Ambulance System Redesign Project – Citygate UPDATE #1



In June 2015, the Alameda County Board of Supervisors awarded the ambulance system re-bid and research project to Citygate Associates, LLC of Folsom, California. The project will result in a Request for Proposal (RFP) to re-bid the ambulance Exclusive Operating Area (EOA) contract currently held by Paramedics Plus due to changing health care economics. The intent is to award a new contract at the end of the current agreement in November 2016. The project has three macro phases:

  1. Investigate the current system situation and identify opportunities for patient care improvements and cost-effective changes
  2. Develop the RFP and bidder evaluation tools
  3. Assist the County with reviewing bidder submittals and finalizing contract language with a preferred vendor

In the RFP for consulting services, the County EMS Agency identified system re-bid objectives it called the Six Pillars:

  1. Preserving a high level of equitable emergency medical response throughout the County
  2. Producing a system that is cost-effective while preserving a high level of response and care
  3. Designing a system that is Countywide (i.e., current EOA) – allowing for consistency of service throughout all areas and jurisdictions of the County
  4. Maintaining and supporting the current workforce
  5. Producing a system that is sustainable for the long term
  6. Maintaining the appropriate regulatory and oversight functions between the Local Emergency Medical Services Agency (LEMSA) and the chosen provider(s)

In June, Citygate obtained a multitude of documents from the County and Paramedics Plus on the current contract and system performance. In July and August, Citygate conducted multiple meetings with EMS Agency staff and stakeholders such as the City Managers Association, Receiving Hospitals, Fire Chiefs Association, Fire Chiefs EMS section, and electronic patient care reporting (ePCR) data system administrator. Citygate also scheduled a meeting on September 2nd with the labor leadership for Paramedics Plus.

Parallel to this “understand the current situation” process, Citygate obtained multiple years of incident records to begin a statistical and geographic analysis of the current deployment and treatment system. We will then marry desired outcomes going forward with the prior historical response performance and form initial opinions on necessary changes, if any.

Citygate, EMS Agency staff, and others are also reviewing the current system economics from a billing recovery perspective to understand new opportunities that may exist. These opportunities may include providing for public agency cost recovery within Medi-Cal, known as Ground Emergency Medical Transport (GEMT), and other new cost recovery opportunities under federal health care reform. The goal, if possible, is to structure a system that is self-supporting within the revenues collected.

In late September, Citygate and EMS Agency staff will brief the stakeholder groups on emerging opinions. At that point the EMS Agency will select and convene an RFP advisory panel to provide input into the final system recommendations and draft RFP language.

If you have questions on this project, or wish to provide individual input, please telephone or email Michelle Voos at the EMS Agency at (510) 667-7984 or Michelle will then direct the question(s) to the appropriate Agency or Citygate team member.

Stewart Gary

Principal, Public Safety (Law Enforcement; Fire & Emergency Services) at Citygate Associates, LLC
Mr. Gary leads Citygate’s public safety practice areas of Law Enforcement and Fire & Emergency Services. He has recently directed the Rancho Cucamonga police services analysis, the Hesperia partners JPA feasibility study, a police and dispatch consolidation study for Brea and partners, and has been working on public safety studies of all types for over a decade. Chief Gary is the retired Fire Chief of the Livermore-Pleasanton Fire Department in Alameda County, California. Over the last fourteen years, he has performed over 200 organizational, staffing, and deployment studies and has worked with a variety of communities on staffing, master plan, and deployment studies. He has worked with The Omega Group, Citygate’s public safety data specialist, for over a decade and understands how to draw staffing and deployment conclusions from data.
Stewart Gary

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