To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Contract Amendment #23-513-7 with OptumInsight, Inc.
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
APPROVE and AUTHORIZE the Health Services Director, or designee, to execute on behalf of the County Contract Amendment #23-513-7 with OptumInsight, Inc., a corporation, to amend Contract #23-513-4, to increase the payment limit by $168,230, from $139,021 to a new payment limit of $307,251, and extend the termination date from January 30, 2025 to January 30, 2030, and for successive one (1) year term(s) thereafter until terminated, for additional patient billing software and support for Contra Costa Health (CCH).
FISCAL IMPACT:
Approval of this Contract Amendment will result in additional expenditures of up to $168,230 and will be funded as budgeted by the department in FYs 2025-30, 100% by Hospital Enterprise Fund I. (Rate increase)
BACKGROUND:
This Contract Amendment meets the needs of Contra Costa Health Information Systems Unit by providing software licensing and support concerning National Coverage Determination (NCD) Data, Local Coverage Determination (LCD) Data, and Optum Correct Coding Initiative Files for Physicians and Hospitals (CCI) in connection with Epic System applications. Optum provides files in a format that can easily be uploaded into the CCH Electronic Health Records system, Epic ccLink. The LCD and CCI files help CCH ensure accurate claims on initial claims submission to Medicare and Medi-Cal. While LCDs define medical necessity and coverage, CCI focuses on coding accuracy and preventing improper billing practices. LCDs and CCI do not contain Protected Health Information, but primarily consist of coding rules, coverage policies, and billing guidelines used for Medicare and Medi-Cal claims processing. This Contractor has been providing these services and fostering a deep understanding of the CCH organizations, mission, values, and long-term objectives since October 2019. This Contract Amendment was approved by Health Services Personnel as a specialized services contract to ensure there are no conflicts with labor relations. This Contractor was approved by the Public Works Department’s Purchasing Department on June 9, 2025. A summary of service contract deliverables, including measurable outcomes required of the Contractor to be monitored by the department, including in compliance with Section III(B) (7) of the Purchasing Policy include technical support for County’s use of the software under the license grant, and access to maintenance and support.
On October 22, 2019, the Board of Supervisors approved Contract #23-513-4 with Optum360 Solutions, LLC, in an amount to exceed $139,021 for license software and support services for the period January 31, 2020 through January 30, 2025.
Under this Contract Amendment #23-513-7 the parties will execute Amendment No. 1 to the Custom Data for Use with Epic Data Systems Product Schedule, effective January 31, 2025, and allow the Contractor to continue to provide license and software support for the Electronic Health Records Systems, through January 30, 2030, and for successive one (1) year term(s) thereafter until terminated under the terms of the agreement. The Division is requesting a retroactive effective date for this amendment caused by administrative delays.
CONSEQUENCE OF NEGATIVE ACTION:
If this Contract Amendment is not approved, the County will lose access to the Custom Data for Use with Epic Product Schedule, rendering the department unable to maintain its software licensing and billing technologies required to stay in compliance with the Centers for Medicare and Medicaid Services initiatives and the Epic medical records platform standards. Non-compliance can negatively affect CCH financially, operationally, and in its approach to holistic patient care.