sleeves” approach on all levels makes our programs successful and our partnerships real. Because of the importance of a seamless and thorough transition, Wellpath uses a transition plan, which has proven useful for both the Jail Administration and our team members. As you will note in our Palm Beach County, Florida 132 transition plan, we can customize our transition in accordance to any requirement the County may have to ensure a smooth and seamless transition. As you’ll see from our Sample Transition Plan included in Attachment A we include the following transition actions:  Preparing proposed transition plan  Preparing a strategic/operational plan  Conducting in-service training to County and Contractor staff  Supervising and developing a disease/injury oriented medical record system  Developing drug utilization data and evaluating existing inventories  Establishing professional contracts with referral facilities and contracts with subcontractors for ancillary medical, behavioral health, and other related services  Personnel recruitment and hiring  Evaluating and ordering of supplies and equipment  Developing both internal and external plans for emergency care  Establishing reporting procedures  Conducting in-serviced training for County and XXCMG staff  Uploading medical records, including electronic medical records software systems  Transitioning services from the current vendor, including, but not limited to pending and future appointments and follow up on care needs for current and active medical and behavioral health cases; and  Meeting applicable licensure requirements prior to the start of the Contract. A written list with the names, years of experience, and types of license held for persons who will be providing these services must be given to the Sample County Administration during the transition phase. Recruitment of Current and New Staff Wellpath will actively begin recruiting efforts on the day we are given notice of award. Recruitment and hiring efforts will be directed by the Wellpath Recruiting Manager with the support of our corporate Human Resources department. We will have discussions with the PBSO leadership to identify the high￾performing members of the current medical and mental health teams so that we may focus our recruitment efforts. Upon extending an offer to candidates, Wellpath will begin the credentialing process for providers. Hospitals, Subcontractors, and Ancillary Services At the direction of the PBSO, the Wellpath Network Development team will contact on-site and offsite subcontractors and specialists to develop and finalize agreements on behalf of the PBSO. Throughout the transition period, we will continue reaching out to these providers and others recommended in order to establish a strong provider network and the best possible on-site programs. Pharmaceutical, Laboratory, Radiology, and Medical Supplies Wellpath will work with our subcontractors and the PBSO to ensure that necessary pharmaceutical, laboratory, radiology, and other medical supplies are available at start-up. Palm Beach County, Florida 133 Identification and Assuming of Current Medical Care Cases Wellpath will communicate throughout the transition process with the Palm Beach County Detention Centers’ medical and mental health teams. We will require knowledge of any inmates currently hospitalized, those in need of specialized chronic care, those with offsite appointments scheduled for the next 30 days, and those on suicide watch. Wellpath will communicate with the PBSO and the current medical and mental health teams throughout the transition process to identify and care for those inmates requiring medical attention. Equipment and Inventory Wellpath will work with the PBSO to ensure that necessary equipment and supplies are available for start-up and to determine a secure place within the Palm Beach County Detention Centers where all packages can be delivered and kept secure until the transition of services occurs. Orientation of New Staff All new employees will participate in training that includes an introduction to Wellpath, security parameters at the Palm Beach County Detention Centers, and information regarding NCCHC and ACA standards and certification. Each employee hired by Wellpath during the transition period will undergo specific training regarding the expectations Wellpath has for our program, as well as their specific role in that program. The PBSO team members are welcome to join in these training sessions, which are conducted outside of regular working hours and are paid on the first Wellpath paycheck. Transition Timeline Although we have transitioned contracts with as little as seven days’ notice, we are planning for a 90- day transition to allow for optimal communication and management of the entire transition process. With that in mind, we present a sample timeline in tabbed Attachment A. Transition Experience Wellpath has significant experience transitioning contracts from other companies in our industry. With our unmatched experience, Wellpath stands ready to complete a successful and smooth transition in Palm Beach County. We have provided the following client testimonials for your review and we encourage you to contact our client references. Ask them why they chose Wellpath and how our operations are different from their previous provider. Client Testimonials – The Wellpath Difference Customer Satisfaction “I made the decision to switch our corrections medical provider to CCS after extensive research and evaluation. This decision was one of the best decisions that I have made as Sheriff. The level of service provided by CCS is second to none! This organization gets it, they go above and beyond every day. We have constant interaction with corporate representatives up to and including the CEO himself. They have increased the level of care to our inmates and reduced our outside medical costs. CCS is focused on customer service and customer satisfaction. Thank you for the partnership CCS.“ Sheriff Rick Ramsay Monroe County, Florida Palm Beach County, Florida 134 Client Testimonials – The Wellpath Difference Transition Process “I am extremely impressed and satisfied with Correct Care Solutions commitment to assuring an effective, efficient, and seamless transition process. In addition to the contractual staffing model, CCS deployed resources and subject matters experts from across the country in order to assure that our transition process was a success.” Lieutenant Colonel James Reyes Broward County Sheriff’s Office Transition Ability “While the partnership between the DeKalb County Sheriff’s Office and Wellpath is new, the transition has been smooth and consistent with the goals and objectives set forth in their proposal. Wellpath immediately hired additional nursing, mid-level clinicians and doctors to meet the growing population of inmates with chronic and acute illnesses. To facilitate a smooth transition, Wellpath identified and dedicated two members of the corporate office to acclimate on-site staff with Wellpath systems, processes, and policies and procedures.” Xernia L. Fortson, Esq. Retired Director of Administration & Legal Affairs, DeKalb County Sheriff’s Office, GA Measurable Results “Since switching to Wellpath, every single objective measure of our medical services has improved, and in some cases, dramatically…Now when I’m in the housing units, fewer inmates by far are approaching me to complain about their medical concerns, which means Wellpath is taking care of business…The response of Wellpath’ regional and corporate representatives to any question I may have is immediate and sustained – they don’t go away until I’m satisfied.” Randy Demory Jail Director, Berkeley County, SC Communication “As advertised, your organization has been extremely responsive to our needs and the proactive manner in which you operate is in stark contrast to our previous provider.” Sheriff Daron Hall Davidson County Sheriff’s Office, TN Creativity “Wellpath was able to creatively structure a contract that managed skyrocketing inmate health care costs in a manner that was consistent with our philosophy of care. This was an amazing feat….I recommend Wellpath as a service provider without reservations.” Gayle Harris Director, Durham County Health Department, NC Overall Quality “Since the transition to Wellpath, we have been impressed with the efficiencies your team has found, creating great cost-saving opportunities…Along with these added efficiencies, your team continues to impress us with their enthusiasm and with their dedication to the valued medical professionals working within the Detention Center….Your team has shown a true commitment to consistently providing the best possible care for our inmates." Major Ed Beckman (retired) Pasco Sheriff’s Office, FL Palm Beach County, Florida 135 Transition Success: Lee County, Florida On May 25, 2018, Wellpath transitioned three Lee County, Florida, facilities, with a total ADP of 1,800. Lt. Anderson and Colonel Tom Eberhardt of the Lee County Sheriff’s Office were impressed with both our onsite and executive teams, along with our expertise used in our implementation. They noted: “Switching providers is nerve-racking and a daunting task, and CMGC took a robust leadership role in helping make this one absolutely seamless. From the weeks of planning prior to launch to our actual start, your team has been fantastic, always accessible and willing to work through any of the many inevitable challenges that arise in this type of large-scale operation. All aspects of the transition, including preparation, recruitment, training and execution, were cohesive, organized, thoughtful and smooth. The team's vast experience, resourcefulness, and operational and clinical knowledge created a "go live" that was second to none. To transition nearly 1,700 inmates without incident is a true accomplishment and CMGC handled it with grace, skill and care.” Colonel Eberhardt praised us for our high level of service and communication, stating: “We set out to find a partner rather than a vendor, and your extraordinary care and attention to the patients, our staff, and your own team demonstrates a shared passion and approach which is beyond encouraging as we look to the years ahead. The level of service and communication we have received thus far has proven we made the right choice." Transition Success: Monroe County, FL At midnight on October 1, 2017, Wellpath successfully transitioned services at three facilities in Monroe County, Florida, with a combined ADP of over 450. The transition took place during and immediately following Hurricane Irma. The facilities had evacuated a few days prior, and no one knew what condition they were in or what kind of supplies would be needed to provide care once the inmates returned. The week before the transition, we began ordering stock meds, lab supplies, computers, etc. so they would be on hand for the startup. Wellpath also had new Policies and Procedures manuals and patient care forms shipped in advance, so the team was ready to begin training nurses at midnight on the start date. Wellpath had a crew on-site over the weekend to prepare for the transition. Since the facilities had been evacuated, no one was sure how much of the existing staff would be able to return for the transition. Wellpath enlisted a much larger transition team than normal, including staff from our other Florida sites. We had Florida-licensed nurses and a Florida-licensed Mental Health Professional on hand to give staff the opportunity to rest when needed. The evening before the transition, the Wellpath transition team arranged a dinner with our new client to introduce everyone and in a relaxed environment and initiate a camaraderie that would continue throughout the transition and continues to this day. Despite the recruiting challenges created by the hurricane and remote location of Key West, Wellpath had key positions filled with permanent staff within 30-60 days of startup. We promoted the former DON to HSA, and having worked for the previous provider and now Wellpath, she has seen a marked improvement in the quality of care provided to the patients in Monroe County. Specific improvements include withdrawal management protocols (CIWAs/COWs) that have led to a drastic decrease in detox￾related seizures since transitioning from the previous provider. Wellpath also improved safety and accountability by improving the count process for sharps and controlled substances, including the introduction of red books; under the previous provider, controlled substance counts were maintained only in an Excel spreadsheet printed and inserted in a binder. Palm Beach County, Florida 136 Transition Success: Broward County, FL On September 1, 2018, Wellpath successfully transitioned services at five facilities in Broward County, Florida, with a combined ADP of over 3700 adults and 20 juveniles. More than 70 staff we on-site to transition this jail system. Staff included administrative personnel, nursing, mid-levels, physicians, mental health staff, regional and executive Vice Presidents. Wellpath identified a number of critical vacancies prior to contract transition and held a number of Job Fairs in Broward County. These fairs were used to interview and hire LPNs, medical records staff, somatic providers to fill positions that had been historically under-staffed. Upon transition, Wellpath identified several critical areas that required enhancement. We then provided in-service training to the new Wellpath on-site HIV providers to identify, treat, and monitor HIV patients in a more timely and effective manner. The Detoxification protocol in Broward County Jails was immediately enhanced. Through training for all BSO and Wellpath staff, we have changed the medications used for Detox and now initiate detox within four hours of intake. Most significantly, we have separated the CIWA and COWS scores to better evaluate these patients and ensure a more accurate representation of their state. Palm Beach County, Florida 137 6 Fees Proposal Thank you for the opportunity to provide pricing details for a comprehensive medical and behavioral health care delivery proposal for the Palm Beach Sheriff’s Office (PBSO). Wellpath has worked diligently to provide a proposal that is not “cookie cutter” by designing a customized health care program, tailor￾made to meet the unique needs of the PBSO. Our program is customized to meet the specific needs of the PBSO inmate population at both the Main Detention Center (MDC) and at the West Detention Center (WDC). Our program has been designed to comply with NCCHC, ACA, FCAC, and Florida Model Jail Standards. Wellpath is prepared to commit the necessary resources to efficiently deliver high-quality, sustainable programs to PBSO at both MDC and WDC. We believe Wellpath will be the best partner for PBSO, both now and in the future. Wellpath has designed an improved healthcare program to meet or exceed the PBSO requirements as we currently understand them. This program offers substantial and measurable value added programming for the PBSO. We have laid the foundation to improve the delivery of care to all PBSO patients and to link them to resources upon community re-entry through our connections with local healthcare and mental health organizations. Following are several enhancements the PBSO can expect with Wellpath as your on-site health care partner: Wellpath Program Enhancements for Palm Beach County Added our OneCare: Collaborative Correctional Care model to align medical and mental health resources for better patient outcomes Increased clinical coverage at intake by replacing LPNs with 24/7 RN coverage Increased Mental Health Professional coverage to support our OneCare model (+2.1 FTEs) Added 7.4 Charge RN FTEs to provide 24/7 coverage at both MDC and WDC to ensure all clinical activities are completed efficiently, with a focus on infirmary care, intake screenings, and pharmacy management. Added three (3.0 FTEs) OneCare Managers to coordinate, guide, support, and drive patient care under the OneCare model Adding InmateCare+ to facilitate on-site specialist e-consult appointments Mental health and medical educational training for correctional staff HIV specialty care clinics provided by a Florida-based HIV/Infectious Disease Clinician, Dr. Bill Ruby Providing PAMM for use by PBSO Officers and Wellpath Mental Health Technicians to facilitate timely segregation and suicide checks Palm Beach County, Florida 138 Cost Elements Staffing Coverage and Associated Costs Wellpath has developed our proposed staffing and the associated budget based on the PBSO service requirements as we currently understand them. Our national and regional clinical leadership has reviewed and evaluated the current medical and behavioral health services being provided at both MDC and WDC. Our clinical leadership team has developed a recommended staffing plan designed to better meet the needs of the PBSO patients. We have utilized salary surveys for health professionals in Palm Beach County, as well as our experience recruiting health care personnel and providing the required services at other facilities across Florida. Since securing and transitioning new Florida partners from your incumbent provider, we have learned why our staff stays with us and why our turnover rate is so low: we consistently pay at or above the local market rates and we strive to ensure every contracted shift is filled. Doing so ensures quality staff and effective retention so consistent care can continually be delivered to our patients. This staffing philosophy delivers better clinical outcomes for our patients but results in higher staffing costs than those previously being paid. We believe these increased front-end costs are only a fraction of the back￾end savings produced by our programs. Savings in short and long-term patient care costs including medication management, sick call escalation, acute care services, and mental health programming. All of which contribute to the delivery of consistent and appropriate patient care. We realize some companies fail to adequately budget anticipated staff costs, including overtime, PRN, and training, in an effort to deliver a more attractive proposal. Unfortunately, this restricts the ability to recruit and retain qualified staff, to develop and deliver sufficient training, and to provide continuity of care, thus jeopardizing the overall quality of the health care program. We are confident we have offered an appropriately budgeted program that will meet the increased needs of the Jail and exceed the expectations of the PBSO. Now and as your program grows, Wellpath is the right partner to ensure the PBSO is prepared with a scalable health care plan. Off-site Medical Costs Wellpath has developed an off-site care cost model based upon the off-site event and cost data we reviewed and based upon the current PBSO healthcare services contract. Our proposal includes Wellpath assuming full-risk for all off-site costs except when any single off-site event exceeds $50,000. PBSO will be responsible for all costs above the $50,000 per incident per occurrence cap. Pharmacy The Wellpath proposal price for PBSO includes all pharmacy costs being paid by Wellpath. Optional Costs Wellpath is not proposing any optional costs at this time. However, we are willing to discuss future changes to off-site and pharmacy cap structures, as well as discussions regarding the implementation of ERMA, our proprietary electronic health record. Palm Beach County, Florida 139 Wellpath Service Summary Following is a summary of services Palm Beach County will receive from Wellpath: Staffing and Services Overview for Palm Beach County Professional On-site Services Provided with Wellpath On Call Enhanced Medical Services   Enhanced Mental Health Services   Dental Services Onsite   On-Call 24/7   Policies and Procedures  Laboratory Services   X-Ray Services   Emergency Services  Medical Equipment, Disposable Medical Supplies  Office Supplies  Medical Waste Disposal  Basic Health Education Training – Inmate/Detention Staff  Comprehensive Medical Malpractice Insurance  Regional & Corporate Management and Oversight   OneCare: Collaborative Correctional Care  $50,000 Annual Escrow  PAMM  Professional Offsite Services Provided Ambulance Transport Coordination  Care Management for Hospitalization and Offsite Care  Pharmacy Services Complete Pharmaceutical Management  Pharmaceuticals: Over-the-Counter  Pharmaceuticals: Prescriptions  TOTAL FTEs 128.10 Palm Beach County, Florida 140 Cost Proposal Wellpath has developed the following detailed Cost Proposal based on our review of the current PBSO healthcare services data and based upon our understanding of the current program and its desired future direction. The Wellpath cost proposal assumes the initial contract term will be a shortened period from May 1, 2019 through September 30, 2019. For contracting and planning purposes, we have provided program costs through September 30, 2023 (Fiscal Year 4). WELLPATH COST PROPOSAL We are aware that some of our pricing assumptions may change after discussions with PBSO staff where more detailed data may be provided. We consider this proposal an excellent starting point and we look forward to additional discussions that allow us to improve our proposal to better meet the needs and expectations of the PBSO. Change in Scope of Work The Wellpath annual base price is calculated upon an average daily population (ADP) of 2100 inmates at the Palm Beach County Detention Centers. The Wellpath Fees Proposal reflects the scope of care as outlined in our Technical Proposal and based on the current community standard of care regarding correctional health care services. Should there be any change in or modification of the local, national, or community standards of care or scope of services, court rulings or interpretation, state or federal law or statute, or interpretation thereof, that results in a material increase in costs to Wellpath, coverage of costs related to such changes are not included in this proposal and may need to be negotiated with Palm Beach County to ensure both parties’ interests are properly aligned. In the event of significant sustained increases or decreases to the inmate population, Wellpath requests the opportunity to negotiate a change in contract terms, which may include a permanent change to the staffing plan. Conclusion Wellpath will operate the PBSO health care program as a TRUE PARTNERSHIP! The program will be compliant with all applicable standards, and we will take full responsibility for maintaining the quality of patient care, the efficiency of operations, and the reporting of real time results. We look forward to discussing the details of our proposed program with you and we would be honored to begin a successful partnership with Palm Beach County. Category Short Period* Fiscal Year 1 Fiscal Year 2 Fiscal Year 3 Fiscal Year 4 Total Staffing Benefits and Salaries $4,642,102 $11,141,045 $11,475,276 $11,819,535 $12,174,121 $51,252,079 Pharmaceuticals 907,402 2,177,764 2,275,763 2,378,173 2,485,190 10,224,292 Medical Supplies 99,808 239,539 245,527 251,666 257,957 1,094,497 Ancillary Services 96,252 231,005 236,780 242,700 248,767 1,055,504 Off-site Medical Services 897,159 2,153,182 2,250,075 2,351,329 2,457,139 10,108,884 Malpractice Insurance 253,988 609,571 627,858 646,694 666,095 2,804,206 Administrative Costs 415,064 2,660,347 2,582,733 2,497,519 2,404,286 10,559,949 Equipment Escrow 50,000 50,000 50,000 50,000 50,000 250,000 Licenses 2,546 2,610 2,675 2,742 2,810 13,383 Total $7,364,320 $19,265,062 $19,746,689 $20,240,356 $20,746,365 $87,362,792 * Short Period - May 1, 2019 through September 30, 2019 _________________________________________________________________________________________________________________ 3228 Gun Club Road  West Palm Beach, Florida 33406-3001  (561) 688-3000  www.pbso.org FIRST ADDENDUM TO THE INMATE HEALTH CARE SERVICE AGREEMENT SHERIFF RIC L. BRADSHAW AND WELLPATH LLC This First Addendum to the Inmate Health Care Service Agreement by and between Wellpath LLC, (hereinafter referred to as “Contractor”), and Ric L. Bradshaw, in his official capacity as the Sheriff of Palm Beach County, Florida (hereinafter referred to as the “Sheriff”), is dated this ______day of March, 2021. The Contractor and Sheriff shall hereinafter be collectively referred to as the “Parties.” WHEREAS, the Parties executed an Inmate Health Care Service Agreement effective June 10, 2019, by which the Contractor agreed to provide Inmate Health Care services for the Sheriff; and WHEREAS, the Parties wish to amend said Agreement, effective immediately. NOW, THEREFORE, in consideration of the mutual covenants herein contained the receipt and sufficiency of which are hereby acknowledged, it is agreed upon as follows: 1. Effective October 1, 2023 through September 30, 2026, the Sheriff and Contractor agree to further extend the agreement for an additional three (3) year term from the end of the initial term which expires 9/30/2023. 2. Article VII A. Base Compensation shall be amended to include the following: TERM BASE COMPENSATION MONTHLY AMOUNT 10/1/2023-9/30/2024 $21,265,024 $1,772,085.33 10/1/2024-9/30/2025 $21,796,650 $1,816,387.50 10/1/2025-9/30/2026 $22,341,566 $1,861,797.17 24th - 2 - 3. In all other respects, the terms and conditions of the Agreement, shall continue unchanged and in full force and effect. IN WITNESS THEREOF, the parties hereto have executed the Addendum to the Agreement as of the last date all signatures below are affixed. Palm Beach County Sheriff’s Office, Wellpath LLC Florida BY: _____________________________ BY: _________________________ Ric L. Bradshaw or Designee Signature Print Name: ______________________ Print Name: __________________ Title: ___________________________ Title: ________________________ Date: ___________________________ Date: ________________________ Kip Hallman President March 19, 2021 Terence Feeney Chief Procurement Officer March 24, 2021 _________________________________________________________________________________________________________________ 3228 Gun Club Road West Palm Beach, Florida 33406-3001 (561) 688-3000 www.pbso.org SECOND ADDENDUM TO THE INMATE HEALTH CARE SERVICE AGREEMENT SHERIFF RIC L. BRADSHAW AND WELLPATH LLC This Second Addendum to the Inmate Health Care Service Agreement by and between Wellpath LLC, (hereinafter referred to as “Contractor”), and Ric L. Bradshaw, in his official capacity as the Sheriff of Palm Beach County, Florida (hereinafter referred to as the “Sheriff”), is dated this day of March, 2023. The Contractor and Sheriff shall hereinafter be collectively referred to as the “Parties.” WHEREAS, the Parties executed an Inmate Health Care Service Agreement effective June 10, 2019 and First Addendum on March 24, 2021 (the “Agreement”) by which the Contractor agreed to provide Inmate Health Care services for the Sheriff; and WHEREAS, the Parties wish to amend said Agreement, effective July 1, 2022. NOW, THEREFORE, in consideration of the mutual covenants herein contained the receipt and sufficiency of which are hereby acknowledged, it is agreed upon as follows: 1. Senate Bill 1236, effective July 1, 2022, provides for penalties based on certain violations of the Florida Model Jail Standards (FMJS). The detention facility is responsible for the payment of the penalties, which will be deposited into the facilities inmate welfare fund. 2. Contractor shall have a site management level (i.e. Health Services Administrator or Director of Nursing) representative present at all times during an announced FMJS inspection. Upon notification from PBSO, this representative shall report within a reasonable amount of time for an unannounced inspection. 3. Sheriff shall notify by email the Contractor’s Health Services Administrator (HSA), Regional Director of Operations (RDO), and Regional Vice President (RVP) of a serious or notable violation within a reasonable amount of time of receiving such notice of violation by the FMJS Working Group, thereby allowing Contractor sufficient time to remedy the violation before penalty is assessed. 15th - 2 - a. Reasonable time for notification of a serious violation shall be within one hour of PBSO receiving the serious violation and notification corrective action form of the violation from FMJS. b. Reasonable time for notification of a notable violation shall be upon completion of the inspection and PBSO receiving notification of the violation from FMJS during the exit interview. 4. In those instances where a penalty for violation of a Florida Model Jail Standard was incurred by Sheriff due solely to the failure of Contractor to comply with a contractual term, Contractor agrees to reimburse Sheriff for the penalty amount, within 30 days of receiving a request from Sheriff for such payment. Such reimbursement shall only be required of the Contractor when the Contractor is notified by Sheriff in the timeframes set out in Paragraph 3 above. 5. The Parties agree that a substantive change to FMJS that affects Contractor’s scope of services constitutes a “Change in Scope” pursuant to Article XVI, Section Q of the Agreement. 6. In all other respects, the terms and conditions of the Agreement, shall continue unchanged and in full force and effect. IN WITNESS THEREOF the parties hereto have executed the Addendum to the Agreement as of the last date all signatures below are affixed. Palm Beach County Sheriff’s Office, Wellpath LLC Florida BY: _____________________________ BY: _________________________ Ric L. Bradshaw or Designee Signature Print Name: _Terence P. Feeney______ Print Name: __________________ Title: Chief Procurement Officer______ Title: ________________________ Date: ___________________________ Date: ________________________ March 15, 2023 _________________________________________________________________________________________________________________ 3228 Gun Club Road  West Palm Beach, Florida 33406-3001  (561) 688-3000  www.pbso.org THIRD ADDENDUM TO THE INMATE HEALTH CARE SERVICE AGREEMENT SHERIFF RIC L. BRADSHAW AND WELLPATH LLC This Third Addendum to the Inmate Health Care Service Agreement, by and between Wellpath LLC, (hereinafter referred to as “Contractor”), and Ric L. Bradshaw, Sheriff of Palm Beach County, Florida (hereinafter referred to as “Sheriff”), is dated this ____day of _______, 2023. The Contractor and Sheriff shall hereinafter be collectively referred to as the “Parties.” WHEREAS, the Parties executed an Inmate Health Care Service Agreement effective June 10, 2019 and subsequent addenda on March 24, 2021 and March 15, 2023 (the “Agreement”) by which the Contractor agreed to provide Inmate Health Care services for the Sheriff; and WHEREAS, the Parties wish to amend said Agreement. NOW, THEREFORE, in consideration of the mutual covenants herein contained, the receipt and sufficiency of which are hereby acknowledged, it is agreed upon as follows: 1. Contractor has reviewed and agreed to adhere to the CJIS Security Policy “CSP”, attached hereto and incorporated herein as Exhibit “A”. 2. Contractor and applicable employees (employees who have access to CJIS information or systems) of the Contractor will sign the Certification page and abide by the guidelines set forth in the CJIS Security Addendum, attached hereto and incorporated herein as Exhibit “B”. 3. The Contractor shall notify the Sheriff when the employee/representative(s) that sign the documents listed as Exhibit “B” and who also sign this addendum is no longer employed by Contractor in order to have another employee/representative execute the documents. 24th May DocuSign Envelope ID: 3B1FE04A-2D74-4267-927F-B76BA34A04D7 - 2 - 4. Contractor employees with access shall be required to maintain the proper CJIS certification at all times. IN WITNESS THEREOF, the Parties hereto have executed this Third Addendum to the Agreement as of the last date all signatures below are affixed. Palm Beach County Sheriff’s Office, Wellpath, LLC Florida BY: _____________________________ BY:__________________________ Ric L. Bradshaw or Designee Signature Print Name: Terence P. Feeney__________ Print Name: ___________________ Title: ____________________________ Title: ________________________ Date: _____________________________ Date: _______________________ Chief Procurement Officer May 24, 2023 Feeney, Terence P. Digitally signed by Feeney, Terence P. Date: 2023.05.24 08:53:56 -04'00' DocuSign Envelope ID: 3B1FE04A-2D74-4267-927F-B76BA34A04D7 President, Local Government Healthcare Justin Searle 7/18/2023 DocuSign Envelope ID: 162C546E-FBDC-4FA9-8CFD-6FEF45CB2F25 FOURTH ADDENDUM TO THE INMATE HEALTH CARE SERVICE AGREEMENT SHERIFF RIC L. BRADSHAW AND WELLPATH LLC This Fourth Addendum to the Inmate Health Care Service Agreement by and between Wellpath LLC, (hereinafter referred to as “Contractor”), and Ric L. Bradshaw, in his official capacity as the Sheriff of Palm Beach County, Florida (hereinafter referred to as the “Sheriff”), is dated this day of August, 2023. The Contractor and Sheriff shall hereinafter be collectively referred to as the “Parties.” WHEREAS, the Parties executed an Inmate Health Care Service Agreement effective June 10, 2019, First Addendum on March 24, 2021, Second Addendum on March 15, 2023, and the Third Addendum dated May 24, 2023, (the “Agreement”) by which the Contractor agreed to provide Inmate Health Care services for the Sheriff; and WHEREAS, the Parties wish to amend said Agreement. NOW, THEREFORE, in consideration of the mutual covenants herein contained the receipt and sufficiency of which are hereby acknowledged, it is agreed upon as follows: 1. Paragraph 2 of the First Addendum shall be amended by deleting Paragraph 2 of the First Addendum and replacing it as follows: Term Base Compensation Monthly Amount 10/1/2023-9/30/2024 $22,198,610 $1,849,884 10/1/2024-9/30/2025 $22,753,575 $1,896,131 10/1/2025-9/30/2026 $23,322,414 $1,943,535 2. Article VII, Paragraph G of the original Agreement shall be amended by removing the phrase “10-Day Counseling Sessions not applicable” that is the first line of the chart under the category of “Liquidated Damages”. The removal of this language does not impact the provisions of the Second Addendum. 3228 Gun Club Road  West Palm Beach, Florida 33406-3001  (561) 688-3000  www.pbso.org 8th DocuSign Envelope ID: 9878C249-335B-481C-9CD5-7998175E12D1 DocuSign Envelope ID: 162C546E-FBDC-4FA9-8CFD-6FEF45CB2F25 3. In all other respects, the terms and conditions of the Agreement, shall continue unchanged and in full force and effect. IN WITNESS THEREOF, the parties hereto have executed this Fourth Addendum to the Agreement as of the last date all signatures below are affixed. Palm Beach County Sheriff’s Office, Wellpath LLC Florida BY: BY: Ric L. Bradshaw or Designee Signature Print Name: Print Name: Title: Title: Date: Date: Terence Feeney Chief Procurement Officer August 8, 2023 Feeney, Terence P. Digitally signed by Feeney, Terence P. Date: 2023.08.08 11:51:50 -04'00' DocuSign Envelope ID: 9878C249-335B-481C-9CD5-7998175E12D1 8/8/2023 Justin Searle President, Local Government Healthcare DocuSign Envelope ID: 162C546E-FBDC-4FA9-8CFD-6FEF45CB2F25 - 2 - DocuSign Envelope ID: 9878C249-335B-481C-9CD5-7998175E12D1 FIFTH AMENDMENT TO THE AGREEMENT FOR INMATE HEALTHCARE SERVICES AT PALM BEACH COUNTY, FL (Effective June 1, 2024) This Fifth Amendment, effective June 1, 2024 (this “Amendment”), to the Inmate Health Care Service Agreement dated June 10, 2019 is by and between Wellpath LLC, (hereinafter referred to as “Contractor”), and Ric L. Bradshaw, in his official capacity as the Sheriff of Palm Beach County, Florida (hereinafter referred to as the “Sheriff”). The Contractor and Sheriff shall hereinafter be collectively referred to as the “Parties.” WHEREAS, the Parties agree to amend the contract to allow for certain telepsychiatry services to be utilized at the West Detention Center; and WHEREAS, in accordance with Section XVII, E., the Parties desire to amend the Agreement to memorialize such changes. NOW, THEREFORE, in consideration of the mutual covenants herein contained and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Sheriff and Contractor agree as follows: 1. RECITALS. The Parties hereto incorporate the foregoing recitals as a material portion of this Amendment. 2. AMENDMENT TO ARTICLE III SECTION J OF THE AGREEMENT. This Section shall be amended by adding the following subsection 13: 13. CONTRACTOR shall have the ability to utilize telepsychiatry at the West Detention Center (WDC). The hours provided via telepsychiatry shall not exceed more than 50% of the total hours per month listed in the staffing matrix for the WDC. Such utilization cannot require additional staffing on behalf of Sheriff nor can it require Sheriff to provide additional staffing hours, positions, or funding to Contractor. The utilization of telepsychiatry is to be contained to the outpatient/general population patients and not those requiring acute or crisis psychiatry services. Acute or crisis psychiatry services are to be provided in person by qualified Contractor mental health professional. 3. SEVERABILITY. If any terms or provisions of this Amendment or the application thereof to any person or circumstance shall to any extent be invalid or unenforceable, the remainder of this Amendment or the application of such term or provision to person or circumstances other than those as to which it is held invalid or unenforceable shall not be affected thereby and each term and provision of this Amendment shall be valid and enforceable to the fullest extent permitted by law. 4. DEFINITIONS. Capitalized terms used but not defined herein shall have the meaning ascribed to them under the Agreement. Docusign Envelope ID: 27B669A5-8C3B-43AF-9071-8B5F3B9E68E4 Docusign Envelope ID: C5624055-4E7D-4DA0-91E1-ADE1F692F5EC 5. REMAINING PROVISIONS. The remaining provisions of the Agreement not amended by this Amendment shall remain in full force and effect. IN WITNESS THEREOF, the parties hereto have executed the Fifth Amendment to the Agreement as of the last date all signatures below are affixed. Wellpath LLC BY: _________________________ Signature Print Name: __________________ Title: ________________________ Palm Beach County Sheriff’s Office, Florida BY: _____________________________ Ric L. Bradshaw or Designee Print Name: Terence P. Feeney Title: Chief Procurement Officer Date: ___________________________ Date: ________________________ Docusign Envelope ID: 27B669A5-8C3B-43AF-9071-8B5F3B9E68E4 July 15, 2024 Feeney, Terence P. Digitally signed by Feeney, Terence P. Date: 2024.07.15 12:58:26 -04'00' Docusign Envelope ID: C5624055-4E7D-4DA0-91E1-ADE1F692F5EC Chief Operating Officer 7/18/2024 Cindy Watson SIXTH AMENDMENT TO THE AGREEMENT FOR INMATE HEALTHCARE SERIVES AT PALM BEACH COUNTY, FL (Effective , 202 ) This Sixth Amendment, effective (this “Amendment”), to the Inmate Health Care Service Agreement dated June 10, 2019 is by and between Wellpath LLC, (hereinafter referred to as “Contractor”), and Ric L. Bradshaw, in his official capacity as the Sheriff of Palm Beach County, Florida (hereinafter referred to as the “Sheriff”). The Contractor and Sheriff shall hereinafter be collectively referred to as the “Parties.” WHEREAS, the Parties agree to amend the contract’s Staffing Matrices without a change in compensation; and WHEREAS, in accordance with Section XVII, E., the Parties desire to amend the Agreement to memorialize such changes. NOW, THEREFORE, in consideration of the mutual covenants herein contained and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Sheriff and Contractor agree as follows: 1. RECITALS. The Parties hereto incorporate the foregoing recitals as a material portion of this Amendment. 2. AMENDMENT TO EXHIBIT C OF AGREEMENT. This Section shall be amended by replacing Exhibit C in its entirety with the attached Exhibit C-1: 3. SEVERABILITY. If any terms or provisions of this Amendment or the application thereof to any person or circumstance shall to any extent be invalid or unenforceable, the remainder of this Amendment or the application of such term or provision to person or circumstances other than those as to which it is held invalid or unenforceable shall not be affected thereby and each term and provision of this Amendment shall be valid and enforceable to the fullest extent permitted by law. 4. DEFINITIONS. Capitalized terms used but not defined herein shall have the meaning ascribed to them under the Agreement. 5. REMAINING PROVISIONS. The remaining provisions of the Agreement not amended by this Amendment shall remain in full force and effect. IN WITNESS THEREOF, the parties hereto have executed the Sixth Amendment to the Agreement as of the last date all signatures below are affixed. Palm Beach County Sheriff’s Office, Wellpath LLC Florida BY: _____________________________ BY: _________________________ Ric L. Bradshaw or Designee Cindy Watson Title: Title: Chief Operating Officer Date: _________________________ Date: Chief Procurement Officer Exhibit C-1 Main Detention Center - 1,400 ADP - Staffing Plan Title Mon Tue Wed Thu Fri Sat Sun Hrs/WK FTE Previous FTE Variance Days Health Services Administrator 8 8 8 8 8 40 1.00 1.00 0.00 Medical Director 8 8 8 8 8 40 1.00 1.00 0.00 Staff Physician 8 8 8 8 8 8 8 56 1.40 1.40 0.00 Mid-level 8 16 8 16 8 56 1.40 1.40 0.00 Director of Nursing 8 8 8 8 8 40 1.00 1.00 0.00 Assistant DON 8 8 8 8 8 40 1.00 1.00 0.00 Charge RN 12 12 12 12 12 24 24 108 2.70 1.80 0.90 RN: Infection Control 8 8 8 8 8 40 1.00 1.00 0.00 RN: H&P 8 16 8 16 8 8 8 72 1.80 1.80 0.00 RN: Intake 8 8 8 8 8 8 8 56 1.40 1.40 0.00 Registered Nurse 24 24 24 24 24 24 24 168 4.20 4.20 0.00 EMT Paramedic Intake 12 12 12 12 12 12 12 84 2.10 0.00 2.10 Licensed Practical Nurse 48 48 48 48 48 48 48 336 8.40 9.80 -1.40 Medical Assistant 24 24 24 24 24 120 3.00 3.80 -0.80 Nurse Educator 8 8 8 8 8 40 1.00 1.00 0.00 Medical Records Supervisor 8 8 8 8 8 40 1.00 1.00 0.00 Medical Records Clerk 12 12 12 12 12 12 12 84 2.10 2.10 0.00 Unit Clerk 8 8 8 8 8 40 1.00 1.00 0.00 Pharmacy Technician 8 8 8 8 8 8 8 56 1.40 1.40 0.00 Administrative Assistant 16 16 16 16 16 80 2.00 2.00 0.00 Discharge Planner 8 8 8 8 8 40 1.00 1.00 0.00 Psychiatrist 8 8 8 8 8 40 1.00 1.00 0.00 Psychiatrist 8 4 8 4 8 32 0.80 0.80 0.00 Psychologist 16 16 16 16 16 80 2.00 2.00 0.00 Mental Health Director 8 8 8 8 8 40 1.00 1.00 0.00 MHP/Substance Abuse Counselor 20 20 20 20 20 12 12 124 3.10 3.10 0.00 Mental Health Technician 24 24 24 24 24 24 24 168 4.20 4.20 0.00 Mental Health Secretary 8 8 8 8 8 40 1.00 1.00 0.00 Care Manager 0 0.00 2.00 -2.00 Mental Health RN 24 24 24 24 24 24 24 168 4.20 2.80 1.40 Dentist 8 8 8 8 32 0.80 0.80 0.00 Dental Assistant 8 8 8 8 32 0.80 0.80 0.00 CNA 16 16 32 0.80 0.00 0.80 TOTAL HOURS/FTE-Day 2,424 60.60 59.60 1.00 Evenings Charge RN 0 0 2.8 -2.8 Intake: RN 8 8 8 8 8 8 8 56 1.4 1.4 0 Registered Nurse 16 16 16 16 16 16 16 112 2.8 2.8 0 EMT Paramedic Intake 12 12 12 12 12 12 12 84 2.1 0 2.1 Licensed Practical Nurse 40 40 40 40 40 40 40 280 7 9.8 -2.8 Medical Record Clerk 12 12 12 12 12 12 12 84 2.1 2.1 0 CNA 16 16 16 16 16 16 16 112 2.8 2.8 0 Mental Health Technician 24 24 24 24 24 24 24 168 4.2 4.2 0 Mental Health RN 0 0 2.8 -2.8 TOTAL HOURS/FTE-Evenings 896 22.4 28.7 -6.3 Nights Charge: RN 24 24 24 24 24 24 24 168 4.2 2.8 1.4 Intake: RN 8 8 8 8 8 8 8 56 1.4 1.4 0 RN 8 8 8 8 8 8 8 56 1.4 0 1.4 Licensed Practical Nurse 8 8 8 8 8 8 8 56 1.4 5.6 -4.2 CNA 16 16 16 16 16 16 16 112 2.8 2.8 0 Mental Health Technician 24 24 24 24 24 24 24 168 4.2 4.2 0 Mental Health RN 24 24 24 24 24 24 24 168 4.2 2.8 1.4 TOTAL HOURS/FTE-Nights 784 19.6 19.6 0 TOTAL 4,104 102.6 107.90 -5.3 Exhibit C-1 West Detention Center - 600 ADP - Staffing Plan Title Mon Tue Wed Thu Fri Sat Sun Hrs/WK FTE Previous FTE Variance Days Staff Physician 8 8 16 0.4 0.40 0.00 Mid- Level 8 8 8 24 0.6 0.60 0.00 Director of Nursing 8 8 8 8 8 40 1 1.00 0.00 Charge RN 12 12 12 12 12 12 12 84 2.1 2.10 0.00 Licensed Practical Nurse 28 28 28 28 28 24 24 188 4.7 4.20 0.50 Medical Assistant 8 8 8 8 8 40 1 1.00 0.00 Medical Records Clerk 0 0 1.00 -1.00 Administrative Assistant 8 8 8 8 8 40 1 1.00 0.00 Care Manager 0 1.00 -1.00 Pyschiatrist 0 0 0.20 -0.20 Mid-Level Psych 8 8 16 0.4 0.00 0.40 MHP/ Substance Abuse Counselor 8 8 8 8 8 40 1 1.00 0.00 RN 12 12 12 12 12 12 12 84 2.1 2.10 0.00 Dentist 8 8 0.2 0.20 0.00 Dental Assistant 8 8 0.2 0.20 0.00 TOTAL HOURS/FTE-Day 588 14.7 16.00 -1.30 Nights Charge RN 12 12 12 12 12 12 12 84 2.1 2.1 0 Licensed Practical Nurse 24 24 24 24 24 24 24 168 4.2 2.1 2.1 CNA 12 12 12 12 12 12 12 84 2.1 2.1 0 RN 12 12 12 12 12 12 12 84 2.1 0 2.1 TOTAL HOURS/FTE-Nights 420 10.5 6.3 4.2 TOTAL 1,008 25.2 22.30 2.9 Exhibit C-1 Wellpath Average Base Rate Title Low High Proposed FTEs Administrative Assistant $ 21.17 $ 23.40 3.00 Assistant DON $ 36.10 $ 39.90 1.00 Charge RN $ 39.34 $ 43.48 11.10 CNA $ 16.17 $ 17.87 8.50 Dental Assistant $ 16.67 $ 18.42 1.00 Dentist $ 93.48 $ 103.32 1.00 Director of Nursing $ 40.85 $ 45.15 2.00 Discharge Planner $ 22.33 $ 24.68 1.00 EMT Paramedic Intake $ 21.71 $ 24.00 4.20 Health Services Administrator $ 49.40 $ 54.60 1.00 Licensed Practical Nurse $ 27.33 $ 30.21 25.70 Medical Assistant $ 15.83 $ 17.50 4.00 Medical Director $ 109.25 $ 120.75 1.00 Medical Record Clerk $ 12.35 $ 13.65 4.20 Medical Records Supervisor $ 21.85 $ 24.15 1.00 Mental Health Director $ 35.63 $ 39.38 1.00 Mental Health RN $ 36.55 $ 40.40 8.40 Mental Health Secretary $ 18.05 $ 19.95 1.00 Mental Health Technician $ 13.78 $ 15.23 12.60 MHP/ Substance Abuse Counselor $ 28.96 $ 32.01 4.10 Mid-Level $ 52.25 $ 57.75 2.00 Mid-Level Psych $ 52.25 $ 57.75 0.40 Nurse Educator $ 32.78 $ 36.23 1.00 Pharmacy Technician $ 17.10 $ 18.90 1.40 Psychiatrist $ 139.47 $ 154.15 1.80 Psychologist $ 44.94 $ 49.67 2.00 Registered Nurse $ 36.55 $ 40.40 19.60 Staff Physician $ 94.37 $ 104.30 1.80 Unit Clerk $ 16.63 $ 18.38 1.00 Grand Total $ 31.74 $ 35.08 127.80 Electronic Record of Contracts This document was generated as a record of certain contracts created, accepted and stored electronically. Summary of Contracts This document contains the following contracts. Title ID Addendum Amendment (Wellpath LLC and Palm Beach County Sheriff's Office) 764b5b2f-3705-4397-88ab-0d6775677253 Contract signed by: Terence Feeney Signer ID: ee0b8496-4e7e-4b21-bea9-433ff37aff8f Email: [email protected] Date / Time: Mar 14, 2025 at 1:15 PM EDT IP Address: 139.64.204.200 User Agent: Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/133.0.0.0 Safari/537.36 Edg/133.0.0.0