Colorado Regional Health Connector Program Attachment E Statement of Work: Regional Health Connector Host Organizations

Transcription

1 1. Background/Introduction 1.1. This Statement of Work ( SOW ) describes the activities and responsibilities (the Work ) of the Regional Health Connector (RHC) Host Organization ( Host ) participating in the Colorado RHC Program (the Program ) The Host will be responsible for the Work described in this SOW within the region which encompasses Denver County (the Region ) The Program is supported through two federally-funded initiatives: EvidenceNOW Southwest (ENSW) and the Colorado State Innovation Model (SIM). As shown in Figure 1, the Program will be developed and managed by the Colorado Foundation for Public Health and the Environment (CFPHE) and the Colorado Health Institute (CHI), under contract with the University of Colorado (for ENSW funding) and the Colorado SIM Office (for SIM funding), respectively. ENSW is funded through the Agency for Healthcare Research and Quality (AHRQ) and SIM is funded through the Centers for Medicare and Medicaid Services (CMS). Figure 1. Colorado Regional Health Connector Program Funding Partnership 1.4. The cost allocation for the Work will be 70% funded by SIM and 30% funded by ENSW. Given the key role of the RHC in engaging partners for both programs, the 70/30 split is based on the planned statewide scope of engagement for each project:

2 Colorado SIM plans to recruit a total of 400 primary care practices and four Community Mental Health Centers to participate in the program. In addition, SIM will fund two Behavioral Health Regional Collaboratives and eight local public health agency (LPHA) collaboratives, which encompass over 30 LPHAs, two Regional Care Coordination Organizations, two school districts, substance use treatment providers, and a variety of community partners. The Colorado SIM Office is also in the process of developing a comprehensive telehealth strategy with additional partners across the state. With over 500 different entities engaged, SIM constitutes 70% of the total statewide engagement for both programs ENSW plans to recruit 208 primary care practices (in Colorado), which constitutes 30% of the total statewide engagement for both programs To ensure that the Work reflects the 70/30 funding split, each RHC will identify three target areas: one directly linked to ENSW target areas and two directly linked to Colorado SIM target areas. Please see Section for additional details The Host will work closely with program staff at CHI and CFPHE (collectively, Program Staff ) to launch the RHC workforce and to continuously improve the program throughout planning, implementation and transition to sustainability phases. 2. Terminology 2.1. Acronyms and abbreviations are identified at their first occurrence in this SOW. The following list is provided to assist the reader in understanding acronyms, abbreviations, and terminology used throughout this document Business Day - Any day in which CHI and CFPHE are open and conducting business, but shall not include days on which CHI and CFPHE observe one of the following holidays: New Year s Day, Martin Luther King, Jr. Day, President s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day or the Friday after Thanksgiving, or Christmas Day CFPHE The Colorado Foundation for Public Health and the Environment CHI The Colorado Health Institute ENSW EvidenceNOW Southwest Host Regional Health Connector Host Organization, the contracted entity in each region responsible for hiring, managing, and supporting the RHC in that region HSR Health Statistics Region, as defined by the Colorado Department of Public Health and the Environment

3 Local Partnership A formal or informal coalition or collaboration between multiple stakeholders within a region. Local Partnerships may include primary care providers, behavioral health specialist, oral health providers, specialty care providers, local public health agencies, social service agencies, child development experts, law enforcement agencies, schools, community-based organizations, housing organizations, transportation services, shelters, food banks, faith-based institutions, fitness facilities, non-profit organizations, health alliances, natural helpers networks, and a variety of other stakeholders Local Priority A health-related priority identified by local stakeholders within a Region, based on community health needs assessments, local public health community assessments and improvement plans, and other local information LPHA Local Public Health Agency Program The Colorado Regional Health Connector Program Program Staff The directors and managers of the Colorado Regional Health Connector Program, housed at both CHI and CFPHE Region An assigned geographic region served by each RHC. Regions will be based on the local HSR(s) and may incorporate adjustments proposed by the Host, at the discretion of Program Staff RHC Regional Health Connector, an employee of the Host dedicated to the activities described in this SOW Roadmap The implementation plan for RHC activities within a region SIM State Innovation Model SMART objectives Objectives which are Specific, Measurable, Achievable, Realistic, and Time-bound SOW Statement of Work Target Area Colorado SIM and ENSW target areas include: anxiety, asthma, cardiovascular disease, child development (screenings), depression, diabetes, hypertension, obesity, prevention (breast and colon cancer), prevention (flu), safety (older adult falls), and substance use 3. Scope 3.1. The scope of this SOW is limited to the roles and responsibilities of the Host and the RHC in the development and implementation of the Program. The SOW also describes the type of support and engagement the Host and the RHC may expect from the Program Staff; however, this document is not intended to be a comprehensive or binding description of Program Staff activities The Host is responsible for hiring, guiding, and supporting the RHC in work within the Region. The Host is ultimately accountable to the Program Staff for the successful completion of all activities described in this SOW, including those assigned to the RHC.

4 3.3. The RHC is responsible for engaging appropriate practice-based and community partners to identify local priorities and to develop and implement a plan to address local priorities within a Region The Host and the RHC will receive training, guidance and support from the Program Staff through frequent virtual and in-person interactions and regular reporting requirements (described further in Section 4) Although this SOW delineates specific required activities and deliverables, Program Staff expect to work closely with the Host and the RHC to improve the Program through continuous iteration. Changes to the Work may be considered to better meet the needs of the local Region; therefore, the Host and the RHC are expected to participate as thought partners for the Program Staff in considering changes and should anticipate and plan for flexibility throughout the Period of Performance. 4. Tasks and Deliverables 4.1. Under this SOW, the Host and the RHC will be responsible for the specific tasks and deliverables described in this section. Tasks and deliverables are identified according to phases of Program implementation, as well as ongoing activities to support training, evaluation and sustainability efforts Table 1 identifies the phases of Program implementation and ongoing activity categories.

5 Phas e Description Table 1. Phases of Program Implementation Timeline for completion* 1 Planning 7 months Step 1: Host hires or assigns RHC Step 2: Review existing data and initiatives to identify local priorities Step 3: Align local priorities with SIM and ENSW Target Areas Step 4: Develop a plan to address local priorities (RHC Roadmap) 2 Implementation of the RHC Roadmap 3 Transition to sustainability Ongoing Activities Evaluation Training & Technical Assistance *Measured in weeks/months from execution of contract. 6 weeks 3 months 3 months 6 months Through Apr Through Jan Through Jan As stated in Section 3.2, the Host is ultimately accountable to the Program Staff for the successful completion of all activities described in this SOW, including those assigned to the RHC. This SOW assigns responsibilities specifically to the RHC in order to provide clarity about the role of this new workforce and the role of the organizations who have been selected to hire, manage, and support them. It is important to note that Sections 4.4, 4.6, 4.9, 0, 4.15, 4.18, 4.20, 4.22, and 1 refer to Host responsibilities as an organization, while the remaining sections refer to activities and responsibilities that are expected to fall within the role of the RHC as an employee of the Host. Phase 1: Planning Step 1: Host Hires or Assigns RHC PHASE 1 STEP 1 TASKS: The Host shall complete the following tasks: Finalize a Region-specific RHC job description, based on the job description template provided by Program Staff, and submit to Program Staff. Submit the name and contact information for the hiring manager and/or RHC supervisor to Program Staff Identify an appropriate internal or external candidate who meets the qualifications specified in the RHC job description.

6 Submit the resume of the proposed RHC candidate to Program Staff at least 48 hours before offering the position to the candidate. Program Staff reserve the right to discuss the proposed candidate s qualifications with the Host before an offer is made; however, Program Staff approval of the proposed candidate is not required Provide the RHC with the necessary resources to perform their duties, including a computer, printer, meeting space, access, etc Notify Program Staff of the RHC start date and connect the RHC to onboarding training and RHC meetings hosted by Program Staff Participate in network analysis activities with Program Staff. Facilitate scheduling and communication with community partners, as needed PHASE 1 STEP 1 DELIVERABLES: The Host shall submit the following deliverables: DELIVERABLE: Hiring Package, which include four separate items due at different points in the hiring process: Final Region-specific job description and hiring manager/supervisor contact information, due within two weeks of the Effective Date Proposed RHC Candidate Resume, due 48 hours before offer is extended Notification of RHC start date upon RHC acceptance of the position Baseline network analysis information, building upon the partnership table submitted with the Host s proposal. Program staff will work with each Host to determine the appropriate timing for delivery of this information. Phase 1: Planning Step 2: Review Existing Data and Initiatives to Identify Local Priorities PHASE 1 STEP 2 TASKS: The Host shall complete the following tasks: Identify and connect RHC to existing assessments of local health needs and priorities within the Region. At a minimum, the existing assessments identified should include the following: Community Health Assessments and Community Health Improvement Plans, developed by public health agencies; Community health needs assessments, conducted by local hospitals; Regional listening session reports, available from various Colorado-based foundations; and Any other local reports and/or assessments that describe the current state of health or health disparities in the Region. The Host should engage local partners and stakeholders to ensure a comprehensive list of existing assessments is compiled Identify existing Local Partnerships, meetings, and projects and (if needed) introduce the RHC to key contacts for each Local Partnership, meeting, and/or project.

7 Ensure that the RHC is engaged in Local Partnerships, meetings, and projects in which the Host participates, as appropriate Provide local historical context to the RHC, as appropriate PHASE 1 STEP 2 TASKS: The RHC shall complete the following tasks: Work with the Host and Program Staff to review existing local assessments and data. At a minimum, the RHC should review the following documents and datasets: Community Health Assessments and Community Health Improvement Plans, available from CDPHE; Community health needs assessments, conducted by local hospitals; Regional listening session reports, available from various Colorado-based foundations; County Health Rankings & Roadmaps, available online; and Colorado Access to Care Index and County Health Report Cards, available from CHI; and Any other local reports and/or assessments that describe the current state of health or health disparities in the Region Discuss local initiatives and projects with key contacts. Ensure that efforts by local practices, LPHAs, AHECs, Alliances, and human services are considered, in addition to any region-specific community organization efforts Engage Practice Transformation Organizations (PTOs), including local Practice Facilitators (PFs) and Clinical Health Information Technology Advisors (CHITAs), participating in Colorado SIM or ENSW within the Region to identify relevant assessments, population health plans, or specific needs related to connecting to community resources and developing partnerships. Leverage relationship with PTOs to engage with practices participating in Colorado SIM and ENSW, while minimizing additional meetings for the practices (e.g., an RHC might attend a previously-scheduled meeting between the PTO and practice rather than initiating a separate meeting) Engage the Regional Care Coordination Organization(s) (RCCOs) covering the Region to identify relevant RCCO assessments and other documents. Review all available RCCO materials. Program Staff will provide introductions to Opportunity Liaisons at the RCCO(s) to facilitate this engagement. Leverage relationship with Opportunity Liaison and RCCO to engage with practices, while minimizing additional meetings for the practices (e.g., an RHC might attend a previously-scheduled meeting between the RCCO and practice rather than initiating a separate meeting) Engage local representatives of Colorado-based foundations, including the following types of representatives: Program Officers from the Colorado Health Foundation, Caring for Colorado Foundation, the Denver Foundation, as well as Community Partners, from the Colorado Trust, and others.

8 Where appropriate, assist local practices and/or communities in conducting selfassessments and/or community health need assessments. This activity should not be duplicative with any existing or planned assessments. It is expected that new assessments will be appropriate only in rare instances Use the local priority alignment tool provided by Program Staff (or an equivalent tool) to identify local priorities that are common across existing assessments. All local priorities should be captured in Step 2 to ensure that the ensuing RHC activities are tailored to the needs of the local community. Program Staff will assist the RHC in aligning local priorities with Colorado SIM/ENSW Target Areas in Step Using the local priority alignment tool (or equivalent), compare local priorities among existing initiatives and efforts. In collaboration with the Host, Local Partnership(s), and other community stakeholders, identify opportunities for RHC work to support and accelerate progress on local priorities PHASE 1 STEP 2 DELIVERABLES: The RHC shall submit the following deliverables: DELIVERABLE: Completed local priority alignment tool (or equivalent) Phase 1: Planning Step 3: Alignment of Local Priorities with SIM and ENSW Target Areas PHASE 1 STEP 3 TASKS: The Host shall complete the following tasks: Provide guidance and support to the RHC in completing all tasks and deliverables Ensure that the RHC is engaged in Local Partnerships, meetings, and projects in which the Host participates, as appropriate Provide local historical context to the RHC, as appropriate PHASE 1 STEP 3 TASKS: The RHC shall complete the following tasks: In collaboration with Program Staff, determine alignment between Local Priorities and Colorado SIM/ENSW Target Areas. In many cases, a Local Priority may be a direct match for a Target Area (e.g., obesity or substance use). In other cases, a Local Priority may be an upstream determinant that impacts a Target Area (e.g., a Local Priority of clean air may impact the asthma Target Area). A list of Target Areas and example contributing factors and social determinants of health are provided in Exhibit 2. Program Staff will assist each RHC in determining areas of alignment to ensure that work on Local Priorities can be linked to Target Areas for evaluation In collaboration with the Host and Local Partnerships, select three Local Priorities that align with one ENSW and two Colorado SIM Target Areas, as shown in Figure 2. The selected Local Priorities will be the focus of the RHC Work.

9 Figure 2. Alignment of selected Local Priorities with ENSW and Colorado SIM Target Areas Local Priority 1 Local Priority 2 Local Priority 3 ENSW Target Area Colorado SIM Behavioral Health Target Area Comorbidity Any Colorado SIM Target Area or other Select a Local Priority that can be directly linked to one of the ENSW target areas around heart health. The ENSW target areas and a few example projects are shown in Table 2 below. The RHC will identify specific projects based on the needs of the community in Step 4, as described in Section Table 2. ENSW Target Areas and Example Projects ENSW Target Area Cardiovascular Disease Cholesterol Hypertension Obesity Substance Use Tobacco Example RHC Projects Help practices implement evidencebased clinical-community linkages for smoking cessation Disseminate patient engagement materials about cardiovascular health Increase access to local community college fitness facility

10 Select a Local Priority that can be directly linked to one of the Colorado SIM target areas on behavioral health (i.e., mental health and/or substance use). The Colorado SIM behavioral health target areas and a few example projects are shown in Table 3 below. The RHC will identify specific projects based on the needs of the community in Step 4, as described in Section Table 3. Colorado SIM Behavioral Health Target Areas and Example RHC Projects Colorado SIM Behavioral Health Target Area Anxiety Child Development Screenings Depression Substance Use Alcohol Substance Use Prescription Drugs Example RHC Projects Connect primary care to statewide early intervention resources Disseminate stigma reduction materials from SIM LPHA grantees to primary care Facilitate coalition between law enforcement, substance use providers, and primary care Improve access to behavioral health services in rural communities via coordinating transportation networks and/or supporting adoption of telehealth.

11 Select a Local Priority that can be directly linked to any of the Colorado SIM target areas, as well as the behavioral health target area selected in Section The goal in selecting this third Local Priority should be to address comorbidities or other linkages between the second Local Priority and another Colorado SIM target area. The RHC might address two behavioral health comorbidities OR comorbidities between behavioral health and physical health. Table 4. All SIM Target Areas and Example RHC Projects SIM Target Area Anxiety Child Development Screenings Depression Substance Use Alcohol Substance Use Prescription Drugs Asthma Diabetes Hypertension Obesity Prevention Breast and Colon Cancer Prevention Flu Safety Falls Substance Use Tobacco Example RHC Projects Facilitate community social support network to address comorbidity between depression and obesity Implement follow-up referral to BH specialist after positive cancer screening Help practices establish referral networks that include support for comorbidities (e.g., joint referral for home assessment for falls and social support evaluation) Record the selection of three Local Priorities in the selected Local Priorities form provided by Program staff PHASE 1 STEP 3 DELIVERABLES: The RHC shall submit the following deliverables: DELIVERABLE: Complete selected Local Priorities form. Phase 1: Planning Step 4: Development of Plan to Address Local Priorities (RHC Roadmap) PHASE 1 STEP 4 TASKS: The Host shall complete the following tasks: Provide guidance and support to the RHC in completing all tasks and deliverables Ensure that the RHC is engaged in Local Partnerships, meetings, and projects in which the Host participates, as appropriate.

12 Provide local historical context to the RHC, as appropriate PHASE 1 STEP 4 TASKS: The RHC shall complete the following tasks: Collaborate with Program Staff to identify and review best practices and/or evidence-based interventions that may be appropriate tools to employ in addressing the selected Local Priorities. Program Staff will support the RHC in tailoring existing evidence-based interventions or developing of promising practices, where appropriate. Focus on opportunities for connection to practices and coordination with practice transformation efforts, as a priority for the RHC work Develop at least one objective related to each selected Local Priority. Objectives should be specific, measurable, achievable, realistic, and time-bound (SMART). Program Staff will provide technical assistance on identifying and specifying SMART objectives. RHCs should also engage PTOs and RCCOs in developing SMART objectives, to ensure coordination with local practice transformation objectives Develop an implementation plan for RHC Work, broken into distinct projects, to achieve each SMART objective. This plan will be called the RHC Roadmap. Program Staff will provide a roadmap template and technical assistance. While the scope of RHC work will be tailored to each Region, the RHCs are expected to prioritize coordination activities over detailed work on individual projects. Table 5 provides an example of how three selected Local Priorities might be linked to Target Areas and translated into projects and SMART objectives. The RHC Roadmap would provide additional detail on implementation plans for each project. Table 5. Example Local Priorities, Target Areas, Projects, and Objectives Local Priorities Target Areas Example Projects Example SMART Objectives Safe places to exercise Obesity Facilitate referral network from practices to local community college fitness facility Expand fitness center access to 200 low income families at an affordable rate of no more than $15/ month by Apr Opioid overdose rate Substance Use Increase availability of naloxone through community coalition Distribute free naloxone kits to 1,000 residents by Jan Suicide death rate Depression Engage local providers and community organizations in LPHAled mental health stigma reduction campaign Reduce suicide death rate from 19.4 per 100,000 to 17.6 per 100,000 by Jan. 2019

13 Identify the Local Partnerships and other community stakeholders who will be engaged in addressing the selected Local Priorities, and include a communication plan in the RHC Roadmap. The RHC Roadmap should specify planned engagement with primary care and behavioral health providers, PTOs, RCCOs, and LPHAs, in particular Review RHC Roadmap with the Host, Local Partnerships, PTOs, RCCOs, and other community stakeholders Complete a health equity assessment for each proposed project. A health equity assessment tool will be provided by Program Staff. The RHC may use the tool provided or an equivalent tool more suited to the needs of the Region. The health equity assessment must evaluate the expected impact of each proposed project on underserved populations and health disparities among the population of the Region PHASE 1 STEP 4 DELIVERABLES: The RHC shall submit the following deliverables: DELIVERABLE: Complete RHC roadmap to address Local Priorities, including SMART objectives DELIVERABLE: Complete health equity assessment for each project proposed in the RHC Roadmap. Phase 2: Implementation of the RHC Roadmap PHASE 2 TASKS: The Host shall complete the following tasks: Provide guidance and support to the RHC in completing all Phase 2 tasks and deliverables Ensure that the RHC is engaged in Local Partnerships, meetings, and projects in which the Host participates, as appropriate Provide local historical context to the RHC, as appropriate Monitor progress against the implementation plan and SMART objectives laid out in the RHC Roadmap and escalate any anticipated issues or delays to Program Staff Provide opportunities for professional development to the RHC, as appropriate Determine ongoing funding required to sustain the work of the RHC beyond the current funding opportunity Collaborate with Program Staff to explore local pathways to sustainable funding of the RHC PHASE 2 TASKS: The RHC shall complete the following tasks: Implement the RHC Roadmap developed in Phase 1, with support from the Host and Program Staff Engage Local Partnerships, PTOs, RCCOs, and other community stakeholders in the implementation of the RHC Roadmap. Continuously seek out additional opportunities to engage new stakeholders in the work.

14 Identify additional local and statewide resources available to support efforts to address Local Priorities. Support efforts to leverage additional resources through grant proposals and other activities, as appropriate Facilitate primary care and behavioral health provider participation in Local Partnerships and ensure that providers are aware of practice transformation opportunities that may support efforts on Local Priorities. Specifically, support SIM and ENSW practice transformation efforts to coordinate with the local community on Local Priorities Facilitate local public health participation in Local Partnerships, if needed. Specifically, support SIM local public health grantee efforts, where applicable, to coordinate with the local community on Local Priorities Serve the local community as a coordination resource, by developing and maintaining a working knowledge of a variety of local and statewide initiatives. Increase understanding of shared community health interests through coordination Communicate to Program Staff any identified opportunities for continued funding for RHC work, both locally and statewide PHASE 2 DELIVERABLES: The RHC shall report on activities (including progress against the SMART objectives identified in the RHC Roadmap) through regular reporting requirements described in Sections 4.20 and 4.21 (Evaluation Tasks and Deliverables) below. The regular reports will occasionally include special onetime reports specific to the phase of the project, as directed by Program Staff, including the following special report in Phase 2: DELIVERABLE: Estimate of ongoing funding needed to sustain RHC role, to be included in the Quarterly Progress Report due in January 2018 Phase 3: Transition to Sustainability PHASE 3 TASKS: In addition to continuing the Phase 2 tasks, the Host and RHC shall complete the following Phase 3 tasks: Take necessary steps to implement plans for sustainability developed through activities described in Section , , and PHASE 3 DELIVERABLES: The RHC shall continue to report on activities (including progress against the SMART objectives identified in the RHC Roadmap and progress towards sustainability) through regular reporting requirements described in Sections 4.20 and 4.21 (Evaluation Tasks and Deliverables) below. Ongoing Activities - Evaluation EVALUATION TASKS: The Host and the RHC shall complete the following evaluation tasks: Maintain regular communication with the assigned member of Program Staff over phone and . The RHC must respond to written requests from Program Staff within three (3) business days.

15 Participate in ongoing training and technical assistance satisfaction surveys and other process evaluation activities Complete a Monthly Metrics Report each month (throughout all Phases), which will feature 3-4 key quantitative metrics and a short written update on progress. Program Staff will provide a Monthly Metrics Report template, which may be updated based on feedback from the RHC workforce Complete a Quarterly Progress Report each quarter with a detailed written update on progress. Program Staff will provide a Quarterly Progress Report template, which may be updated based on feedback from the RHC workforce Participate in network analysis activities with Program Staff at the beginning and end of the total program funding period. Facilitate scheduling and communication with community partners, as needed Host Program Staff for an annual site visit, to deepen understanding of the work on the ground and to support the development of the Annual Reports to be written by Program Staff at the end of each respective grant period Complete a Final Report for each funding initiative at the end of the respective grant periods. Program Staff will provide a Final ENSW Report template and a Final SIM Report template Complete a Health Equity Impact Report describing the impact of RHC Work on health disparities in the Region at the end of the funding period. Program Staff will provide a Health Equity Impact Report template EVALUATION DELIVERABLES: The Host and the RHC shall submit the following evaluation deliverables: DELIVERABLE: Monthly Metrics Report, due seven calendar days after the end of each month (incorporated into Quarterly Progress Report every three months) DELIVERABLE: Quarterly Progress Report, due 20 calendar days after the end of each calendar year quarter DELIVERABLE: Final ENSW Report, detailing the completion of the SMART objectives identified in the RHC Roadmap linked to cardiovascular disease DELIVERABLE: Final SIM Report, detailing the completion of all SMART objectives identified in the RHC Roadmap. The final SIM report will also include network analysis requirements DELIVERABLE: Health Equity Impact Report, detailing the impact of RHC work on health disparities in the Region. Ongoing Activities - Training and Technical Assistance TRAINING TASKS: The Host shall complete the following training tasks: Ensure that the RHC is available to attend Program biweekly calls, monthly webinars, and semi-annual in-person trainings, barring any extenuating circumstances. These events are mandatory and regular RHC attendance will be a condition of payment for monthly and quarterly milestones.

16 Collaborate with Program Staff to provide any training necessary to augment the specific experience and skills of the individual RHC TRAINING TASKS: The RHC shall complete the following training tasks: Attend biweekly calls, monthly webinars, and semi-annual in-person trainings provided by Program Staff and other partners. These events will cover a broad range of topics, including the role of an RHC in the community, basic information about statewide initiatives, best practices for community engagement, and evaluation tools. Program Staff will tailor the topics to the needs of the RHC workforce. These events are mandatory and regular RHC attendance will be a condition of payment for monthly and quarterly milestones Request technical assistance from Program Staff on any relevant topic, as needed. Each RHC is expected to work closely with Program Staff to identify and address emerging issues and obstacles throughout implementation of the Program TRAINING DELIVERABLES: RHC attendance will be tracked by Program Staff. No submission is required of the RHC or Host. 5. Requirements / Project Management 5.1. Deliverable Requirements All deliverables shall meet CHI and CFPHE-approved format and content requirements. Program Staff will specify the number of copies and media for each deliverable Each deliverable will follow the deliverable submission process as follows:

17 The Host or the RHC shall submit each deliverable to Program Staff for review and approval Program Staff will review the deliverable and may request that the Host or the RHC make changes to the deliverable. The Host or the RHC shall make all changes within five (5) Business Days following Program Staff direction to make the change unless Program Staff provide a longer period in writing Changes Program Staff may direct include, but are not limited to, modifying portions of the deliverable, requiring new pages or portions of the deliverable, requiring resubmission of the deliverable or requiring inclusion of information that was left out of the deliverable Program Staff may also direct the Host or the RHC to provide clarification or provide a walkthrough of each deliverable to assist Program Staff in review. The Host or the RHC shall provide the clarification or walkthrough as directed by Program Staff Once Program Staff have received an acceptable version of the deliverable, including all changes directed by Program Staff, Program Staff will notify the Host of its acceptance of the deliverable in writing. A deliverable shall not be deemed accepted prior to Program Staff's notice to the Host of acceptance of that deliverable The Host shall employ an internal quality control process to ensure that all deliverables, documents and calculations are complete, accurate, easy to understand and of high quality. The Host and the RHC shall provide deliverables that, at a minimum, are responsive to the specific requirements for that deliverable, organized into a logical order, contain no spelling or grammatical errors, are formatted uniformly and contain accurate information and correct calculations In the event that any due date for a deliverable falls on a day that is not a Business Day, then the due date shall be automatically extended to the next Business Day, unless otherwise directed by Program Staff All due dates or timelines that reference a period of days, months or quarters shall be measured in calendar days, months and quarters unless specifically stated as being measured in Business Days or otherwise. All times stated in the Contract shall be considered to be in Mountain Time, adjusted for Daylight Saving Time as appropriate, unless specifically stated otherwise No deliverable, report, data, procedure or system created by the Host or the RHC for CHI and CFPHE that is necessary to fulfilling the Host or the RHC's responsibilities under the Contract, as determined by Program Staff, shall be considered proprietary.

18 If any deliverable contains ongoing responsibilities or requirements for the Host and/or the RHC, such as deliverables that are plans, policies or procedures, then the Host and the RHC shall comply with all requirements of the most recently approved version of that deliverable. The Host and the RHC shall not implement any version of any such deliverable prior to receipt of Program Staff's written approval of that version of that deliverable. Once a version of any deliverable described in this subsection is approved by Program Staff, all requirements, milestones and other deliverables contained within that deliverable shall be considered to be requirements, milestones and deliverables of the Contract Any deliverable described as an update of another deliverable shall be considered a version of the original deliverable for the purposes of this subsection Communication Requirements The Host shall enable the RHC to exchange documents and electronic files with the Program Staff in formats compatible with CHI and CFPHE's systems. CHI and CFPHE currently use Microsoft Office 2013 for PC. If the Host uses a compatible program that is not the system used by CHI and CFPHE, then the Host shall ensure that all documents or files delivered to Program Staff are completely transferrable and reviewable, without error, on CHI and CFPHE's systems The Host shall ensure that the RHC and other key personnel assigned to the Contract are available for meetings with Program Staff during CHI and CFPHE's normal business hours, as determined by CHI and CFPHE. The RHC and other key personnel shall be available for all regularly scheduled meetings between the Host and Program Staff, unless Program Staff has granted prior, written approval otherwise The Host and the RHC shall respond to all telephone calls, voic s and s from Program Staff within three (3) Business Day of receipt Performance Reviews Program Staff may conduct performance reviews or evaluations of the Host or the RHC in relation to the Work performed under the Contract Program Staff may work with the Host in the completion of any performance reviews or evaluations or Program Staff may complete any or all performance reviews or evaluations independently, at CHI and CFPHE's sole discretion The Host shall provide all information necessary for Program Staff to complete all performance reviews or evaluations, as determined by Program Staff, upon request. The Host shall provide this information regardless of whether Program Staff decide to work with the Host on any aspect of the performance review or evaluation CHI and CFPHE may conduct these performance reviews or evaluations at any point during the term of the Contract for any reason.

19 If CHI and CFPHE decide to conduct a performance review of the Host or the RHC, Program Staff will notify the Host twenty (20) business days in advance of the review. Program Staff shall provide the Host with the criteria upon which a performance review will be based Host Personnel The Host shall designate people to hold the following positions: Regional Health Connector This position will be responsible for the tasks and deliverables assigned to the RHC in Section Regional Health Connector Supervisor This position will be responsible for the tasks and deliverables assigned to the Host in Section The Host shall not voluntarily change individuals in the RHC or Supervisor positions without prior notification to CHI and CFPHE. The Host shall supply Program Staff with the name(s), resume and references for any proposed replacement whenever there is a change. Any individual replacing the RHC or other key personnel shall have qualifications that are equivalent to or exceed the qualifications of the individual that previously held the position In the event that any individual filling an RHC or Supervisor position leaves employment with the Host, the Host shall propose a replacement person to CHI and CFPHE. The replacement person shall have qualifications that are equivalent to or exceed the qualifications of the individual that previously held the position The Host shall not change the RHC job description without prior notification to CHI and CFPHE. The Host shall supply Program Staff with any proposed changes to the RHC job description, which should remain in alignment with the mission, principles, and objectives of the program. 6. Period of Performance 6.1. The Parties' respective performances under this SOW shall commence on the Effective Date. This SOW shall expire on January 31, 2019 unless sooner terminated or further extended. 7. Compensation and Invoicing 7.1. Compensation The maximum amount payable under this SOW to the Host by CHI and CFPHE is shown in Exhibit 1, as determined by CHI and CFPHE from available funds. Payments to the Host are limited to the unpaid obligated balance of the SOW at the rates set forth in Exhibit The compensation under the Contract consist of Deliverable Payments.

20 CHI and/or CFPHE shall pay the Host a Deliverable Payment each month for each of the deliverables shown in the following table that were delivered to CHI or CFPHE during that month, as listed in Exhibit A, Rates. Compensation under the Contract shall consist of payments made to the Host upon CHI and CFPHE s on-time receipt and acceptance of the deliverables The Host shall not receive any separate payment for any deliverables not shown in the Deliverable Table in Exhibit 1. The Host shall not receive compensation or payment for any other costs under this SOW Invoicing and Payment Procedures CHI and/or CFPHE shall generate an invoice on behalf of the Host upon approval of a deliverable. All deliverables approved during a calendar month will be included in a single invoice for that month, to be generated by the fifteenth (15th) Business Day of the month following the month for which the invoice covers The invoice shall contain all of the following for the month for which the invoice covers: The milestone payment for the deliverables described in Section 7.1, only if all deliverables described in that section were received by their required due dates and accepted by CHI and CFPHE CHI and/or CFPHE shall remit payment to the Host, for all amounts shown on the invoice generated by CHI and/or CFPHE.

21 Exhibit 1. Payment Milestone Schedule- Example Note: The following example payment milestone schedule assumes an Effective Date of October 1, Program staff will update the Payment column based on the outcome of budget negotiations. Ref. Deliverable Due Payment Phase 1: Planning (Effective Date April 30, 2017) Hiring Package, including: Final Region-specific job description and hiring manager/ supervisor contact information Proposed RHC Candidate Resume Notification of RHC start date. Baseline network analysis information Staged submission: Within two weeks of effective date, 48 hours before offer is extended Upon acceptance TBD TBD Monthly Metrics Report (October) 7-Nov-16 TBD Monthly Metrics Report (November) 7-Dec-16 TBD Completed Local Priority Alignment Tool (or equivalent) - 3 mos. Selection of two or three Local Priorities (including a Local Priority linked to cardiovascular disease) as the focus of RHC work - 3 mos. 2-Jan-17 2-Jan Quarterly Progress Report (Oct-Dec 2016) 20-Jan-17 TBD Monthly Metrics Report (January) 7-Feb-17 TBD Monthly Metrics Report (February) 7-Mar-17 TBD TBD TBD Complete RHC Roadmap to address local priorities, including SMART objectives - 6 mos. 3-Apr-17 TBD Health equity assessment for each project proposed in RHC Roadmap 3-Apr-17 TBD Quarterly Progress Report (Jan-Mar 2017) 20-Apr-17 TBD

22 Phase 2: Implementation (May 1, 2017 April 30, 2018) Monthly Metrics Report (April) 8-May-17 TBD Monthly Metrics Report (May) 7-Jun-17 TBD Quarterly Progress Report (Apr-Jun 2017) 20-Jul-17 TBD Monthly Metrics Report (July) 7-Aug-17 TBD Monthly Metrics Report (August) 7-Sep-17 TBD Quarterly Progress Report (Jul-Sep 2017) 20-Oct Monthly Metrics Report (October) 9-Nov-17 TBD Monthly Metrics Report (November) 7-Dec-17 TBD TBD , Quarterly Progress Report (Oct-Dec 2017) including estimate of ongoing funding needed to sustain RHC Role 22-Jan-18 TBD Monthly Metrics Report (January) 7-Feb-18 TBD Monthly Metrics Report (February) 7-Mar-18 TBD Final ENSW Report (replaces QPR) 20-Apr-18 TBD Health Equity Impact Report - ENSW 20-Apr-18 TBD Phase 3: Transition to Sustainability (May 1, 2018 January 31, 2019) Monthly Metrics Report (April) 7-May-18 TBD Monthly Metrics Report (May) 7-Jun-18 TBD Quarterly Progress Report (Apr-Jun 2018) 20-Jul-18 TBD Monthly Metrics Report (July) 7-Aug-18 TBD Monthly Metrics Report (August) 7-Sep-18 TBD Quarterly Progress Report (Jul-Sep 2018) 22-Oct Monthly Metrics Report (October) 7-Nov-18 TBD Monthly Metrics Report (November) 7-Dec-18 TBD Final SIM Report (replaces QPR) 21-Jan-19 TBD TBD

23 Colorado Regional Health Connector Program Health Equity Impact Report - SIM 21-Jan-19 TBD Total TBD

24 Exhibit 2. The Connection between Social Determinants of Health and SIM/ENSW Target Areas