Proposal for Jail Medical Services

Chatham County, Georgia

August 8, 2017

Submitted by

Submitted by Centurion, LLC

1593 Spring Hill Road, Suite 600
Vienna, VA 22182
Phone: (703) 749-4600
Proposal Statement

Centurion, LLC is a national leading provider of medical services to

inmate populations and currently serves in over 100 correctional
facilities in seven states. Centurion was formed by two of the most
respected and well-established companies in correctional healthcare
and managed care: MHM Services, Inc. and Centene Corporation.

Centurion understands Chatham County has had difficulty in recent

years with its jail medical and mental health services and contractors,
and that an urgent need may arise warranting an emergency contract
to ensure the continued provision of medical services to inmates of the
Chatham County Jail.

Should the need arise, Centurion is poised to become the Countys

contractor for inmate healthcare services, inclusive of medical, dental,
and mental health services, under an emergency contract, or any other
such contracting format, compliant with the Countys procurement
rules. Centurion further understands that a future solicitation for
services would be required under the Countys normal, competitive
procurement processes.

A. About Centurion
Centurion, LLC is a correctional healthcare company formed through a partnership between
Centene Corporation, a Fortune 100 Medicaid managed care company with 33 years of
managed care experience, and MHM Services, Inc., a national leader in providing healthcare
services to correctional systems with over 36 years of experience.

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Centurion brings together the ideal mix of MHMs long history of unparalleled client satisfaction
and management expertise in the correctional environment with Centenes Medicaid managed
care experience and innovative resources. Centurion was developed specifically to deliver a
level of innovative correctional managed care service approaches never before available in
correctional healthcare. Centurion delivers a new model for inmate healthcare, a model that
adopts approaches commonly found in freeworld settings such as Medicaid, commercial
insurance, and health maintenance organizations and takes a more proactive approach to
preserving and promoting the overall health of individuals, rather than reacting to illnesses and
acute crises as they arise. With this model, Centurion exists as a fresh alternative to the
traditional, mainstream correctional healthcare companies.

Centurion was also strategically developed to meet the healthcare challenges and needs of
correctional agencies with specific consideration to the tenets of federal healthcare reforms
(i.e., the Affordable Care Act), Medicaid, and the convergence of correctional healthcare with
the broader public health spectrum. Now more than ever, with continuous reforms occurring
to national healthcare programs, correctional agencies need the real managed care resources
and industry expertise to stay ahead of changes to healthcare funding and entitlement
programs that only a national managed care company can offer. Our unique managed care
resources have implications beyond just the healthcare delivered to inmates while
incarcerated. Our model integrates with the local public health systems resources so that
inmates are better prepared and better able to successfully manage their healthcare needs
after release. Our model is particularly well suited for county detention facilities that must
integrate with numerous other care organizations and service providers in the community.

Through its affiliation with MHM, Centurion has significant resources in Georgia, including two
regional offices and more than 300 employees in the state, giving the company a solid
foundation to support the operations of the Chatham County detention facility.

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B. Scope of Services
Centurion understands that an emergency contract awarded to Centurion would closely mirror
the scope of services required under the Countys contract with the current jail medical services
contractor (CorrectHealth). In short, Centurion understands the scope of services for any
contract awarded to Centurion would entail the following services:

1. Onsite medical services

2. Offsite medical services (i.e., hospitalization, specialty care)
3. Dental services
4. Mental health services
5. Staffing of all medical positions
6. Emergency transportation
7. Pharmaceuticals
8. Laboratory
9. Specialty care

Centurion has reviewed a copy of the current medical services contract through an open
records request and understands the scope of services related to the medical, dental, and
mental health programs, including the staffing and ancillary service needs associated with the
overall healthcare program.

Centurion understands the jails current population is approximately 1,700 inmates and that
medical services are needed on a daily basis in the jails clinic areas, intake area, housing units,
and infirmary unit. Centurion understands the scope of services includes the development and
management of referral relationships with area hospitals and specialty service providers for
services that require the offsite transport of inmates (e.g., hospitalization, emergency room
trips, etc.).

Centurion understands the jail includes a 22-bed infirmary unit that operates 24/7 providing
housing and medical services for inmates who cannot be maintained in other housing areas due
to their medical condition.

Centurion will deliver services in compliance with local jail standards as well as the standards of
the Medical Association of Georgia (MAG), The American Correctional Association (ACA), and
the National Commission on Correctional Health Care (NCCHC). Centurion has experience with
supporting the accreditation processes of each of these organizations.

C. Staffing
Centurion has a basic understanding of the present staffing levels at the jail and the challenges
to date in being able to attract and retain qualified healthcare staff.

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Based on the level of information available, Centurion proposes the staffing pattern shown
below:

Staffing Pattern, Current v. Proposed

Administration Current Proposed
Health Services Administrator 1.00 1.00
Director of Nursing 1.00 1.00
CQI Nurse 1.00 1.00
Administrative Assistant 1.00 1.00
Providers
Medical Director 1.00 1.00
NP/PA Intake 1.00 4.20
NP/PA Clinic/Womens Health 0.10 1.00
Nursing Intake
RN Intake 4.20 4.20
LPN Intake 4.20 4.20
Nursing Clinic / Sick Call
RN Sick Call 1.00 1.00
LPN Sick Call 1.00 1.00
LPN-Court Education/Releases/Labs 1.00 1.00
Nursing Infirmary
RN Infirmary 4.20 4.20
LPN Infirmary 4.20 4.20
CMA Flex 2.10 2.10
Housing Staff
LPN 10.50 6.00
Dental
Dentist 0.50 0.50
Dental Hygienist 0.50 0.50
Medical Records
Health Information Supervisor 1.00 1.00
Health Information Tech 1.00 1.00
Mental Health
Psychiatrist 0.5 1.0
CNS Mental Health 0.5 0.0
Licensed Masters Level 3.8 6.8
Total 46.3 48.9

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Centurion understands there is a requirement to fund an additional liaison position under the
mental health program that is placed by the local community health system (i.e., CMHC
Liaison). Centurion is amenable to continuing the current arrangement and entering into an
agreement with the local mental health authority to continue the services of the liaison.

The staffing pattern above is based upon Centurions cursory review of the current staffing
pattern and Centurions understanding of the pressing needs and concerns regarding access to
services, timeliness of assessment and treatment services, and shortcomings within the mental
health program. The proposed staffing pattern provides more practitioner and mental health
coverage to the intake area of the jail while maintaining existing required staffing levels in other
areas of the facility. The proposed staffing pattern increases the number of medical providers,
namely mid-level providers (i.e., nurse practitioners, physician assistants, clinical nurse
specialists) as well as licensed mental health professionals to be able to provide 24/7 coverage
for intake assessments for both medical and mental health services. In addition, the proposed
staffing pattern increases psychiatric coverage over what is understood to be the present
coverage level.

Centurion will fill the above positions with qualified professionals retained as employees of the
company and offer employees competitive wages and benefits as well as other valuable
employee supports.

In addition to the above positions, Centurion will provide a physician consultant for an
Infectious Disease Management program. Centurion also understands there is a current
relationship between the current medical contractor and a local Federally Qualified Health
Center (Curtis V. Cooper) for 340B medication services.

Centurion will give first consideration to incumbent employees in the above positions who are
in good standing with the County and wish to remain in their positions. Any remaining
positions will be filled with qualified candidates generated through our recruiting processes.

D. Program Management
Centurion will designate a full-time Health Services Administrator based in Savannah to serve as
the local manager of the program and serve as the primary point of contact for the County on
the day-to-day operations of the jail medical contract. This individual will be dedicated solely to
the Chatham County Jail program and serve as the primary liaison with jail and County
personnel, as well as other local stakeholders, regarding the jail medical program.

Centurion will provide clinical leadership to the program at a local level via a full-time physician
medical director and full-time director of nursing. These individuals will be based in the jail and
dedicated to the Chatham County Jail medical program.

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Centurion has many middle and senior management personnel with many years of experience
in correctional healthcare in both state prison and urban jail settings. Centurions Recruiting,
Human Resources, Network Development, and Clinical Operations departments will fully
support the Chatham County Jail healthcare program operations.

E. Recruiting

Centurion places thousands of healthcare professionals in correctional settings in seven states.

Centurions Recruiting needs are met by a team of over 30 full-time healthcare recruiters, most
having more than 10 years of experience in healthcare recruiting. Centurion succeeds where
other companies fail in being able to attract and retain highly qualified healthcare professionals
to work in challenging correctional environments in even the most remote, rural locations.

Centurion has the flexibility in our recruiting and retention packages to customize our searches
for each position and tailor compensation packages to attract qualified candidates in todays
difficult healthcare recruiting environment. Centurion will be able to attract and retain
qualified clinicians to stabilize the jails staffing patterns so that consistent coverage is provided.

F. Program Support Services

Centurion will support the program using significant corporate resources in:

1. Clinical Operations Support: Clinical Operations Department comprised of nationally

recognized experts in correctional healthcare who will conduct:

Contract monitoring
Accreditation support (e.g., ACA, NCCHC)
Program development
Training and continuing education
Case consultations
Psychotropic medication utilization review and management
Clinical guidelines development and prescriber training
Litigation management / avoidance

Clinical Operations team members routinely visit contract locations to perform quality
and compliance audits, provide training programs, and work with the client agencies on
developing programming enhancements and clinical guidelines for treatment.

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Julie Mueller, RN, MBA Julie Buehler, BS-RT, MPA, CCHP Jeffrey Keller, MD, FACEP Angela Goehring, RN, MBS, CCHP
Sr. Vice President, Director of Operational Support Chief Medical Officer Chief Nursing Officer
Clinical Operations

2. Pharmacy Utilization Management: Centurion offers a comprehensive program of

psychotropic medication management and utilization review to assist client agencies
with managing medication costs and to ensure prescribers are up to date on the latest
research and prescribing trends. This program is managed under Centurions Director of
Pharmacy Management, Dr. Gregg Puffenberger (PharmD), a clinical pharmacologist.
Dr. Puffenberger and his team of pharmacists and analysts work with each contract
towards the goal of appropriate and efficient use of medications. This team will begin
the review of prescribing practices at the Chatham County Jail and ensure modern, yet
cost efficient prescribing practices.

3. Mental Health Services: Because of the companys affiliation with MHM Services, Inc.,
Centurion is able to offer superior mental health programming and clinical operations
expertise. MHM is a national leading provider of mental health services and has been
providing mental health services in Georgia for 20 years through its contract with the
Georgia Department of Corrections. MHM is also the contract mental health provider
for the DeKalb County Jail in Atlanta (since 2000). Centurion will engage the resources
and clinical operations support from MHMs team of nationally recognized experts in
correctional mental health services.

4. Training: Centurions clinical operations department supports the training initiatives in

the companys contracts. Our training resources include numerous modules geared
specifically towards correctional healthcare.

5. Telehealth: Centurion will advance the use of telehealth technology to help minimize
the transport of inmates offsite for healthcare services (e.g., for specialists consults).
Telehealth services will accentuate the level of services provided on site.

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G. Start-Up and Transition
Centurion is capable of transitioning large and complex correctional healthcare contracts under
compressed time constraints and urgent circumstances. Centurion has transitioned eight major
contracts with state correctional agencies in recent years, each requiring the activation of staff
and services in multiple facilities across large geographic areas.

Centurion invests in new contract startups to ensure successful transitions with no lapses in
care. We dispatch large teams of correctional healthcare managers and clinical experts to be
physically present and on site during the transition of each new contract. We use a high-touch,
high-visibility approach to rapidly transition employees and clinical services.

Centurion will give first consideration to any existing personnel whose positions are affected by
this project and who wish to remain in their positions, and are in good standing with the
County.

Often during contract transitions, there are negative rumors and false information that create
anxiety among existing staff. Centurion takes steps to minimize this situation by being available
in person in the facility to meet directly with staff to address any questions or concerns. We
also prefer disseminating an immediate written correspondence in the form of a general
welcome letter that introduces Centurion to employees and stakeholders, and provides
immediate contact information for stakeholders to reach out to Centurion.

Our transition team will consist of our Georgia regional leadership, as well as other clinical and
human resources personnel necessary to ensure live availability at the jail and after-hours
access for staff and others who may have questions or concerns during the transition.

We already have a database of personnel and candidates to source from for the Chatham
facility to fill the additional positions proposed in the staffing plan above, plus to fill any
vacancies that may occur during the transition.

Centurions transition plan assumes a target contract start date of October 1, 2017, but can be
modified to fit any actual start date. Centurion recognizes the urgent nature of the present
circumstances and the need to be poised to transition the contract under compressed time
constraints. In anticipation of the project, we are already taking steps to prepare for the
transition. The following table outlines basic activities to occur upon notification of award and
as part of the initial transition and start-up process:

Activity Comments
Initial team meeting Day 1. A meeting between Centurion and the
County to discuss start-up plan and transition
activities.

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 Activity Comments
Communication Day 1. Submit a draft document to existing staff
who may be affected by this project to dispel any
rumors and anxieties regarding the nature of the
project and to provide immediate contact
information for questions or concerns.
Site visit ASAP. Centurion start-up team visit the jail to
meet with facility administration and other
stakeholders locally, as well as any staff affected by
this project. Centurion team would include local
managers, recruiters, and clinical operations
specialists.
Clinical and Program Day 1, ongoing. The clinical operations members
Operations of the transition team will have reviewed the
operational procedures for medical services prior
to the startup date and ensure services continue
successfully at the point of contract transition and
operate smoothly in the early days of the contract.
The team will also begin the work towards
expanding services, identifying roles and
responsibilities of the expansion staff,
recommending enhancements to intake services,
screening services, programming on the infirmary,
and responding to medical emergencies.

Intake evaluations, sick call clinics, infirmary

Policies and Procedures
management, and responsiveness to medical
emergencies will be initiated day one.
Day 1, ongoing. Will seek to review any policies
and procedures presently in force, whether they
be from the County or the medical contractor, and
make recommendations for modifying or replacing
existing policies and procedures, as well as
implementing needed policies where none exist.
Centurion has libraries of standard policies and
procedures that are used as a baseline toward
development of custom policies for each client
agency. Our approach avoids the use of erroneous
or cookie-cutter policies.

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 Activity Comments
Recruiting Ongoing. Activate formal recruiting processes,
source candidates, schedule interviews and site
visits for candidates, position advertising, etc. to fill
the expansion positions as well as any vacancies
that occur as a result of the transition.
Orientation Review new employee orientation, credentialing,
and onboarding procedures with the County.
Value-adds Determine which additional value-added services
to implement and establish schedule and process
for implementation and integration.
Reporting and Monitoring Establish reporting and monitoring systems.

Throughout the transition, Centurion personnel will be highly visible and available to the jail
administration, the medical personnel, and other stakeholders.

Pharmacy Services and Network Development: At this point in time, Centurion has not had
any contact or dialogue with the existing pharmacy subcontractor or other entities or
stakeholders who are involved in the provision of services to jail detainees (i.e., hospitals,
specialists, community mental health centers, etc.). Centurion would initiate dialogue with
such entities immediately upon a notification to proceed from the County or as part of the
startup of an official contract for services.

H. Contracting Method
Centurion understands the urgent nature of the present circumstances regarding the medical
services program at the Chatham County Jail. Centurion is amenable to providing the services
described herein via a direct contract with the County, including an emergency contract of a
shorter duration than customary if necessary. Centurion understands that, if an emergency
contract is awarded, the County will be required to conduct a future competitively bid
solicitation to comply with County procurement rules.

Centurion has experience providing services under emergency contracts. Centurion

understands the current medical services contractor is reimbursed under a per-diem rate based
on the jail inmate population count and that the current contractor bears full risk for medical
services under the per-diem rate structure. Centurion has similarly funded contracts and is
amenable to a per-diem rate structure. However, due to the urgent nature of the contract and
the likelihood of the initial contract being an emergency contract, Centurion recommends
consideration of a cost-based reimbursement methodology that reimburses Centurion for
actual costs plus an administrative fee to cover company overhead and margin. A cost-based

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model ensures the County only pays for personnel and services actually provided and allows for
the flexibility to make adjustments to staffing patterns without having to adjust contract terms.

For example, we believe that once the jail has a dedicated full-time medical director and a full-
time midlevel in R&D, that there may no longer be the need for another mid-level provider in
the jail. In addition, the staffing pattern has two masters-level individuals in R&D 24/7, a
midlevel (such as an NP), and a masters level LPC. Centurion is not sure that all would be
needed 24/7 and believes it may be possible to eliminate the LPC on certain shifts. Therefore,
once Centurion has received the necessary data to get a firm price (as described in the
Compensation section below), it is open to revisiting the staffing matrix. It is common for
Centurion to operate in new contracts and make adjustments to staffing and pricing after
approximately six months of operation.

Centurion is amenable to exploring various reimbursement options with the County to ensure
the lowest cost for services.

Six-month reconciliation. Centurion also understands the County may offer an opportunity to
revisit the terms and expenses of the contract after an initial six-month period to review the
effectiveness of the staffing patterns proposed and the contract reimbursement rate.
Centurion believes this review would allow us to make adjustments to staffing and services that
could lower the cost of services.

Indemnification. Centurion has read the indemnification language contained in the Countys
agreement with the current medical contractor, and Centurion is amenable to similar
indemnification language for any future contract between Centurion and the County.

I. Compensation
Centurion has priced only the staffing pattern listed in the table in Section C above using market
compensation rates and other overhead assumptions. The monthly reimbursement rate for the
staffing and administration of the jail medical, dental, and mental health programs is:

Monthly Reimbursement

$508,312

Offsite and ancillary services: The above amount does not include any costs for offsite
medical services (i.e, hospitalization, emergency room visits, specialty care) or services
provided on site by specialists. Centurion would need additional information, including
historical utilization and costs to be able to generate estimates of costs and pricing for
these services as well as an opportunity to hold dialogue and negotiations with hospital
and specialty service providers.

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 Medications and Pharmacy: The above amount also does not include any costs for
medications and pharmacy services. Centurion would need historical pharmacy
utilization, drug prices, and prescribing trend information to be able to generate
estimates of costs and pricing for medications and pharmacy services. Centurion
understands the jail is currently served by a locally owned pharmacy vendor, and
Centurion proposes a continuation of this relationship, but Centurion has withheld from
initiating contact or dialogue with the current pharmacy vendor.

County Budget Considerations and Financial Risk: Centurion understands the County
currently has budgeted approximately $7.2 million for FY18 for the medical services
contract. The pricing quoted above approximates $6.1 million annualized, and
represents costs for the on-site staffing and management of the program.

Centurion understands the Countys current contract with Correct Health is based upon
a full-risk model, under which the Contractor bears all financial risks for offsite care,
specialty care, medications, staffing, and other costs. While Centurion believes the
Countys budget may be sufficient to meet acceptable standards for inmate healthcare
services, a firm price for all services from Centurion would require a review of historical
utilization trends as well as a process of negotiations with offsite service providers (i.e.,
hospitals, specialists) and the pharmacy vendor.

Centurion has no information at this point reflecting the utilization levels for offsite
medical services, specialty services, or pharmacy utilization and drug spend upon which
to build cost assumptions for pricing.

Penalties: Centurion understands that a fully functioning health care system requires
ensuring full staffing. Centurion expects that there will be penalties associated with
unfilled positions. Centurion requests a 90-day grace period before staffing penalties
are assessed in order to give time to address the operational and staffing shortcomings
inherited upon contract startup.

Price Contingencies: As stated above, Centurion has not made any contact at this point
with local hospitals, specialists, or the current pharmacy provider to discuss historical
utilization or to negotiate pricing. Should the County desire to move forward with
Centurion, we would be able to generate additional cost and pricing assumptions for
offsite and pharmacy services towards a mutually acceptable pricing and contracting
structure after dialogue with potential subcontractors for these services. Any final, firm,
fixed price quote from Centurion would be contingent upon an opportunity to review
historical utilization trends as well as a process of negotiations with offsite service
providers (i.e., hospitals, specialists) and the pharmacy vendor.

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Summary
Centurion respectfully submits this proposal for services and appreciates the Countys sense of
urgency to secure a long-term contractual relationship for quality healthcare services.
Centurion is able to rapidly transition and initiate contract services. While we feel the Countys
budget is likely sufficient to meet the operating costs of the medical program, we would need
additional information related to historical utilization of hospital and specialty services, as well
as drug prices from the current pharmacy provider, in order to provide a firm, fixed price to
cover all services.

Inquiries
Mike Brewer
Sr. Vice President, Development
Centurion, LLC
1593 Spring Hill Road, Suite 600
Vienna, VA 22182
Phone: (571) 232-4327
Email: mbrewer@CenturionManagedCare.com

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