healthy maine partnerships’ fy13 contracts and funding

8/13/2019 Healthy Maine Partnerships FY13 Contracts and Funding

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GOVERNMENT OVERSIGHT COMMITTEE OF THE 126THLEGISLATURESenator Emily Ann Cain, Chair Representative Chuck Kruger, Chair

Senator Roger J. Katz Representative Paul T. Davis, Sr.Senator David C. Burns Representative Andrea M. Boland

Senator Margaret M. Craven Representative H. David Cotta

Senator Christopher K. Johnson Representative Lance Evans Harvell

Senator Edward M. Youngblood Representative Matthew J. Peterson

OFFICE OF PROGRAM EVALUATION GOVERNMENT ACCOUNTABILITYDirector Beth Ashcroft, CIA

Staff Mailing Address:

Wendy Cherubini, Senior Analyst 82 State House Station

Scott Farwell, Analyst Augusta, Maine 04333-0082

Matthew Kruk, Analyst Phone: (207) 287-1901

Etta Connors, Administrative Secretary Fax: (207) 287-1906

Web: http://www.maine.gov/legis/ope

Maura Pillsbury, Contracted Analyst Email: [email protected]

ABOUT OPEGA THE GOVERNMENT OVERSIGHT COMMITTEEThe Office of Program Evaluation and Government Accountability (OPEGA) was createdassist the Legislature in its oversight role by providing independent reviews of the agenciesGovernment. The Office began operation in January 2005. Oversight is an essential functioneed to know if current laws and appropriations are achieving intended results.

OPEGA is an independent staff unit overseen by the bipartisan joint legislative GovernmeCommittee (GOC). OPEGAs reviews are performed at the direction of the GOC. Indeperesources and the authorities granted to OPEGA and the GOC by the enacting statute areability to fully evaluate the efficiency and effectiveness of Maine government.

Requests for OPEGA reviews are considered by the Government Oversight Committee instandard process. Requests must be made in writing and must be initiated or sponsored bylegislators or citizens should review the process and FAQ that are posted on OPEGAs wehttp://www.maine.gov/legis/opega/ProcessProducts.html.There is also a form there to hGOCs consideration of the request. Legislative committees can request reviews directly thcommunication to the Government Oversight Committee.
http://www.maine.gov/legis/opega/ProcessProducts.htmlhttp://www.maine.gov/legis/opega/ProcessProducts.html


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Healthy Maine Partnerships FY

Table of ContentsIntroductionQuestions, Answers and IssuesIn SummaryBackground

Overview of HMP Program

Monitoring HMP Performance

Overview of MCDC HMP Lead Selection Process and Timeline

DHHS Internal Review of Scoring Methodology

Lack of Competitive Process Was Not Ideal, Although MCDC Followed DAFS GuidanceDAFS Purchases Division Advised MCDC that an RFP Process Was Not Necessary for FY13 Con

Lack of Competitive Process Was Not Ideal

M D s Lead Selection Process Was Poorly Implemented and Allowed for ManipulationMCDC Managers Were Integrally Involved in the Lead Selection Process

Atypical Methodology Used for Survey of Project Officers and District Liaisons

Criteria and Weighting Changed During the Lead Selection Process Scoring Methodology Inconsistent and Emphasized Subjective Criteria

Scoring Methodology Possibly Adjusted to Influence Outcome in Penquis District

HMP Funding Was Divided Evenly Based on Role, Resulting in a Large Decrease for Some HM

Incomplete Documentation of the Lead HMP Selection Process MaintainedAgency Decision Making Process Was Not Fully Documented

Staff Were Instructed to Destroy Documents

RecommendationsAgency ResponseAcknowledgementsAppendix A. Scope and Methods

Appendix B. Map of Local Healthy Maine Partnerships

Appendix C. MCDC Public Description of the Lead Selection Criteria and Scoring Methodology

Appendix D. MCDC Public Description of HMP Structure and Funding Changes for FY13

Appendix E. Healthy Maine Partnerships Scoring Matrix as Publicly Released by MCDC

Agency Response Letter


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Healthy Maine Partnerships FY13 Contracts and FundingSelection Approach Appropriate but Process Poorly Implemented a

Manipulation; Funding Consistent Across HMPs Based on Role; DoInsufficient to Support Key Decisions

Introduction

The Maine Legislatures Office of Program Evaluation and G

Accountability (OPEGA) has completed a review of the HePartnerships Contracts and Funding for Fiscal Year 2013 (Fperformed at the direction of the Government Oversight Cothe 126thLegislature.

The Healthy Maine Partnerships program is a community baaffecting policy and environmental changes in support of heplaces and communities. The program is administered by the

Health and Human Services (DHHS) Center for Disease Co(MCDC) and implemented through independent, local coalitMaine Partnerships (HMP). The program is primarily suppofrom the Fund for a Healthy Maine (FHM). Historically MCbased on a competitive process directly to between 27 and 2collectively serving the States eight Public Health Districts. MCDC also provided funding to establish a dedicated TribalPartnership under the authority of Maines four Tribal Natio

funding distributed to the HMPs and Tribal Health District imillion.

MCDC made significant changes to the programsorganizatfunding distribution for FY13 to absorb funding cuts includMaineCare Emergency Supplemental Budget. MCDC selectefunding to one lead HMP in each of the eight Public Health Tribal District HMP. The lead HMPs were directed to subco

provide a set amount of funding to, the other HMPs in theirDistricts now referred to as supporting HMPs. Under MClead HMPs received more funding than supporting HMPs wHMPs realizing significant cuts from prior year funding.

In June 2012, MCDC announced the new HMP organizationHMP d f di di ib i f FY13 P bli i

The Healthy MainePartnerships Program isadministered by the MaineCenter for Disease Controland Prevention andimplemented throughindependent, local HMP

coalitions.

For FY13, MCDC made

significant changes to theHMP program structureand funding distributionsto the HMP coalitions.These changes wereannounced in June 2012and public questionsquickly arose about the

process MCDC used tomake its decisions.


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In April 2013, a senior manager at MCDC who participatedselection process filed a complaint with the Maine Human Rclaiming she had been asked by her supervisor to shred docu

the selection process, and alleging the process was biased anthe senior manager resigned. She has since filed a civil suit agamong other things, that she was subjected to a hostile worknot shred documentation when instructed to do so. As of Dlawsuit is still ongoing.

These allegations prompted renewed legislative concerns resrequest for an OPEGA review signed by five legislators, inclrepresenting the Western Maine Public Health District. The concerns about MCDCs alleged shredding of documents relawards, and the process used to select lead HMPs and distribvarious HMPs. These concerns were the focus of OPEGAsaddressed by OPEGA were approved by the GOC prior to See Appendix A for complete scope and methods.

Questions, Answers and Issues 1. Did the Maine CDC use appropriate and consistent processes for scoring HMPs, sele

agencies, awarding contracts and determining how funds would be allocated among

OPEGA found the lack of a new request for proposal (RFPgrant awards was not ideal given the change in roles and respselected as leads. However, MCDC did not have sufficient ti

typical RFP process and followed guidance from Departmenand Financial ServicesDivision of Purchases in deciding to approach.

OPEGA also found that while the overall approach MCDC selecting lead agencies could have been an appropriate alternwhich it was implementedselecting criteria, scoring HMPsleadswas neither appropriate nor consistent. Multiple probundermined the integrity and credibility of the results and cr

for MCDC to intentionally manipulate the lead selection. Thindications, including accounts from multiple interviewees, tmanipulation may have occurred in the selection of the lead District.

The means for determining the funding distribution among Hb

see page 14 for

more on this point

Allegations made by aMCDC senior manager in

April 2013 promptedrenewed legislativeconcerns about theprocess used to selectlead HMPs and thepotential shredding ofrelated documents. Thoseconcerns were the focus ofOPEGAs review.


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2. Did Maine CDC maintain adequate documentation supporting key HMP scoring, seledecisions for FY13? Were any documents related to the scoring, selection or fundinFY13 HMP contracts disposed of or concealed?

OPEGA found that MCDC did not maintain sufficient docukey decisions in the course of its FY13 HMP lead selection pprovided OPEGA with several documents related to the FYselection decisions. However, OPEGA had difficulty reconsevents that occurred, in part due to lack of sufficient documMCDC during what became an iterative process for selectingHMPs.

DHHS told OPEGA that in making revisions to the scoringsaved over previous versions of the file. MCDC managementhere was direction or guidance that only documentation shotheir process should be retained; not working copies. Howsaved several versions of the scoring sheet and provided thereview.

Based on accounts provided by MCDC managers, there was

of the scoring matrix which showed a different outcome forPenquis District prior to final adjustments to criteria and/orSeveral interviewees acknowledged that a paper copy of this existed at a June 13, 2012 meetingthe day before MCDCsof its lead selectionsbut itwas considered a working copynot provided to OPEGA, nor in response to any Freedom o(FOAA). To date, there has also been no electronic version located through searches of computer files and backup tapes

Office of Information Technology.OPEGA did not identify any documentation that was withhFOAA requests DHHS received. However, we know a docudescription to the scoring matrix referenced above is claimedfiles of a former MCDC senior manager and it has not been to her FOAA request.

OPEGA identified the following issues during the course of this review. See pages 26-30discussion and our recommendations.

Existing HMP performance data was not useful for lead selection and criteria userelevant to key lead responsibilities in new structure.

l l k h d l d d d b l f

see page 24 for

more on this point


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In SummaryIn December 2011, the Department of Health and Human S

cutting nearly all funding for the Healthy Maine Partnershipspart of its FY13 Emergency Supplemental Budget in order tshortfall in the MaineCare program budget. Anticipating thaapprove some portion of this cut, MCDC began formulatingthe HMP program from 27 local HMPs to nine, one for eachHealth Districts and one for the Tribal District. MCDC consDepartment of Administrative and Financial ServicesPurchPurchases) in late February 2012 to determine whether a newfor proposals (RFP) process was needed to reduce the numbPurchases advised that MCDC did not need to issue a new Rcontract scope and terminate contracts with some HMPs. Dadvised, however, that MCDC establish a transparent and judoing so.

A core group of MCDC managers and staff began meeting idetermine how to identify the bestHMPs in each Public H

developed a survey for the Project Officers and District Liaiclosely with HMPs and explored other relevant criteria that cMay 2012, the Legislature passed the Emergency SupplemenFHM funding for the HMP program by approximately one-to $4.7 million. The budget included a provision requiring Mfunding all 27 HMPs. MCDC decided to move forward withthe program by funding nine lead HMPs that would subcontas supporting HMPs.

The core group continued to meet throughout May and Juneselection criteria for the lead HMPs, discuss scoring results, aand scoring methodology. They selected eight lead HMPs baincluding: cost of operations; salary guide compliance; suppodeveloping infrastructure; survey of project officers; and survOne tiebreaker criterion - average completion of tobacco-relactivity and nutrition-related milestoneswas applied for Ce

District only. The Tribal District HMP was not included in tonly one HMP in that District.The results of the selection pin mid-June 2012 and grants were awarded under the new stFY13. The grant awards were renewed for FY14. MCDC plaagain for FY15 and issue a new RFP for the FY16 award.

In early 2012, MCDCplanned to absorbexpected funding cuts byrestructuring the HMPprogram from 27 localHMPs to nine. DAFSPurchases advised a newRFP process was not

needed and MCDC beganexploring how to identifythe best HMP in each

Public Health district.

In May 2012, the

Legislature passed abudget cutting funding forthe HMP program by aboutone-third and requiringthat MCDC continuefunding all 27 HMPs.MCDC decided torestructure by selectingnine lead HMPs that would

subcontract with the other

18 supporting HMPs.

A core group at MCDC

chose selection criteria,discussed scoring resultsand revised criteria andscoring methodology.Based on total scores,they selected eight leadHMPs one for each


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OPEGA also found that while the overall approach MCDC selecting lead agencies was an appropriate alternative for its the time constraints faced, it was implemented in an inappro

manner. According to MCDC, existing HMP performance dlead selection and the selection criteria evolved throughout tcriteria were eliminated from consideration because they weror, after scoring, they did not sufficiently differentiate the HMOPEGA found the criteria ultimately used lacked measures rresponsibilities in new structure.

OPEGA also found that the scoring methodology was flawe

concurring with DHHSs Office of Quality Improvement Sescoring methodology was made overly complex by the use orankings, weightings, and an extra measure used as a tie brealed subjective criteria to be emphasized more than objective the selection criteria and scoring methodology changed throorder to maintain the integrity of the process, MCDC shouldand set the scoring methodology at the outset, before initiatiproblems with the lead selection process undermined the int

the results and created an opportunity for MCDC to intentiooutcome of the lead selection. OPEGA found strong indicataccounts from multiple interviewees, that the scoring resultsintentionally manipulated to alter the outcome in the Penqui

Regarding HMP funding levels, OPEGA found that the meafunding distribution among HMPs differed from prior yearsacross HMPs. Previously, a population-based funding formu

FY13, MCDC determined a base funding level of $120,000 fprogrammatic work and then distributed additional funds to$28,336 for their administrative role and $134,605 for publicwork. According to MCDC, the base funding each HMP recbased on an analysis of the amount of funding needed for opone full-time staff person per HMP. The Tribal District rece$235,000 in funding for two Tribal District Liaisons and theisupport. MCDC said these positions perform functions simi

District Liaisons employed by MCDC which includes Districthe HMP program. OPEGA noted that the Tribal District Hhandled differently than the other HMP contracts.

OPEGA also found that MCDC maintained incomplete docHMP lead selection process. The electronic version of the scpp r tl r ritt th rit ri d i hti h d

MCDC did not have time tocomplete a typical RFPprocess, but the lack of acompetitive process in thissituation was not ideal.Although MCDCs overallapproach to lead selectionwas an appropriatealternative, it wasimplemented in aninappropriate and

inconsistent manner.

Multiple issues with thescoring methodologyundermined the integrity

and credibility of resultsand created an opportunityfor MCDC to manipulate theoutcomes. There are strongindications that suchintentional manipulationmay have occurred inselecting the lead for thePenquis District.

Regarding HMP fundinglevels for FY13, OPEGA

found that the means fordetermining the distributionamong HMPs differed fromprior years, but wasconsistent across HMPs.


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Two members of the core group said they had been instructdocuments by a superior because only the final product shouthe process. They did not destroy their documents and OPE

and review them. The superior who advised them to destroyacknowledged doing so, but the accounts of the tenor and cidiscussions differs among the three. Management at MCDCbelieved this instruction may have resulted from a desire for keep survey responses confidential, rather than to intentiona

OPEGA notes that an agency cannot reasonably be expecteworking document. However, in this instance the working d

only written record of MCDCs process generated during theConsequently, it was difficult for OPEGA to confirm accouwhat basis, key decisions were made.

OPEGA did not identify any documentation provided to us response to the FOAA requests DHHS received. However, next to final version of the scoring matrix referenced by mulwhich showed a different outcome for the lead HMP in the also did not locate it among the electronic documents resultiback-up tapes and computer drives conducted by the OfficeTechnology. This document is acknowledged to have existedat least June 13, 2013the day before MCDC publicly annostructure and funding decisionsbut was considered a worOPEGA is aware that the former MCDC Director of Local was part of the core group, claims she had a paper copy of adescription to this in her files, but it has not been provided i

FOAA request and was not provided to OPEGA by DHHS

MCDC maintainedincomplete documentationof the HMP lead selection

process making it difficultfor OPEGA to confirmaccounts of how, and onwhat basis, key decisionswere made. Two core groupmembers were eitherinstructed or advised todestroy documents but saidthey did not.

OPEGA did not identify anydocumentation provided tous that was withheld inresponse to FOAA requests.However, a next to final

version of the scoringmatrix apparently existed inpaper copy at least untilmid-June 2012. It was notprovided to OPEGA or inresponse to FOAA requests.According to DHHS, it wasconsidered a working copythat was not expected to be

retained.


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BackgroundOverview of HMP ProgramMaines HMP Program is a community based approach to afenvironmental changes in support of healthier schools, workcommunities. According to MCDC, this approach is evidencwith current efforts by the United States Centers for DiseasePrevention (CDC) to address tobacco use and chronic diseasactivities reflect and build upon CDCs Healthy Communitieaddressing chronic disease and tobacco use.

The specific goals of the HMPs are to:

1. Ensure Maine has the lowest smoking rate in the2. Prevent the development and progression of obe

and chronic diseases related to or affected by tob

3. Optimize the capacity of Maines cities, towns, anhealth promotion, prevention, education, and selhealth.

4. Develop and strengthen local capacity to deliver services across the State of Maine.

The activities to obtain these goals are primarily carried out bas local HMPs, that work with a variety of community partnin their service areas. Appendix B contains a listing of the lo

locations as well as a graphic illustrating the HMP structure. Introduction, beginning in FY13 MCDC established a new Hnow contracts with a lead HMP in each of the eight geograpdistricts. Lead HMPs subcontract with other HMPs in their

HMP results are policy or environmental changes that suppoFor example, an HMP grantee may work with a local schoolpolicy that reduces unhealthy food available in vending mach

this strategy links this environmental change to the HMP inipreventing the development and progression of obesity and capacity of towns and schools to provide health promotion.

Lead HMPs are also tasked with developing and strengthenideliver essential public health services across their district. A

Maines HMP Program is

consistent with efforts bythe U.S. CDC to addresstobacco use and chronicdiseases. HMP activitiesbuild upon CDCs approach

toward four specific goals.

HMP activities are primarilycarried out by grantees,referred to as local HMPs,that work with a variety ofcommunity partners and

school districts. In FY13,MCDC established a newHMP structure and nowcontracts with a lead HMPin each public healthdistrict. The leadsubcontracts with otherHMPs in that district.


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Statute establishes District Coordinating Councils (DCC) anCoordinating Council for public health (SCC) as componenthealth infrastructure. These are representative bodies of pub

working toward collaborative public health planning and cooeffectiveness and efficiencies in the public health system.1Threport annually to the Joint Standing Committee on the HeaServices and the Governor's office on public health system presult of its work.

Monitoring HMP PerformanceAlthough HMP work is carried out by grantees working in cschools and communities across Maine, employees of DHHmonitoring that work and ensuring it is completed effectivelAccording to MCDC, DHHS staff from MCDC and SubstanHealth Services (SAMHS) act as Project Officers supporting

Each HMP is under the oversight of, and supported by, a Dcomprised of a HMP Project Officer from one of the compoHMP initiative, a District Liaison from the Division of Locaprogram specialists. The District Support Team is responsibeach HMP receives necessary monitoring and support of all activities and deliverables. Together, the Project Officers andprovide oversight and technical support to grantees throughlocal HMP staff. They also review information and data entemonitoring system. The Team monitors contract compliancework plan implementation and overall performance of all HMassigned district.

According to MCDC, the following information has historicuse in assessing performance. OPEGA did not review the avthis project.

Quarterly Narrative Reportsall HMPs, as part of thInformation Technology system reporting requiremetheir efforts over the past quarter, including significa

barriers they have encountered. HMPs are also askedof successes they have had in their local work.

Knowledge-based Information Technology (KIT) Drequired to report on their work plan activities in KIreporting data through a web portal. This data becomtime for MCDC staff to review MCDC uses this dat

Statute also establishesDistrict and StatewideCoordinating Councils

made up of public healthstakeholders ascomponents of the States

public health infrastructure.

DHHS employees areresponsible for supportingand monitoring the work ofthe HMPs. These includeDistrict Liaisons in MCDCs

Division of Local PublicHealth and other staff from

MCDC and SAMHS that actas Project Officers.

According to MCDC, it hashistorically collected dataand information to use inassessing HMPperformance through

several avenues.


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Site Visitsconducted by the Project Officers respoVisits are conducted several times annually. These inthroughout the contract year as necessary and conve

HMPs. Statewide Surveillance Statistics from the Behavioral

Surveillance System (BRFSS)administered by the fthe worlds largest, on-going telephone health surveyhealth conditions and risk behaviors throughout the territories. About 6,500 Maine adults participate in th

Statewide Surveillance Statistics from the Maine InteSurvey (MIYHS)administered by MCDC, SAMHSEducation. This instrument combines several State hYouth Risk Behavioral Survey, a national health survschool-aged children.

HMP Evaluation DataThe University of New EngCommunity & Public Health is contracted by MCDCinitiative. For example, the Evaluation Team has us

data sheets highlighting HMP accomplishments statethe areas of tobacco, nutrition, chronic disease, physcoordinated school health.

Overview of MCDC HMP Lead Selection Process and TimIn December 2011, the Maine Department of Health and Hfaced a significant FY13 funding shortfall resulting from MaThe Governor submitted an Emergency Supplemental BudgLegislature that proposed cutting nearly all funding to the HPartnerships (HMP) program, which is primarily funded by tMaine. The Maine Center for Disease Control and Preventioanticipating that the Legislature would approve some level obegan exploring how to reduce the programs administrativemore efficient way to deliver the most-needed preventive hecommunities.

MCDC decided this could be accomplished by changing thestructure and identifying a more focused set of program objeFY13. In January 2012, MCDC staff began discussing the sc27 local HMPs to nineone for each of the States eight Puand one for the Tribes. MCDC met with Department of AdFinancial Services Purchases Division (DAFS Purchases) in

In January 2012, inanticipation of funding cuts,MCDC began exploring

changing the HMP fundingstructure as a means toreduce the programs

administrative costs andcreate a more efficient wayto deliver the most neededpreventive health services.

MCDC was consideringreducing the number ofHMPs from 27 to nine andidentifying a more focused


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The Legislature passed the Emergency Supplemental Budgetin cuts to the HMP program of more than one-third, from $million. Just prior to passage, the budget was amended to inc

that MCDC continue funding the same number of HMPsrequirement, MCDC decided to proceed with a change in thmove from directly funding 27 HMPs to directly funding ninwould subcontract with the remaining 18 HMPs. The lead Hreceive funding for supporting local public health infrastructdevelopment in their districts, as well as programmatic workwould be required to provide a set amount of funding for preach of the remaining HMPs as well.

MCDCs approach shifted from reducing the number of HMselecting nine lead HMPs using the same selection criteria andescribed further beginning on page 14.2MCDC initiated thearly May 2012 with surveys of the Project Officers (POs) an(DLs) that worked closely with the HMPs. From May to Junmet multiple times to revise the criteria and scoring methodo

In late May 2012, MCDC met with stakeholders from the FrHealthy Maine to solicit input on the planned changes. The included the Statewide Coordinating Council Co-Chair who with the Bangor Region Public Health and Wellness HMP anMCDC, served as a representative of the HMP perspective. information or input from individual HMPs as part of its plaprocess.

The HMP scoring process was completed in June 2012. Thefunding distribution was announced by the MCDC Directormeeting of the Statewide Coordinating Council. MCDC posto its website that day describing the changes and the processelections. All HMPs selected as leads were contacted by Junto assume the lead role. Supporting HMPs were also contact

From mid-June through the end of July 2012, MCDC and Dquestions and concerns from individual HMPs and legislator

and the selection process. MCDC also began receiving medithe first of several official Freedom of Access Act informatio2012.

The budget passed in mid-

May 2012 cut funding forthe program by one-thirdand required that MCDCcontinue to fund all 27HMPs. MCDCs approach to

restructuring shifted fromreducing the number ofHMPs to selecting nine leadHMPs using the samecriteria and a scoringprocess.

MCDC initiated the scoringprocess in early May 2012with surveys of the POsand DLs. A core group atMCDC met multiple timesfrom May to June to revise

the criteria and scoringmethodology. The newlead structure and fundingdistributions werepublically announced on

June 14, 2012.


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Table 1 provides a detailed timeline of events relevant to thiselection process and the overall changes in FY13 HMP stru

Table 1: Timeline of Relevant Events Related to HMP Lead SelectionTime Frame Description

November 2010 Bidders conference held to begin RFP process for FY12 HMP awa

July 1, 2011Contracts awarded to 26 HMPs as a result of RFP process. Tribal awarded.

December 2011 DHHS proposes cuts to HMP program in FY13 Emergency Supplem

January 2012 MCDC begins strategizing about possible move to nine HMPs.

February 29, 2012MCDC core group members meet with DAFS Purchases for guidanprocess is needed to reduce the number of HMPs.

April 2012MCDC core group begins meeting to select criteria for determiningHMPs.

May 3, 2012 MCDC conducts surveys of District Liaisons.

May 8, 2012 Provision requiring MCDC to fund all 27 HMPs is added to the bud

May 16, 2012FY13 Supplemental Budget passes, including one-third cut in HMmillion to $4.7 million, and requirement for MCDC to fund all 27 H

May 16, 2012 MCDC conducts surveys of Project Officers.

Late May 2012 Purpose of HMP selection shifts from choosing nine HMPs to choo

May 29, 2012MCDC meets with stakeholders from the Friends for a Fund for Heinput on the planned changes.

May through June 2012 Criteria and scoring methodology are revised multiple times.

June 6, 2012MCDC core group meets with the Director of MCDC to present theselection process.

June 13, 2012Director of MCDC and core group members meet with the Commispresent the results of their lead selection process.

June 14, 2012Director of MCDC announces new HMP structure, funding distribuat State Coordinating Council meeting.

June 18, 2012 MCDC has contacted lead HMPs who have agreed to serve in thatof contacting supporting HMPs.

Mid-June through July 2012 MCDC responds to questions from HMPs and concerned legislato

July 1, 2012 Contracts awarded to nine lead HMPs, terminated with 18 suppor


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DHHS Internal Review of Scoring MethodologyIn response to both internal questions and external scrutiny,DHHS asked the DHHS Office of Quality Improvement Sereview the scoring component of the HMP selection procesinternal and external stakeholders to assist in policy developmmaking through the evaluation of service outcomes, analysisstructures and research.

The OQIS review, completed in April 2013, utilized interviestaff and review of multiple documents and data sources. Thidentified strengths and weaknesses of the process and ultimthe process established to identify lead HMPs had a numbewhen taken together, lead to doubts about the overall integriscoring system and the resulting selection process. OPEGAreport and relied on the results included in it.

Lack of Competitive Process Was Not Ideal, Although

Followed DAFS Guidance

DAFS Purchases Advised MCDC that a RFP Process WasFY13 ContractsIn late 2010 and into 2011, MCDC conducted a competitiveRFP to award HMP grants for FY12. The grants were renew

year period. In accordance with State procurement rules, DAMCDC with this RFP process and dealt with the appeals thaannouncement of the awards. MCDC and DHHS Division oManagement (DHHS Contracting), which oversees the admicontracts, defer to procurement guidance provided by DAFS

MCDC and the DHHS Contracting consulted DAFS Purcharegarding the need to conduct another RFP process for the F

award renewals. According to DAFS Purchases, MCDC wasto correctly move to a new service model due to significantlyMCDC described the new service model as a reduced scope HMPs. DAFS Purchases advised that a new RFP was not neMCDC planned to reduce, rather than expand, the scope of had already been competitively procured. There are also prov

In April 2013, DHHS Office

of Quality ImprovementServices completed aninternal review of MCDCs

scoring methodology. Theresulting report noted somestrengths of the processbut ultimately concludedthat there were a numberof shortcomings impacting

the integrity and credibilityof the scoring and selectionprocess.

MCDC consulted DAFSPurchases in February2012 about whether anRFP process was needed tomove to a new service

model for the FY13 HMPgrant award renewals. Atthis time, MCDC wasplanning to reduce the totalnumber of HMPs the leadstructure had not beenconsidered yet.

DAFS Purchases advisedthat a new RFP was notneeded given the scenarioMCDC described. DAFSPurchases further advisedthat MCDC use a

i t t j tifi bl


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DAFS Purchases was not involved in the selection process, ause its programmatic expertise to determine how to select thconsistent, justifiable process. DAFS Purchases told OPEGArequired to undertake such a selection process according to Dadvised MCDC to do so because it would make the agencysprocess more transparent.

DAFS Purchases told OPEGA that there was no precedent situation where funding had been reduced and a program quits service model in order to continue operating. Because theand due to the complexity of the RFP process for this partictold OPEGA it would have been impossible for MCDC to cprocess to have contracts in place for the start of FY13. Sinccompleted a competitive RFP process for the FY12 contractFY13 renewals as a scoping-down of previously competitive

OPEGA concluded that at the time MCDC consulted with Dplan was to reduce the number of HMPs to nine. When MCapproach from selecting nine HMPs to selecting nine lead Hwith DAFS Purchases again regarding whether the new lead expansion or reduction in scope.

Lack of Competitive Process was Not IdealMCDC expanded the scope of work from the FY12 to FY13HMPs selected as leads. The lead HMPs gained responsibilitadministrators for the supporting HMPs, including monitoriHMPs performance and service delivery, and as leaders in d

health infrastructure in their districts. Although there were sithe prior HMP contracts3, the lead roles were new and carrieresponsibilities and expectations than MCDC had placed on

OPEGA observed that the lack of a competitive process witscope of work was not ideal. Additionally, MCDC chose notinformation from the HMPs on their ability or desire to fulfiinstead excluded them from this process.

Although MCDC faced a limited timeframe to make changelight of funding cuts, the cuts were proposed by DHHS six mMCDC was thinking about changes to the program at least fthe contract expiration. MCDC stated, however, that it couldthe budgetary outcome, and noted the budget was amended

According to DAFSPurchases, MCDC did nothave time to conduct a RFP

process and the proposedchanges for FY13 wereconsidered to be a scopingdown of work that hadpreviously been

competitively awarded.

MCDC expanded the rolesand responsibilities of theHMPs selected as leads forFY13. OPEGA observed that

the lack of a competitiveRFP process given this

change was not ideal.

OPEGA concluded thatMCDC did not consult withDAFS Purchases againwhen its plans changed todiscuss whether the HMPlead role constituted an

expansion of scope.


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MCDC told OPEGA that the contracts with the nine lead HFY14 without significant changes although the agency had tiRFP process. According to MCDC, although possible, this wdifficult to successfully achieve given the amount of time necomplete a standard RFP process, which for this award is at MCDC plans to complete the current five-year grant cycle, bcycle in FY16. They plan to issue a new RFP at that time. ThDHHS told OPEGA that while she was not completely satislead selection process, she did not see a need to throw it outtime.

MCDCs Lead HMP SelectionProcess Was Poorly Impand Allowed for Manipulation

MCDC Managers Were Integrally Involved in the SelectioMCDC formed a core group, including senior management a

carry out the HMP lead selection process. Based on accountand document review, OPEGA determined that those primalead selection process included the Deputy Director; the DirHealth Equity, the Division of Local Public Health (DLPH)Population Health (DOPH); and the Senior Program Managadministering the HMP program. MCDC staff told OPEGAmanagement at this level to be involved in the HMP contraconly the DOPH staff would oversee the process and the Dir

be responsible for providing the contract language related toinfrastructure.

Others involved included the Director of the MCDC who pmilestones. Final results of the process were reviewed and apCommissioner. Project Officers and District Liaisons had limthis process; they completed a survey that was used in the H

OPEGA had difficulty discerning the precise extent of involmaking authority of some members of the core group. Somemembers OPEGA spoke with characterized their involvemeothers in the group. For example, some members tended to role in certain decisions or actions while others characterizedgreater role. Therefore, in the remainder of this section, OPE

MCDC renewed thecontracts with the nine leadHMPs for FY14 and plans to

continue with annualrenewals through thecurrent five year grantcycle. Plans are for a RFP tobe issued for the new grantcycle that begins in FY16.

The HMP lead selectionprocess was carried out bya core group of MCDCsenior management and

program staff.

The MCDC Directorprovided input at keymilestones and final resultsof the process werereviewed and approved by

the DHHS Commissioner.


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The core group met several times from April-June 2012 to cand review the scoring methodology. Five final criteria and oultimately used in generating total scores for the HMPs withtwo categories. As shown in Table 2, the HMP with the highPublic Health District was selected as the lead HMP for thatis MCDCs publicly released description of each of these cat

Cost of Operations Salary Guide Compliance Support and Promotion of Developing Infrastructur Project Officer Discussions (double weighted) District Liaison Discussions Average Completion of Tobacco-related and Physica

Nutrition-related Milestones (tiebreaker rating used f

Table 2. HMP Final Scores by DistrictDistrict HMP

Aroostook Healthy AroostookPower of Prevention

CentralGreater Somerset Public Health CollaborativeHealthy Communities of the Capital Area

Healthy Northern Kennebec

Healthy Sebasticook Valley

CumberlandHealthy PortlandHealthy Casco Bay

Healthy Lakes

Healthy Rivers

Downeast Healthy AcadiaWashington County: One Community

MidcoastACCESS HealthHealthy Waldo County

Knox County Community Health Coalition

Healthy Lincoln County

Penquis Bangor Region Public Health and WellnessPartnership for a Healthy Northern PenobscotPiscataquis Public Health Council

Western MaineRiver Valley Healthy Communities CoalitionHealthy Androscoggin

H lth O f d Hill

The core group met severaltimes from April June2012 to choose selection

criteria and review scoringmethodology and results.

Five final criteria and one

tiebreaker were ultimatelyused in generating totalscores for the HMPs.Double weight was given totwo categories Supportand Promotion ofDeveloping Infrastructureand Project OfficerDiscussions.


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Atypical Methodology Used for Survey of Project OfficersThe basis for the rankings of the two criteria called Project ODistrict Liaison (DL) Discussions was the result of a survey DLs using a web-based survey tool. Despite the name of thirankings were not generated from discussions with the POs from the sums of ratings on survey questions.

The core group agreed on the survey questions and conductblind survey process. The Senior Program Manager and thDivision of Local Public Health conducted the surveys of threspectively, via conference calls with each group. During th

were read each survey question and instructed to enter their their District on a 1-5 Likert scale into the web-based survey

POs and DLs were intentionally not informed of the true puhow their ratings would be used. They also were not allowedquestions in writing - only question numbers and response oin the survey formand were instructed not to write down other notes. According to some members of the core group,

deployed in this manner due to concerns that the HMPs woutheir efforts, questions could leak, and they wanted to keep tconfidential. Others explained that they were concerned aboobjective responses from the POs and DLs as possible. The Director of the OQIS4said he did not think it was necesurvey in order to keep the responses objective and he wouldon getting complete information. This survey methodology w

compared to OPEGA's own experience with survey deploymguidance OPEGA identified.

The fact that participants did not know the true purpose of tnot provided guidance on scoring (e.g. what merited a highehave impacted the quality of responses. The circumstances uPOs completed it, without seeing the questions and within thconference call, also did not allow them to give as much tho

might otherwise have occurred. However, it is not possible twould have been very different had a different process beenDLs indicated they were comfortable with ratings they gave purpose of survey, although comments on some surveys indgiven different ratings had they known.

The rankings for the two

criteria called PO and DLDiscussions were based onsurveys completed by POsand DLs during groupconference calls where thequestions were read tothem.

POs and DLs wereintentionally not informedof the purpose of the surveyor how their ratings wouldbe used. They also were notallowed to see the surveyquestions in writing.

OPEGA observed that thissurvey methodology wasatypical and may haveimpacted the quality ofresponses. However, mostPOs and DLs said they werecomfortable with theratings they gave even afterlearning the true purpose of

the survey.


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Criteria and Weighting Changed During the Lead SelectiAccording to MCDC core group members, the criteria wereoutset. Instead they evolved and changed multiple times durin part because MCDC did not have useful data for what it wSenior Program Manager determined what data was availablecriteria, and the group discussed the strengths and weaknesswell as the merits of the metrics and their appropriateness. Tprocess. Due to data quality issues, certain criteria originally were not used, including the quality of quarterly KIT reportiaddressing health disparities. MCDC staff told OPEGA someliminated from consideration because they were too subjectwere given to them, they did not sufficiently differentiate theother (i.e. the ratings were very close). (See Recommendation

In addition to changing criteria, the decision to weight certaidecision on what additional criteria to use as a tie breaker didthe criteria were scored, multiple weighting scenarios were tefor each HMP had been derived. The core group member recompiling the scoring explained that the weightings occurred

survey results were obtained because the initial scoring efforother categories) showed little variation in the scores amongdistricts.MCDC staff also told OPEGA that the Support anDeveloping Infrastructure criterion was added late in the prowere assigned to other criteria and initial scores had been tot

The State of Maines Division of Purchases Request for ProActivity Schedule, a step-by-step schedule of the RFP proce

development of scoring material should occur at the same timdevelopment of the RFPwell before proposals are revieweDirector of OQIS at DHHSalso questioned why MCDC hacriteria, scoring protocol and weighting at the beginning of tfound that continually changing criteria and weightings throuprocess impacted the integrity of the final results. (See Recom

Scoring Methodology Inconsistent and Emphasized SubSeveral issues with the scoring methodology and processweOQIS that also concerned OPEGA. OQIS concluded that tmethodology was made overly complex by the use of aggregweightings, and an extra measure used as a tie breaker. In adthat the scoring methodology was not consistently applied T

According to core group

members, the selectioncriteria evolved andchanged multiple timesduring the scoring process,in part because MCDC didnot have useful data for

what it wanted to measure.

In addition, decisions toweight certain criteria andwhat criteria to use as a tiebreaker did not occur untilafter criteria were scored,

multiple weightingscenarios were tested andinitial total scores for eachHMP had been derived.

OPEGA found that the

continual changing ofcriteria and weightingsthroughout the scoringprocess impacted theintegrity of the final results.

Several issues with thescoring methodology werenoted by OQIS and alsoconcerning to OPEGA. Itwas made overly complex,


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Ratings of 1-HMPs for the

Rankings of eto the other Hwere used as

all the other c

The following specific weaknesses in how total scores were d

Use of rankings reduced differentiation in scores. Rankithe criteria except "Support and Promotion of Developing I

which was rated on a Likert scale of 1-5. The use of rankingor ratings limited differentiation in theresults making it more difficult to determinea clear winner. The use of rankingseffectively removed the variability betweenHMPs because it minimized the degree ofseparation between the HMPs. Forexample, HMPs with results differing by asignificant margin on the criteriaCompliance with Salary Guidelines (e.g. 29% versus 57% Cumberland District) or that had widely different total ratingsurveys (e.g. 27 versus 59 for two HMPs in the Western Maiwith rankings that were only one or two points apart. Accordcore group member responsible for creating the scoring spreintroduced due to the lack of variability in the total HMP scoOPEGA notes that there were also instances where rankingsthe differentiation between HMPs that were separated by onexample in Central District, there was only a difference of .3top HMPs on the Cost of Operations criterion but the ranki4) created a full one point spread between them.

Additionally, the use of rankings for the more objective criteCosts and Administrative Efficiency and Compliance withmeant HMPs could only score a maximum number of point

of HMPs in the district in these categories, while they could maximum of five points in the more subjective SPDI categosubjective measure already potentially carried more weight inthe objective measures (even before weighting of criteria wacarried more weight in some districts than others. In the Aroexample, there were only two HMPs, resulting in all criteria oawarded a maximum of two points before weighting. For thicategory represented 38% (5 out of 13) of possible points beadded. After weightings, it increased to 50% (10 out of 20) o

Scoring criteria for key category not well defined.The wdouble counted SPDI and the Project Officer surveys. The Othat every HMP that won the SPDI category was selected asSPDI rit ri dd d l t i th pr d th r ti

Rankings were used for all

criteria except SPDI whichwas rated on a Likert scaleof 1 to 5. The use ofrankings limited thedifferentiation in the resultsmaking it more difficult todetermine a clear winner.Lack of differentiation iswhat led MCDC to weight

certain criteria.

Using rankings for the twoobjective criteria and aLikert rating for thesubjective SPDI categoryalso meant that SPDIpotentially carried moreemphasis in the totalscores even before weightswere applied.

OQIS analysis showed that

every HMP that won theSPDI category was selected

as the lead HMP. The SPDIcriterion was added late inthe process and ratingswere assigned by two coregroup members. OQISfound the concepts on


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OPEGA noted that the detailed description of the SPDI catscored, which were released as part of a FOAA request, was after the scoring and selection was complete. This indicated perhaps there was not a strong justification for the scoring otime, and MCDC had attempted to document the reasoning after the fact. We also noted there was also conflicting informOQIS report and MCDC staff accounts of whether staff revDL responses to survey questions related to public health indevelopment in assigning the SPDI ratings.

Inconsistencies in the District Liaison surveys for WestThe District Liaison survey responses to several questions wWestern Maine District and, therefore, all responses related the district were excluded from the totaled survey points in tspecific questions with no ratings were:

degree to which addressing health disparities is a priorit completeness and integrity of implementation of Mobil

through Planning and Partnership;

degree of achievement of intent of Core Competencies formation and effective functioning (independent of pa

governance or advisory board.

In addition, the DL survey responses for this district were defrom other districts. OPEGA was told that three individualsto assign ratings to each question for each of the HMPs in thof the departure of the previous DL. Accounts from individregarding details of how the ratings were assigned and there

documentation. It is unclear how the individual ratings on eadetermined and who entered them into the web-survey formunable to tell us who entered the responses, and some who Mreported had been involved did not claim responsibility for asurvey questions for this district. Although it can be argued tMaine District HMPs were rated under the same conditions,this district was a departure from the overall process.

Scoring Methodology Possibly Adjusted to Influence OutDistrictChanging the criteria and weighting during the scoring procefor MCDC to manipulate outcomes. OPEGA found strong scoring may indeed have been intentionally manipulated to a

The DL surveys for WesternMaine District werehandled differently than theother districts in a couple ofways. Although all WesternMaine District HMPs wererated in the same way, the

survey process in thisdistrict was a departure

from the overall process.

OPEGA noted that changingthe criteria and weightingd i th i


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those districts where the scoring was close such as the Penqudistricts.

Multiple MCDC managers described a meeting during which

scoring matrix with a HMP other than Bangor Region Public(Bangor) as high scorer in the Penquis District was reviewedof them said a final adjustment must have been made to the because in the end Bangor was the top scorer, but they did ndone or why. Others said there was specific discussion and ashould be the lead, although it did not have the highest scorethe Co-Chair of the Statewide Coordinating Council was cloHMP and had been a good partner to MCDC.6

The OQIS report contains an analysis of six scoring scenariodifferent methodologies that could have been applied. In twthese different scenarios resulted in different lead HMPs - wdistricts being Penquis. While the total scores for the three HDistrict were very close under all OQIS scenarios, Bangor haunder only three of the six scenarios. Healthy Northern Penunder two scenarios and Piscataquis Public Health was the w

In possible scoring scenarios OPEGA generated based on staddition of the SPDI criteria, and the specific combination orankings for the Project Officer surveys and SPDI, were critout as the top scorer.

The other district where the top scorer changed in the variouscenarios was the Central District. In this district, there was aHMPs after MCDC applied the final scoring methodology. A

(average completion percentage of tobacco, physical activitymilestones) was selected and applied. Selection of this tiebrequestions about the integrity of the process, but OPEGA heMCDC desiring a particular outcome in this district.

There were concerns about the outcome of the lead selectionDistrict that prompted this OPEGA review.According to Oseveral different weighting and scoring scenarios, the winner

district (Healthy River Valley) remained unchanged. The samOPEGAs scenarios. Healthy Androscoggin was not the higany of the individual categories.

MCDC also had opportunityto manipulate the outcome

in Central District by virtueof the tie breaker criteriachosen, but OPEGA heardno accounts of MCDCdesiring a particularoutcome in that district.


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HMP Funding was Divided Evenly Based on Role, ResultDecrease for Some HMPsAccording to MCDC staff, they were trying to make funding

an uncertain environment. They report being concerned thatprogram would be so significant that if they divided the remnone of the 27 HMPs would have enough funding to stay opto the program were much larger than the actual cut of apprpassed in the final Emergency Supplemental Budget in May

MCDC told OPEGA they decided to move to a new structusupporting HMPs with funds distributed according to role to

funding and maintain all the HMPs. In the past, funding amo27 HMPs were determined according to a formula based on rural/urban classification. For FY13, MCDC senior managemfunding amount of $120,000 was what each HMP would neeoperations with one full-time staff person and distributed fu

Each lead HMP received the $120,000 for programmatic wofunding of $134,605 for public health infrastructure work an

administering the subcontracts with the supporting HMPs. THMPs varies by district, the funding provided to the lead foradministration is the same regardless of how many subcontradministers. Each supporting HMP received $120,000 via sudistricts lead HMP for programmatic work.Additional fundHMPs by DHHSs Office of Substance Abuse and Mental H(SAHMS) in the amount of $20,000 to $60,000 per HMP deof HMPs per district.

The FY13 HMP contract for the Tribal District also includetwo Tribal District Liaisons and administrative support. Funpositions was also provided to the Tribal District in FY12. Athese positions perform functions similar to the Public Healtemployed by MCDC, which includes District-wide work outprogram. OPEGA noted that the contract for the Tribal Dishandled differently within MCDC and DHHS than the othe

Recommendation 4.)

The funding for each lead and supporting HMP is summarizchange in funding structure and scope of work resulted in soexperiencing a reduction in funds from FY12, while others rFY12 amounts include funds for School Health Coordinator

In the past, fundingamounts for each HMP

were determined by aformula based onpopulation and rural/urbanclassification. For FY13,MCDC determined a basefunding amount of$120,000 for each HMPand distributed fundingbased on that.

Lead HMPs receivedadditional funding forpublic health infrastructurework and administeringsubcontracts to supportingHMPs. The change infunding structure andscope of work resulted in

some HMPs experiencing areduction in funds fromFY12, for other it was anincrease.

H lth M i P t hi FY


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Table 3: Funding to Healthy Maine Partnerships for FY12 and FY13 by Public Health DistrictDistricts and Local Healthy Maine Partnerships FY 12 Funding FY 13 Funding

Aroostook DistrictHealthy Aroostook $347,629 $322,941Power of Prevention $273,671 $160,000

Central DistrictGreater Somerset Public Health Collaborative $238,432 $302,941

Healthy Northern Kennebec $277,126 $140,000

Healthy Communities of the Capital Area $415,038 $140,000

Healthy Sebasticook Valley $225,510 $140,000Cumberland DistrictHealthy Portland $255,147 $302,941

Healthy Casco Bay $366,632 $140,000

Healthy Rivers $376,388 $140,000

Healthy Lakes $307,964 $140,000

Downeast DistrictHealthy Acadia $460,416 $322,941

Washington County: One Community $319,446 $160,000

Midcoast DistrictACCESS Health $317,763 $302,941

Healthy Lincoln County $253,565 $140,000

Healthy Waldo County $276,269 $140,000

Knox County Community Health Coalition $267,859 $140,000

Penquis DistrictBangor Region Public Health and Wellness $437,413 $309,607Partnership for a Healthy Northern Penobscot $297,831 $146,667

Piscataquis Public Health Council $279,355 $146,667

Western Maine DistrictRiver Valley Healthy Communities Coalition $242,161 $302,941

Healthy Androscoggin $403,215 $140,000

Healthy Community Coalition $227,920 $140,000

Healthy Oxford Hills $234,500 $140,000

York DistrictCoastal Healthy Communities Coalition $373,156 $309,607

Choose To Be Healthy $413,112 $146,667



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Incomplete Documentation of the Lead HMP SelectioMaintained

Agency Decision Making Process was Not Fully DocumeMCDC staff told OPEGA that, although the core group dischanging the HMP structure were for internal consideration perception that this information had somehow leaked to theprocess. As a result, staff said there were strict directives to kconfidential. There was very limited email traffic during the pdocumentation was created or kept.

Following the announcement of the changes to the HMP prStatewide Coordinating Council Meeting on June 14, 2012, Mreleased three documentsa description of the lead selectiothe criteria used (see Appendix C); an outline of the plan to of the funding reduction (see Appendix D); and the scoring selection results (see Appendix E). This was the first time thstaff, including District Liaisons and Project Officers, were mdecision.MCDC staff told OPEGA that some of this documdeveloped in order to describe the selection process becausenot documented during the process.

Additional documentation was released by MCDC in responThe Attorney Generals Office (AG) conducted an investigaand complete documentation was provided by DHHS in resrequests.At the request of theAGs office, the Office of Inf(OIT) searched network drives and back-up tapes at MCDCthe former Director of Local Public Health, in an effort to idthat may have been destroyed or concealed. At the time of thinvestigation was not yet complete. OPEGA had the opportdocumentation obtained by the Attorney Generals office.

OPEGA did not identify any documentation provided to us response to the FOAA requests DHHS received. However,

locate a version of the scoring matrix referenced by multipleshowed a different outcome in the Penquis District. Accordidocument existed as late as a June 13, 2012 meeting with theDHHS - one day before the public announcement of the selaware that the former MCDC Director of Local Public Heali il d i h fil d h d h b

There was limited emailtraffic and limiteddocumentation wascreated or kept during theduring the HMP lead

selection process.

OPEGA obtaineddocumentation from DHHSand interviewees for thisreview. We also obtained

electronic files fromsearches of network drivesand backup tapesconducted by OIT. We didnot identify anydocumentation given to usthat was withheld inresponse to FOAArequests.

We were unable to locatea next to final version of

the scoring matrixreferenced by multipleMCDC staff that existed aslate as mid-June 2012.This document may havebeen similar to one

O


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Recommendations MCDC Should Gather Relevant Performance DaMCDC did not have relevant, consistent, objective data avaiperformance of the individual HMPs, which led to a relianceinformation. MCDC had difficulty identifying data that spokperformance particularly in areas relevant to the lead role. Inthe MCDC core group also did not include criteria related to

considers to be key or different responsibilities of the new lesubcontracting and monitoring of subcontractor performancother HMPs and schools; and capacity to serve the entire dis

Since the lead HMP role was new, the fact that MCDC was relevant data is somewhat understandable. However, OPEGefforts to focus on ensuring better data collection in the futuOPEGA that efforts are currently underway to collect data o

Recommended Management Action:MCDC should gather relevant, objective performance data ofuture based on the key responsibilities of the HMPs in this

MCDC Should Ensure Integrity of Future ProcesDetermine Funding Awards or Make Selections Competing GranteesDHHSs Office of Quality Improvement Services (OQIS) annumber of issues with MCDCs scoring methodology and prweaknesses, described in more detail on pages 17-21, include

using atypical methodology in deploying the survey oDistrict Liaisons;

inconsistencies in District Liaison survey ratings for Maine District;

lacking a well-defined basis for ratings assigned to thSupporting and Promoting Developing Infrastructur

1

2



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y p

These weaknesses resulted in a greater emphasis on subjectivparticular focus on each HMPs cooperation and collaboratiosupport for development of public health infrastructure. Thesubjective input was also less than optimal given issues with

surveys and the basis for the SPDI criterion.

The scoring methodology ultimately put significant emphasisubjective Support and Promotion of Developing Infrastrucobserved that the HMP in each district with the highest ratinreceived the top score and was selected the lead HMP in eaccriterion was introduced late in the scoring process and the rassigned by two core group members closest to the HMPs. O

concepts on which these ratings were based were not definesupport a consistent and reliable measurement.

The decision to alter the selection criteria during the processintroduction of weights and tie breakers to the scoring methquestions about the credibility of the process and allowed opmanipulation of the outcome. All managers and staff OPEGdescribed the groups desire to have an overall process that w

possible. The core group member responsible for compiling maintains that any changes to the scoring methodology weredifferentiation in total scores among HMPs, not to create pa

Nonetheless, OPEGA heard accounts from multiple MCDCfinal adjustment was made to the scoring methodology at thprocess that changed the outcome in the Penquis District. Soalso suggest that the adjustment was intentional as there was

Region Public Health and Wellness (Bangor) to be the lead.

Various weighting scenarios presented in the OQIS report shscenarios producing different top scorers in Penquis Districtmethodology scenarios illustrated in the OQIS report, Bangoscorer. OPEGA observes that the addition of the SPDI critemay also have been related to a final adjustment to the scorinpossible scoring scenarios OPEGA generated based on staff

appears that the addition of the SPDI criteria, and the specifdouble weighting it and the rankings for the Project Officer Bangor coming out as the top scorer.

OPEGA finds that the OQIS scenarios, and our own, suppoBangor was not the top scorer in the next to final round of s


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As a result, MCDC ended up developing some documents inrequests because relevant documentation had not been mainprocess. For example, OPEGA noted that the detailed descrcategory and the rationale for the ratings assigned, which DH

response to a FOAA request, was prepared in July 2012 aftecompleted and MCDCs selections made public. OPEGA redocuments created during the timeframe of MCDCs selectiosupported these descriptions, indicating to us that MCDC hadocument the reasoning to support the ratings after the fact.

Members of the core group acknowledge there was discussiodisposing of documents related to the PO and DL surveys a

scoring matrix that were working documents or drafts. Hoas to the tenor (i.e. directed vs. advised) and timing of those present, and the reasons for the directive or advice to destro

Two MCDC core group members OPEGA spoke with descaround the whole process due to concerns at MCDC that inplans were being, or would be, leaked to the HMPs. These ssaid they had been instructed to destroy documents by a sup

final product should remain at the end of the process. They and provided what they had from their files to OPEGA.

The MCDC superior who gave the instruction to discard dobeing part of these conversations and giving advice to other who were concerned about maintaining the confidentiality obehalf of the POs and DLs. The superior also described a didiscarding a draft scoring sheet so it would not be confused

Others, including the Director of MCDC and Commissionerversion control being discussed as well.

OPEGA did not find any documentary evidence that MCDCintentionally destroyed or concealed specific documents in rerequests or OPEGAs requests for documents. However, stamembers of the core group, the Director of MCDC and the DHHS, indicate that at least one document existed in the latand selection process which was not provided by DHHS andlocate in documents resulting from asearch of electronic file

The version of the scoring matrix described showed an HMPthe high scorer in the Penquis District and prompted a discuresults. We believe this document may have been reviewed b



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paper files at her MCDC office. DHHS said it was unable toand did not provide it in response to her FOAA request. It wdocuments from her files that DHHS provided to OPEGA.know whether the document she sought is the same version

that has been described to us by others.

OPEGA notes that an agency cannot reasonably be expecteworking document and we did not identify formal guidance Department level on what documentation should be retainedor decisions in situations such as this. However, in this instandocuments were the only written record of MCDCs processhas resulted in a lack of transparency and questions about th

Recommended Management Action:OPEGA observes generally that major agency decisions, andthem, should be transparent. The extent of documentation nthis objective should be set out in clear and relevant guidancshould consider the adequacy of their existing policies and gactions and document retention in situations such as the FYchange and lead selection process that are anticipated to havstakeholder or public impact. Policies and other guidance shupdated as necessary.

MCDC Should Clarify the Roles and ResponsibilContract and Make Them Consistent with ThoseThe FY13 Tribal District HMP contract was for over half a effectively a sole source contract as there are no other compTribal District. OPEGA noted that the contract for the Tribdeveloped and processed differently than the contracts for thOPEGA was unable to discern from the interviews who wasdeveloping, reviewing and approving the FY13 contract for HMP. We ultimately identified an email that confirmed the cby the Office of Health Equity despite the fact that the direcbeen unsure who developed it, though she acknowledged sigthe DHHS Contracting Group told OPEGA they have nevecontracts although they process all the other HMP contracts

Recommended Agency Action:

4



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Agency Response

In accordance with 3 MRSA 996, OPEGA provided the Dand Human Services an opportunity to submit additional comthis report. DHHSs response letter can be found at the end

Acknowledgements OPEGA would like to thank the management and staff of bfor Disease Control and Prevention and the Maine DepartmHuman Services for their cooperation during this review, as employees who met with us. We would also like to thank thein the Department of Administrative and Financial ServicesTechnology and Division of Purchases, as well as the Legislaand Program Review for their assistance in providing inform


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Appendix A Scope and MethodsThe scope for this review, as approved by the Government Oversight Committee, focused narquestion. OPEGAs methodology included:

Conducting interviews with current and former Maine Center for Disease Control and staff involved in the lead HMP selection process, including managers, division directorProject Officers;

Conducting interviews with Department of Health and Human Services (DHHS) and Administrative and Financial Services (DAFS) staff with knowledge of events related toprocess;

Reviewing documentation (including files and emails) provided by MCDC, DHHS, andpaper and electronic files, pertaining to the lead HMP scoring and selection process;

Reviewing electronic files provided by the Attorney Generals office resulting from the Initiating a request for the Office of Information Technology to retrieve appointments

key staff from the time period in question, and reviewing the results;

Reviewing best practices in survey methodology; and Reviewing DHHS documentation provided to third parties in response to FOAA requ

Healthy Maine Partnerships FYAppendix B Map of Local Healthy Maine Partnerships


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See the following page. Source: Maine Center for Disease Control and Prevention



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Healthy Maine Partnerships FYAppendix C MCDC Public Description of the Lead


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Selection Criteria and Scoring MethodologySource: Maine Center for Disease Control and Prevention

Selection of Lead and Supporting Healthy Maine Partnerships for FY13

With a reduction in funding approved by the Legislature from approximately $7.5 million to $4.7 m

making changes to support continuation and sustainability of the Healthy Maine Partnerships (HM

understands that these funding cuts are difficult for local HMPs, and that some HMPs are experien

reductions as a result of these changes.

Previously, 27 HMP community Partnership directors and 31 HMP school health coordinators were

public health districts and 164 school administrative units. HMPs were asked to assess the needs

choose from a menu of approximately 70 objectives to develop a work plan.

Starting July 1st, there will be 9 Lead HMPs and 18 Supporting HMPs spread across Maine. Each HM

individual service area. HMPs will have a more focused set of objectives, including both communiThere will be flexibility to choose objectives within the defined set of objectives, but HMPs will be

school objectives as part of the work plan with priority schools. Priority schools will be identified b

Department of Education in order to ensure the most vulnerable children are benefiting from the H

This plan reduces administrative overhead, duplication of work and reduces the administrative bur

government (nine contracts vs. twenty seven). It also focuses the limited resources available on th

put people most at risk. In order to move to a lead and supporting HMP structure, Maine CDC assfollowing qualities:

The HMPs demonstrated ability to meet the expectations of the contract Efficient use of public resources Collaborative partnership with Maine CDC Ongoing support and promotion of new and developing public health infrastructure

Please see the attached spreadsheet for total scores. All scores provided the highest points to th

condition required within each respective district. Example: Power of Prevention received a "2" aOverhead and G&A because Power of Preventions rate was lower. In those instances where there

score was awarded to each coalition that made up the tie. At the end, scores were aggregated to

Summary Explanation of Total Scoring

Cost of Operation Column All Operating Costs and General and Administrative (G&A)


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Questions asked of District Liaisons

Collaboration with MCDC


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Collaboration with MCDC

1. Degree of cooperation with Maine CDC2. Willingness and ability to follow Maine CDC leadership and direction3. Engages district liaison in professional and collegial manner4.

Facilitates engagement between coalition board and district liaison5. Staff of the HMP conduct themselves professionally

Support of Public Health Infrastructure

6. Rate the understanding of the HMP regarding their role in the public health infrastructure7. Degree to which the HMP has been positively involved in developing or supporting develo

health infrastructure

8. Rate the contribution of the HMP to the development of the public health infrastructure9. Degree of positive engagement in DCC and DCC activities10.

Rate the degree of flexibility of the HMP in allowing other public health entities to take a lepublic health infrastructure

Capacity to Serve the District

11.Degree to which addressing health disparities is a priority12.Completeness and integrity of MAPP implementation13.Degree of achievement of intent of Core Competencies14.Formation and effective functioning (independent of paid staff) of a governance or adviso

Healthy Maine Partnerships FYAppendix D MCDC Public Description of HMP Structure and


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Funding Changes for FY13Source: Maine Center for Disease Control and Prevention

Healthy Maine Partnership Funding from Maine CDC

June 2012

Below are highlights about the plan to fund Healthy Maine Partnerships (HMPs), with a reduction

the Legislature from approximately $7.5 million to $4.7 million:

Mirroring Maine CDCs public health infrastructure that established eight regional public htribal health district, nine current HMPs were chosen to be the lead HMPs.

The lead HMPs will receive approximately $281,000 and will also take on the responsibilitypublic health infrastructure efforts and leading local infrastructure and capacity developm

respective districts.

The lead HMPs are required to subcontract with the remaining 18 supporting HMPs, whic$120,000 from Maine CDC.

Because school based health coordinators will no longer be funded, all HMPs will be expecpriority schools, as identified by Maine CDC and the Department of Education.

This plan reduces administrative overhead, duplication of work and reduces the administrgovernment (nine contracts vs. twenty seven). It also focuses the limited resources availab

factors that put people most at risk.

The Lead HMPs that were selected are:

Healthy Aroostook (Aroostook County Action Program) Greater Somerset (Redington Fairview Hospital) Healthy Portland (City of Portland) Healthy Acadia (Healthy Acadia) Access Health (Mid Coast Hospital) Healthy River Valley (River Valley Healthy Communities Coalition) Coastal Healthy Communities (University of New England) Bangor Regional (Bangor Health and Welfare) Tribal Healthy Maine Partnership

The selection of the Lead HMPs was based on ratings of:

The HMPs demonstrated ability to meet the expectations of the contract Efficient use of public resources Collaborative partnership with Maine CDC


Each of the 31 HMP school health coordinators was employed by one of the 164 school ad


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p y y

across Maine. The 31 school health coordinators were required to address objectives spec

setting.

Work plans for contracts to be effective 7-1-12:

HMPs will have a more focused set of objectives, including both community and school setflexibility to choose objectives within the defined set of objectives, but HMPs will be requi

objectives as part of the work plan with priority schools.

Priority schools will be identified by Maine CDC and the Department of Education to ensurchildren are benefiting from the HMP work.

How will schools be connected to the work of HMPs?

HMPs will be required to work with priority schools to address school-related objectives ocontracts. HMPs will be unable to replicate all of the work that the 31 full-time school health coordin

the districts in which they were employed.

In order to be successful addressing the school-related objectives, it will be important for with the HMPs to make progress toward meeting these objectives.

How can HMPs address sustainability?

It is understood that these funding cuts are difficult for local HMPs, and that some HMPs asignificant reductions.

HMPs are encouraged to secure additional private and public funding. Many HMPs have bthe past.

Supporting HMPs may have the opportunity to obtain funding from the lead HMP to controut District-wide activities.

It is believed that $120,000 will allow a supporting HMP to function effectively, especially administration.

The range of contractual funding provided to each community HMP by Maine CDC prior toFund for a Healthy Maine was from $135,000 to $344,000 (excluding funds to school heath

HMPs statewide were above the $300,000 amount.

How will the work of HMPs be monitored to ensure quality services for Maine communities and

Maine CDC requires quarterly reporting on HMP objectives. Each HMP has a project officer from Maine CDC to provide support and technical assistanc

project officer notes that an HMP is not meeting its milestones for an objective, the projecHMP to provide technical assistance. Maine CDC project officers can follow up to determin

assistance is implemented, and whether further assistance is necessary.

At years end, Maine CDC will assess the performance of the HMPs and will make decisionsand funding for the coming year based on the overall performance of the HMP, which will


Information Superintendents may want to know about the HMPs:

School-health coordinators, once funded as part of the HMP funding line, will not be funde


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effective July 1, 2012.

In order to connect to schools located in their respective communities, all HMPs will be expriority schools, as identified by Maine CDC and the Department of Education.

HMPs will be required to choose specific school-related objectives in the new contract yea The number of objectives and focus of objectives will be determined by Maine CDC to assu

levels of work are being conducted with schools.

The school-related objectives have been drawn from the previous programming menu andappropriate and do-able without the additional resource of a school health coordinator.

Maine CDC project officers will closely follow the progress of the HMPs as reported in the will actively work with those HMPs that do not meet the expectations.

Maine CDC project officers will work with the Department of Education to assure that anynecessary for HMP work with schools is appropriate for the setting.

Because this work will be conducted in partnership with a school, HMPs will be held accoucontribution to the partnership. HMP project officers will assess whether the HMP is meet

that have been set and also review how the technical assistance provided has been implem

Appendix E Healthy Maine Partnerships Scoring Matrix as Publicly Released by MCDC Source: MCDC, Cost of Operations

Salary Guide

Compliance

Project Officer

Discussions

District Liais

Discussion


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Office of Program Evaluation & Government Accountability

HMP

Support and

Promotion of

Developing

Infrastructure

Discussions DiscussionAll

operating

costs+ G&A

as % of

Community

Total

Over-

head

Rating

Percent of

staff within

salary

guidelines

Salary

Rating Total Rating Total Ra

Healthy Aroostook (Aroostook County Action Program) 17.00% 1 80.00% 2 5 43 2 57

Power of Prevention (Cary Medical Center) 5.51% 2 66.67% 1 3 34 1 54

Healthy Communities Capitol Area 4.65% 4 75.00% 1 3 36 4 27

PATCH (MaineGeneral Health) 7.38% 2 100.00% 2 3 33 1 61

Greater Somerset (Redington Fairview Hospital) 11.87% 1 100.00% 2 5 34 2 59

Healthy SV (Sebasticoo k Valley Hospital) 5.00% 3 100.00% 2 3 34 2 28

Healthy Portland (Portland, City of) 8.29% 3 28.57% 1 5 39 4 60

Healthy Casco Bay (Portland, City of) 7.48% 4 57.14% 2 3 38 3 59

Healthy Lakes (People's Regional Opportunit y Program) 18.76% 1 60.00% 4 4 36 2 58

Healthy Rivers (People's Regional Opportunit y Program) 16.33% 2 40.00% 3 3 36 2 57

Healthy Acadia 17.35% 1 80.00% 2 4 34 1 56

Washington Co. One (Washington, County of) 9.36% 2 66.67% 1 2 35 2 35

Access Health (Mid Coast Hospital) 12.01% 2 42.86% 2 5 40 4 58

Healthy Lincoln Co. (Youth Promise) 24.52% 1 100.00% 4 2 25 2 44

Knox Co. Healthy Com. (Penobscot Bay YMCA) 8.98% 4 33.33% 1 3 22 1 59

Healthy Waldo Co. (Waldo County General Hospital) 11.59% 3 33.33% 1 3 37 3 57

Bangor Regional (Bangor Health and Welfare) 13.04% 1 75.00% 2 5 36 3 44

Healthy No. Penobscot (Katahdin Shared Services) 8.66% 3 100.00% 3 4 34 1 49

Piscataquis Pub Health (Mayo Regional Hospital) 10.47% 2 66.67% 1 4 35 2 50

Healthy Androscoggin (Central Maine Community Health) 10.00% 1 66.67% 1 3 38 3 30

Healthy Comm. Coalition (Healthy Community Coalition Greater Franklin Cty) 7.32% 3 100.00% 2 1 27 1 17

Healthy River Valley (River Valley Healthy Communities Coalition) 9.33% 2 100.00% 2 5 40 4 46

Healthy Oxford Hills (Western Maine Health) 5.87% 4 100.00% 2 2 28 2 16

Partners for Healthier Comm (Goodall Hospital, Inc.) 16.05% 1 66.67% 3 2 29 1 29

Coastal Healthy Comm (University of New England) 13.32% 2 50.00% 2 5 35 2 62

Choose to be Healthy (York Hospital) 9.38% 3 25.00% 1 3 36 3 35

Healthy Maine

Summary Explanation of Total Scoring

Cost of Operation Column:All Operating Costs and General and Administrative (G&A) were derived from the FY12 contract numbers. Total contrac

funding were used to determine the percentage. Scoring was done on a ranking basis within each District with the HMP with th e lowest G&A awar


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Office of Program Evaluation & Government Accountability

Salary Guide Compliance Column:Staff within salary guidelines was determined by the hourly salary rate from each FY12 budget compared to the r

201010788. Scoring was conducted on a ranking basis within each District with the HMP with the greatest percentage of salaries within guidelines g

Infrastructure Development Column:The Support and Implementation of Developing Infrastructure score was determined from staff knowledge o

area. Each HMP was scored in a Likert scale (rating scale) within each District

Project Officer and District Liaison Columns: These discussions focused on questions that assessed grantee collaboration with Maine CDC, complian

implementation of Maine CDC initiatives at the local level, and support of Maine CDC's district level work. Each HMP was rated by applying a Likertdesigned to show the individual HMP performance in key areas of leadership (as opposed to programmatic performance) that were determined to

were aggregated to provide a total score within the Project Officer/District Liaison discussion columns. HMPs were then rated within their district d

Tie Breaker Column:Where aggregate scores tied, a tie breaker was used. The tie breaker consisted of the measure of completion of tobacco-relat

related milestones as reported by each grantee in the HMP KIT monitoring system. This score was a strict percentage of completion of milestones

percent of their milestones given the highest score.

Aggregate Subtotal: Aggregate subtotal score was derived from totaling the rating score from each column after applying a weighting to two areas

and Promotion of Developing Infrastructure and responses from the Project Officer Discussions. These areas were selectedbecause of Maine CDCs

infrastructure at the district level. In addition, because the project officers have worked closely with the HMPs for a significant number of years an

strengths and weaknesses their input was considered key. The formula used to reach the aggregate subtotal compiled the ratings in the following w

Compliance + (Support and Promotion of Developing Infrastructure *2) + (Project Officer discussions*2) + District Liaison