Emergency Department (ED) Comprehensive Care Program
Request for Proposals
|A. Eligible Applicants: Organizations with proven, documented outcomes in the implementation and delivery of emergency department (ED) based Medication Assisted Treatment (MAT) programs for identified individuals with Opioid Use Disorder. Only organizations with a proven track record and the ability to begin immediately should consider responding to this request for proposals. This is not a development grant.
|B. RFP Type: Contract with Hamilton County Public Health (HCPH) based on availability of funds from the Ohio Department of Health (ODH)
|C. Number of Awards: 1
|D. Total Project Period Funding: $1,000,000
|E. Number of Years of Award: Approximately 1 year
|F. Approximate Date When Awards will be Announced: September 11, 2018|
Hamilton County Public Health announces the availability of funds to address the opioid crisis in the southwest region of Ohio, including Montgomery County. This funding is made possible through the Prescription Drug Overdose Prevention grant from the Ohio Department of Health.
HCPH is a local health department located in Southwest Ohio that was founded in 1919. It provides public health services for 48 distinct political jurisdictions. Staff addresses the well-being of Hamilton County residents through a community-focused approach, the examination of health and disease trends, healthcare coordination, inspections, education and by providing assistance to communities to cope with disease prevention and emergencies. In March 2017, HCPH became the first health department in Southwest Ohio to become a nationally accredited health department by the Public Health Accreditation Board. The agency is organized into two departments: Community Health Services and Environmental Health Services. HCPH serves a population of approximately 480,000 residents in the county with a staff of 100 full time employees and a budget of $12.7 million.
Hamilton County is an urban county in southwest Ohio with a population of 805,965 residents. It is the third most populous county in the state, with 37% of the population residing in the county seat, Cincinnati. Hamilton County is diverse, with an estimated to be 66.4% of the population being non-Hispanic white, 25.7% non-Hispanic black, 2.9% Hispanic, and 2.3% Asian. There are an estimated 40,999 foreign born residents living in Hamilton County, and 79.7% of those individuals speak a language other than English at home. The median household income in the county is $50,399, and the median family income is $68,356. An estimated 13.2% of families and 17.8% of the population as a whole had an income below the poverty line in the past 12 months. Looking at poverty across age, 26.1% of those under age 18 and 9.2% of those age 65 and over had an income below the poverty line. Hamilton County is also home to the University of Cincinnati (UC), a large public university with over 44,000 students. Among first-time degree-seeking undergraduates to UC in 2016 with a known race/ethnicity, 76.1% were non-Hispanic white, 9.2% non-Hispanic black, 4.6% Multiracial, 3.6% Hispanic, and 2.4% were international.
In 2016, Ohio was a leading state in opiate overdoses, with the second highest rate of drug overdose deaths in the country. More than 4,000 Ohio residents died from overdose in 2016, and nearly 32,000 residents are estimated to have been seen in the emergency department (ED) due to overdose., Hamilton County had 318 overdose deaths in 2016, and the 19th highest Ohio county rate of overdose fatalities with 39.3 overdose-related deaths per 100,000 population. There were an estimated 3,551 overdoses ED visits to Hamilton County hospitals and 3,657 Hamilton County 911 dispatches due to overdose. Preliminary 2017 numbers indicate 444 overdose deaths, an increase from 2016 of 39.6%. ED visits and 911 dispatches indicate a similar trend from 2016 to 2017, with ED visits increasing 7.5% to 3,816 and 911 dispatches increasing 14.1% to 4,173. Overdose deaths in 2017 were predominantly aged 35-49 (39%), non-Hispanic white (83%), and male (69%). There were 1,245 ED visits due to overdose during the first half of 2018 with about 37% aged 25-34, 62% male, and predominantly non-Hispanic white (85%).
HCPH has distributed 28,165 doses of naloxone since 2015 to the community, first responders, and healthcare and social service agencies. HCPH believes partnering with an Emergency Department to facilitate the implementation and delivery of an emergency department (ED) based Medication Assisted Treatment (MAT) program for identified individuals with Opioid Use Disorder is a natural next step in our fight against opioid overdoses.
III. Program Infrastructure and Organizational Capacity
Applicants must describe their organizational capacity to carry out the activities, strategies, performance measures, and evaluation requirements outlined in the RFP. HCPH anticipates that over the 1-year project period, all applicants will demonstrate their capacity to carry out the following activities including an evaluation component:
- Maintain appropriate staffing to support the program.
- Identify a qualified staff person or equivalent responsible for managing the planning, implementation, monitoring, and reporting of the program, with management experience in population-based interventions relevant to the selected strategies.
- Provide support for planning and implementation, monitoring of short-term outcomes, and evaluation of an innovative strategy, that is based on evidence and/or best practice.
- Establish and maintain other qualified staff, contractors, and consultants, as needed, sufficient in number and expertise to ensure project success and who have demonstrated skills and experience in partnership development, community engagement, health equity, addressing the social determinants of health (SDOH) and other competencies related to the strategies supported by the RFP over the course of the project period.
- Project Information
It is the expectation that the following project components will be implemented into the Emergency Department setting as comprehensively and seamlessly as possible:
- Identification and Screening for Opioid Use Disorder (OUD)
- including identifying evidence-based screening tools, secure screening platforms as needed, electronic health record modifications and order sets developed;
- Emergency Department Management of Opioid Withdrawal/Related issues
- Establish ED protocols for patients presenting post-opioid overdose or with OUD related issues.
- Provide onsite and online academic detailing to medical providers to begin appropriate medications (including MAT) post overdose/when indicated.
- Optimize distribution of naloxone to high impact points in the community; including ED’s.
- Work with healthcare system to establish OUD treatment algorithms in the acute healthcare setting (hospitals) where appropriate and agreed upon.
- Provide on-call addiction specialist hotline where appropriate and agreed upon with healthcare system.
- Provide a secure platform for physicians to discuss patient care.
- Transition Patients from the ED
- Including the development/support of a real-time local treatment finder for referrals and warm handoffs.
- Develop capacity and systems for peer support and identify and link patients to comprehensive harm reduction services.
- Connect patients to the appropriate SDOH interventions where applicable.
Around each of the topics below, the applicant needs to have the capacity and expertise to work alongside the ED staff to:
- Develop policies and procedures for each component, specialized to health system and customized to each ED.
- Develop or identify appropriate screening tools for each component.
- Integrate all aspects of inpatient management into ED workflows.
- Integrate transfer management of patients to outpatient settings (if referred to in-system provider).
- Integrate transfer and linkage activities into ED workflows for external setting referrals.
- Develop systems for each of the three components above to flow seamlessly between each other in the ED workflow.
- Upgrade electronic health records to update work flows and order sets.
- Once developed, educate and train staff members (physicians, APNs, pharmacists, Nurses, and Case Workers) on each component above and the integration between the three components.
- Provide documentation regarding the Program Components which include, but are not limited to, the following:
- Submit a detailed work plan that identifies the total cost for each deliverable and components of this project proposal to be approved by HCPH and in accordance with the Ohio Department of Health guidelines and restrictions.
- Develop policies and procedures for every component of the project, specailized to health systems and customized to each Emergency Department (ED).
- Develop or identify appropriate screening tools for each component.
- The integration of all aspects of inpatient management into ED workflows.
- The integration of transfer management of patients to outpatient settings (if referred to in-system provider).
- The integration of transfer and linkage activities into ED workflows for external setting referrals.
- Develop systems for each of the three components above to flow seamlessly between each other in the ED workflow
- Upgrade electronic health records to update work flows and order sets
- Educate and train staff members (physicians, APNs, pharmacists, Nurses, and Case Workers)
- Hire adequate staffing to ensure the project deliverables are met including, but not limited to a project manager to oversee the workflow
- Comply with all applicable federal and state regulations, rules, statutes and guidelines regarding the expenditure of funds and program requirements.
- Submit a Monthly invoice with documentation of the completion of each deliverable referenced in section V by the 10th day of the month. Late invoices may not be paid.
- Grantee must follow and meet Contract Performance requirements. Discrepancies in data, compliance and/or site reviews will require a “corrective action plan.” The Grantee further understands that their present allocation and/or future allocations will be determined based on the Grantee’s success in fully meeting the Contract Performance Requirements.
- Elements of Proposal
Narrative should be no more than 5 pages, double-spaced, 12 point font one inch margins
- Evidence of previously measured impact and program outcomes
- Proposed strategies/activities for this project
- Plan to address requirements detailed in sections Program Infrastructure and Organizational Capacity IV. Project Information and V. Deliverables of the RFP
- Evaluation Plan
Request for Proposal timeline
- August 14, 2018 – RFP published
- August 24, 2018 – Organizations will submit questions regarding the RFP no later than 4:00pm Close of Business electronically.
- Send Questions to:
- August 28, 2018 – HCPH will post on its website and publish responses to all questions received by the deadline.
- August 31, 2018 – Six hard copies of all proposals must be hand delivered to HCPH by no later than 1:00pm (EST). Proposals will be time stamped upon receipt.
- Deliver proposals to:
Hamilton County Public Health
ATTENTION: Greg Varner, Finance Officer
250 William Howard Taft Road, 2nd floor
Cincinnati, Ohio 45219
All submissions must be received by: August 31, 2018 by 1 P.M. (EST)
- September 4 – 10, 2018 – A committee comprised of HCPH staff and others will review and score proposals submitted by the deadline.
- September 11, 2018 – The Award Announcement will be made.
VIII. Additional Information
- All projects must be in compliance with federal and state guidelines for funding through the 2018 Overdose Crisis Cooperative Agreement, CDC-RFA-TP18-1802.
- Please see Attachment A to review the scoring criteria.
- This agreement will be in effect on October 1, 2018 or before through August 31, 2019.
- All work on the project must be completed by August 31, 2019.
All submissions for this proposal must be received at HCPH by: August 31, 2018 by 1P.M. (EST)
 All population estimated derived from the 2016 American Community Survey
 The University of Cincinnati, 2016 (https://www.uc.edu/inclusion/latest/diversitydata.html)
 ED visit estimates per the Ohio Department of Health’s EpiCenter Hospital Surveillance System
 Death estimates are per the Ohio Department of Health Bureau of Vital Statistics
 911 dispatch estimates are derived from data provided to HCPH by the city of Cincinnati and the Hamilton County Communications Center.
Emergency Department (ED) Comprehensive Care Program
|Proposal Scoring Tool|
Service: Emergency Department (ED) Comprehensive Care Program
Date: / /
1. Questions contained in Step 1 are Pass/Fail.
2. Please complete one score sheet for each proposal.
3. Remember to rate each statement listed on the score sheet. If you believe the proposal meets none of the standards described in the statement, mark as “0”. Other ratings should be used to quantify other levels of standards met.
4. The leader of the scoring meeting will collect the evaluations completed by all evaluating team members and return these documents to the scoring team leader.
|Summary of Evaluation Criteria||Score|
|1. Adherence to Mandatory Requirements (followed instructions and standard format)||(circle one)
|2. RFP Cover Sheet signed.||(circle one)
|3. Budget: The cost for each deliverable was clearly outlined in a work plan.||(circle one)
|4. Evaluation plan: an evaluation component for the overall project was included.||(circle one)
|Provider Narrative, Program Infrastructure and Organizational Capacity scoring (20 Points Total)|
|1. The Provider Narrative: This section should cover all important history and development of the organization to date, along with including the organizational chart and indicate that agency/provider historically has had an acceptable working relationship with local healthcare systems and hospitals in Southwest Ohio and specifically Montgomery County. (10 points)||
|2. The Provider Narrative: This section should highlight the organizational capacity to carry out the strategies, identify performance measures and evaluation plan. (10 points)||
|Project Information and Deliverables Scoring (80 points Total)|
|1. Identification and Screening for Opioid Use Disorder (OUD): Proposal provides a detailed description of an evidence-based screening tool and how that tool can be integrated in the ED electronic health record. (10 Points)||
|2. ED Management of Opioid Withdrawal: Proposal provides a comprehensive description of how the 6 components listed in the RFP will be implemented. (10 Points)||/10|
|3. Transition Patients from the ED: Proposal provides a comprehensive description of how the 3 components listed in the RFP will be implemented. (20 Points)
|4. Deliverables: Proposal provides a detailed work plan and proposal narrative that specifically addresses the capacity and expertise to work alongside the ED staff to: (40 Points)
a. Submit a detailed work plan and budget for each deliverable to be approved by HCPH.
b. Develop policies and procedures for every component of the project, specailized to health systems and customized to each Emergency Department (ED).
c. Develop or identify appropriate screening tools for each component.
d. The integration of all aspects of inpatient management into ED workflows.
e. The integration of transfer management of patients to outpatient settings (if referred to in-system provider).
f. The integration of transfer and linkage activities into ED workflows for external setting referrals.
g. Develop systems for each of the three components above to flow seamlessly between each other in the ED workflow
h. Upgrade electronic health records to update work flows and order sets
i. Educate and train staff members (physicians, APNs, pharmacists, Nurses, and Case Workers)
j. Hire adequate staffing to ensure the project deliverables are met including, but not limited to a project manager to oversee the workflow
Evaluator Signature Date
Hamilton County Public Health will at the sole discretion of the agency determine which proposal(s) offer the best means of servicing the interests of the County in implementing this Emergency Department Comprehensive Care project. The exercise of this discretion will be final.
Frequently Asked Questions
Q: Is there a standard cover sheet?
A: We do not have a standard form for the RFP cover sheet. Please feel free to create a cover sheet that includes basic information about the project.
Q: Why is there a focus on Montgomery County?
A: The Ohio Department of Health has indicated as part of this funding the work should be implemented and expanded to the SW region of Ohio including Montgomery County where this model does not currently exist. ODH has not defined “Southwest Ohio region”. Any application that does not meet the components and deliverables for the needs of Montgomery County is likely to receive a lower score than those applications that do address the needs of Montgomery County.
Q: Are organizations allowed to budget indirect expenses?
A: ODH has indicated the entire budget of $1,000,000 must be directed toward implementation activities. Therefore, all expenses in the proposed budget should be direct expenses for implementation of the project.
Q: Relative to provider education, can funds be applied to training costs related to increasing the number of DATA 2000 waivered providers? Can this include uncompensated time for clinicians (8 hours for physicians, 24 hours for advanced practice providers)?
A: Yes to both questions as long as it fits within the $1M budgeted limit.
Q: There is a five page limit on the narrative, and you all have asked that we include an organizational chart. To make the organizational chart legible, it’s going to need to be a page (or maybe 3/4 a page if we scale it down). Are we correct in assuming that the org chart does not count in the five page limit, but that we can include it as an attachment?
A: The organizational chart can be included as an attachment. Please note in the narrative that the organizational chart is an attachment.
Q: You did not ask for project staff bios, but we think the expertise on this project are a big selling point. Can we include those as attachments, also?
A: Staff bios can be included as attachments.
Q: Regarding the deliverables listed in the RFP, do all applicants need to submit them with their proposals, or does only the selected organization submit the deliverables after they have been chosen for funding?
A: Applicants should submit how they will accomplish the deliverables as part of their response to the proposal. The selected organization will be evaluated on how well they accomplish the deliverables as they stated in their proposal.
Posted by: Mike Samet