To: Board of Supervisors
From: Dr. Ori Tzvieli, Interim Health Services Director
Report Title: Contract #77-782 with HealthPlanCRM, LLC, (dba Cavulus)
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
APPROVE and AUTHORIZE the Interim Health Services Director, or designee, to execute on behalf of the County a Master Subscription and Services Agreement with HealthPlanCRM, LLC, d/b/a Cavulus, a Delaware limited liability company (Cavulus), in an amount not to exceed $510,000, for a hosted Medicare Advantage customer relationship management software application and services for Contra Costa Health Plan (CCHP) for the period from June 24, 2025 through June 23, 2028.
FISCAL IMPACT:
This Contract will result in contractual service expenditures of up to $510,000 over a 3-year period and will be funded 100% by Contra Costa Health Plan Enterprise Fund II.
BACKGROUND:
This Contract meets the needs of CCHP by providing an electronic Customer Relationship Management (CRM) system. CCHP requires a Medicare Advantage CRM system for enrollment functions that meet all federal and state regulatory requirements. Cavulus’ MedicareCRM and Enrollment Channel Management (ECM) are cloud-based (hosted) member acquisition solutions specially designed for organizations such as CCHP, whose members may qualify as dual-eligible healthcare beneficiaries eligible for Medicare and Medicaid services. For that reason, Special Needs Plans (D-SNP) from Medicare Advantage provide a way to manage healthcare services under one policy. CCHP members with dual eligibility status can sign up for a type of D-SNP. Cavulus offers a solution tailored to the unique compliance and operational needs of a D-SNP Medicare Advantage (MA) plan that can integrate into CCHP's electronic health records system. CCHP must comply with, Department of Health and Human Services Centers for Medicare & Medicaid Services regulations outlined in 42 Code of Federal Regulations (CFR) section 422.60 (Enrollment Process) and 42 CFR § 422.2272 (Marketing and Communication Standards) to ensure a compliant, efficient, and member-friendly enrollment process. Additionally, under California’s Knox-Keene Health Care Service Plan Act (Health & Safety ode §13431.5), CCHP must maintain an enrollment system that safeguards consumer protections and ensures seamless member onboarding.
This Contract supports CCHP access to a Medicare Advantage CRM system securely and in compliance with HIPAA regulations. This Contractor was approved by the County Administrator's Office as a sole source provider of its hosted system. A summary of service contract deliverables, including measurable outcomes required of the vendor to be monitored by the department in compliance with Section III(B)(7) of the Purchasing Policy (AB600.3), includes configuration and deployment of Contractor’s MedicareCRM and ECM, the County’s use of the software as a service under the license grant, and access to maintenance and support. This Contract was approved by Health Services Personnel to ensure there is no conflict with labor relations.
Under this Contract #77-782, the parties will execute a Master Subscription and Services Agreement (including a Health Insurance Portability and Accountability Act of 1996 (HIPAA) Business Associate Exhibit) for CCHP’s access to Cavulus’ MedicareCRM and ECM member acquisition solutions. Under the Master Subscription and Services Agreement: (1) Cavulus’ liability is limited to the amount County has paid to Cavulus’ in the twelve months preceding the claim except for Cavulus’ indemnification obligations under the Master Subscription and Services Agreement or claims arising from a breach of County data.; (2) the County is obligated to indemnify Cavulus against claims arising from County’s misuse of the products, County’s breach of the Master Subscription and Services Agreement, and infringement of a third party’s intellectual property rights; and (3) the County is restricted from directly hiring employees of Cavulus.
Approval of this new Contract #77-782 allows the contractor to provide its CRM Software as a Service through June 23, 2028.
CONSEQUENCE OF NEGATIVE ACTION:
If this Contract is not approved, CCHP will not have the ability to enroll any D-SNP Medicare Advantage Members. There is no manual workaround or alternative system in place so failure to implement this solution will result in CCHP being completely unable to participate in D-SNP Medicare Advantage, leading to a loss of up to $22 million in projected funding and 52 unfunded County staff positions.