Request for Grant Proposals CRITICAL ACCESS HOSPITAL AND COORDINATED CARE ORGANIZATION POPULATION HEALTH PROJECTS

FUNDING OPPORTUNITY OVERVIEW: Request for Grant Proposals CRITICAL ACCESS HOSPITAL AND COORDINATED CARE ORGANIZATION POPULATION HEALTH PROJECTS Oregon s health system transformation is founded on a model of care coordination that includes new expectations for coordinating care, accountability for performance, and alternative models of payment based on outcomes and health. Health Information Technology (HIT) infrastructure is crucial in making these reforms and transformation possible. With funding from the Health Resources and Services Administration (HRSA) Rural Hospital Flexibility Grant funds, the Oregon Office of Rural Health (ORH) is pleased to announce a grant fund opportunity for Critical Access Hospitals (CAHs) to partner with their Coordinated Care Organization(s) (CCO) to implement an innovative, technology-driven population health project. Applicants are invited to submit proposals that include: What evidence-based population health priority or priorities they will collaborate to address; How the CAH and CCO will use innovative technology (e.g., smart phone apps, video conferencing, etc.) to drive healthy behavior changes, health education, social engagement in order to improve these population health priorities; How they will work together; How they will measure success; How they will communicate project successes as well as challenges. BACKGROUND: Managing population health requires different levels of commitment for different Critical Access Hospitals. Despite similar social determinants of health in education, diversity and economic status across Oregon CAH communities, there is wide variation in health status from community to community. The highest age-adjusted death rate (1,133 per 100,000) in a CAH community is nearly twice that of the community with the lowest rate (637 per 100,000) (Center for Health Statistics: 2014). Demographic variation in individual communities creates individualized need for population health resources. For instance, four agricultural communities have Latino populations of over 15% (and as high as 35%). In some communities on the Oregon coast, the population over age 65 exceeds 30% while in others it is barely 10% (Nielsen: 2014). In some communities, the percent of the population living in poverty is nearly twice that of others: for instance, in Hood River, Oregon 9.9% of people live below the poverty line versus 20.9% in Madras, Oregon (American Community Survey: 2008-2012). Despite these differences in population health, Oregon CAHs are proactive in providing community outreach, enrollment assistance, and health education, significantly exceeding the percentage of CAHs nationwide providing those services by 30%, 35% and 13% respectively. Oregon CAHs are also nearly twice as likely to provide obstetric services, and more likely to provide hospice and palliative care services than CAHs nationally (Community Benefit Activities of Critical Access, Other Rural, and Urban Hospitals: National and Oregon Data: 2015). There is striking agreement amongst CAH leadership and community members on population health challenges and priorities. Access to care continues to be the most frequently prioritized area in Oregon CAHs Community Health Improvement Programs (CHIPs) (Oregon CAH Community Engagement and Population Health Report: 2015). All but one of Oregon s 25 CAHs spend at least CAH CCO REQUEST FOR GRANT PROPOSALS March 2016 1

60% of their community benefit dollars on charity care and unreimbursed costs and 16 of these are spending over 80% (Oregon CAH Community Engagement and Population Health Report: 2015). Despite this, residents of rural Oregon are 25% more likely to die from cancer, 20% more likely to die from unintentional injuries and 27% more likely to die from heart disease than an average Oregonian (Center for Health Statistics: 2014). The Center for Medicare and Medicaid Innovation (CMMI) awarded a State Innovation Model (SIM) grant to Oregon in April 2013. The SIM grant supports Oregon s ongoing health system transformation and funds innovative approaches to improving health and lowering costs across the healthcare system. A portion of Oregon s SIM grant is dedicated to supporting and accelerating statewide HIT initiatives. OHA Health Information Technology (HIT) partnered with ORH to administer a telehealth pilot project grant program in November 2014. Sixty-seven applications were received and 5 grants were awarded for innovation projects that will run through August 2016. As the administrator of these grants, ORH was in a unique position to understand Oregon s need for telehealth. Nearly all of the applications received were from rural and frontier Oregon. Of particular interest were the 4 CCOs that applied, the 9 CAHs, the 11 local community-based organizations and the 2 networks (awardees of the HRSA Network Planning and/or Development grant). When ORH analyzed the applications by region, type of applicant and thematic area, an interesting alignment of need between the CCOs and the CAH applicants was apparent. Both independently proposed solutions to improve population health by using telehealth to change behaviors and do health-coaching outreach. These applications focused on implementing behavior change through mobile applications and/or providing video-conferencing health coaching for complex patients who need more dedicated and frequent support. The average proposed budget cost for these 18- month implementation projects was $80,000. This complements information identified in the 2015 Oregon CAH Community Engagement and Population Health Report. Oregon Public Health Institute analyzed the frequency of community/population health priorities for both CAHs and CCOs and found alignment in trying to address the challenges around behavioral and social determinants of health. This current cycle of Flex grant funding is an opportunity for ORH to support CAH alignment with critical community partners to improve population health. This is an especially important time for CAHs and CCOs to begin working together and identifying areas of shared value. KEY DATES: Optional question & answer call: April 15, 2016 2 p.m. PST Letter of Intent (LOI) deadline: May 9, 2016 5 p.m. PST Invitation to submit: May 16, 2016 Application deadline: June 20, 2016 5 p.m. PST Notification of award: June 28, 2016 Project start date: July 1, 2016 Contract signed/payment 1: July 15, 2016 Payment 2: January 16, 2017 Final Payment: January 15, 2018 Project end date: June 30, 2018 Project evaluation due: August 31, 2018 5 p.m. PST CAH CCO REQUEST FOR GRANT PROPOSALS March 2016 2

ELIGIBLE APPLICANTS: This opportunity is open to proposals from Oregon s Critical Access Hospitals. Due to the funding source, the primary applicant must be a Critical Access Hospital representative. In order to apply a CAH must demonstrate partnership with its Coordinated Care Organization. Applicants are strongly encouraged to also partner with local public health and/or diverse community organizations (e.g., housing, transportation, community corrections, behavioral health, etc.) Preference will be given to applicants that can leverage matching funds (e.g., from their CCO, other grants, etc.) ANTICIPATED AVAILABLE FUNDING AND PROJECT PERIOD: The total amount of awards available is $150,000 through the close of the grant: August 2018. ORH anticipates awarding grant funds to one or two projects. The project implementation period is 2 years, in alignment with the Flex grant cycle. Project implementation starts July 1, 2016 and ends on June 30, 2018. Grantees will then have two months to compile their final evaluation report (due August 31, 2018). Grantees may submit a proposed project budget of up to $150,000 for the project period with the following payment timeline: Payment Date Project Timeline Amount Payment Coverage Period July 15, 2016 When contract is signed Up to $50K Project start First 6 months to 12/31/16 Jan 16, 2017 2017 implementation Up to $50K Project period: 1/1/17 to 12/31/17 Jan 15, 2018 2018 implementation Up to $50K Project period: 1/1/18 to 6/30/18 Final evaluation: 7/1/18 to 8/31/18 ORH may reject all proposals and make no awards under this funding opportunity or elect to fund less than the total amount of the available awards. All payments depend on successful completion of contract deliverables. GRANTEE REQUIREMENTS: Grantees will be required to: Take part in periodic telephone and on-site meetings with ORH representatives; Provide a Memorandum of Understanding between the applicant and Coordinated Care Organization for the project. Report quarterly on agreed upon indicators; Compile qualitative and quantitative project evaluation results for a final evaluation report, which will be publically available; Provide budget and spending reports at the request of ORH; and Create a presentation on their project and present at the annual Oregon Rural Health Conference. APPLICATION INSTRUCTIONS: Optional Question & Answer Call April 15, 2016 Representatives from ORH will be available to answer questions on April 15, 2016 at 2 p.m. PST. Interested applicants should submit questions in advance of the call when possible. Please email guardino@ohsu.edu to submit questions and/or register for the phone call and receive the call-in number. CAH CCO REQUEST FOR GRANT PROPOSALS March 2016 3

Letter of Intent (LOI) Due May 9, 2016 5 p.m. PST All interested parties are required to submit a brief, non-binding Letter of Intent (LOI) by X by 5 p.m. PST. The email should be sent to Meredith Guardino at guardino@ohsu.edu and should contain the following information: Name and affiliation of the applicant(s); Name, mailing address, email address and phone number of proposed CAH director; Name, mailing address, email address and phone number of CCO project director; Up to three paragraphs describing the project the applicant(s) plan to propose, including: o The target population and population health priorities (please include an evidencebased summary of these needs); o Project intervention/approach; o Desired outcomes; o Collaborating partners and roles of each Brief proposed budget up to $150,000 for the period of July 1, 2016 through August 31, 2018 (non-binding estimate). All submissions will receive a confirmation that the LOI has been received and may receive requests for clarification or suggestions for revision. Invitation to Submit a Full Application May 16, 2016 The Grant Review Committee will review Letters of Intent. Successful submissions will be invited to submit a full application. All parties who submit an LOI will be notified of the committee s decision by 5 p.m. on May 16, 2016. Full Application Due June 20, 2016 5 p.m. PST The application should address the following items in the order listed below. Please use the titles provided for each section. Please use an 11-point or larger font size for text, tables and budgets and no smaller than half-inch margins. The full application should be submitted in a single PDF document via email to Meredith Guardino at guardino@ohsu.edu by June 20, 2016, 5 p.m. All applicants will receive a confirmation that the application has been received. I Cover Sheet (Attachment A) Please complete all sections of the Application Cover Sheet (Attachment A) including signature from the Authorized Representative. This page should be included as the first page in the full application PDF. II III Executive Summary (Maximum 1/2 page) Provide a brief summary of the proposed project including: The project goal(s); Target population(s); The evidence-based population health priority or priorities, The proposed project intervention. Project Description (Maximum 3 pages) Provide a detailed description of the proposed project including: Detailed project activities; A brief description of each of the persons responsible for the project, their organizational affiliation as well as their role and experience. Collaboration with additional partners and their project responsibilities; CAH CCO REQUEST FOR GRANT PROPOSALS March 2016 4

Methodology of recruiting participants; Expected outcomes and how they help meet the project goal(s); and Potential challenges and how they will be addressed. IV Project Targets and Measurable Indicators (Attachment B) Using Attachment B as a guideline for each project goal, please present: Measurable description(s); Data source(s) and method(s) of data collection; Baseline values (if available); A timeline for the project process and milestones; and Target values. If more space is needed, Attachment B may exceed one page. V Budget (Attachment C) Using Attachment C as a template, please provide a detailed budget and brief budget narrative. Budgets may include, but need not be limited to: Personnel expenses including person(s), role(s), hourly rate and hours assigned to project If fringe benefits are included, the budget must include the percentage of salary dedicated to fringe benefits and what is included in the percentage. Materials and supplies expenses (must specify items and per unit cost) Travel expenses Budget should include locations, number of participants traveling to each location and per unit cost details for airfare, mileage, lodging, meal per diems, etc. Grantees are required to present at a public conference. Therefore the budget should include the travel expenses associated with traveling to Sunriver for two days. Equipment/capital expenses (must specify items and per unit cost) Equipment must be justified in the budget narrative. The budget narrative should include justification for the use of each item. All IT equipment should be uniquely identified in the budget. As an example, there should not be a single item for software. Please detail the unit cost of each item, number needed and total amount. Meeting/conference expenses (must specify items and per unit cost) The budget should include a description of the meeting purpose, number of participants attending and per unit cost details for rental of space, audio-visual services, employee/contractor travel to and from the meeting and any other meeting costs. Consultants and contracted services including person(s), role(s), hourly rate and hours assigned to project The budget narrative should include the name(s) of the contractor, method of selection, scope of work and method of accountability. If fringe benefits are included, the contracted services budget must include the percentage of salary dedicated to fringe benefits and what is included in the percentage. If materials/supplies, travel and/or meeting expenses are included in the contracted services budget, the same level of detail as described above must be included. Professional training and development expenses (must specify items and per unit cost) Budget should include a description of the training, number of participants attending and per unit cost details. CAH CCO REQUEST FOR GRANT PROPOSALS March 2016 5

Indirect costs (cannot exceed 10% of direct costs). FUNDING RESTRICTIONS Food/catering is not an allowable expense; Funds may not be used to provide individuals with services that are already funded through Medicare, Medicaid and/or CHIP; Funds may not be used to lobby or advocate for changes in Federal and/or State law. If more space is needed, Attachment C may exceed 1 page. VI Letters of Support Letters of support are required. Each applicant must have a letter of support from the CCO it is partnering with that clearly defines how the CCO will be partnering on the project and who at the CCO will be leading this effort. Please provide a letter of support from each partner. There is no maximum on the number of letters that can be submitted. Letters of support should be addressed to: The Population Health Project Grant Review Committee and should include: Name and affiliation of the supporter(s): Mailing address, email address and phone; Title of the project; Commitment of support to participate in the project. Their responsibilities as part of the project. REVIEW CRITERIA All applications will be reviewed for eligibility. Those applications that are eligible will be scored and will undergo a comprehensive evaluation by an impartial review committee composed of members designated by ORH. Applications will be assessed with regard to the following review criteria: Impact Does the project address an important problem or barrier to improve population health? Are these problems clearly identified in the hospital and/or CCO/CAC needs assessments? Does the project increase individuals access to their own health data and engagement in their health? If the goals of the project are achieved, how will the outcomes affect the population health of this community? Are the population target numbers high enough to demonstrate significant impact? Collaboration Is the leadership role of the CAH clearly assigned? Is CCO commitment to the project clearly defined? Is the CCO contributing matching funds? Is the project leveraging other funding? Does the project partner with local public health and/or community organizations? Are their roles clearly defined? Has high-level leadership at each demonstrated a commitment to the project if the proposal is successful? Innovation and sustainability CAH CCO REQUEST FOR GRANT PROPOSALS March 2016 6

Does the project propose new concepts or approaches to improve population health? Is the project scalable and/or transferable to other similar environments? Is the project sustainable and likely to continue beyond the grant period? Capacity and Approach: Is the population clearly identified? Are the population health priorities clearly described and supported by evidence? Are the project activities likely to achieve the stated goals? Are the activities and timeline thoroughly described and reasonable given limitations of the environment, project time period and funding? Is the budget clear, reasonable and appropriate to the work proposed? Are administrative costs minimized? Does the project include the collaborative partners likely to contribute to its success? Does the proposed project have the staffing capacity to perform in the allotted time period? Is the proposed methodology for data collection feasible and likely to result in meaningful evaluation of the project process and impact? ORH may reject proposals if the proposed projects do not meet the intent of the grant opportunity or do not include all of the required information. QUESTIONS: For any questions related to this opportunity, please email Meredith Guardino at guardino@ohsu.edu. CAH CCO REQUEST FOR GRANT PROPOSALS March 2016 7

ATTACHMENT A: APPLICATION COVER SHEET Applicant Name: Name of Project Director/Principal Investigator: Address: City, State, Zip: Telephone: Email: Name and title of the person(s) authorized to represent the Applicant in any negotiations and sign any Grant Agreement that may result: Name: Title: By signing this page and submitting an application, the Authorized Representative certifies that the following statements are true: 1. No attempt has been made or will be made by the Applicant to induce any other person or organization to submit or not submit an application. 2. The Applicant does not discriminate in its employment practices with regard to race, creed, age, religious affiliation, sex, disability, sexual orientation or national origin. 3. Information and costs included in this application shall remain valid for 90 days after the application due date or until a grant is approved, whichever comes first. 4. The statements contained in this application are true and complete to the best of the Applicant s knowledge and the Applicant accepts as a condition of the grant, the obligation to comply with the applicable State and Federal requirements, policies, standards and regulations. The undersigned recognizes that this is a public document and open to public inspection. 5. The Applicant, by submitting an application in response to this Request for Grant Proposals (RFGP), certifies that it understands that any statement or representation contained in, or attached to, its application, and any statement, representation or application the Applicant may submit under any grant awarded under this RFGP, that constitutes a claim (as defined by the Oregon False Claims Act, ORS 180.750(1)), is subject to the Oregon False Claims Act, ORS 180.750 to 180.785, and to any liabilities or penalties associated with the making of a false claim under that Act. 6. The Applicant acknowledges receipt of all addenda issued under this RFGP. 7. If the Applicant is awarded a grant as a result of this RFGP, the Applicant will be required to complete, and will be bound by, a Grant Agreement. At the time of signing the Grant Agreement, the Applicant will be required to provide the Federal Employer Identification Number (FEIN) or Social Security Number (SSN) as applicable Signature: Date: (Authorized to Bind Applicant) CAH CCO REQUEST FOR GRANT PROPOSALS March 2016 8

ATTACHMENT B: TARGETS & INDICATORS TEMPLATE Descriptions of Metrics Used to Evaluate Project Please include description of measures used in the project. Data Source and Collection Data Source Method of Data Collection Data Values Metric Description Baseline Value (if applicable) Target Value Timeline Project Task/Milestone Date Comments CAH CCO REQUEST FOR GRANT PROPOSALS March 2016 9

ATTACHMENT C: BUDGET FORMAT Project Title Personnel Expenses Name Role on Project Number of Hours Hourly Rate Total Cost Amount Requested* Fringe at X% of salary (includes: X, X, X) Personnel Subtotal Materials and Supplies Expenses Item Number of Units Per Unit Cost Total Cost Amount Requested* Materials and Supplies Subtotal Travel Expenses Travel Location 1: Number of Participants Per Unit Cost Total Cost Amount Requested* Airfare/Transport Details Mileage Details Lodging Details Meal Per Diem Details Other Subtotal Travel Location 1 Travel Location 2: Number of Participants Per Unit Cost Total Cost Amount Requested* Airfare/Transport Details Mileage Details Lodging Details Meal Per Diem Details Other Subtotal Travel Location 2 Travel Expenses Subtotal Equipment/Capital Expenses Item Number of Units Needed Per Unit Cost Total Cost Amount Requested* Equipment/Capital Expenses Subtotal Meeting/Conference Expenses Meeting/Conference 1: Number of Participants Per Unit Cost Total Cost Amount Requested* Rental Space Audio-visual Services Travel To/From Other SubtotalMeeting/Conference 1: Meeting/Conference 2: Number of Participants Per Unit Cost Total Cost Amount Requested* Rental Space Audio-visual Services Travel To/From Other SubtotalMeeting/Conference 2: Meeting/Conference Expenses Subtotal Consultants/ Contracted Services Expenses Name Role on Project Number of Hours Hourly Rate Total Cost Amount Requested* Fringe at X% of salary (includes: X, X, X) Consultants/Contracted Services Subtotal Professional Training & Development Expenses Description of Training Professional Training & Development Expenses Subtotal Number of Participants Per Unit Cost Total Cost Amount Requested* Total Direct Costs Indirect Costs at X% Total Project Budget * If amount requested is different from total cost, please describe the source(s) of additional funds in the budget narrative CAH CCO REQUEST FOR GRANT PROPOSALS March 2016 10