HomeMy WebLinkAbout2026-048-E-Health Dept-The Hills Tandem-Staffing and efficiency analysis of medical and dental clinicsRevised 01/24 1
[Departmental Use Only]
TITLE THT Staffing Analysis
FY 2025-2026
NORTH CAROLINA
SERVICES AGREEMENT RFP/RFQ
ORANGE COUNTY
This Services Agreement (hereinafter “Agreement”), made and entered into this 21st day of
January, 2026, (“Effective Date”) by and between Orange County, North Carolina a political
subdivision of the State of North Carolina (hereinafter, the "County") and The Hills Tandem,
LLC, (hereinafter, the "Provider").
WITNESSETH:
That the County and Provider, for the consideration herein named, do hereby agree as
follows:
1. Services
a. Scope of Work.
i) This Services Agreement (“Agreement”) is for services to be rendered by
Provider to County with respect to (insert type of project): Staffing and efficiency
analysis for Orange County Health Department's medical and dental clinics.
ii) By executing this Agreement, the Provider represents and agrees that Provider is
qualified to perform and fully capable of performing and providing the services
required or necessary under this Agreement in a fully competent, professional and
timely manner.
iii) Time is of the essence with respect to this Agreement.
iv) The services to be performed under this Agreement consist of Basic Services, as
described and designated in Section 3 hereof. Compensation to the Provider for
Basic Services under this Agreement shall be as set forth herein.
2. Responsibilities of the Provider
a. Services to be provided. The Provider shall provide the County with all services
required in Section 3 to satisfactorily complete the Project within the time limitations set
forth herein and in accordance with the highest professional standards.
b. Standard of Care.
i) The Provider shall exercise reasonable care and diligence in performing services
under this Agreement in accordance with the highest generally accepted standards
of this type of Provider practice throughout the United States and in accordance
with applicable federal, state and local laws and regulations applicable to the
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Revised 01/24 2
performance of these services. Provider is solely responsible for the professional
quality, accuracy and timely completion and submission of all work related to the
Basic Services.
ii) Provider shall be responsible for all errors or omissions of its agents, contractors,
employees, or assigns in the performance of the Agreement. Provider shall
correct any and all errors, omissions, discrepancies, ambiguities, mistakes or
conflicts at no additional cost to the County.
iii) The Provider shall not, except as otherwise provided for in this Agreement,
subcontract the performance of any work under this Agreement without prior
written permission of the County. No permission for subcontracting shall create,
between the County and the subcontractor, any contract or any other relationship.
iv) Provider is an independent contractor of County. Any and all employees of the
Provider engaged by the Provider in the performance of any work or services
required of the Provider under this Agreement, shall be considered employees or
agents of the Provider only and not of the County, and any and all claims that may
or might arise under any workers compensation or other law or contract on behalf
of said employees while so engaged shall be the sole obligation and responsibility
of the Provider.
v) If activities related to the performance of this Agreement require specific licenses,
certifications, or related credentials Provider represents that it or its employees,
agents and subcontractors engaged in such activities possess such licenses,
certifications, or credentials and that such licenses certifications, or credentials are
current, active, and not in a state of suspension or revocation.
vi) Should this Agreement involve project designs, the construction or creation of
which is to be bid out or fulfilled by other contractors, and bidding or negotiation
with contractors produce prices which, when added to the other elements of the
approved total project cost, produce a cost that is in excess of the approved total
project cost, the Provider shall participate with the County in negotiation and
design adjustments to the extent such are necessary to obtain prices within the
approved total project cost. All activity of the Provider with respect to these
matters shall constitute Basic Services and shall be performed by the Provider
without additional compensation. If negotiation and design adjustments fail to
bring costs within the total project cost the County may reject all bids and
Provider will redesign or reduce portions of the project in an effort to reduce the
bid prices to within the total project cost and rebid the project. One such redesign
is included within Basic Services. If this second letting for bids does not produce
bids that are within the approved total project cost initially or after negotiations
with the contractor the cost is not reduced to an amount within the total project
cost, the Provider is not obligated to engage in further redesign.
3. Basic Services
a. Basic Services.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Revised 01/24 3
i) The Provider shall perform as Basic Services the work and services described
herein and as specified in the County’s Request for Proposals or Request for
Qualifications (the “RFP”) “RFP Number 367-0C5455 for “Conduct a Staffing
and Efficiency Analysis for Orange County Health Department, Medical &
Dental Clinics” issued April 22, 2025, and the Provider’s proposal, which are
fully incorporated and integrated herein by reference together with Attachments
A, B, and C (designate all attachments). In the event a term or condition in any
referenced document or attachment conflicts with a term or condition of this
Agreement the term or condition in this Agreement shall control. Should such
conflict arise the priority of documents shall be as follows: This Agreement, the
County’s RFP together with attachments, Provider’s Proposal together with
attachments.
ii) The Basic Services will be performed by the Provider in accordance with the
following schedule: (Insert milestones task list, dates and fees. If milestones
are not established mark N/A under Milestone Task 1.)
Milestone Task Milestone Date Milestone Fee
1. Contract Execution and Mobilization
February 6, 2026 $10,000
2. Discovery, Site Visits & Baseline Assessment
March 27, 2026 $12,000
3. Staffing, Workflow & Relief Factor Analysis
May 22, 2026 $14,000
4. Technology, Revenue & Compliance Analysis
June 19, 2026 $10,000
5. Final Report, Tools & Board Presentation June
30, 2026 $9,300
6.
7.
8.
9.
10.
iii) Should County reasonably determine that Provider has not met the Milestone
Dates established in Section 3(a)(ii), County shall notify Provider of the failure to
meet the Milestone Date. The County, at its discretion may provide the Provider
seven (7) days to cure the breach. County may withhold the accompanying
payment without penalty until such time as Provider cures the breach. In the
alternative, upon Provider’s failure to meet any Milestone Date the County may
modify the Milestone Date schedule. Should Provider or its representatives fail to
cure the breach within seven (7) days, or fail to reasonably agree to such modified
schedule, County may immediately terminate this Agreement in writing, without
penalty or incurring further obligation to Provider. This section shall not be
interpreted to limit the definition of breach to the failure to meet Milestone Dates.
4. Duration of Services
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Revised 01/24 4
a. Term. The term of this Agreement shall be from February 1, 2026 to June 30, 2026.
b. Scheduling of Services
i) The Provider shall schedule and perform its activities in a timely manner so as to
meet the Milestone Dates listed in Section 3.
ii) Should the County determine that the Provider is behind schedule, it may require
the Provider to expedite and accelerate its efforts, including providing additional
resources and working overtime, as necessary, to perform its services in
accordance with the approved project schedule at no additional cost to the
County.
iii) The Commencement Date for the Provider's Basic Services shall be February 1,
2026.
5. Compensation
a. Compensation for Basic Services. Compensation for Basic Services shall include all
compensation due the Provider from the County for all services satisfactorily (as
determined by the County) performed pursuant to this Agreement. The maximum
amount payable for Basic Services is Fifty Five Thousand Three Hundred Dollars
($55,300). In the event the amount stated on an invoice is disputed by the County, the
County may withhold payment of all or a portion of the amount stated on an invoice
until the parties resolve the dispute. Payment for Basic Services shall become due and
payable in direct proportion to satisfactory services performed and work accomplished.
Payments will be made as Project milestones as set out in Section 3(a)(ii) are achieved
up to the corresponding milestone fee. (For example, Provider may invoice for the
amount listed as the milestone fee corresponding to the first milestone task upon
County’s acknowledgement of the satisfactory completion of Task one. Upon the
County’s acknowledgement that the second Task has been satisfactorily completed
Provider may invoice for that corresponding milestone fee.) Milestone fees shall be the
maximum amount payable for its corresponding milestone task which shall not be
altered except by written amendment.
b. Additional Services. County shall not be responsible for costs related to any services in
addition to the Basic Services performed by Provider unless County requests such
additional services in writing and such additional services are evidenced by a written
amendment to this Agreement.
6. Responsibilities of the County
a. Cooperation and Coordination. The County has designated (Quintana Stewart) to act
as the County's representative with respect to the Project who shall have the authority to
render decisions within guidelines established by the County Manager or the County
Board of Commissioners and who shall be available during working hours as often as
may be reasonably required to render decisions and to furnish information.
7. Insurance
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Revised 01/24 5
a. General Requirements. Provider shall obtain, at its sole expense, Commercial General
Liability Insurance, Automobile Insurance, Workers’ Compensation Insurance, and any
additional insurance as may be required by County’s Risk Manager as such insurance
requirements are described in the Orange County Risk Transfer Policy and Orange
County Minimum Insurance Coverage Requirements (each document is incorporated
herein by reference and may be viewed at
http://www.orangecountync.gov/departments/purchasing_division/contracts.php.) If
County’s Risk Manager determines additional insurance coverage is required such
additional insurance shall consist of Cyber Liability (if no additional insurance required
mark N/A as being not applicable). Provider shall not commence work until such
insurance is in effect and certification thereof has been received by the County's Risk
Manager.
8. Indemnity
a. Indemnity. To the extent authorized by North Carolina law the Provider agrees, without
limitation, to defend, indemnify and hold harmless the County from all loss, liability,
claims or expense, including attorney's fees, arising out of or related to the Project and
arising from property damage or bodily injury including death to any person or persons
caused in whole or in part by the negligence or misconduct of the Provider except to the
extent same are caused by the negligence or willful misconduct of the County. It is the
intent of this provision to require the Provider to indemnify the County to the fullest
extent permitted under North Carolina law.
9. Amendments to the Agreement
a. Changes in Basic Services. Changes in the Basic Services and entitlement to additional
compensation or a change in duration of this Agreement shall be made by a written
Amendment to this Agreement executed by the County and the Provider. The Provider
shall proceed to perform the Services required by the Amendment only after receiving a
fully executed Amendment from the County.
10. Termination
a. Termination for Convenience of the County. This Agreement may be terminated without
cause by the County and for its convenience upon seven (7) days prior written notice to
the Provider.
b. Other Termination. The Provider may terminate this Agreement based upon the County's
material breach of this Agreement; provided, the County has not taken all reasonable
actions to remedy the breach. The Provider shall give the County seven (7) days' prior
written notice of its intent to terminate this Agreement for cause. Either party may
terminate this Agreement upon notice to the other party that obligations pursuant to this
Agreement are made impractical due to declarations of emergency by Orange County or
by North Carolina due to events directly impacting Orange County. Both parties shall
remain responsible for all payment and performance due up to the receipt of such notice,
but shall have no further obligation or responsibility beyond that date provided the
terminating party has taken all reasonable steps to complete the performance of its
obligations.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Revised 01/24 6
c. Compensation After Termination.
i) In the event of termination, the Provider shall be paid that portion of the fees and
expenses that it has earned to the date of termination, less any costs or expenses
incurred or anticipated to be incurred by the County due to errors or omissions of
the Provider. Upon request of the County, the Provider shall submit to County all
relevant documentation, including but not limited to, job cost records, to support
its claims for final compensation.
ii) Should this Agreement be terminated, the Provider shall deliver to the County
within seven (7) days, at no additional cost, all deliverables including any
electronic data or files relating to the Project.
d. Waiver. The payment of any sums by the County under this Agreement or the failure of
the County to require compliance by the Provider with any provisions of this Agreement
or the waiver by the County of any breach of this Agreement shall not constitute a
waiver of any claim for damages by the County for any breach of this Agreement or a
waiver of any other required compliance with this Agreement.
e. Suspension. County may suspend the Basic Services and this Agreement at any time for
County’s convenience and without penalty to County upon three (3) days’ notice to
Provider. Upon any suspension by County, Provider shall discontinue the Basic
Services and shall not resume the Basic Services until notified to proceed by County.
11. Additional Provisions
a. Limitation and Assignment. The County and the Provider each bind themselves, their
successors, assigns and legal representatives to the terms of this Agreement. Neither the
County nor the Provider shall assign or transfer its interest in this Agreement without the
written consent of the other. There are no third-party beneficiaries of this Agreement and
nothing in this Agreement, express or implied, is intended to confer on any person other
than the parties hereto (and their respective successors, heirs and permitted assigns), any
rights, remedies, or obligations.
b. Governing Law. This Agreement and the duties, responsibilities, obligations and rights
of respective parties hereunder shall be governed by the laws of the State of North
Carolina.
c. Compliance with Laws. Provider shall at all times remain in compliance with all
applicable local, state, and federal laws, rules, and regulations including but not limited
to all state and federal anti-discrimination laws, policies, rules, and regulations and the
Orange County Non-Discrimination Policy and Orange County Living Wage Policy
(each Orange County policy is incorporated herein by reference and may be viewed at
http://www.orangecountync.gov/departments/purchasing_division/contracts.php.) Any
violation of this requirement is a breach of this Agreement and County may immediately
terminate this Agreement without further obligation on the part of the County. This
paragraph is not intended to limit and does not limit the definition of breach to
discrimination. By executing this Agreement Provider affirms that Provider and any
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Revised 01/24 7
subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter
64 of the North Carolina General Statutes. By executing this Agreement Provider
certifies that Provider has not been identified, and has not utilized the services of any
agent or subcontractor identified, on the list created by the State Treasurer pursuant to
G.S. 147-86.58. By executing this Agreement Provider certifies that Provider has not
been identified, and has not utilized the services of any agent or subcontractor identified,
on the list created by the State Treasurer pursuant to G.S. 147-86.81.
d. Dispute Resolution. Any and all suits or actions to enforce, interpret or seek damages
with respect to any provision of, or the performance or non-performance of, this
Agreement shall be brought in the General Court of Justice of North Carolina sitting in
Orange County, North Carolina. It is agreed by the parties that no other court shall have
jurisdiction or venue with respect to such suits or actions. Binding arbitration may not
be initiated by either Party, however, the Parties may agree to nonbinding mediation of
any dispute prior to the bringing of a suit or action.
e. Entire Agreement. This Agreement, together with the RFP and its attachments and the
Proposal and its attachments, represents the entire and integrated agreement between the
County and the Provider and supersedes all prior negotiations, representations or
agreements, either written or oral. This Agreement may be amended only by written
instrument signed by both parties. Modifications may be evidenced by facsimile
signatures.
f. Severability. If any provision of this Agreement is held as a matter of law to be
unenforceable, the remainder of this Agreement shall be valid and binding upon the
Parties.
g. Ownership of Work Product. Should Provider’s performance of this Agreement generate
documents, items or things that are specific to this Project such documents, items or
things shall become the property of the County and may be used on any other project
without additional compensation to the Provider. The use of the documents, items or
things by the County or by any person or entity for any purpose other than the Project as
set forth in this Agreement shall be at the full risk of the County.
h. Non-Appropriation and Government Action. Provider acknowledges that County is a
governmental entity, and the validity of this Agreement is based upon the availability of
public funding under the authority of its statutory mandate.
In the event that public funds are unavailable or not appropriated for the performance of
County’s obligations under this Agreement, then this Agreement shall automatically
expire without penalty to County immediately upon written notice to Provider of the
unavailability or non-appropriation of public funds. It is expressly agreed that County
shall not activate this non-appropriation provision for its convenience or to circumvent
the requirements of this Agreement.
In the event of a change in the County’s statutory authority, mandate or mandated
functions, by state or federal legislative or regulatory action, which adversely affects
County’s authority to continue its obligations under this Agreement, then this Agreement
shall automatically terminate without penalty to County upon written notice to Provider
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Revised 01/24 8
of such limitation or change in County’s legal authority.
i. Signatures. This Agreement together with any amendments or modifications may be
executed electronically. All electronic signatures affixed hereto evidence the consent of
the Parties to utilize electronic signatures and the intent of the Parties to comply with
Article 11A and Article 40 of North Carolina General Statute Chapter 66.
j. Notices. Any notice required by this Agreement shall be in writing and delivered by
certified or registered mail, return receipt requested to the following:
Orange County Provider’s Name & Address
Attention: Kimberlee Quatrone The Hills Tandem, LLC
P.O. Box 8181 644 Holly Springs Rd. Ste.
125
Hillsborough, NC 27278 Holly Springs, NC 27540
IN WITNESS WHEREOF, the Parties, by and through their authorized agents, have hereunder
set their hands and seal, all as of the day and year first above written.
ORANGE COUNTY: PROVIDER:
By: _________________________________
Travis Myren, County Manager
By: __________________________________
Jennifer Fields, President & CEO
Printed Name and Title
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Revised 01/24 9
ORANGE COUNTY—INTERNAL USE ONLY
______________________________________________________________________________
Finance Information
Vendor Name: The Hills Tandem, LLC Vendor Contact Person: Jennifer Fields Phone: 919-473-3181 Address:
4242 Six Forks Road, Suite 1550-3170 City Raleigh State: NC Zip: 27609 Department: Health Amount: $55,300
Purpose: Staffing and efficiency analysis of medical and dental clinics Budget Code(s): 10414020-630000-71466
Vendor # 69225
Vendor Status with NCSOS: Current-Active Vendor is a BOCC consultant: Yes No
Contract Details
Contract Type: New Amendment (Original Contract: ) (Most Recent Amendment )
Effective Date 2-1-2026 End Date 6-30-2026 Notice Date (Notice Purpose )
Award
Approved by Board (Agenda Date: ); Made or Administered by
Signature Authority
- BOCC Express Delegation (Agenda Date: )
- Policy 9.4: Under $5,000; Service Under $90,000; Construction Under $250,000
- Budget Policy Section XV (Capital Improvement Project: )
Bidding
Informal Bidding ($30k-$90k); Formal RFP ($90k+); Other (<$30k); Exception(# )
Department Affirmation
This agreement is approved as to technical form and content and I as Department Director affirmatively state
work on this project has not been initiated prior to execution of the agreement.
This agreement is approved as to technical form and content. Services related to this agreement have already
begun or been completed. Description of the nature of the emergency condition that was addressed:
Department Director’s Signature ________________________________________ Date: ________
Information Technologies
This agreement has been reviewed and is approved as to information technology content and specifications:
Office of the Chief Information Officer___________________________________ Date: ________
Inapplicable because no hardware/software purchases or related services
Risk Management
This agreement is approved for sufficiency of insurance standards, specifications, and requirements:
Office of the Risk Management Officer___________________________________ Date: _________
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act:
Office of the Chief Financial Officer ____________________________________ Date: _________
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney __________________________________________Date: ________
Clerk to the Board
All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Received for record retention:
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
1/26/2026
2/1/2026
2/2/2026
2/6/2026
Revised 01/24 10
Office of the Clerk to the Board __________________________________________Date:_________
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Request for Proposal (RFP)
Orange County, North Carolina
Conduct a Staffing and Efficiency Analysis for the Orange County Health
Department, Medical & Dental Clinics
Document Title: Proposed Solution
Due Date: May 20, 2025, by 2pm ET
Prepared in Response to:
Bid Number: 367-OC5455
Prepared for:
ATTN: Jovana Amaro, Purchasing Department
Email: finance-purchasing@orangecountync.gov
Prepared by:
The Hills Tandem, LLC
ATTN: Jennifer Fields
Address: 644 Holly Springs Rd Ste 125, Holly Springs, NC 27540
Email: Jennifer@thehillstandem.com
Phone: 919-805-2516
The information provided herein is accurate to the best of our knowledge at the time of submission.
Attachment ADocusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 2
THT reserves the right to modify content as necessary should project requirements evolve.
Table of Contents
1. COVER LETTER .................................................................................................................4
2. PROJECT ORGANIZATION NARRATIVE ......................................................................6
2.1. Organizational Strategy and Governance ..................................................................... 6
2.2. Key Project Personnel and Responsibilities .................................................................. 7
2.2.1. Jennifer Fields, MPH ...............................................................................................................................7
2.2.2. Keia Eaves, MSL .......................................................................................................................................8
2.2.3. Amistad St. Arromand, MSHS ..............................................................................................................9
2.2.4. Sherrita Summerour, MA ................................................................................................................... 10
2.2.5. Shalini Vora, MPH ................................................................................................................................ 11
2.2.6. Chris Smith, MBA, PMP, SPC ............................................................................................................. 12
2.2.7. Sharon Homer-Drummond, PhD .................................................................................................... 13
2.3. Reporting and Communication Structure ................................................................... 14
2.4. Tools and Project Management Approach ................................................................. 15
2.5. Commitment to Compliance and Collaboration ........................................................ 15
2.5.1. Regulatory and Contractual Compliance....................................................................................... 15
2.5.2. Collaboration with Stakeholders ...................................................................................................... 16
3. TECHNICAL APPROACH NARRATIVE ....................................................................... 17
3.1. Introduction ...................................................................................................................... 17
3.2. Guiding Principles ............................................................................................................ 17
3.3. Phased Work Plan and Deliverables ............................................................................. 18
3.3.1. Phase 1: Discovery & Initial Assessment (Weeks 1–4) ............................................................... 19
3.3.2. Phase 2: Operational & Staffing Evaluation (Weeks 5–8) ......................................................... 22
3.3.3. Phase 3: Technology, Compliance & Revenue Optimization (Weeks 9 –11)....................... 25
3.3.4. Phase 4: Strategic Recommendations & Dynamic Modeling (Weeks 12–14) ..................... 28
3.3.5. Phase 5: Finalization, Presentation & Knowledge Transfer (Weeks 15–16) ........................ 31
4. EXPERIENCE AND QUALIFICATIONS ........................................................................ 35
4.1. Relevant Organizational Experience ............................................................................. 35
4.2. Qualifications of Assigned Project Team ..................................................................... 38
4.3. Access to Prior Analyses and Reports .......................................................................... 39
5. CAPABILITY AND CAPACITY TO PERFORM THE PROJECT ................................... 40
5.1. Firm Profile and Track Record ....................................................................................... 40
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 3
5.2. Capability Aligned to Scope of Work ........................................................................... 41
5.3. Operational Infrastructure and Team Capacity .......................................................... 43
6. PROJECT TIMELINE ...................................................................................................... 44
6.1. Proposed Timeline ........................................................................................................... 44
6.2. Ongoing Throughout the Project ................................................................................. 45
7. REFERENCES.................................................................................................................. 46
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 4
1. COVER LETTER
May 18, 2025
Jovana Amaro
Purchasing Agent
Orange County Finance and Administrative Services Department
300 West Tryon Street
Hillsborough, NC 27278
Email: finance-purchasing@orangecountync.gov
Subject : Proposal Submission – RFP No. 367-OC5455: Staffing and Efficiency Analysis for
the Orange County Health Department, Medical & Dental Clinics
Dear Ms. Amaro,
The Hills Tandem (THT) is pleased to submit our proposal in response to Orange County's
Request for Proposals No. 367-OC5455 to conduct a comprehensive Staffing and Efficiency
Analysis for the Orange County Health Department’s Medical and Dental Clinics.
As a nationally respected, SBA-certified Economically Disadvantaged Woman-Owned
Small Business (EDWOSB) headquartered in North Carolina, THT brings more than a
decade of excellence in healthcare consulting, operational analysis, public health
optimization, and stakeholder engagement. Our firm has led transformative public health
and clinical service projects for local governments, hospitals, and nonprofit institutions ,
delivering strategic solutions that are data-driven, community-informed, and operationally
sustainable.
We understand that Orange County seeks a thoughtful and thorough evaluation of the
Health Department’s staffing structure, workflows, and physical operations in both medical
and dental clinics. Our multidisciplinary team is uniquely qualified to support th is initiative
with proven tools, a technology-enhanced methodology, and deep experience in similar
environments.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 5
We are proposing Jennifer Fields, our Founder and President, to serve as Project Manager
for this engagement. Ms. Fields has over 18 years of direct experience in public health
program delivery, organizational strategy, and stakeholder collaboration. Her leadership
on similar initiatives, including our work with the Howard University Hospital Sickle Cell
Center of Excellence, the Sickle Cell Disease Foundation of California, and the Nevada
Cancer Institute demonstrates her ability to manage complex evaluations with clarity,
insight, and results.
The Hills Tandem team is committed to aligning our work with Orange County’s priorities
of enhancing patient care, improving clinic efficiency, and ensuring equitable access to
services. We welcome the opportunity to partner with you in developing actionab le,
forward-looking recommendations that reflect the County’s values and operational goals.
We appreciate the opportunity to submit this proposal and express our sincere interest in
contributing to Orange County’s vision for optimized, patient-centered clinical operations.
We look forward to the possibility of working together to achieve lasting impact for your
community.
Sincerely,
Jennifer Fields
President & Project Manager
The Hills Tandem LLC
jennifer@thehillstandem.com
919-805-2516
www.thehillstandem.com
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 6
2. PROJECT ORGANIZATION NARRATIVE
The Hills Tandem (THT) proposes a strategically structured and expert-led organizational
model to execute the comprehensive staffing and efficiency analysis for the Orange County
Health Department’s Medical and Dental Clinics. THT’s approach is designed to ensure
efficient, compliant, and impactful delivery of services aligned with the County’s priorities
and the project’s stated goals. Our operational framework is built on four core principles:
strategic oversight, technical execution, cross -functional collaboration, and stakeholder
integration.
2.1. Organizational Strategy and Governance
THT’s organizational structure leverages a matrix project delivery model that ensures
strong executive governance, technical coordination, domain expertise, and stakeholder
engagement across every aspect of the project. This model allows for agile project
management while maintaining robust accountability, quality assurance, and
communication pathways throughout the contract lifecycle.
Our project team includes distinguished professionals with deep experience in healthcare
systems analysis, clinical operations, data analytics, public health strategy, and systems
implementation. This diverse and seasoned team will maintain constant commun ication
with Orange County stakeholders and adhere to all regulatory, data security, and project
reporting protocols outlined in the RFP.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 7
2.2. Key Project Personnel and Responsibilities
The personnel assigned to this project are carefully selected for their proven expertise and
relevance to the scope of services outlined in the RFP. Below are details of the team structure,
roles, and respective responsibilities:
2.2.1. Jennifer Fields, MPH
Project Director
Jennifer Fields will lead this engagement as Project Director, bringing 18+ years of
experience in public health administration, strategic planning, and federally funded
healthcare initiatives. As President & CEO of The Hills Tandem since 2014, she has
successfully directed regional and national projects focused on clinical efficiency, equitable
access, and health system transformation.
Education
• MPH, Certificate in Public Health Analysis – East Carolina University
• BA, Family & Consumer Science – East Carolina University
• MBA coursework – Florida International University
Relevant Experience
Ms. Fields has led federally funded programs and strategic initiatives with organizations
such as:
• Sickle Cell Disease Foundation of California – Co-led development of the nationally
adopted SC Cares Case Management System.
• Pacific Sickle Cell Regional Collaborative (PSCRC) – Supported multi-state care
coordination and provider training.
• Nevada Cancer Institute (CDC Grant) – Directed public health outreach and
compliance reporting.
• Imara TX & Sickle Cell Disease Association – Advanced advocacy and patient
engagement in chronic disease programs.
She currently serves as a Patient-Family Advisor for UNC Health and was appointed to the
NC Governor’s Council for Sickle Cell Disease (2024).
Role in the Project
As Project Director, Ms. Fields will:
• Oversee overall engagement strategy and deliverable quality
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 8
• Serve as primary liaison to County leadership and Commissioners
• Guide risk mitigation, stakeholder engagement, and decision -making
Her leadership will ensure the project aligns with Orange County’s goals for equitable,
efficient, and sustainable clinic operations.
2.2.2. Keia Eaves, MSL
Technical Project Delivery Manager
Keia Eaves brings over 20 years of experience in public health systems management,
program implementation, and strategic oversight of federally funded initiatives. With a
strong background supporting agencies like the CDC and HHS, she excels at turning public
health priorities into results-driven operational plans.
Education
• MSL – Master of Science in Leadership
• Certifications in Project Management, Human-Centered Design, and Federal Grant
Compliance
Relevant Experience
Ms. Eaves has led high-impact roles including:
• Public Health Operations Manager – Directed CDC-funded initiatives focused on
HIV/AIDS, vaccine access, and health equity, managing multi-agency collaboration
and compliance.
• Proposal Strategy & Implementation Specialist – Managed federal healthcare RFP
responses from planning to execution.
• Organizational Performance Advisor – Designed metrics-driven systems to boost
cross-sector coordination and program accountability. She has also supported
multistate public health programs across the Southern and Eastern U.S., with
experience in Medicaid and health equity strategy.
Role in the Project
As Technical Project Delivery Manager, Ms. Eaves will:
• Lead daily operations, team coordination, and project tracking
• Serve as the liaison between THT and Orange County stakeholders
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 9
• Ensure all phases stay on schedule and meet quality standards
Her expertise ensures seamless execution, risk mitigation, and stakeholder alignment
throughout the engagement.
2.2.3. Amistad St. Arromand, MSHS
Lead Analyst
Amistad St. Arromand is a seasoned public health analyst with over 10 years of experience
managing complex federal contracts, conducting multi-state performance assessments, and
leading monitoring and evaluation efforts for public health programs. He curre ntly serves
with the Health Resources and Services Administration (HRSA), overseeing contracts
across ten states.
Education
• MSHS – Master of Science in Health Sciences
• BS – Bachelor of Science
• Certified in federal program operations, contract management, and performance
evaluation
Relevant Experience
• HRSA – Public Health Analyst
Leads performance assessments, oversees deliverables, and aligns contracts with
federal standards using advanced analytics and quality improvement tools.
• RELI Group – Evaluation Specialist
Designed evaluation frameworks and KPI tracking systems for large-scale federal
healthcare programs.
• NAESM Inc. – Executive Director
Led operations, compliance, and strategic partnerships for a regional HIV
prevention and health equity nonprofit.
His expertise spans contract lifecycle management, financial compliance, and data
visualization.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 10
Role in the Project
As Lead Analyst, Mr. St. Arromand will:
• Lead the design and execution of the staffing and efficiency evaluation framework
• Conduct workload modeling and productivity analysis
• Benchmark OCHD against peer institutions
• Synthesize insights with the Clinical Operations and Revenue teams to support
data-driven recommendations
His analytical precision and deep understanding of public health compliance will form the
backbone of the project’s evaluation methodology.
2.2.4. Sherrita Summerour, MA
Clinical Operations Specialist
Sherrita Summerour brings over 15 years of experience in public health program
management, clinical coordination, and maternal and child health (MCH) systems
leadership. Her expertise spans early intervention, behavioral health integration, and cross -
sector collaboration in state, nonprofit, and healthcare settings.
Education
• MA, Criminology – University of West Georgia
• BS & BA, Psychology and Criminology – University of West Georgia
Relevant Experience
• Georgia DPH – Strategist & Project Manager (Help Me Grow / MCH)
Led the statewide expansion of early childhood programs reaching over 2,000
families annually. Directed collaboration across public health and education sectors
and developed strategic communication and training materials.
• Georgia DPH – Advisor, Project LAUNCH
Managed SAMHSA-funded initiatives focused on young child wellness, overseeing
program monitoring, federal reporting, and interagency coordination.
• CHRIS 180 – Program Manager & Compliance Officer
Supervised clinical programming for adolescent group homes, ensuring regulatory
compliance and workforce efficiency across 65+ staff.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 11
Her core strengths include clinic workflow evaluation, systems integration, and
compliance tracking.
Role in the Project
As Clinical Operations Specialist, Ms. Summerour will:
• Evaluate clinic workflows, team coordination, and scheduling structures
• Identify service bottlenecks and recommend operational improvements
• Collaborate with analysts and tech leads to align findings with data models
Her leadership in MCH systems and operational improvement equips her to guide efficient,
patient-centered enhancements across Orange County’s medical and dental clinics.
2.2.5. Shalini Vora, MPH
Revenue Cycle Expert
Shalini Vora brings over 15 years of experience in clinical finance, grant management, and
revenue cycle optimization within federally funded healthcare environments. She
currently serves as Director of Grants Administration at the Center for Inherited Blood
Disorders (CIBD) and Co-Regional Administrator for the Western States Regional
Hemophilia Network.
Education
• MPH – Keck School of Medicine, University of Southern California
• BS in Public Health – Rutgers University
Relevant Experience
• CIBD – Director of Grants Administration
Oversees full grant lifecycles, financial compliance, and revenue strategy across
multi-site programs. Prepares funder reports, conducts audits, and supports
collaborative financial planning.
• Charles B. Wang Community Health Center
Managed a $1.5M grant portfolio and led cross-departmental coordination between
fiscal, IT, and clinical operations.
• Women’s Health Program Manager & APHCV Coordinator
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 12
Directed prevention programs, financial oversight, and community health
initiatives with a focus on compliance and sustainability.
Her expertise spans billing efficiency, claims management, payer mix analysis, and aligning
finance with care delivery.
Role in the Project
As Revenue Cycle Expert, Ms. Vora will:
• Evaluate billing practices and reimbursement cycles
• Identify opportunities to increase revenue capture and reduce loss
• Assess financial impacts of staffing and scheduling models
• Recommend strategies to enhance fiscal performance while maintaining full
compliance
Her insight will help Orange County establish a more financially resilient and sustainable
clinical service model.
2.2.6. Chris Smith, MBA, PMP, SPC
Technology Implementation Lead
Chris Smith is a senior technology strategist with 15+ years of experience leading digital
transformation initiatives, including EHR optimization, cloud migration, and advanced
analytics deployment in regulated healthcare environments. He holds certificati ons in
project management, cloud architecture, and AI/ML technologies across AWS, Google
Cloud, and Azure platforms.
Education & Certifications
• MBA – California Coast University
• BS, Computer Information Systems – DeVry University
• PMP, SAFe SPC, SSM, POPM, RTE
• AWS (Solutions Architect, DevOps Engineer, Data Analytics)
• Google Cloud (Data Engineer, Machine Learning Engineer)
Relevant Experience
• Senior Program Manager – Led migration of 200+ applications to hybrid cloud
systems, built data dashboards, and achieved 30–40% efficiency gains.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 13
• AI/ML Platform Architect – Designed predictive models for healthcare and
environmental metrics; integrated machine learning with EHR systems using
Vertex AI and SageMaker.
• Strategic Advisor – Managed global teams on multi-million dollar projects,
improving deployment success rates and operational responsiveness.
Role in the Project
As Technology Implementation Lead, Mr. Smith will:
• Assess current EHR and digital infrastructure at OCHD
• Identify inefficiencies in scheduling, billing, and documentation workflows
• Recommend system enhancements to improve interoperability and usability
• Develop an interactive staffing model and performance dashboard tools
His cross-disciplinary expertise will help Orange County implement scalable, future -ready
solutions aligned with operational and strategic goals.
2.2.7. Sharon Homer-Drummond, PhD
Research Analyst
Dr. Sharon Homer-Drummond is a senior research and evaluation expert with over 25
years of experience in public policy analysis, program evaluation, and strategic research
design across health, environmental, and education sectors. She specializes in equity -
centered methodologies and translating complex data into actionable policy and
operational strategies.
Education
• PhD
• Additional training in applied research, public policy, and strategic evaluation
Relevant Experience
• AAAS Science & Technology Policy Fellow
Advised federal health and science agencies on equity -centered policy design and
research evaluation; developed cross-agency learning initiatives.
• Strategic Evaluation Consultant
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 14
Led multi-sector evaluations focused on health equity, access, and outcomes;
supported the design of integrated policy initiatives across education, workforce,
and healthcare.
• Equity & Stakeholder Engagement Leader
Conducted participatory research and supported organizational change using
community-informed models and data ethics frameworks.
Her expertise includes benchmarking, stakeholder engagement, narrative analysis, and
public health systems evaluation.
Role in the Project
As Research Analyst, Dr. Homer-Drummond will:
• Lead stakeholder interviews and community engagement
• Conduct peer benchmarking of comparable public health models
• Synthesize findings into a policy-aligned, equity-informed final report
Her systems-thinking approach ensures that the final analysis reflects both operational
realities and the diverse needs of Orange County’s communities.
2.3. Reporting and Communication Structure
We will follow a clearly defined communication and escalation protocol. The Project
Director (Jennifer Fields) will serve as the central point of contact for all County
communications and will ensure that all internal teams are aligned with Orange County’s
expectations and timelines. Regular reporting will be conducted as follows:
• Weekly Internal Coordination Meetings – To monitor progress, assign tasks, and
address risks.
• Bi-weekly Progress Updates to Orange County – Summary updates with task
statuses, findings, and pending items.
• Stakeholder Interviews and Feedback Loops – Conducted throughout the
assessment period to ensure findings reflect on-the-ground realities.
• Board Presentations – Draft and final presentations to the Orange County Board of
Commissioners, as required.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 15
2.4. Tools and Project Management Approach
The project team will leverage industry-standard tools including Microsoft Teams,
SharePoint, Smartsheet, and cloud-based dashboards for real-time collaboration, task
tracking, and deliverable management. All documents will be submitted with sectioned
bookmarks and metadata to support the County’s document navigation preferences.
THT’s project methodology integrates elements of Lean Six Sigma, Agile project delivery,
and human-centered design. This hybrid approach ensures that analysis is not only data-
driven and evidence-based but also considerate of staff realities, space limitat ions, and
sustainability post-engagement.
2.5. Commitment to Compliance and Collaboration
We are deeply committed to full compliance with all applicable federal, state, and local
regulations, as well as maintaining a highly collaborative posture throughout the lifecycle
of the project. We recognize that a successful staffing and efficiency analysis must be rooted
in legal, ethical, and operational integrity while also fostering mutual respect, transparency,
and shared ownership with the County and all stakeholders involved.
2.5.1. Regulatory and Contractual Compliance
THT will fully adhere to:
• HIPAA Privacy and Security Rules to safeguard all protected health information
(PHI) encountered during assessments.
• OSHA Standards for evaluating and recommending safe, efficient clinic
environments.
• Orange County’s procurement policies, terms, and insurance requirements ,
including those outlined in the RFP and referenced contractual documents.
• All applicable state and federal program regulations, particularly those tied to public
health, grant funding, and clinical operations.
Our internal team has deep experience working with Health Resources and Services
Administration (HRSA), Centers for Disease Control and Prevention (CDC), and other
agencies, ensuring a strong understanding of compliance in federally and state -funded
health initiatives.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 16
2.5.2. Collaboration with Stakeholders
We understand the value of collaborative engagement in ensuring the analysis is both
accurate and actionable. THT is committed to:
• Maintaining open, consistent communication with the Health Director, Medical
Director, Dental Director, and Personal Health Services Director.
• Respectfully engaging clinical staff and frontline workers, whose insights are
essential to our understanding of operational challenges and opportunities.
• Incorporating community perspectives through interviews or focus groups when
appropriate, especially given Orange County’s diverse linguistic and cultural
population.
• Conducting all interactions professionally and ethically, with sensitivity to the
demands placed on staff and leadership during the project.
THT views this engagement not merely as a consultancy, but as a strategic partnership, one
grounded in shared goals of improving efficiency, expanding access to care, and optimizing
public health outcomes for the communities served by Orange County Health Department.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 17
3. TECHNICAL APPROACH NARRATIVE
3.1. Introduction
The Hills Tandem presents a structured, phased, and highly collaborative approach to
conducting the Staffing and Efficiency Analysis for the Orange County Health
Department’s (OCHD) Medical and Dental Clinics. Our methodology is purpose -built for
public health environments and leverages the combined power of data analytics,
stakeholder engagement, and implementation foresight.
Our goal is not only to deliver a comprehensive analysis, but to provide the County with
an actionable roadmap for optimization, backed by data, national best practices, and
realistic local implementation strategies. We understand the operational complexities,
regulatory environment, and staffing challenges faced by health departments, particularly
in the wake of the COVID-19 pandemic and ongoing workforce shortages.
3.2. Guiding Principles
We approach this engagement with a commitment to delivering value that is sustainable,
actionable, and responsive to the realities of public health operations. Our technical
approach is anchored in six guiding principles that ensure the effectiveness, integr ity, and
relevance of every component of the staffing and efficiency analysis.
• Stakeholder-Informed Decision-Making : We believe that lasting solutions are built
through collaboration and listening. Our process will engage Health Department
leadership, frontline staff, administrative personnel, and relevant community
stakeholders to ensure the final recommendations are grounded in operational
reality and aligned with local priorities. From initial discovery to final presentation,
our approach includes mechanisms for collecting input, validating findings, and
ensuring shared ownership of solutions.
• Data-Driven Analysis: We apply both quantitative rigor & qualitative insight to
drive every recommendation. Using a blend of real-time operational data, staffing
patterns, service demand, and financial metrics, our team will identify patterns, test
hypotheses, and develop optimization strategies that are informed by evidence not
assumptions. Where possible, we integrate benchmark comparisons and predictive
modeling to deepen analysis.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 18
• Compliance-Aligned & Policy-Sensitive: Operating in healthcare, especially public
health requires alignment with a complex web of regulations, mandates, and policy
directives. Our team has deep experience ensuring compliance with HIPAA, OSHA,
and other applicable laws and regulations. We will assess all existing policies and
practices against regulatory requirements and industry standards, ensuring any gaps
or vulnerabilities are clearly identified and addressed.
• Equity-Centered and Community-Conscious: Orange County serves a diverse and
linguistically varied population, including underserved and immigrant
communities. Our recommendations will be shaped through an equity lens,
ensuring that proposed changes do not inadvertently widen access gaps. We will
assess the alignment between current services, population needs, and staffing
configurations, aiming to strengthen culturally competent and accessible care
delivery.
• Technology-Enhanced for Deeper Insight : To uncover workflow inefficiencies and
support smarter staffing, we use technology-enabled tools such as process mapping
software, simulation modeling, and advanced analytics platforms. This enables us to
go beyond surface-level observations to uncover latent inefficiencies, bottlenecks,
or missed opportunities for revenue recovery or time savings. Our digital tools are
also leveraged to produce a dynamic staffing model for ongoing use by County
leaders.
• Sustainability-Focused Implementation: We design every recommendation with a
clear understanding that feasibility matters just as much as innovation. All
deliverables, from staffing plans to process improvements, will be actionable and
accompanied by a roadmap that outlines cost, training needs, timeline, and
anticipated outcomes. In addition, our staffing analysis tool is designed to be
maintained and updated internally, helping the County adapt to future changes
without recurring consultant dependence.
3.3. Phased Work Plan and Deliverables
To ensure precision, transparency, and measurable outcomes, we propose a five-phase work
plan spanning 16 weeks. This phased approach balances strategic analysis with tactical
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 19
implementation & is built to ensure consistent communication, timely insights, and the
ability to adjust based on emerging findings.
Each phase culminates in a clear set of deliverables, providing Orange County Health
Department (OCHD) with documentation, tools, and presentations that build cumulatively
toward a final, actionable staffing and efficiency report.
3.3.1. Phase 1: Discovery & Initial Assessment (Weeks 1–4)
Objective:
To establish a comprehensive understanding of current operations, staffing dynamics, clinic
workflows, and the strategic goals of the Orange County Health Department (OCHD). This
foundational phase ensures all subsequent analysis is grounded in context, al igned with
stakeholder expectations, and informed by accurate, up-to-date data.
Approach & Activities
1. Kickoff Meeting & Alignment Session :
We will begin the engagement with a formal kickoff meeting involving the Health
Director, Medical Director, Dental Director, Personal Health Services Director, and
other identified project stakeholders. This meeting will clarify expectations,
confirm objectives, review the proposed project timeline, and identify key data
sources and points of contact.
o Discuss project goals, success criteria, and any prior assessments.
o Confirm access to facilities, systems, and data.
o Finalize communication protocol and escalation process.
o Identify internal champions to support information flow.
2. Stakeholder Mapping and Engagement Planning :
We will create a stakeholder engagement map that outlines roles, influence, and
interaction across clinical, administrative, and leadership levels. This tool ensures
we capture diverse perspectives across both clinic locations (Chapel Hill and
Hillsborough).
o Identify individuals for one-on-one interviews or focus groups.
o Determine optimal channels and timing for engagement.
o Ensure inclusion of part-time, full-time, and contracted personnel.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 20
3. Document and Data Collection :
Our team will request and review a core set of documents, including but not limited
to:
o Organizational charts and job descriptions
o Staff schedules and shift rotations
o Appointment and patient flow data
o Budget and expenditure reports
o Policy and procedure manuals
o Compliance reports and audits
o Space/facility usage plans
The goal is to build a clear picture of the department’s staffing model, workload
distribution, physical infrastructure, and regulatory environment.
4. On-Site Clinic Observations:
We will conduct structured observational site visits at both the Chapel Hill and
Hillsborough clinic locations. Our team will shadow workflows at key service
stations (e.g., reception, triage, exam rooms, dental operatory, check-out, supply
rooms) to:
o Identify inefficiencies or delays in service flow
o Document spatial constraints affecting productivity
o Evaluate staff interactions and role overlap
o Understand how equipment, supplies, and space impact clinical operations
5. Interviews and Focus Groups:
We will conduct confidential interviews and/or facilitated group discussions with
key personnel to gather experiential insights on current processes, perceived
challenges, and improvement opportunities. Interviews will include:
o Medical and dental clinicians
o Nursing staff
o Support and administrative personnel
o Billing and front-desk staff
o Leadership and supervisors
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 21
Discussions will be guided by semi-structured protocols to ensure consistency, but
also allow room for open dialogue and discovery.
6. Preliminary Analysis of Service Context and Population Needs :
To ensure our work aligns with OCHD’s broader mission, we will also review
secondary data on:
o Community demographics and social determinants of health
o Service utilization trends across clinics
o Mandated programs (e.g., immunizations, refugee health, family planning)
o Access challenges for underrepresented populations
Deliverables
At the conclusion of Phase 1, we will deliver the following:
• Project Work Plan (Finalized)
Includes a confirmed timeline, roles/responsibilities, and communication cadence.
• Stakeholder Engagement Map & Interview Plan
Identifies all individuals and groups to be consulted, along with interview/focus
group guides.
• Data Collection Matrix
Outlines received datasets, pending documents, and identified gaps.
• Environmental Scan Summary
Summarizes key observations, strengths, challenges, and early insights from site
visits and preliminary data review.
• Operational Snapshots (per Clinic)
One-page summaries per site, highlighting workflows, staffing structures, and
physical setup.
Expected Outcomes of Phase 1
• Alignment between THT and OCHD on scope, goals, and methodology
• Clear understanding of current state operations, staffing patterns, and clinic
environments
• Established trust and rapport with key stakeholders
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 22
• A strong foundation for targeted, relevant, and feasible recommendations in future
phases
3.3.2. Phase 2: Operational & Staffing Evaluation (Weeks 5–8)
Objective:
To conduct a comprehensive evaluation of staffing patterns, operational workflows, and
service delivery structures to determine how well current human resources align with
patient demand, mandated programs, and clinic capacity. This phase will also assess the
scheduling, skill mix, and coverage plans that directly impact access, efficiency, and cost -
effectiveness.
Approach & Activities
1. Current Staffing Model Analysis
Using the data gathered in Phase 1, we will construct a detailed staffing map
showing current staff allocation by role, location, shift, and credential. This analysis
will focus on both Medical and Dental Clinics and will include:
o Full-time, part-time, temporary, and contract staff
o Clinical vs. administrative vs. support roles
o Credentialed assignments (e.g., RN, NP, MA, DDS, DA)
o Average patient load per provider type
The analysis will identify underutilization, redundancy, and any gaps that may be
affecting patient throughput or service coverage.
2. Schedule and Shift Assessment
We will analyze existing daily and weekly scheduling patterns, including:
o Start/end times for clinics and overlap of staff shifts
o Adequacy of provider coverage during peak and low-volume times
o Inefficiencies or overstaffing during periods of low demand
o Use of staggered shifts or cross-functional teams
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 23
Recommendations will focus on realigning schedules to reduce patient wait times,
improve team coordination, and maximize coverage using existing personnel.
3. Relief Factor Calculation
To accurately assess staffing needs, we will calculate a “relief factor” that
incorporates:
o Holidays
o Paid time off (PTO)
o Sick leave
o FMLA
o Military leave
o Administrative time (e.g., meetings, trainings)
o Turnover and vacancy buffers
This ensures that recommendations account for actual available work hours, not just
headcount.
4. Workload and Service Demand Matching
We will map service lines (e.g., maternal health, immunizations, STI testing, dental
hygiene, extractions) against staffing hours to determine:
o If demand outpaces availability in specific service areas
o How staff time is distributed across high - and low-volume services
o Where cross-coverage is needed (e.g., float nurses, dental assistants)
o How mandatory programs are impacting resource allocation
5. Workflow and Role Assessment
Leveraging the workflow maps from Phase 1, we will:
o Conduct task analysis to determine who is doing what, and whether tasks
are appropriately matched to credentials
o Identify duplication, delays, or breakdowns in communication and hand -
offs.
o Evaluate the role of administrative staff in clinic flow (e.g., scheduling,
check-in, record prep, discharge).
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 24
o Explore delegation opportunities and “top of license” practice models to
improve efficiency.
6. Coverage Optimization Scenarios
We will explore staffing model scenarios, including:
o Expanded hours vs. compressed schedules
o Team-based care models
o Hybrid staffing (mix of FTE, PTE, and temporary roles)
o Staff rotation or mobility between sites
Deliverables
At the conclusion of Phase 2, THT will deliver:
• Staffing Utilization Matrix
A comprehensive spreadsheet detailing current staffing coverage, utilization rates,
patient ratios, and gaps by service area.
• Relief Factor Report
A calculation model showing required FTE adjustments to account for leave time
and ensure consistent coverage.
• Schedule & Shift Efficiency Analysis
A narrative and visual report showing where scheduling changes could increase
patient access or reduce redundancy.
• Role and Task Alignment Report
A breakdown of functions vs. credentials, identifying inefficiencies and
recommending delegation or reassignment strategies.
• Service Demand vs. Staffing Alignment Map
An overlay of clinical services and corresponding staffing coverage to highlight
areas of imbalance or unmet need.
Expected Outcomes of Phase 2
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 25
• A clear picture of how well current staffing aligns with clinic operations and
community demand
• Identification of inefficiencies in scheduling and task delegation
• Evidence-based recommendations to better utilize existing human resources
• Foundational insights for strategic modeling in Phase 4
• Practical suggestions for immediate operational adjustments
3.3.3. Phase 3: Technology, Compliance & Revenue Optimization
(Weeks 9–11)
Objective:
To evaluate the technological infrastructure, regulatory compliance posture, and financial
operations of the Orange County Health Department’s Medical and Dental Clinics. This
phase is focused on identifying system-related inefficiencies, gaps in compliance, and
opportunities to improve revenue collection, documentation practices, and data-driven
decision-making.
Approach & Activities
1. Electronic Health Records (EHR) System Review
We will conduct a functional review of the use of UNC’s EPIC (Medical) and
Eaglesoft (Dental) systems, assessing:
o Ease and efficiency of use for clinical and administrative staff
o Data entry duplication or bottlenecks during patient visits
o System integration with scheduling, billing, and reporting workflows
o Barriers to real-time data capture, reporting, or patient tracking
o Training needs or variation in system use across staff members
The goal is to understand how EHR usage supports or hinders clinic efficiency,
provider productivity, and accurate reporting.
2. Data Management and Reporting Processes
We will evaluate how the clinics capture, store, retrieve, and utilize operational and
clinical data:
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 26
o Internal performance metrics (e.g., patient wait time, appointment volume,
follow-ups)
o Reporting for federal or state compliance (e.g., immunization rates,
screenings)
o Use of data for strategic decision-making, grants, and communication with
stakeholders
We will identify areas where improved data architecture, dashboards, or
automation could reduce administrative burden and support better operational
oversight.
3. Regulatory Compliance Assessment
THT will perform a gap analysis of OCHD’s adherence to applicable federal, state,
and internal regulatory frameworks, focusing on:
o HIPAA compliance : privacy protocols, electronic records handling, staff
awareness
o OSHA compliance: clinical safety standards, training, workplace policies
o State and County policies: adherence to specific documentation, scheduling,
and reporting standards
o Risk areas: recent or recurrent compliance issues, staff feedback, observed
lapses
Where gaps are identified, we will offer prioritized recommendations and best
practice examples for remediation.
4. Billing & Revenue Cycle Review
Using billing and financial data, we will conduct a revenue analysis focused on:
o Current payer mix (Medicaid, Medicare, self -pay, commercial insurance)
o Denial rates and root causes
o Timeliness of billing and claim submission
o Frequency and reason for write-offs or lost revenue
o Charge capture accuracy and documentation practices
o Billing staff workflow, training, and technology interface
We will also identify additional revenue streams and grant opportunities that align
with OCHD’s services and mission.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 27
5. Peer Benchmarking & Comparative Analysis
THT will conduct a benchmarking exercise, comparing OCHD’s staffing ratios,
clinical productivity, billing practices, and technology usage to similar county -based
health departments. This contextual analysis will inform:
o Staffing efficiency and coverage standards
o Technology integration benchmarks
o Financial performance comparisons
o Best practices adaptable to Orange County’s context
Deliverables
At the conclusion of Phase 3, THT will provide:
• EHR and Technology Optimization Report
Summary of findings on system usability, data entry flow, integration gaps, and
improvement opportunities.
• Compliance Gap and Readiness Assessment
Matrix of compliance strengths, risks, and prioritized actions for HIPAA, OSHA,
and local standards.
• Revenue Cycle and Billing Efficiency Report
Financial operations analysis including denial reasons, inefficiencies in claims
processing, and new revenue recommendations.
• Payer Mix and Reimbursement Opportunity Snapshot
Overview of current payer distribution and untapped or underutilized
billing/reimbursement options.
• Peer Benchmarking Dashboard
A comparative snapshot showing how OCHD clinics align with similar public
health entities on staffing, systems, and revenue indicators.
Expected Outcomes of Phase 3
• Clarity on how current technology platforms impact efficiency and care delivery
• Specific system enhancements or workflow redesigns to streamline data capture and
documentation
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 28
• A roadmap for improving regulatory compliance and reducing liability risk
• Financial insights and action items to strengthen revenue collection, accuracy, and
sustainability
• Broader context from peer comparisons to inform final recommendations and
strategic planning
3.3.4. Phase 4: Strategic Recommendations & Dynamic Modeling
(Weeks 12–14)
Objective:
To translate findings from the previous phases into a clear, actionable set of strategic
recommendations supported by scenario modeling tools and cost-benefit analysis to guide
Orange County Health Department (OCHD) toward sustainable improvements in clinic
efficiency, access to care, staffing alignment, and financial performance.
Approach & Activities
1. Development of Future-State Staffing Models
Leveraging data from Phases 1 through 3, we will design customized, right-sized
staffing configurations for both the Medical and Dental Clinics. These models will:
o Match staffing to actual patient demand, clinic hours, and mandatory
programming
o Recommend an optimal mix of full-time equivalents (FTEs), part-time, and
temporary staff
o Align roles with licensure, scope of practice, and productivity standards
o Incorporate relief factor adjustments for leave time, training, and vacancies
o Ensure cross-coverage between service lines and support staff
These future-state models will reflect both immediate needs and potential growth
scenarios based on community demand trends.
2. Clinic Hours and Access Optimization
We will evaluate how changes to clinic hours, appointment availability, and
scheduling practices could increase client access and reduce bottlenecks. This
includes:
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 29
o Extended or staggered hours for underserved populations
o Mobile unit utilization for after-school or weekend outreach
o Shift realignment to address peak demand times
o Reduced downtime through improved appointment flow & scheduling
strategy
Recommendations will emphasize maintaining service quality while increasing
throughput.
3. Scenario-Based Dynamic Modeling Tool
THT will develop and deliver an interactive Excel-based model that enables OCHD
leadership to simulate various staffing and operational scenarios. This tool will allow
users to:
o Adjust staffing levels and role configurations
o Calculate corresponding changes in labor costs, patient capacity, and
productivity
o Test the impact of expanded hours or new service lines
o Forecast budget implications under different funding or policy conditions
o Account for policy mandates or population growth projections
The model will be user-friendly, flexible, and accompanied by documentation so it
can be updated and used independently over time.
4. Cost-Benefit and ROI Analysis
Each strategic recommendation will be accompanied by financial projections to
support informed decision -making. This includes:
o Projected cost savings from improved efficiency, reduction in overtime, or
staff reallocation
o Revenue gains from improved billing accuracy, increased service capacity,
or expanded hours
o Long-term return on investment (ROI) based on implementation of
recommended strategies
o Trade-off scenarios, showing short-term investments vs. long-term value
Our financial models will help the County balance efficiency with affordability,
ensuring recommendations are grounded in fiscal reality.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 30
5. Draft Report Development
We will compile all findings, analyses, and recommendations into a well-organized
Draft Report. The report will:
o Summarize key issues, data findings, and stakeholder input
o Present clear recommendations supported by evidence
o Include visualizations (charts, maps, matrices) for clarity
o Reference benchmarks and peer comparisons
o Embed an executive summary suitable for leadership and Board -level
communication
Deliverables
By the end of Phase 4, THT will deliver:
• Future-State Staffing Plan
Detailed recommendations for staffing alignment and structure across Medical and
Dental Clinics.
• Access Optimization Recommendations
Suggestions to improve client access, appointment availability, and care
coordination.
• Interactive Staffing and Operations Simulation Tool
An editable Excel tool with variable inputs, output dashboards, and guided
instructions.
• Cost-Benefit and ROI Forecast Report
Financial modeling of proposed changes and their projected impact.
• Draft Staffing & Efficiency Analysis Report
A comprehensive document that includes:
o Executive Summary for leadership and public communication
o Section-by-section analysis of staffing, operations, technology, revenue, and
compliance
o Strategic recommendations with rationale and implementation
considerations
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 31
o Visuals including staffing matrices, workflow maps, and cost modeling
graphics
o Appendices with data sources, stakeholder input summaries, and
methodological notes
• Presentation Materials (Draft Version)
A visual deck prepared for review with the County leadership and Board of
Commissioners, summarizing:
o Key findings
o Proposed staffing models
o Technology and revenue opportunities
o Cost and benefit projections
o Implementation considerations
Expected Outcomes of Phase 4
By the end of this phase, Orange County Health Department will have a clear, data-backed
strategic plan and practical tools to guide operational decision-making. Specific outcomes
include:
• Strategic Clarity: A well-articulated roadmap for improving clinic efficiency and
aligning staffing with service demand
• Actionable Tools: A dynamic simulation model to support future internal planning
without ongoing consultant support
• Financial Insight: A comprehensive understanding of the fiscal implications of
proposed changes, allowing for smarter budgeting and resource allocation
• Leadership Buy-In: A concise and compelling narrative to engage senior
stakeholders and support the change management process
3.3.5. Phase 5: Finalization, Presentation & Knowledge Transfer
(Weeks 15–16)
Objective:
To finalize all deliverables, validate findings with key stakeholders, present the final
analysis and recommendations to County leadership, and ensure a smooth handoff of tools,
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 32
insights, and implementation support. This final phase is centered on knowledge transfer,
collaborative refinement, and preparing OCHD for sustained action beyond the consulting
engagement.
Approach & Activities
1. Stakeholder Review of Draft Report
THT will facilitate a structured review of the Draft Staffing and Efficiency Analysis
Report with County leadership and clinic managers. This collaborative session will:
o Walk through each section of the report, focusing on findings, methodology,
and recommendations
o Solicit clarifications, feedback, or corrections from stakeholders
o Identify sections that require further detail or contextual adaptation
o Align on any proposed changes before the report is finalized
This step ensures that the report is not only accurate but also reflects internal
realities and garners broad organizational buy-in.
2. Revisions and Final Report Production
Based on the review session and feedback received, THT will revise the draft and
produce the Final Report, ensuring clarity, visual appeal, and actionable structure.
This will include:
o Executive Summary for external or leadership-facing use
o Technical narrative for internal operations and planning
o Appendices with modeling data, methodology, and supporting
documentation
o Clearly labeled recommendations by category (Staffing, Workflow,
Revenue, Technology, Compliance) with timelines and resource
implications
3. Board of Commissioners Presentations
THT will support two in-person presentations to the Orange County Board of
Commissioners:
o Draft Presentation : Walkthrough of key findings and strategic options to
gather preliminary feedback from elected officials
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 33
o Final Presentation: A refined and formal presentation of the final report and
recommendations, inclusive of costs, benefits, and implementation roadmap
Presentations will be tailored to a non-technical audience, using visuals and succinct
language to highlight community impact, efficiency gains, and sustainability.
4. Knowledge Transfer & Capacity Building
To ensure long-term success, THT will facilitate a knowledge transfer session with
designated County staff. This session will:
o Train personnel on how to use and update the Dynamic Staffing &
Operations Model
o Provide walkthroughs of templates, calculations, and assumptions
o Review how to apply the model during budgeting, hiring, or service
expansion planning
o Ensure that clinic leadership feels confident in interpreting and applying
findings
We will also provide a Toolkit for Implementation, which includes:
o A Change Management Checklist
o Recommended Communication Templates for staff rollout
o Milestone Timeline for short-term and long-term actions
o Resource Planning Guide to align staffing recommendations with available
funding
5. Project Close -Out and Ongoing Support Planning
We will conclude the engagement with a formal Close-Out Memorandum,
summarizing:
o What has been delivered
o Remaining open questions or next steps
o Opportunities for future technical assistance (if requested)
o Optional check-in or follow-up sessions to support implementation
Deliverables
By the conclusion of Phase 5, THT will deliver:
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 34
• Final Staffing and Efficiency Analysis Report (Word & PDF formats)
• Executive Summary Slide Deck (PowerPoint)
• Final Dynamic Staffing & Operations Simulation Tool with embedded formulas and
drop-down inputs
• Toolkit for Implementation including checklists, guides, and templates
• Presentation to Board of Commissioners (Draft and Final)
• Knowledge Transfer Guide & Live Training Session for Key Staff
• Close-Out Memo summarizing engagement outcomes and final recommendations
Expected Outcomes of Phase 5
• Stakeholder validation and ownership of findings and strategies
• Increased confidence and capacity within OCHD leadership to act on
recommendations
• A shared vision between County administration and elected officials
• A lasting set of tools and documentation to guide future operations and decision -
making
• A clean and confident transition from planning to implementation
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 35
4. EXPERIENCE AND QUALIFICATIONS
The Hills Tandem brings over a decade of experience delivering innovative, data-informed
solutions to public health departments, healthcare systems, and mission-driven
organizations. Our consulting firm specializes in the assessment, transformation, and
optimization of health service delivery models, particularly for clinics and community
health programs serving diverse and underserved populations.
THT’s work has consistently centered on strengthening operational efficiency, improving
clinical access, building sustainable staffing structures, and aligning practice management
strategies with state and federal mandates. Our team is equipped with deep t echnical
expertise, real-world policy insight, and on-the-ground experience supporting
organizations that mirror the size, scope, and complexity of the Orange County Health
Department’s Medical and Dental Clinics.
4.1. Relevant Organizational Experience
1). Howard University Hospital – Center of Excellence (Sickle Cell Disease)
We provided strategic and operational support to Howard University Hospital in its
designation and development as a Center of Excellence for Sickle Cell Disease. This
federally supported initiative required a high level of clinical coordination, stakeholder
engagement, and performance planning to ensure the sustainability and quality of
specialized care.
As part of this engagement, we worked closely with hospital leadership and clinical teams
to:
• Conduct an assessment of existing clinical services and staffing resources ,
identifying gaps in service delivery and misalignment in provider roles.
• Develop a comprehensive strategic framework for optimizing clinical workflows,
streamlining patient navigation, and aligning staff scheduling with service demand.
• Support the integration of federal care coordination standards with the hospital’s
internal systems, including compliance with HRSA program expectations and sickle
cell-specific clinical benchmarks.
• Advise on sustainable resource allocation, recommending strategies to improve
clinic operations, patient access, and staff utilization within the constraints of a
complex academic hospital setting.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 36
The Howard University Hospital engagement is especially relevant to Orange County’s
goals, as it involved a multi-disciplinary health clinic serving a diverse and often medically
underserved population, navigating challenges in staffing, efficiency, revenue recovery,
and strategic service planning. The work required translating federal and state mandates
into local, operationalized strategies, a key parallel to the current RFP scope.
2). Sickle Cell Disease Foundation of California (SCDF)
We have maintained a long-standing, multi-year partnership with the Sickle Cell Disease
Foundation of California (SCDF), one of the largest and oldest community -based
organizations serving individuals with sickle cell disease nationwide. This engagement
showcases THT’s ability to deliver the full range of services outlined in Orange County’s
RFP: from staffing assessment and workflow redesign to data system implementation and
financial sustainability planning.
Key areas of contribution included:
• Clinical Staffing and Operations Analysis: THT conducted a thorough review of
SCDF’s staffing structure across both fixed-site and mobile clinic operations. The
team assessed staff utilization, scheduling efficiency, and alignment of credentials
with roles, resulting in an optimized personnel strategy that improved service reach
and reduced bottlenecks in care delivery.
• Case Management and Data Systems Innovation : THT co-designed and
implemented SC CARES, a HIPAA-compliant, cloud-based case management
platform. This system is now nationally used across sickle cell -serving organizations
and enables staff to track patient encounters, document support services, analyze
clinical touchpoints, and report on outcomes, all in real time.
• Revenue Cycle and Financial Strategy: We supported SCDF in identifying
underutilized billing codes and opportunities to recover costs through proper
documentation, coding, and payer engagement. This work included training
administrative staff on best practices and building internal controls to sustain
financial compliance.
• Strategic Planning and Workforce Development : We led the design of SCDF’s long-
term workforce plan, including tools for onboarding, cross -training, and retaining
part-time staff amid recruitment challenges, particularly aligned with post-
pandemic constraints in hiring clinical & support personnel.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 37
• Regulatory and Compliance Alignment : In collaboration with SCDF’s leadership,
we ensured that all workflows, staffing models, and service delivery adjustments
complied with state and federal standards, including HRSA, CMS, HIPAA, and
California Department of Public Health guidelines.
This engagement demonstrates our ability to support a community-facing clinic model
serving a racially diverse and medically vulnerable population, while delivering sustainable
operational improvements across clinical, administrative, and strategic domains. The depth
and complexity of this project mirrors many of the challenges and expectations identified
in the Orange County RFP.
3. Nevada Cancer Institute / Southern Nevada Health District
We served as a strategic implementation partner for a CDC-funded tobacco cessation
initiative delivered through a regional partnership between the Nevada Cancer Institute
and the Southern Nevada Health District . This engagement spanned several counties and
involved collaboration with public health departments, clinical service providers, and
community health educators, many of whom operated in both urban and rural settings.
THT’s contributions directly reflect the scope of services required by Orange County and
included:
• Clinic Workflow Design and Staff Utilization Analysis : THT assessed operational
structures across community health centers and mobile service units, focusing on
how staff were deployed, trained, and supervised across sites. We developed role
clarity tools and realigned responsibilities to improve efficiency in intake,
education, referral, and follow-up.
• Performance Tracking and Impact Measurement : The team created custom data
dashboards and evaluation frameworks to measure service impact, track client
engagement, and assess staff productivity across sites. THT also supported the
collection and interpretation of key performance indicators (KPIs) needed to meet
CDC reporting requirements.
• Interdepartmental Coordination Support : THT facilitated alignment between
public health educators, clinical supervisors, and administrative staff to streamline
communication, reduce duplication of effort, and ensure consistency in patient
messaging and documentation.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 38
• Compliance and Federal Grant Management : In partnership with leadership at the
Nevada Cancer Institute, THT provided technical assistance on CDC compliance,
reporting accuracy, and the alignment of clinical activities with the grant’s intended
outcomes.
This project required an ability to manage the complex intersection of public health
priorities, clinical services, community engagement, and federal grant deliverables , all
within a setting where workforce shortages, regulatory compliance, and geographic reach
were active challenges. These same dynamics are present in Orange County’s medical and
dental clinics, making this experience highly relevant to the County’s current needs.
4.2. Qualifications of Assigned Project Team
THT has assembled a team of deeply experienced professionals with subject matter
expertise directly aligned to the scope and deliverables defined by Orange County. Each
individual brings a successful history of supporting federally and state-funded public health
programs, clinic efficiency projects, and performance reporting systems.
• Jennifer Fields, MPH – Project Director
Ms. Fields is the Founder and CEO of THT and brings over 15 years of experience
in public health program design and strategic clinic operations. She has led regional
and national contracts involving HRSA, CDC, and multiple state departments of
health. Her leadership on the SC CARES platform and North Carolina’s Governor’s
Council for Sickle Cell Disease showcases her ability to navigate clinical compliance,
workforce strategy, and data -informed public health improvement.
• Keia Eaves, MSL – Technical Project Delivery Manager
Ms. Eaves is a veteran in federal public health program management with over 20
years of experience leading multi-million-dollar government contracts. Her
expertise includes operational planning, inter-agency coordination, and quality
assurance, making her essential to the delivery of this project’s milestones.
• Amistad St. Arromand, MSHS – Lead Analyst
Currently a Public Health Analyst with HRSA, Mr. St. Arromand brings critical
experience in contract performance, staffing analysis, and workload modeling. He
has managed federal programs across 10 states and has designed performance
metrics and evaluation frameworks directly relevant to this project’s deliverables.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 39
• Sherrita Summerour, MA – Clinical Operations Specialist
Ms. Summerour’s background in maternal and child health systems at the Georgia
Department of Public Health provides unique insight into clinical workforce
coordination, public-private partnerships, and early intervention services. She has
led multi-agency system-building efforts and clinic-level workflow transformation
initiatives.
• Shalini Vora, MPH – Revenue Cycle Expert
Ms. Vora has over 15 years of experience managing clinical program funding and
reimbursement. Her roles at the Center for Inherited Blood Disorders and Charles
B. Wang Community Health Center included oversight of financial compliance,
reporting, and identification of billing inefficiencies, making her ideally suited to
lead revenue opportunity analysis for OCHD.
• Chris Smith, MBA, PMP, SPC – Technology Implementation Lead
Mr. Smith is a certified cloud and AI systems architect who has overseen technology
integration projects across healthcare and environmental sectors. His experience
with EHR modernization, data governance, and machine learning platforms aligns
directly with the County’s request for an assessment of its current clinic data
systems.
• Sharon Homer-Drummond, PhD – Research Analyst
Dr. Homer-Drummond has served as a strategic advisor and evaluator across
science, health, and equity-focused government programs. Her ability to conduct
policy-relevant benchmarking and translate data into action will strengthen the
narrative and strategic framing of the final report.
4.3. Access to Prior Analyses and Reports
THT maintains internal samples of de-identified staffing assessments, performance
dashboards, and workflow analysis tools that can be adapted for Orange County. These
include:
• A replicable, editable staffing and efficiency model, built using validated data and
aligned with federally accepted productivity standards.
• Narrative reporting templates used in past presentations to county boards and public
health leadership teams.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 40
• Process mapping tools for front-desk intake, EHR transitions, and
interdepartmental workflow tracking.
• Compliance reporting frameworks for HIPAA, OSHA, and Title V programs.
Upon award, Orange County will receive customized versions of these tools for use in
internal planning, policy presentations, and future benchmarking
5. CAPABILITY AND CAPACITY TO PERFORM THE
PROJECT
The Hills Tandem possesses the proven capability, operational infrastructure, and expert
personnel to successfully execute the comprehensive staffing and efficiency analysis for the
Orange County Health Department (OCHD). Our firm has an extensive track re cord
delivering high-stakes projects in public health environments with comparable complexity,
regulatory requirements, and community needs.
THT has supported local health departments, safety net providers, and federally funded
clinics in developing scalable systems for operational efficiency, financial sustainability,
and equitable service delivery. Our portfolio demonstrates our ability to assess and improve
clinic workflows, align staffing models with demand, enhance service access, and build
sustainable revenue structures.
5.1. Firm Profile and Track Record
Founded to drive systems transformation across healthcare and community health
ecosystems, we are a consulting firm with national reach. We specialize in workforce
design, health technology optimization, strategy execution, & stakeholder-centered public
health delivery models.
THT has led high-impact engagements with:
• Howard University Hospital – Center of Excellence (Sickle Cell): THT served as a
strategic partner to support clinical program design and optimization, stakeholder
coordination, and service delivery modeling.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 41
• Sickle Cell Disease Foundation of California (SCDF): Our multi-year partnership
included conducting operational capacity assessments, implementing a cloud-based
case management platform (SC Cares), training community health workers, and
aligning state-funded programming with long-term sustainability strategies.
• Nevada Cancer Institute / Southern Nevada Health District: THT designed and
executed a regional tobacco cessation initiative with the CDC, focusing on scalable
outreach, program tracking, and clinic integration, delivering measurable outcomes
in access & participation across multiple jurisdictions.
These references affirm our ability to navigate multidisciplinary projects requiring
stakeholder engagement, compliance oversight, data integration, and culturally responsive
design characteristics central to the Orange County Health Department's needs.
5.2. Capability Aligned to Scope of Work
Our service delivery model is uniquely positioned to meet all expectations outlined in the
Orange County RFP. Our internal capacity includes technical and subject matter experts
who will directly lead the execution of each required task:
1). Staffing Analysis and Workforce Modeling
We specialize in conducting comprehensive staffing assessments that account for:
• Net annual work hours
• Relief factor calculations (e.g., FMLA, holidays, sick leave, training time)
• Role alignment by credential and scope of practice
• Full-time, part-time, and temporary workforce mix modeling
Our analysts have experience calculating coverage ratios that align with both current
demand and future growth, particularly within safety net clinics and county health
departments.
2). Workflow and Process Evaluation
Our clinical operations team brings expertise in Lean-informed, patient-centered workflow
assessments. We evaluate:
• Scheduling and registration processes
• Documentation and information flow between clinic stations
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 42
• Physical space utilization
• Client throughput and service time per visit
• Coordination among multidisciplinary care teams
This enables us to deliver precise, actionable recommendations that improve operational
flow and reduce staff strain key for Orange County’s dual-clinic model in Chapel Hill and
Hillsborough.
3). Revenue Cycle and Financial Performance
We have a long-standing record of analyzing financial systems in clinics serving Medicaid,
Medicare, and uninsured populations. Our fiscal consultants will assess:
• Billing practices, coding accuracy, and claim rejections
• Missed revenue opportunities from under-documented services
• Financial impact of current scheduling models
• Alignment of clinical services with reimbursable activities
Our experience with federally funded programs, including HRSA and CDC grants, enables
us to contextualize financial recommendations within applicable compliance frameworks.
4). Practice Management Technology Review
Our technology implementation team has led digital modernization efforts across health
systems and public agencies. For this engagement, we will evaluate:
• Efficiency of electronic medical record (EMR) and practice management systems
• Data interoperability and accessibility across departments
• Accuracy and timeliness of reporting systems
• Potential for system enhancements or integrations to support operational and fiscal
goals
We bring enterprise-level expertise in both cloud -based and hybrid systems, allowing us
to tailor recommendations to the County’s infrastructure and regulatory constraints.
5). Strategic and Policy Alignment
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 43
Our cross-sector research and advisory teams will:
• Benchmark OCHD against peer institutions and best practices
• Assess compliance with HIPAA, OSHA, and relevant state/federal mandates
• Align recommendations with public health mandates, Board of Health goals, and
evolving community needs
• Translate findings into policy-adaptable insights to support executive and legislative
decision-making
5.3. Operational Infrastructure and Team Capacity
We maintain the internal capacity and infrastructure to initiate and manage this
engagement efficiently and effectively. Our structure includes:
• A dedicated project leadership team, including a full -time Project Director and
Technical Project Delivery Manager, to oversee the day-to-day operations,
stakeholder communications, and deliverable coordination.
• A full team of specialists with verified expertise in analysis, clinical operations,
research, technology, and finance all of whom have been assigned to this project
and are available to begin upon contract award.
• A secure, cloud-based project management environment to ensure timely
communication, document version control, and full transparency with Orange
County stakeholders.
• Organizational readiness to deliver within the anticipated timeline and adjust to
changes as needed based on data availability, stakeholder access, or updated county
priorities.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 44
6. PROJECT TIMELINE
The Hills Tandem proposes a structured, milestone-based project timeline to execute the
comprehensive staffing and efficiency analysis for the Orange County Health Department’s
Medical and Dental Clinics. This timeline reflects a phased approach aligned with the
County’s priorities, the scope of work defined in the RFP, and the expected deliverables
and review process outlined in the project requirements.
We will maintain open and consistent communication with the County’s designated
project management team throughout the engagement and ensure adherence to all timeline
expectations. We anticipate project kickoff upon contract award and completion of all
deliverables by the final deadline established by Orange County.
6.1. Proposed Timeline
We propose a comprehensive 16-week timeline, segmented into five key phases. Each
phase is strategically designed to build upon the insights of the previous one, ensuring
continuous stakeholder engagement, timely deliverables, and a seamless transition from
assessment to actionable recommendations.
Week(s) Phase Key Activities Primary Deliverables
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 45
1–4 Phase 1: Discovery
& Initial
Assessment
Kickoff meeting with County
leadership and clinic directors;
data collection; stakeholder
interviews; site visits at Chapel
Hill and Hillsborough clinics;
workflow observations
• Project Work Plan
• Environmental Scan
Summary
• Data Matrix
• Stakeholder Engagement
Plan
• Site Visit Snapshots
5–8 Phase 2:
Operational &
Staffing Evaluation
Analyze staffing structures,
scheduling patterns, relief
factors, role/task alignment, and
service coverage; map workflows
and gaps
• Staffing Utilization Matrix
• Relief Factor Report
• Task Alignment Analysis
• Service Demand vs. Staffing
Map
9–11 Phase 3:
Technology,
Compliance &
Revenue
Optimization
Review use of EPIC and Eaglesoft
systems; assess data/reporting
processes, HIPAA/OSHA
compliance, billing practices, and
payer mix; benchmark against
peer clinics
• EHR Optimization Report
• Compliance Gap Matrix
• Revenue Cycle Analysis
• Peer Benchmarking
Dashboard
12–14 Phase 4: Strategic
Recommendations
& Dynamic
Modeling
Develop future-state staffing
models; build simulation tool;
conduct cost-benefit analysis;
draft strategic report and
presentation materials
• Future-State Staffing Plan
• Scenario Modeling Tool
• Cost-Benefit Analysis
• Draft Report & Presentation
Deck
15–16 Phase 5:
Finalization,
Presentation &
Knowledge
Transfer
Finalize all deliverables; conduct
staff training; present final
recommendations to Board of
Commissioners; complete project
close-out
• Final Report
• Executive Summary Slides
• Implementation Toolkit
• Training Session
• Close-Out Memo
6.2. Ongoing Throughout the Project
• Status Updates: Bi-weekly written progress reports and standing calls with Orange
County Health Department.
• Documentation: All deliverables will be submitted electronically in accessible
formats (e.g., Microsoft Word, Excel, PDF), with bookmarked navigation and
appropriate version control.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 46
• Adaptability: Timeline may be adjusted slightly based on County preferences or
external constraints, with all changes formally communicated in writing and
mutually agreed upon.
7. REFERENCES
We have a demonstrated record of excellence in managing high-impact public health
initiatives, systems transformation projects, and clinical operations improvement
engagements. Below are three references that reflect our relevant experience in conducting
complex assessments and providing strategic guidance to medical and public health entities.
Each project showcases our capacity to work with multidisciplinary stakeholders, deliver
data-driven recommendations, and implement sustainable solutions in both clinical a nd
community-based settings.
1). Howard University Hospital – Center of Excellence (Sickle Cell Disease)
Client Contact:
• Name: Shalewa Noel
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 47
• Title: Executive Director
• Phone: 410-507-8731
• Email: shalewa.noel@howard.edu
Scope of Work:
We served as a strategic advisor and coordination partner for the Howard University
Hospital’s federally funded Sickle Cell Disease Center of Excellence. Our team supported
program development, stakeholder engagement, and regional planning. This included
facilitation of multi-agency collaboration, data infrastructure development, and technical
assistance aligned with HRSA performance standards. We also assisted in aligning
programmatic activities with state and federal compliance expectations.
2). Sickle Cell Disease Foundation of California (SCDF)
Client Contact:
• Name: Mary Brown
• Title: President and CEO, SCDF
• Phone: 909-743-5226
• Email: maryb@scdfc.org
Scope of Work:
Since 2016, we have maintained a multi-year partnership with SCDF, providing
comprehensive strategic and operational support. Services include implementation of the
SC Cares Case Management System (a cloud-based SaaS platform designed by THT),
workforce development, sustainability planning, and regional technical assistance for
HRSA-funded demonstration programs. We also led stakeholder interviews, data analytics,
and compliance support under the Pacific Sickle Cell Regional Collaborative (PSCRC).
3). Nevada Cancer Institute / Southern Nevada Health District
Client Contact:
• Name: Maria Azzarelli
• Title: Manager, Office of Chronic Disease Prevention & Health / Southern Nevada
Health District (SNHD)
• Phone: 702-768-7659
• Email: azzarelli@snhdmail.org
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
The Hills Tandem, LLC | May 18, 2025
Staffing and Efficiency Analysis | Solution
Confidential and Proprietary: This proposal is intended solely for the use of the recipient organization. 48
Scope of Work:
Through a CDC-funded initiative, THT (via Ms. Jennifer Fields / Jennifer Calevro) led
public health programming at the Nevada Cancer Institute in collaboration with the
Southern Nevada Health District. The project included a regional tobacco cessation
program, clinical-community linkage development, performance monitoring, and
compliance management. THT contributed to strategy design, community engagement,
and reporting aligned with federal grant requirements.
These references demonstrate our capability to manage multidisciplinary health
improvement initiatives, conduct efficient clinic and system evaluations, and deliver
strategic recommendations that drive measurable outcomes. We welcome the opportunity
for Orange County to contact these organizations to further validate our impact and
professionalism.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
13
SUBMIT WITH PROPOSAL
PRICING FORM
TASKS DESCRIPTION PRICE
Task 1 Project Management $
Task 2
Evaluation of current service delivery (Medical &
Dental) $
Task 3
Analysis of Staffing Model (to include calculation of
relief factors) (Medical & Dental) $
Task 4 Workflow/Process Analysis (Medical & Dental) $
Task 5
Assessment of Physical Space(s) (Medical &
Dental)
Task 6 Assessment of billing/collections process
$
Task 7
Comprehensive Health Department Clinical
(Medical & Dental) Staffing & Efficiency Analysis
Report $
Total Cost $
8,500.00
9,600.00
7,300.00
7,200.00
5,900.00
8,600.00
8,200.00
55,300.00
$
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
ADDENDUM ACKNOWLEDGEMENT FORM
Consultants must acknowledge receipt of addendums posted by Orange County before the
RFP/RFQ deadline. Please initial for Addendums received.
Addendum No 1 ________________
Addendum No 2 ________________
Addendum No 3 ________________
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
SUB*IIT WITH PROPOSAL
STATE OF NORTH CAROLINA
AFFIDAVIT
ORANGE COUNTY
,t*** *,S *,fi * * !i t:1.d.* rr,*** * * ** * **
individual attesting below), being duly authorized by and on behalf of
{the entity bidding on project hereinafter "Employer") after first being duly
sworn hereby swears or affirms as follows
1. Employer understands that E;,Ve,rifv is the federal E-Verify program operated by the United $tate$
Department of Homeland Security and other federal agencies, or any $uccessor or equivalent program used to verify
the work authorization of newly hired employees pursuant to federal law in accordance with NCG$ $64.2${5}.
2.EmpIoyerunderstandsthatM.Eachemployer,afterhiringanemployeetowork
in the United States, shallverify the work authorizatiorr of the employee through E-Verifu in accordance with
NCG5964-?6(a).
3. Emqlqyer is a person, business entity, or other organization that transacts business in this State and that
employ* 25 or more employees in this State. (mark Yes or No)
a. YES
b. N0
,or7
4. Employer's subcontractors comply with E-Verifo, and if Employer is the winning bidder on this project
Employer will ensure compliance with E-Verify by any subcontractors subsequently hired by Employer.
rhis llhdav ot W4^ .zo,af
of nt
br Type Name:,)enn'.fte ae tdS
State of Ngqth Sflrolina, Chrllu;rn County
$igned and sworn to (or affirmed) hefore me, this *fi lq
day of [\ao 2a!5
My Commission Expires: \Ct "' ,Ae1
+*'o+t
P.n)
zo
o,g
IAoq)
L
I,V ; 1* ch'?
lso1r41, L Ss-cl,.z Notary Public
t,
I
NOTARP
PuaLtc
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
ORANGE COUNTY NONDISCRIMINATION CERTIFICATION
The undersigned bidder or proposer hereby certifies and agrees that the following
information is correct:
1.In preparing its enclosed bid or proposal, the undersigned bidder or proposer has
considered all bids and proposals submitted from qualified, potential subcontractors and
suppliers, and has not engaged in discrimination as defined in Section 12-52 of the
Orange County Non-discrimination Ordinance.
2.Without limiting any other remedies that Orange County may have for a false
certification, it is understood and agreed that, if this certification is false, such false
certification will constitute grounds for Orange County to reject the bid or proposal
submitted with this certification, and terminate any contract awarded based on such bid
or proposal. It shall also subject the bidder or proposer to disqualification from
participating in county contracts or bid processes for up to two years.
3.As a condition of contracting with Orange County, the undersigned bidder or
proposer agrees to promptly provide to Orange County all information and
documentation that may be requested by Orange County from time to time regarding
the solicitation and selection of suppliers and subcontractors in connection with this
solicitation process. Failure to maintain or failure to provide such information constitutes
grounds for Orange County to reject the bid or proposal and to terminate, without
penalty to Orange County, any contract awarded on such bid or proposal. All such
information and documentation shall be maintained for a period of three years after the
expiration of the contract.
4.As part of its bid or proposal, the undersigned bidder or proposer shall provide to
Orange County a list of all instances within the past ten years where a complaint was
filed or pending against bidder or proposer in a legal or administrative proceeding
alleging that bidder or proposer discriminated against its subcontractors, vendors,
suppliers, or commercial customers, and a description of the status or resolution of that
complaint, including any remedial action taken.
5.As a condition of submitting a bid or proposal to Orange County the undersigned
bidder or proposer agrees to comply with the Orange County Non-discrimination
Ordinance. Falsification of this certification shall constitute a violation of the Orange
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
County Non-Discrimination Ordinance and shall be grounds for rejection of the bid or
proposal or termination of an existing contract, without fault or further obligation to
Orange County.
6.As a condition of submitting a bid or proposal to Orange County the undersigned
bidder or proposer agrees that Orange County may consider the information submitted
as part of this certification in its determination of the responsibility of the undersigned
bidder or proposer. The undersigned bidder or proposer, as the case may be, waives
the right to challenge the rejection of a bid or proposal when such rejection is based, in
its entirety, on information submitted as part of this certification.
The bidder or proposer certifies the undersigned has full authority to sign on its behalf.
By:________________________________________
___________________________________________
Printed Name and Title
On behalf of _________________________________
___________________________________________
Company or Corporate name
Jennifer Fields, President & CEO
The Hills Tandem LLC,
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Supplemental Vendor Information: HISTORICALLY UNDERUTILIZED BUSINESSES
Vendor Name: __________________________________ Date: _________
Per G.S. 143-128.4, Historically Underutilized Businesses (HUBs) consist of minority, women and disabled
business firms that are at least fifty-one percent (51%) owned and operated by an individual(s) who are
members of the following groups: Black, Hispanic, Asian American, American Indian, Female, Disabled,
Disadvantaged.
The Vendor shall respond to question No 1 and No 2 below.
1)Is Vendor a Historically Underutilized Business?Yes No
If yes, please select from the following:
Ethnicity:Gender Disabled
Black Male Yes
Hispanic Female No
Asian American
American Indian
2)Is Vendor Certified with North Carolina as a Historically Underutilized Business?Yes No
If so, state HUB classification: _______________________________________________________
Any questions concerning NC HUB certification, contact the North Carolina Office of Historically
Underutilized Businesses at (919) 807-2330.
SUBMIT WITH PROPOSAL
__________The Hills Tandem, LLC________05/19/2025
Black
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Attachment B – Revised Project Staffing Plan
Revised Project Staffing Plan
Orange County Health Department – Medical & Dental Clinics Staffing and Efficiency
Analysis
Purpose of Amendment
This amendment documents a revision to the consultant project staffing plan for the Orange
County Health Department Medical and Dental Clinics Staffing and Efficiency Analysis. The
adjustment reflects a realignment of personnel assignments following a delayed project launch
and is intended to ensure efficient execution, continuity of leadership, and timely delivery of all
contracted services. The scope of work, deliverables, timeline expectations, and total contract
value remain unchanged.
Rationale for Staffing Realignment
Due to a delay between contract award and project initiation, several originally proposed
personnel became unavailable for participation during the revised project execution window as a
result of prior contractual obligations. To address this change while maintaining project
continuity and performance standards, The Hills Tandem restructured the project team to a
focused, senior-led implementation model.
This realignment was intentionally designed to:
• Preserve full compliance with the approved scope of services
• Concentrate analytical and operational responsibilities among experienced senior staff
• Reduce handoffs and coordination complexity
• Maintain direct accountability for deliverables and stakeholder engagement
The revised staffing structure reflects a practical adjustment to project timing conditions and
does not represent a reduction in expertise, capacity, or service commitment.
Revised Project Staffing and Responsibilities
Jennifer Fields, MPH – Project Director
Ms. Fields will retain full responsibility for executive oversight, strategic direction, and quality
assurance for the duration of the engagement.
Primary responsibilities include:
• Serving as the primary point of contact for Orange County leadership
• Providing strategic oversight of staffing models, efficiency analyses, and final
recommendations
• Co-leading advanced staffing and operational analysis with the Lead Analyst
• Ensuring compliance with applicable regulatory, policy, and best practice standards
• Reviewing and approving all deliverables prior to submission
• Leading or co-presenting findings to County leadership and the Board of Commissioners,
as required
Antonette Esmele – Program Manager
Ms. Esmele will oversee day-to-day project coordination and execution management.
Primary responsibilities include:
• Managing the project timeline, task sequencing, and milestone tracking
• Coordinating data requests, interviews, site visits, and stakeholder meetings
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Attachment B – Revised Project Staffing Plan
• Monitoring progress across all workstreams to ensure adherence to schedule and
deliverables
• Supporting documentation management, meeting facilitation, and status reporting
• Ensuring timely communication and follow-through between the consultant team and
County staff
Synetheris Nettles – Lead Analyst
Ms. Nettles will serve as the primary analytical lead and will dedicate the majority of project
hours to execution of the staffing and efficiency analysis.
Primary responsibilities include:
• Leading quantitative and qualitative staffing analyses, including workload assessment
and relief factor calculations
• Evaluating staffing alignment with service demand and clinic operations
• Co-developing future-state staffing models with the Project Director
• Supporting development of the electronic staffing analysis model
• Drafting analytical components of the staffing and efficiency report
Ron Toran – Workflow and Process Analysis Specialist
Mr. Toran will support evaluation of clinic operations and workflow efficiency.
Primary responsibilities include:
• Conducting workflow assessments across medical and dental clinic operations
• Mapping patient flow and identifying operational bottlenecks
• Assessing physical space utilization and its impact on service delivery
• Aligning workflow findings with staffing and scheduling recommendations
• Contributing workflow-related findings to the final report
Assurance of Scope, Quality, and Deliverables
The Hills Tandem affirms that this staffing realignment does not modify the approved scope of
services, required deliverables, or performance expectations outlined in the contract. All work
products identified in the original Request for Proposals and consultant proposal will be
completed as specified.
The revised staffing model enhances efficiency by assigning a greater proportion of project work
to senior staff directly responsible for analysis, synthesis, and recommendation development.
This structure supports timely execution, clear accountability, and high-quality outcomes for the
County. No reduction in analytical rigor, stakeholder engagement, or reporting quality will result
from this amendment.
JENNIFER FIELDS, MPH, MBA
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Attachment B – Revised Project Staffing Plan
Founder & Project Director
The Hills Tandem, LLC | Raleigh, NC | 2014–Present
Professional Summary
Strategy and systems leader with 20+ years of experience directing multi -sector public health,
workforce, and compliance initiatives. Proven expertise leading complex, federally and state-
funded programs, designing staffing and efficiency models, and translating operational data into
policy-aligned recommendations for government clients.
Relevant Experience
The Hills Tandem, LLC – Founder & Director (2014–Present)
• Lead national consulting firm delivering staffing, governance, and operational efficiency
analyses for public health departments, healthcare systems, and state agencies
• Direct multi-million-dollar portfolios aligned with HRSA, Medicaid, CDC, and state
public health priorities
• Lead staffing and workflow analyses, relief factor modeling, and executive-level
recommendations for county and state clients
• Serve as lead presenter to Boards of Commissioners and executive leadership
(Prior experience retained as submitted; no material changes required)
MARTHA ANTONETTE ESMELE, RND, MPH
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Attachment B – Revised Project Staffing Plan
Program Manager
The Hills Tandem, LLC | 2023–Present
Professional Summary
Public health program manager with experience overseeing complex, multi -stakeholder
initiatives, coordinating data collection, monitoring implementation, and supporting evidence-
based decision -making. Background in nutrition programs, public health reporting, and cross-
agency coordination.
Relevant Experience
The Hills Tandem, LLC – Program Manager (2023–Present)
• Manage project timelines, milestones, and deliverable coordination for public-sector
consulting engagements
• Coordinate data requests, site visits, interviews, and stakeholder meetings
• Track progress across staffing, workflow, and analytical workstreams to ensure timely
completion
• Support preparation of reports, presentations, and status updates for government clients
National Nutrition Council – Nutrition Officer II (2024–Present)
• Support management and monitoring of national nutrition programs
• Prepare progress reports and inter-agency coordination materials
Samaritan’s Purse – Nutrition Program Manager (2016–2023)
• Led design, implementation, and evaluation of multi-year nutrition programs
• Managed budgets, staff supervision, procurement, and performance monitoring
RON TORAN
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Attachment B – Revised Project Staffing Plan
Workflow & Process Analysis Specialist
The Hills Tandem, LLC | 2024–Present
Professional Summary
Senior organizational effectiveness and workforce strategy professional with extensive
experience in workflow optimization, talent systems, and operational transformation across
public and private sectors. Brings a systems-level perspective to aligning staffing, processes, and
organizational performance.
Relevant Experience
The Hills Tandem, LLC – People and Strategy Officer (2024–Present)
• Conduct workflow and process assessments for public-sector and healthcare clients
• Map operational flows, identify bottlenecks, and assess role alignment
• Support integration of workflow findings into staffing and efficiency recommendations
Smithfield Foods – Director, People & Culture (2022–Present)
• Lead enterprise workforce strategy, engagement, and organizational effectiveness
initiatives
SYKES Enterprises – Director, DEI & Talent Strategy (2019–2021)
• Directed global workforce strategy and leadership development initiatives
(Prior experience retained as submitted; no material changes required)
SYNETHERIS NETTLES, MA
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Attachment B – Revised Project Staffing Plan
Lead Analyst – Staffing & Efficiency Analysis
The Hills Tandem, LLC | 2026–Present
Professional Summary
Senior analytical and systems consultant with more than 20 years of experience supporting large-
scale public sector, healthcare, and enterprise initiatives involving workforce systems, business
process analysis, operational efficiency, and change management. Extensive background in
translating complex operational, staffing, and workflow data into structured analytical models
and actionable recommendations.
Demonstrated expertise in workload analysis, role alignment, process mapping, documentation
of current- and future-state operations, and development of sustainable staffing and efficiency
frameworks. Brings deep experience working within regulated environments, including state
health agencies, Medicaid-aligned programs, and large healthcare systems, with a strong ability
to collaborate across clinical, administrative, and technical teams.
The Hills Tandem, LLC – Sr. Strategist (2026–Present)
Serves as the primary analytical lead for staffing, efficiency, and operational assessments for
public-sector and healthcare clients.
Key Responsibilities:
• Lead quantitative and qualitative staffing analyses, including workload assessment, net
available work hours, and relief factor calculations
• Analyze staffing alignment with service demand, clinic flow, and operational constraints
• Conduct detailed review of staffing distribution by role, credential, and scope of practice
• Develop and validate future-state staffing models aligned with operational realities and
best practices
• Support creation of dynamic electronic staffing models that can be updated by client
teams over time
• Synthesize data from interviews, observations, workflow assessments, and
documentation reviews into actionable findings
• Draft core analytical sections of staffing and efficiency analysis reports, including
methodology, findings, and recommendations
• Collaborate closely with Project Director and Workflow Specialist to ensure staffing
recommendations are operationally feasible and fiscally responsible
Relevance to Orange County Engagement:
Ms. Nettles is dedicating the majority of project hours to the analytical execution of the staffing
and efficiency analysis, ensuring depth, rigor, and continuity from data collection through final
recommendations.
Oracle Cloud Consultant – Atlantic Health System (Remote)
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Attachment B – Revised Project Staffing Plan
May 2022 – December 2023
• Conducted business and process analysis to identify operational gaps and workforce
inefficiencies
• Mapped roles and responsibilities to HCM and payroll processes to support staffing
alignment
• Supported training delivery, metrics tracking, and post-implementation optimization
• Developed detailed documentation, job aids, SOPs, and reporting artifacts supporting
enterprise operations
SAP Fiori Trainer / Content Developer – Interior Logic Group
January 2021 – February 2022
• Conducted workflow and process assessments for enterprise supply chain operations
• Analyzed role-based process flows and identified inefficiencies impacting productivity
• Developed standardized documentation and training materials supporting operational
consistency
• Supported system rollout through data preparation, role mapping, and performance
tracking
Oracle Cloud Consultant – Cable One
February 2020 – December 2020
• Documented business processes and operational changes associated with cloud-based
financial system implementation
• Developed analytical and training artifacts to support operational transition and system
adoption
• Supported UAT testing and end-user readiness activities
IT Trainer – North Carolina Department of Health and Human Services
November 2018 – December 2019
• Delivered system and workflow training supporting NC FAST (IBM Curam) for Child
Welfare programs
• Developed job aids and best-practice documentation to support transition from paper-
based to electronic systems
• Created sample cases and testing scenarios to support workforce readiness
• Worked directly within a state public-sector health and human services environment,
supporting regulated programs and compliance-driven operations
Direct relevance: Experience within NC DHHS provides familiarity with public-sector health
operations, data sensitivity, compliance, and workforce constraints similar to those of county
health departments.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Attachment B – Revised Project Staffing Plan
Senior SAP Consultant / Training Project Support – Seqirus / Novartis
Pharmaceuticals
January 2018 – September 2018
• Supported large-scale SAP Materials Management training for over 2,000 employees
• Coordinated scheduling, registration, and documentation of training and workforce
readiness
• Maintained training records and performance documentation in enterprise LMS systems
Senior HRIS Analyst – American Airlines
November 2015 – April 2017
• Maintained organizational structures and staffing data within SAP and Oracle systems
• Supported workforce data integrity, reporting, and organizational alignment
• Assisted with UAT testing and system optimization
PeopleSoft IT Manager III – University of Texas at Arlington
April 2013 – November 2015
• Delivered training and documentation supporting PeopleSoft Campus Solutions for
faculty and staff
• Supported operational change initiatives impacting multiple departments and
stakeholders
• Assisted with process documentation, system testing, and workflow optimization
Consultant – GP Strategies
November 2010 – April 2013
• Managed SAP HCM and payroll training teams supporting enterprise clients
• Developed standardized business process procedures and operational documentation
• Collaborated with business process, change management, and client SMEs
Founder / Principal Consultant – SMNettles Enterprises, LLC
March 1998 – October 2010
• Provided long-term consulting services in business process analysis, workforce systems,
and training
• Designed and documented operational workflows, job aids, and procedural manuals
• Supported UAT testing, staffing alignment, and operational readiness across multiple
industries
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Attachment B – Revised Project Staffing Plan
Education
• Master of Arts, Organizational Management – Dallas Baptist University
• Bachelor of Arts, Sociology – Fayetteville State University
• Foundations of Consulting Certificate – Yale University
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Attachment C – Updated Milestone Payment Schedule
Total Contract: $55,300
Performance Period: Up to 6 months (delivery in ~4 months)
Recommended Milestone Payment Schedule
Milestone Week Amount
1. Contract Execution & Mobilization 1 $10,000
2. Discovery, Site Visits & Baseline Assessment 8 $12,000
3. Staffing, Workflow & Relief Factor Analysis 16 $14,000
4. Technology, Revenue & Compliance
Analysis
20 $10,000
5. Final Report, Tools & Board Presentation 22 $9,300
• Milestone may not be completed in order as seen above.
• Milestones from RFP have been combined and simplified to reduce the number of
payments and reporting by Health Department Finance.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
1
July 2024
BUSINESS ASSOCIATE AGREEMENT
This Business Associate Agreement (“Agreement”) is made effective the 23rd day of January, 2026,
by and between Orange County (“Covered Entity”), and The Hills Tandem, LLC, (“Business Associate”).
Covered Entity and Business Associate may be referred herein individually as a “Party” or collectively as
the “Parties”. This Agreement supersedes any previously executed Business Associate Agreement between
the Parties.
WITNESSETH:
WHEREAS, Sections 261 through 264 of the federal Health Insurance Portability and
Accountability Act of 1996 (“HIPAA”), Public Law 104-191, as modified by the Health Information
Technology for Economic and Clinical Health Act (“HITECH”), Public Law 111-5, known as “the
Administrative Simplification Provisions,” direct the Department of Health and Human Services to develop
standards to protect the security, confidentiality and integrity of health information; and
WHEREAS, pursuant to the Administrative Simplification provisions, the Secretary of Health and Human
Services (“Secretary”) has issued regulations modifying the Privacy, Security, Breach Notification, and
Enforcement Rules at 45 CFR Parts 160 and 164, as the same may be amended from time to time (the
“HIPAA Security and Privacy Rule”); and
WHEREAS, the Parties wish to enter into or have entered into an arrangement whereby Business Associate
will provide certain services to Covered Entity, and, pursuant to such arrangements, Business Associate
may be considered a “Business Associate” of Covered Entity as defined in the HIPAA Security and Privacy
Rule (the agreement evidencing such arrangement is detailed below and hereinafter referred to as the
“Service Agreement(s)”); and
WHEREAS, Business Associate may have access to Protected Health Information (as defined below) in
fulfilling its responsibilities under such arrangement;
THEREFORE, in consideration of the Parties’ continuing obligations under the Service Agreement,
compliance with the HIPAA Security and Privacy Rule, and other good and valuable consideration, the
receipt and sufficiency of which is hereby acknowledged, the Parties agree to the provisions of this
Agreement in order to address the requirements of the HIPAA Security and Privacy Rule and to protect the
interests of both Parties.
I. DEFINITIONS
(a) Service Agreement. Agreement(s) for services affected by this HIPAA Business Associate
Agreement, which this Business Associate Agreement shall be attached to, and is (are) hereby incorporated
by reference, and which shall be taken and considered as a part of this document the same as if fully set out
herein:
THT Staffing Analysis
(b) Catch-all Provision. Except as otherwise defined herein, any and all capitalized terms in
this Agreement shall have the definitions set forth in the HIPAA Security and Privacy Rule, 45 CFR Parts
160 and 164, subparts A and E. In the event of an inconsistency between the provisions of this Agreement
and mandatory provisions of the HIPAA Security and Privacy Rule, as amended, the HIPAA Security and
Privacy Rule shall control. Where provisions of this Agreement are different than those mandated in the
HIPAA Security and Privacy Rule, but are nonetheless permitted by the HIPAA Security and Privacy Rule,
the provisions of this Agreement shall control.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
2
July 2024
(c) Business Associate. Business Associate shall generally have the same meaning as the term
Business Associate at 45 CF R160.103, and in reference to the party to this agreement, shall mean The
Hills Tandem, LLC.
(d) Covered Entity. Covered Entity shall generally have the same meaning as the term Covered
Entity at 45 CFR 160.103, and in reference to the party to this agreement, shall mean Orange County, North
Carolina.
(e) HIPAA Rules. HIPAA Rules shall mean the Privacy, Security, Breach Notification, and
Enforcement Rules at 45 CFR Part 160 and Part 164.
(f) Electronic Protected Health Information. Protected Health Information that is transmitted
by or maintained in Electronic Media (as defined in the HIPAA Security and Privacy Rule).
(g) Protected Health Information. “Protected Health Information” shall have the same meaning
as the term in 45 CFR § 160.103, limited to the information created or received by Business Associate from
or on behalf of Covered Entity and includes without limitation “Electronic Protected Health Information.”
Business Associate acknowledges and agrees that all Protected Health Information that is created or
received by Covered Entity and disclosed or made available in any form, including paper record, oral
communication, audio recording, and electronic display by Covered Entity or its operating units to Business
Associate or is created or received by Business Associate on Covered Entity’s behalf shall be subject to this
Agreement.
(h) Required by Law. “Required by Law” shall have the same meaning as the term in 45 CFR
§ 164.103.
II. OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATE
(a) Use and Disclosure. Business Associate agrees to fully comply with the requirements
under the HIPAA Rules applicable to Business Associates and not to use or disclose Protected Health
Information other than as permitted or required by this Agreement, the Service Agreement or as Required
by Law. To the extent Business Associate carries out obligations of Covered Entity under the HIPAA
Rules, Business Associate shall comply with the applicable provisions of the HIPAA Rules as if such use
or disclosure were made by Covered Entity. Business Associate agrees to comply with Covered Entity’s
policies regarding the minimum necessary use or disclosure of Protected Health Information.
(b) Appropriate Safeguards. Business Associate agrees to use appropriate safeguards to
prevent use or disclosure of Protected Health Information other than as provided for by the Service
Agreement(s), this Agreement or as Required by Law. This includes the implementation of physical,
technical, and administrative safeguards to prevent use or disclosure of Protected Health Information other
than as permitted in this Agreement or Required by Law and reasonably and appropriately protect the
confidentiality, integrity, and availability of any Electronic Protected Health Information that it creates,
receives, maintains, or transmits on behalf of Covered Entity as required by the HIPAA Rules. The
Business Associate shall maintain appropriate documentation of its compliance with the HIP AA Rules,
including, but not limited to, its policies, procedures, records of training and sanctions of members in its
workforce.
(c) Assurances. Business Associate agrees to provide Covered Entity with written assurances
that any Protected Health Information placed on any type of mobile media, including, but by no means
limited to, laptop computers, tablets and mobile phones, is encrypted in accordance with guidance issued
by the Department of Health and Human Services.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
3
July 2024
(d) Agents and Subcontractors. In accordance with 45 CFR 164.502(e)(1)(ii) and
164.308(b)(2), if applicable, Business Associate shall ensure that any agents or subcontractors that create
receive, maintain, or transmit protected health information on behalf of the business associate agree by
written contract to the same, or greater, restrictions, conditions, and requirements that apply to the Business
Associate with respect to such information, and to agree to implement reasonable and appropriate
safeguards to protect any of such information that is Electronic Protected Health Information. In addition,
Business Associate agrees to take reasonable steps to ensure that its employees’ actions or omissions do
not cause Business Associate to breach the terms of this Agreement.
(e) Mitigation of Breach. Business Associate agrees to mitigate, to the extent practicable, any
harmful effect that is known to Business Associate of a use or disclosure of Protected Health Information
by Business Associate in violation of the requirements of this Agreement, as well as to provide complete
cooperation to Covered Entity should Covered Entity elect to review or investigate such noncompliance or
Security Incident. Business Associate shall cooperate in Covered Entity’s breach analysis and/or risk
assessment, if requested. Furthermore, Business Associate shall cooperate with Covered Entity in the event
that Covered Entity determines that any third parties must be notified of a Breach, provided that Business
Associate shall not provide any such notification except at the direction of Covered Entity.
(f) Breach Reporting. Business Associate shall report in writing to Covered Entity’s Privacy
Officer (see Attachment A), any use or disclosure of Protected Health Information that is not in compliance
with the terms of this Agreement, as well as any Security Incident and any actual or suspected Breach, of
which it becomes aware, without unreasonable delay, and in no event later than forty -eight (48) hours of
such discovery. For purposes of this Agreement, “Security Incident” means the attempted or successful
unauthorized access, use, disclosure, modification, or destruction of information or interference with system
operations in an information system. Such notification shall contain the elements required by 45 CFR
164.410.
(g) Compliance. To the extent applicable, Business Associate will comply with (i) Covered
Entity’s Notice of Privacy Practices; (ii) any limitations to which Covered Entity has agreed regarding an
Individual’s permission to use or disclose his or her Protected Health Information; and (iii) any restrictions
to the use or disclosure of Protected Health Information to which Covered Entity has agreed or is required
to agree.
(h) Government Access. Business Associate will make its internal practices, books and
records available to the Department of Health and Human Services for purposes of determining compliance
with the terms of the HIPAA Security and Privacy Rule, and, at th e request of the Department of Health
and Human Services, will cooperate with any investigations and compliance reviews, permit access to
information, and address any complaints, as Required by Law. Without unreasonable delay and, in any
event, no more than 48 hours of receipt of the request or notification, Business Associate will notify
Covered Entity in writing of any request by any governmental entity, or its designee, to review Business
Associate’s information of any kind.
(i) Electronic Transactions. If Business Associate conducts any Standard Transactions for or
on behalf of Covered Entity, Business Associate shall comply with the requirements under Federal
Electronic Transaction Rules.
(j) Audit. Business Associate shall permit Covered Entity, in its discretion, to conduct an
audit of Business Associate’s compliance with this Agreement, HIPAA, and HITECH. Such audit may
consist of an onsite visit, a series of inquiries that require written respons es, or both. Business Associate
shall promptly and completely respond to Covered Entity’s requests for information in support of the audit,
which shall not be conducted more than once annually except in cases of an actual or reasonably suspected
Security Incident or reasonably suspected noncompliance with this Agreement, HIPAA or HITECH. Each
Party shall bear its own costs associated with the audit.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
4
July 2024
(k) Identity Theft. Business Associate shall implement Identity Theft Monitoring Policies and
Procedures to protect any patient information that may be breached by the Business Associate to the extent
applicable under the Federal Trade Commission’s Red Flag Rules.
(l) HITECH Compliance. Business Associate shall:
A. Not receive, directly or indirectly, any impermissible remuneration in exchange
for Protected Health Information or Electronic Protected Health Information,
except as permitted by HITECH § 13405(d) or the HIPAA Regulations;
B. Comply with the marketing and other restrictions applicable to Business
Associates contained in HITECH § 13406 and the HIPAA Regulations;
C. To the extent required under HITECH § 13404, fully comply with the applicable
requirements of 45 CFR 164.502(e)(2) for each use and disclosure of Protected
Health Information;
D. To the extent required under HITECH § 13401, fully comply with 45 CFR
164.308, 164.310, 164.312, and 164.316;
E. To the extent required under HITECH §§ 13401 and 13404, comply with the
additional privacy and security requirements that apply to Covered Entities in the
same manner and to the same extent as Covered Entity is required to do so; and
F. To the extent required under the HIPAA Regulations, comply with the privacy and
security requirements that apply to Business Associates.
(m) State Privacy Laws. Business Associate shall understand and comply with state privacy
laws to the extent that such privacy laws are not preempted by HIPAA or HITECH.
III. PERMITTED USES AND DISCLOSURES BY BUSINESS ASSOCIATE
(a) Use of Protected Health Information on Behalf of Covered Entity. Except as otherwise
limited in this Agreement, Business Associate may use or disclose Protected Health Information to perform
functions, activities, or services for, or on behalf of, Covered Entity described in the Service Agreement,
provided that such use or disclosure would not violate the HIPAA Security and Privacy Rule if it were made
by Covered Entity, or would not violate the Covered Entities minimum necessary policies.
(b) Other Uses of Protected Health Information. Except as otherwise limited in this
Agreement, Business Associate may use Protected Health Information within its workforce for the proper
management and administration of Business Associate, and to carry out the legal responsibilities of the
Business Associate, but not to include Marketing or Commercial Use; and
(c) Third Party Confidentiality. Except as otherwise limited in this Agreement, Business
Associate may disclose Protected Health Information for the proper management and administration of
Business Associate or to carry out the legal responsibilities of Business Associate, provided that if Business
Associate discloses any Protected Health Information to a third party for such purpose, the Business
Associate shall enter into a written agreement with such third party requiring the following:
A. Disclosure only as Required by Law; or
B. Reasonable assurances from the person to whom the information is disclosed that the
information will remain confidential and will be used or further disclosed only as Required
by Law or for the purpose for which it was disclosed to the person, and the person notifies
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
5
July 2024
Business Associate of any instances of which it is aware in which the confidentiality,
integrity, and or availability of the Protected Health Information has been breached
immediately upon becoming aware.
(d) Business Associate may provide data aggregation services relating to the health care
operations of Covered Entity pursuant to any agreements between the Parties evidencing their business
relationship as permitted by 45 CFR 164.504(e)(2)(i)(B).
(e) Other Uses Strictly Limited. Nothing in this Agreement shall permit the Business
Associate to share Protected Health Information with Business Associate’s affiliates or contractors except
for the purposes of the Service Agreement(s) between the Covered Entity and Business Associate(s)
identified in Section I (a) of this Agreement.
(f) Covered Entity Authorization for Additional Uses. Any use of Protected Health
Information by Business Associate, its affiliate or Contractor, other than those purposes of this Agreement,
shall require express written authorization by the Covered Entity, and a new Business Associate Agreement
or amendment as necessary. Activities which are prohibited include, but are not limited to, Marketing, as
defined by 45 CFR 164.503 or the sharing for Commercial Use or any purpose construed by Covered Entity
as Marketing or Commercial Use, even if such sharing would be permitted by federal or state laws.
(g) Business Associate may de-identify Protected Health Information only at the specific
direction of and only for the use of Covered Entity. Business Associate may not sell Protected Health
Information except at the direction of Covered Entity and in compliance with the requirements of the
HIPAA Rules.
IV. AVAILABILITY OF PHI
(a) Access to Protected Health Information. Business Associate agrees, in the event the
Business Associate maintains protected health information in a Designated Record Set, to make available,
within ten (10) days of a request by Covered Entity in a time and manner designated by Covered Entity,
Protected Health Information in a Designated Record Set, to Covered Entity or as directed by Covered
Entity, to an individual in order to meet the requirements of 45 CFR 164.524 of the HIPAA Rules.
(b) Amendments to Protected Health Information. In the event that the Business Associate
maintains Protected Health Information in a Designated Record Set, Business Associate agrees to make any
amendment(s) to Protected Health Information in a designated record set that the Covered Entity directs or
agrees to pursuant to the HIPAA Rules at the request of Covered Entity or an individual, within ten (10)
days of receipt of a request from Covered Entity and in the time and manner designated by Covered Entity.
(c) Accounting of Disclosures. Business Associate agrees to maintain and make available the
information required to provide an accounting of disclosures, as required by 45 CFR 164.528 of the HIPAA
Security and Privacy Rule. Business Associate will comply with Covered Entity’s policy regarding
accounting of disclosures.
(d) Document Disclosures. In the event an Individual makes a request under this Section of
the Agreement directly to Business Associate, Business Associate will notify Covered Entity of such
request within three (3) business days and shall cooperate with, and act only at the direction of Covered
Entity in responding to such request.
V. OBLIGATIONS OF COVERED ENTITY
(a) Notice of Privacy Practices. Covered Entity shall provide Business Associate with the
Notice of Privacy Practices that Covered Entity produces in accordance with 45 CFR 164.520, as well as
any changes to that notice.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
6
July 2024
(b) Notice of Changes in Individual’s Access or Protected Health Information. Covered Entity
shall provide Business Associate with any changes in, or revocation of, permission by an Individual to use
or disclose Protected Health Information, if such changes affect Business Associate’s permitted or required
uses.
(c) Notice of Restriction in Individual’s Access to Protected Health Information. Covered
Entity shall notify Business Associate of any restrictions to the use or disclosure of Protected Health
Information that Covered Entity has agreed in accordance with 45 CFR 164.522 to the extent that such
restriction may affect Business Associate’s use of Protected Health Information.
VI. PERMISSABLE REQUESTS BY COVERED ENTITY
Requests Permissible Under HIPAA. Covered Entity shall not request Business Associate to use
or disclose Protected Health Information in any manner that would not be permissible under the HIPAA
Rules.
VII. TERMINATION
(a) Term. This Agreement shall be effective as of the date first set forth above and shall
terminate upon the earlier of (i) the termination of all agreements between the parties, and (ii) the
termination by Covered Entity for cause as provided herein.
(b) Termination for Cause. Notwithstanding anything in this Agreement to the contrary,
Covered Entity shall have the right to terminate this Agreement and the Service Agreement immediately if
Covered Entity determines that Business Associate has violated or will violate any material term of this
Agreement. Upon Covered Entity’s knowledge of a material breach by Business Associate, Covered Entity
may provide an opportunity for Business Associate to cure the breach or end the violation. Covered Entity
may terminate this Agreement and the Service Agreement if Business Associate does not cure the breach
or end the violation within the time period specified by Covered Entity. Covered Entity may report the
violation to the Department of Health and Human Services.
(c) Obligation of Business Associate Upon Termination. At termination of this Agreement,
the Service Agreement (or any similar documentation of the business relationship of the Parties), or upon
request of Covered Entity, whichever occurs first, Business Associate, shall:
A. if feasible, return (in a manner or process approved by the Covered Entity) or destroy
all Protected Health Information, regardless of form, including but not limited to paper
or electronic format, received from Covered Entity, or created, maintained or received
by Business Associate on behalf of Covered Entity. Business Associate shall retain no
copies of the Protected Health Information. This provision shall also apply to Protected
Health Information and other confidential information in the possession of sub-
contractors or agents of Business Associate.
B. If such return or destruction is not feasible, Business Associate shall (i) retain only that
Protected Health Information necessary for Business Associate to continue its proper
management and administration or to carry out its legal responsibilities; (ii) return or
destroy the remaining Protected Health Information that the Business Associate still
maintains in any form; (iii) extend the protections of this Agreement to the retained
Protected Health Information; (iv) limit further uses and disclosures to those purposes
that make the return or destruction of the Protected Health Information not feasible;
and (v) return or destroy the retained Protected Health Information when it is no longer
needed by Business Associate.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
7
July 2024
(d) Survival. This obligations under this Section shall survive the termination of this
Agreement and shall apply to Protected Health Information created, maintained, or received by Business
Associate and any of its subcontractors.
VIII. MISCELLANEOUS
(a) Indemnification. Business Associate agrees to indemnify, defend, and hold harmless
Covered Entity, its officers, agents, contractors and agents, against, and in respect of, any and all claims,
losses, expenses, costs, damages, obligations, penalties, and liabilities which Covered Entity may incur by
reason of Business Associate’s breach of or failure to perform any its obligations pursuant to this
Agreement, including but not limited to any injury or damages arising from any noncompliance with this
Agreement or any Security Incident attributable to the negligence of Business Associate, including failure
to execute the terms of this Agreement. Further, Business Associate agrees to indemnify, defend, and hold
harmless Covered Entity, its officers, employees, contractors and agents, against all costs and expenses,
including but not limited to, reasonable legal expenses, which are incurred by or on behalf of Business
Associate in connection with the defense of such claims.
(b) Disclaimer. Covered Entity makes no warranty or representation that compliance by
Business Associate with this Agreement, HIPAA, HITECH, or the HIPAA Rules will be adequate or
satisfactory for Business Associate’s own purposes. Business Associate is solely responsible for all
decisions made by Business Associate regarding the safeguarding of Protected Health Information.
(c) Assistance in Litigation or Administrative Proceedings. Business Associate shall make
itself, and any subcontractors, employees, affiliates or agents assisting Business Associate in the
performance of its obligations under this Agreement, available to Covered Entity, at no cost to Covered
Entity, to testify as witnesses, or otherwise, in the event of litigation or administrative proceedings being
commenced against Covered Entity, its directors, officers or employees based upon a claimed violation of
HIPAA, HITECH, the HIPAA Rules, or other laws relating to security and privacy, except where Business
Associate or its subcontractor, employee or agent is named adverse party.
(d) Survival. The obligations of Business Associate under this Agreement shall survive the
expiration, termination, or cancellation of this Agreement, the Service Agreement and/or the business
relationship of the parties, and shall continue to bind Business Associate, its agents, employees, contractors,
successors, and assigns as set forth herein.
(e) Ownership of Information. Covered Entity holds all right, title, and interest in and to the
Protected Health Information and Business Associate does not hold and will not acquire by virtue of this
Agreement or by virtue of providing goods or services to Covered Entity, any right, title, or interest in or
to the PHI or any portion thereof.
(f) Right to Injunctive Relief. Business Associate expressly acknowledges and agrees that the
breach, or threatened breach, by it of any provision of this Agreement may cause Covered Entity to be
irreparably harmed and that Covered Entity may not have an adequate remedy at law. Therefore, Business
Associate agrees that upon such breach, or threatened breach, Covered Entity will be entitled to seek
injunctive relief to prevent Business Associate from commencing or continuing any action constituting such
breach without having to post a bond or other security and without having to prove the inadequacy of any
other available remedies. Nothing in this paragraph will be deemed to limit or abridge any other remedy
available to Covered Entity at law or in equity. Except as expressly stated herein or in the HIPAA Security
and Privacy Rule, the parties to this Agreement do not intend to create any rights in any third parties.
(g) Amendment. The Parties agree to take such action as is necessary to amend this
Agreement from time to time as is necessary for Covered Entity to comply with the requirements of the
HIPAA Regulations. In addition, this Agreement may be amended or modified by the Parties only in
writing.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
8
July 2024
(h) Assignment. No Party may assign its respective rights and obligations under this
Agreement without the prior written consent of the other Party.
(i) Independent Contractor. None of the provisions of this Agreement are intended to create,
nor will they be deemed to create any relationship between the Parties other than that of independent parties
contracting with each other solely for the purposes of effecting the provisions of this Agreement and any
other agreements between the Parties evidencing their business relationship. No change, waiver or
discharge of any liability or obligation hereunder on any one or more occasions shall be deemed a waiver
of performance of any continuing or other obligation, or shall prohibit enforcement of any obligation, on
any other occasion.
(j) Regulatory References. A reference in this Agreement to a section in HIPAA, HITECH or
the HIPAA Rules means the section as it currently is in effect or as amended.
(k) Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a meaning
that permits Covered Entity to comply with the HIPAA Rules. The parties agree that, if any documentation
of the arrangement pursuant to which Business Associate provides services to Covered Entity contains
provisions relating to the use or disclosure of Protected Health Information that are more restrictive than
the provisions of this Agreement, the more restrictive provisions will control. The provisions of this
Agreement are intended to establish the minimum requirements regarding Business Associate’s use and
disclosure of Protected Health Information.
(l) Severability. In the event any part or parts of this Agreement are held to be unenforceable,
the remainder of this Agreement will continue in effect. In addition, in the event a party believes in good
faith that any provision of this Agreement fails to comply with the then-current requirements of the HIPAA
Rules, such party shall notify the other party in writing. For a period of up to (30) thirty days, the parties
shall address in good faith such concern and amend the terms of this Agreement, if necessary to bring it
into compliance. If, after such thirty-day period, a party believes in good faith that the Agreement fails to
comply with the HIPAA Rules, then either party has the right to terminate upon written notice to the other
party.
(m) Notices and Communications. All instructions, notices, consents, demands, or other
communications required or contemplated by this Agreement shall be in writing and shall be delivered to
the Party at the address below:
For Covered Entity: For Business Associate:
Orange County Health Department The Hills Tandem, LLC
300 West Tryon Street 4242 Six Forks Rd, Suite 1550-3170
Hillsborough, NC 27278 Raleigh, NC 27609
(n) Strict compliance. No failure by any Party to insist upon strict compliance with any terms
or provisions of this Agreement, to exercise any option, to enforce any right, or to seek any remedy upon
any default of any other Party shall affect, or constitute a waiver of, any Party’s right to insist upon such
strict compliance, exercise that option, enforce that right, or seek that remedy with respect to that default
or any prior, or contemporaneous, or subsequent default. No custom or practice of the Parties at variance
with any provisions of this Agreement shall affect, or constitute a waiver of, any Party’s right to demand
strict compliance with all provisions of this Agreement.
(o) Governing Law. This Agreement shall be governed and construed in accordance with the
laws of the State of North Carolina except to the extent that North Carolina laws have been pre-empted by
HIPAA and without giving effect to principles of conflicts of law. Jurisdiction shall be Orange County,
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
9
July 2024
North Carolina, for purposes of litigation resulting from disagreements of the Parties for purposes of this
Agreement and the Service Agreement(s).
(p) E-Verify. Employers and their subcontractors with 25 or more employees as defined in
Article 2 of Chapter 64 of the NC General Statutes must comply with E-Verify requirements to contract
with governmental units. E-Verify is a Federal program operated by the United States Department of
Homeland Security and other federal agencies, or any successor or equivalent program used to verify the
work authorization of newly hired employees pursuant to federal law. Where applicable, failure to maintain
compliance with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes shall
constitute breach of this Agreement. If applicable, by executing this Agreement, Business Associate affirms
that they are in compliance with Article 3 of Chapter 64 if the North Carolina General Statutes.
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the day and year written above.
COVERED ENTITY: BUSINESS ASSOCIATE:
By:_________________________________ By:___________________________________
Title:________________________________ Title:__________________________________
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Jennifer Fields/ President & CEOOrange County Health Director
10
July 2024
ATTACHMENT A
COVERED ENTITY PRIVACY OFFICER CONTACT INFORMATION
To report to Covered Entity any use or disclosure of Protected Health Information not in compliance with
the terms of this Agreement that might be considered a privacy breach, Business Associate should contact
the Privacy Officer at the applicable entity. To report to Covered Entity any Security Incident (as defined
in the Agreement), Business Associate should contact Ashley Rawlinson (919-245-2440), or the Security
Officer at The Orange County Health Department.
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9
Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9