Theoria_Medical_PLLC_s_Proposal_REDACTED.pdf

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, Solicitation No. BPM004228 1

Theoria Medical, PLLC Proposal for RFP No. BPM004228 Medical Director and Physician Services for the Arizona State Veterans’ Homes

Table of Contents

i. Offer and Acceptance Form signed by Authorized Person

ii. Acknowledgement of Amendment 1

iii. Executive Summary

iv. Experience and Expertise;

v. Method of Approach;

vi. Completed Items Tab in APP; and

vii. Attachments (A, B, C, D, E, F, G, H, I and resumes, degrees, and license information, etc.).

viii. Exhibits 1, 2, 3, and 4

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, Solicitation No. BPM004228 2

Offer and Acceptance Form

SUBMISSION OF OFFER: Undersigned hereby offers and agrees to provide Non-Emergency Transportation Services in compliance with the Solicitation indicated above and our Offer indicated by the latest dated version below:

Initial Offer:

2/4/22

Date Signature

Revised Offers:

Date Signature Date Signature

Date Signature Date Signature

Best and Final Offer:

Date Signature

Theoria Medical, PLLC Offeror company name Signature of person authorized to sign Offer

41800 W 11 Mile Rd Ste 109 Kevin Pezeshkian, Chief Operating Officer Address Printed name and title

Novi, Michigan, 48375 Kevin Pezeshkian, Chief Operating Officer City | State | ZIP Contact name and title

83-0826814 kevin@theoriamedical.com 810-623-6362 Federal tax identifier (EIN or SSN) Contact Email Address Contact phone number

CERTIFICATION: By signature in the above, Offeror certifies that it:

1. !"##$ %&'$ (")*+","%-'.$ -/-"%)'$ -%0$ .,1#&0..$ &+$ -11#"*-%'$ 2&+$ .,1#&0,.%'$ "%$ 3"&#-'"&%$ &2$ 4.(.+-#$ 56.*7'"3.$ 8+(.+$ 99:;<=$ >?+"@&%-A$B'-'.$

56.*7'"3.$8+(.+$:CCDED$&+$?FGFBF$H$;9I9;<9$'J+&7/J$9;<KL

2. has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted offer. Failure to provide a valid signature affirming the stipulations required by this clause will result in rejection of the Offer. Signing the Offer with a false statement will void the Offer, any resulting contract, and may be subject to legal penalties under law;

3. complies with A.R.S. § 41-3532 when offering electronics or information technology products, services, or maintenance; ad

4. is not debarred from, or otherwise prohibited from participating in any contract awarded by federal, state, or local government.

ACCEPTANCE OF OFFER: State hereby accepts the initial Offer, Revised Offer, or Best and Final Offer identified by the latest date and number at the top of this form (the Accepted Offer). Offeror is now bound (as Contractor) to carry out the Work under the attached Contract, of which the Accepted Offer forms a part. Contractor is cautioned not to commence any billable work or to provide any material or perform any service under the Contract until Contractor receives the applicable Order or written notice to proceed from the Procurement Officer.

State’s Contract Number is: Contract Effective Date:

Procurement Officer Signature Award Date Procurement Officer Name Title

Attachment A: Offer and Acceptance

Request for Proposal

Solicitation No. BPM004228

Medical Director and Physician Services for the Arizona State Veterans’ Homes

Arizona Department of Veterans’ Services

3839 N. 3rd Street

Phoenix, Arizona 85012

4th February

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 3

Executive Summary

Dear Ms. Adame:

Enclosed you will find Theoria Medical’s (Theoria) proposal in response to RFP No. BPM004228. We are pleased to submit a proposal to demonstrate our model of care and outline the benefits Theoria can provide to the veteran’s population at the ASVHs. As an introduction to Theoria Medical, we are a nursing home physician group dedicated to and promoting a culture of innovation and high-quality care that treats the whole person with a full understanding of the social determinants of health. We leverage innovative technologies in our practice and invest heavily in staff training and education in the long-term care space.

Theoria provides comprehensive medical directorship and physician services to long-term care facilities.

Theoria’s model of care leverages technology to provide high quality care. This includes consistent weekly provider coverage, 24/7/365 on-call coverage via Theoria’s telemedicine program, use of an advanced proprietary electronic health record, and much more.

Theoria has extensive experience in long-term care medical management and also has experience providing medical director and physician services to State Veterans Homes in Michigan, New Hampshire, and Tennessee. With our high quality model of care, technology, and past experience, we are confident in the services we offer to ASVH.

I truly appreciate the opportunity to submit a response to this RFP. I am confident in the services we provide, and on that note, I do hope to work with the team at the 4 ASVH locations.

Very Respectfully, Kevin Pezeshkian Chief Operating Officer Theoria Medical, PLLC 41800 W. 11 Mile Rd. Suite 109 Novi, Michigan, 48375 Telephone: 810-623-6362 Facsimile: 248-282-5044 Email: kevin@theoriamedical.com

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 4

Executive Summary

Dear Ms. Adame:

Enclosed you will find Theoria Medical’s (Theoria) proposal in response to RFP No. BPM004228. We are pleased to submit a proposal to demonstrate our model of care and outline the benefits Theoria can provide to the veteran’s population at the ASVHs. As an introduction to Theoria Medical, we are a nursing home physician group dedicated to and promoting a culture of innovation and high-quality care that treats the whole person with a full understanding of the social determinants of health. We leverage innovative technologies in our practice and invest heavily in staff training and education in the long-term care space.

Theoria provides comprehensive medical directorship and physician services to long-term care facilities.

Theoria’s model of care leverages technology to provide high quality care. This includes consistent weekly provider coverage, 24/7/365 on-call coverage via Theoria’s telemedicine program, use of an advanced proprietary electronic health record, and much more.

Theoria has extensive experience in long-term care medical management and also has experience providing medical director and physician services to State Veterans Homes in Michigan, New Hampshire, and Tennessee. With our high quality model of care, technology, and past experience, we are confident in the services we offer to ASVH.

I truly appreciate the opportunity to submit a response to this RFP. I am confident in the services we provide, and on that note, I do hope to work with the team at the 4 ASVH locations.

Very Respectfully, Kevin Pezeshkian Chief Operating Officer Theoria Medical, PLLC 41800 W. 11 Mile Rd. Suite 109 Novi, Michigan, 48375 Telephone: 810-623-6362 Facsimile: 248-282-5044 Email: kevin@theoriamedical.com

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 5

Experience and Expertise:

Theoria Medical has extensive experience managing nursing home residents providing medical directorship and physician services. It started with Theoria’s CEO Dr. Justin Di Rezze, who started as a hospitalist physician after his residency and shortly thereafter identified a significant need for improvements in care for nursing home residents. He truly found a passion for post-acute care that resonates throughout Theoria.

From a physician staffing perspective, Theoria medical directors are either internal medicine physicians or family medicine physicians with healthy experience in practice. All of Theoria’s medical staff undergo comprehensive training prior to starting at their facility. Physicians undergo extensive medical director training, and advanced practice practitioners undergo training with their regional clinical leadership team.

Since the inception of Theoria Medical, we have significantly expanded throughout numerous states and currently operate in over states. We have successfully demonstrated positive results for our patients.

As a result, we have gathered a great deal of support from the nursing homes in the communities in which we serve. We continue our expansion and furtherance of our mission and vision for excellent medical care for nursing home residents.

With the facilities that we manage, we significantly reduced readmissions, completed medication deprescribing initiatives, improved collaboration between psychiatry and internal medicine, designed novel physiatry programs, improved medication reconciliation processes, improved fall assessment protocols, designed addiction treatment programs, amongst much more.

To illustrate our success, Theoria’s COO, Kevin Pezeshkian, presented a case study at the Society for Post-Acute and Long-Term Care Medicine last year in which we managed a COVID unit facility in Detroit where we freed up hospital beds from a local hospital at the climax of the COVID pandemic. We managed the COVID patients at the nursing home with a 5.4% mortality rate, 91.48% recovery rate, and a 9.8% 2020 readmission rate (N=352).

Furthermore. we work with nursing home chains such as

These groups collectively manage over 400 nursing homes in multiple states. Additionally, we have experience providing medical services in State Veterans Homes as we currently provide services to Michigan Veteran’s Home at Chesterfield, the New Hampshire Veterans’ Home, and the Ben Atchley Tennessee State Veterans' Home. With this experience and success, we are confident in the service we offer to you and your residents.

We provide Arizona Medical Board License, Medical Degree, and CV as Exhibits 2, 3, and 4.

Method of Approach

Theoria Medical is an experienced provider of medical director and physician services in the long-term care setting. Theoria has extensive experience working with skilled nursing facility operators in providing high quality medical services by leveraging its unique model and technology. In order to demonstrate its method of approach to provide the services outlined in the scope of work, Theoria outlines its overall model of care in the skilled nursing facility below. Theoria will also address its approach to each line item in 5.2.1.4 as well in order to further demonstrate its capacity to perform services required under this contract.

Medical Director and Physician Services

Theoria categorizes physician services in the following manner:

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 6

1. Acute Illness Visits

2. Initial Patient Care/Care Transitions

3. Discharges and Transfers

4. Appropriate Care for Residents

5. Appropriate, Timely Medical Orders and Documentation

6. Relationship with Residents and Families

Medical directorship and attending physician services are provided in accordance with all the requirements of this RFP and state and federal laws. The medical director will be heavily involved in QAPI meetings and with all quality and process improvement efforts. The medical director will be available to discuss any and all issues relating to medical care delivered at the facility; the medical director will employ strategies to continuously promote improvement of the facility’s care delivery operations. In Theoria’s care model, the medical director serves as the primary attending physician for facility residents; this way, the medical director is engaged and has firsthand insight with respect to the care delivered and has a more effective approach from the medical directorship perspective.

Theoria has many initiatives from a medical director and physician extender perspective. Theoria promotes

There is a culture of clinical quality improvement and facility process improvement that Theoria instills with the facility.

Physician extender services will be provided with a nurse practitioner or physician assistant rounding on-site typically 5 days per week depending on the census, acuity, and overall needs of a particular facility;

coverage may be adjusted based on an increase in census, acuity, and at the request of the facility. This provider will manage the day-to-day clinical operations of the facility, perform routine visits, perform acute visits, coordinate care with other professionals, and conduct all of the requirements of physician services as defined in this RFP and standard medical practice in coordination with the medical director.

Acute Illness Visits

Theoria Medical has a comprehensive understanding of the nursing home resident population; Theoria’s core patient population is the clinically complex nursing home resident with multiple chronic comorbidities.

Theoria’s care program is characterized by

This professional acumen, paired with Theoria’s infrastructure, allows the medical staff to identify, assess, and manage acute situations at any given time.

With a plethora of experience and training in geriatrics and nursing home clinical practice, Theoria providers are in an exceptional position to manage acute patients at ASVH. Theoria’s care model typically includes

If the acuity of the resident population merits weekend coverage to establish a , Theoria will provide this. If the census and acuity of the facility does not require then Theoria will scale back in collaboration with facility administration.

With a consistent weekly in-person medical staff coverage at the facility, Theoria is able to address acute issues promptly in close collaboration with the nursing team when the providers at on-site. The medical staff will promptly address all acute issues that is notified by nursing and the providers will be vigilant in closely monitoring high-risk residents. When the team is off-site, the nursing staff will still have a team of providers that are available immediately to address any acute issues via phone calls or telemedicine video visits provided through Theoria’s proprietary platform.

It is important to note that Theoria’s program allows for

. Hence, emergencies will be managed immediately, and issues will be addressed as appropriate at the facility rather than at a hospital setting unless a

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 7 transfer is deemed unavoidable by the provider. Instances will be communicated to families and nurses accordingly. Moreover, Theoria’s program emphasizes

Fundamentally, Theoria’s program Residents are closely monitored in conjunction with nursing, and any and all issues are immediately addressed.

When performing any visit, providers will properly document, in a timely fashion, symptoms and problems, clarify and verify diagnoses, relate diagnoses to patient problems, and help establish a realistic prognosis and care goals in coordination with resident families and nurses. The documentation provided in H&Ps and progress notes will be prepared in accordance with relevant clinical and regulatory guidelines and subsequently signed, dated, and electronically transmitted to the ASVH EMR system. Additionally, the providers and Theoria administrative team if appropriate.

A collaborative, cohesive physician-nurse relationship is critical to proper patient care and facility management. Theoria purposefully fosters this relationship with an emphasis on resident-centric care and notification of potential issues and issues. Particularly, it is crucial that nursing reports any symptoms or suspicion of a decline immediately to the medical team; identification of the clinical presentations that merit such coordination with the medical team are nursing skills that are integral in the appropriate care of the residents at ASVH and management of acute issues. As a result, Theoria emphasizes

Theoria educates on the nursing team; consequently, this approach allows for the immediate and appropriate management of acute issues for ASVH residents.

In summary, Theoria takes a systematic approach to managing acute patients. This approach includes the following:

1.) for any issue 2.) Consistent t of acute issues 3.) Communication visits 4.) families and nursing staff 5.) Risk and management 6.) Nursing staff education

Initial Patient Care/Care Transitions

Theoria Medical recognizes the importance of a proper transition of care on admission, discharge, and transfer in ensuring residents are properly managed. Hence, Theoria has processes that are specific to the nursing home setting to facilitate a proper transition for a new resident admitted to the facility along with residents discharging and transferring; also, we understand that it is imperative that new admissions are evaluated in a timely fashion.

Theoria physicians strive to perform physicians will , within reason, accordingly, to At a bare minimum, all . In addition, Theoria physicians strive to address as well if the patient consents to the conversation; Theoria believes this practice is critical in

Notably, an internal performance metric for the new admissions.

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 8

Finally, annual H&Ps are scheduled by . I would like to outline part of Theoria’s process for scheduling visits.

When admissions occur late in the day or when a physician cannot make it same day, Theoria has processes

Theoria providers will manage all residents pending transfer to another level of care or another medical team until responsibility is accepted; further, Theoria will provide an appropriate sign-out to the new team with all appropriate information to facilitate a proper transition of care. This includes discharge summaries with all relevant documentation for the new team to seamlessly assume care. Moreover, residents who are sent to the hospital and readmitted can present with a unique need for a proper transition back to the facility. Particularly, residents transferred to the hospital are typically in unavoidable situations that require additional evaluation and workup that the facility team is not equipped to provide. Consequently, there may be adjustments and additions to medications and treatments and other relevant clinical changes that the Theoria medical team will consider upon performing the readmission H&P.

Discharges and Transfers

With the daily presence of a Theoria provider, appropriate management and coordination of discharges and transfers is seamless. Regardless of the care setting to which residents are discharged or transferred to, Theoria will ensure that the new medical team (if applicable) has the appropriate documentation and information available to manage the patient moving forward; a proper sign out will be performed when appropriate for acutely ill or unstable patients. All Theoria providers use methods of documentation; therefore, the communication of relevant clinical documentation is straightforward to the appropriate sources.

For facility discharges, Theoria providers work closely with the social work team to coordinate an appropriate timeline for discharge in accordance with the patient and families wishes along from a rehabilitation/medical standpoint. Theoria understands the the documentation is completed and submitted promptly, and the Theoria team ensures all

Appropriate Care for Residents

The entire premise of the Theoria care model is to set a new standard of patient care management in the nursing home setting. With this in mind, Theoria provides comprehensive

Based on resident and family wishes, the team will adjust treatment plans. Finally, Theoria providers have a deep

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 9

The Theoria Medical staff will coordinate with ASVH staff to facilitate the comprehensive assessment and care plan. Theoria staff will communicate all relevant items to nursing staff and provide documentation of such.

Appropriate, Timely Medical Orders and Documentation

Theoria Medical recognizes the importance of timely order entry, documentation, and signature as it relates to facility operations and patient care. The medical team prefers for example. However, Theoria will adopt to the methods that the facility has available.

If electronic methods of order entry and signature are available, Theoria providers will utilize them in a timely fashion. If written methods of order entry are available, and when they are necessary (discharge scripts), Theoria providers will write them legibly with all the appropriate information associated with the medication orders. The providers’ documentation clearly explains medical decision making rational associated with particular treatment orders.

Controlled substance orders are closely managed. Theoria ensures that residents do not go without their pain medication. Due to our telemedicine team proper follow up and management.

All orders and documentation will be completed in accordance with all other relevant areas of the requirements in this RFP. Items such as

There will be cohesive coordination with all relevant team members associated with orders such as

Relationship with Members and Families

Theoria values the relationship between patients and families in all care settings, particularly for nursing home residents. Theoria providers promote the relationship between the medical team and the resident families; providers are available for do not need to be communicated.

Policies, Procedures, and Quality Assurance and Process Improvement

In order to continuously improve its services and maintain quality, Theoria invests heavily in policy, procedure, and process development. Theoria’s medical directo

Theoria’s QAPI involvement is significant. Theoria equips its medical directors

. We’ll establish policies and procedures in collaboration with facility administration.

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 10

In addition, Theoria will be heavily involved in policy and procedure development from multifarious perspectives related to improving the quality of care delivered at ASVH. This includes addressing

. The medical director will coordinate with the administrator on these items and ensure a healthy, positive environment at ASVH.

Medical Staff Training

In order to demonstrate Theoria’s sophisticated infrastructure for medical staff management, I would like to outline part of Theoria’s staff training program. This training includes in the LTC population.

In order to improve and maintain quality care throughout the organization, Theoria substantially invests in its provider training programs and tools. Every provider who joins Theoria patient-centric care.

Medical staff training occurs with a staff members. Training promotes independent practice at their facility.

Continuing education is an important component of maintaining knowledge of relevant clinical guidelines and updates particularly with geriatric pharmacology; as a result, Theoria provides

Further, all Theoria providers undergo continuous education.

Finally, to further demonstrate Theoria’s competence and innovative mindset with respect to gero-pharmacology, for the clinical management of LTC patients.

Non-physician medical staff oversight

Theoria Medical will this solicitation. As a result, I would like to outline Theoria’s perspective and process with respect to in the facility.

Physician extenders such as nurse practitioners and physician assistants are a key component of the care team. All Theoria non-physician providers work in strong collaboration with the medical director and attending physicians at the facility. These providers are highly trained with Theoria and will understand all of the components required in this RFP and described above. If there are quality or education issues, Theoria will intervene as appropriate in collaboration with ASVH staff.

Technological Capabilities

Theoria’s model of care includes technology at its core; Theoria has developed technology to facilitate its daily operations and provide high quality care. Theoria’s

. This system is integrated with

ASVH nurses and residents. We further explain infrastructure.

Proprietary Electronic Health Record, ChartEasy

The system integrates with

24/7 Coverage and Telemedicine

Theoria provides telemedicine services to enable 24/7 immediate care and coverage for all residents under our care.

The On-Call physician services requirement of this RFP will be provided via Theoria’s telemedicine program. This program is significantly more comprehensive than a traditional on-call, and it will provide great value to the State and the home’s residents.

The 24/7 availability of immediate on-call and telehealth support is as follows:

Theoria will provide the facility with telemedicine capabilities with the inclusion of a the following features:

With the inclusion of a

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 12

From a staffing perspective, Theoria can address issues right away.

Transition of Services Upon Contract Award

In the event of a contract award, Theoria outlines its transition plan to provide services with minimal disruption to daily clinical operations.

Theoria understands the importance of a proper transition plan in the execution of the requirements of this RFP and in general when launching services at a new site. The transition to Theoria’s services will be well coordinated, smooth, and with excellence; Theoria has designated hence, we will tailor our transition plan to ASVH.

Typically, the initial step is to

Other items that will be addressed upon the

Usually, the first few weeks leading up to the go-live date will be the

I hope this outline provides insight into our transition and implementation process. It is comprehensive and includes multiple members of our team. We are dedicated to ensuring the staff is comfortable with all aspects of the transition and any changes.

The above outlines Theoria Medical’s model of care in the skilled nursing setting. Below, we address each line item in the scope of work:

5.2.1.4.1. Theoria Medical’s medical staff will participate in policy and procedure review and development in emergency treatment situations. In addition, Theoria will provide coverage for medical emergencies and continuous support for ASVH nursing staff whether in-person or via telephone/telemedicine video call.

5.2.1.4.2. Theoria Medical’s medical staff will assist with the maintenance, review, and development of the policies listed in this section in accordance with its medical directorship duties.

5.2.1.4.3. Theoria Medical’s medical staff will chart and review screening and diagnostic results within the applicable EMR portal, whether that is MatrixCare or another platform. Staff will review and sign off on

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 13 results and manage resident care accordingly based on the context of the results. Management will be documented in the EHR.

5.2.1.4.4. Theoria Medical’s medical staff will participate in policy and procedure review and development with respect to resident care policies.

5.2.1.4.5. Theoria Medical’s medical staff will participate in policy and procedure review and development for admission screening and selection. Theoria’s staff will also actively participate with the facility’s admission team to answer any questions and provide guidance on candidates for admission.

5.2.1.4.6. Theoria Medical’s medical staff will actively participate in the review, certification, and re-certification of resident eligibility for ASVH services.

5.2.1.4.7. Theoria Medical’s medical director will coordinate closely with other attending physicians to ensure proper medical care is provided, and a high quality of medical care is provided in accordance with professional standards.

5.2.1.4.8. Theoria Medical’s medical director will collaborate closely with other physicians on ASVH’s medical staff to communicate expectations and proper standards of care. Communication will center around providing high quality care to ASVH’s population.

5.2.1.4.9. Theoria Medical’s medical staff will be diligent in acting if any physician fails to provide quality care and perform in accordance with ASVH’s and its medical director’s policies and procedures. Theoria does not tolerate poor quality care and will take action if any physician does not practice quality care.

5.2.1.4.10. Theoria Medical’s medical staff will provide alternate coverage to fill any gap in physician coverage for ASVH’s residents. Theoria has an extensive network of physicians and on-call team members who will ensure continuous coverage for all ASVH residents.

5.2.1.4.11. Theoria Medical’s medical staff will collaborate with facility administration to develop an annual report of the quality, adequacy, and appropriateness of the ASVH’s resident care services.

5.2.1.4.12. Theoria Medical’s medical staff will be available to meet with the administrator of the facility on an as needed basis. Availability will be much more open than once a quarter. Theoria’s staff can meet weekly with the administrator to discuss anything that is necessary.

5.2.1.4.13. Theoria Medical’s medical staff will be available in-person or via phone to meet with resident family members to discuss their medical care, any concerns, and answer any questions.

5.2.1.4.14. Theoria Medical’s medical staff will be available to meet with the Administrator, the Director of Nursing, and social workers frequently to discuss the needs of ASVH residents. Meetings can be in-person and via phone. Theoria’s team members are traditionaly very available and communicative.

5.2.1.4.15. Theoria Medical’s medical staff will be available for in-services and training to assist with the development and maintenance of ASVH’s EMR system. Theoria’s IT staff can also assist if necessary, and Theoria’s clinical staff will provide clinical insight and input where necessary.

5.2.1.4.16. Theoria Medical’s medical staff will represent ASVH on any clinical situations and matters.

5.2.1.4.17. Theoria Medical’s medical staff will appear, attend, and cooperate on behalf of ASVH on any judicial proceedings or investigation that is requested.

5.2.1.4.18. Theoria Medical’s medical director will provide medical director services to ASVH up to 20 hours per month. Hours will be logged in accordance with ASVH policies, and hours are also

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 14

5.2.1.4.19. Theoria Medical’s medical director will seek approval in accordance with ASVH policy if administrative duties exceed 20 hours per month.

5.2.1.4.20. Theoria Medical’s medical staff are trained on long-term care and understand the rules and regulations governing clinical practice in long-term care.

5.2.1.4.21. Theoria Medical’s medical staff will coordinate with ASVH administration in writing to request approval of any desired changes in policies and procedures. Requests will be made in a collaborative manner.

5.2.1.4.22. Theoria Medical’s medical staff agree to this provision and will cooperate with any requests to review records and activities performed by the medical director or any Theoria medical staff member.

5.2.1.4.23. Theoria Medical’s medical staff will be screened for T.B. before commencing work. As part of Theoria’s credentialing and onboarding process, employees are screened, and results are recorded.

Results will be provided to ASVH within 2 hours of a request.

5.2.1.4.24. Theoria Medical’s medical staff will review in-depth the orientation packet provided. Staff will acknowledge understanding of the same and training will be documented in accordance with ASVH and Theoria’s policies.

5.2.1.4.25. Theoria Medical is interested in providing medical director services in all 3 ASVH locations listed: ASVH-Tucson, ASVH-Flagstaff, and ASVH-Yuma are all of interest. Theoria would like to provide its model of care to Tucson, Flagstaff, and Yuma.

5.2.1.4.26. Theoria Medical’s medical staff will provide written, signed admission orders as needed.

Theoria staff will collaborate closely with ASVH on this need.

5.2.1.4.27. Theoria Medical’s medical staff will closely supervise the medical care of all residents assigned to Theoria’s caseload. Theoria will provide its full model of care as described above to all residents assigned to Theoria.

5.2.1.4.28. Theoria Medical is a full-service physician group with a network of physicians. Theoria will arrange coverage with another Theoria physician in the event that the primary Theoria physician is unavailable for a period of time. Theoria has internal processes that manage physician coverage such as during vacation and sick leave times.

5.2.1.4.29. Theoria Medical’s medical staff will establish and review each resident’s care plan in collaboration with ASVH nursing staff. All residents admitted under Theoria’s care will have an H&P completed.

5.2.1.4.30. Theoria Medical’s medical staff will complete progress notes for all resident visits in the EHR system. All notes will be shared with MatrixCare in a timely manner.

5.2.1.4.31. Theoria Medical’s medical staff are highly responsive. Theoria staff will respond quickly to all nursing staff and resident needs. Theoria’s on-call telemedicine model ensures proper and immediate coverage for any and all medical needs.

5.2.1.4.32. Theoria Medical’s medical staff will provide on-call coverage through Theoria’s comprehensive telemedicine program 24/7/365.

5.2.1.4.33. Theoria Medical’s medical staff will regularly communicate with ASVH staff at all times to ensure proper medical care and that treatment goals are being communicated.

5.2.1.4.34. Theoria Medical’s medical staff will participate in all quality improvement activities as requested. Theoria also has many of its internally developed quality improvement processes as well.

Medical directors will attend QAPI as scheduled.

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 15

5.2.1.4.35. Theoria Medical’s physicians will be responsible for all care provided by Theoria’s physician assistants and nurse practitioners. Theoria has a robust management structure for its PA and NPs working under the direction of its physicians.

5.2.1.4.36. Theoria Medical’s medical staff will see residents in accordance with the frequency of medical visits outlined in this section. All visits are automatically scheduled within Theoria’s proprietary EHR software and seen in a timely fashion. Patient schedules are frequently audited to ensure visits are not missed and patients are in compliance.

5.2.1.4.37. Theoria is interested in providing physician services to all 4 ASVH locations: ASVH-Phoenix, ASVH-Tucson, ASVH-Flagstaff, and ASVH-Yuma. Theoria would like to provide its model of care to all 4 locations.

5.2.1.4.38. Theoria Medical’s medical staff will hold all the licenses required in section 6 of the scope of work. All physicians will have active, unrestricted medical license with the Arizona State Medical Board.

All physicians, PAs, and NPs will hold active, unrestricted licenses to practice. All staff will comply with all Arizona state statutes. Theoria’s credentialing department manages all licensure matters and has internal processes to ensure all staff are fully licensed to practice in the state in which they are providing services.

Theoria’s credentialing department holds copies of all licenses, degrees, etc. In addition, Theoria’s credentialing department enrolls Theoria’s medical staff in the relevant payers in the market. In this case, Theoria’s credentialing department will ensure staff are enrolled with Medicare, Medicaid, Banner Healthcare, UnitedHealthCare, and Mercy Care. Theoria will ask for a payer list from each facility to ensure that it is enrolled with each applicable payer.

5.2.1.4.39. Theoria’s administrative team can generate the reports outlined in section 8. Items in 8.1.1., 8.1.2., and 8.1.3. are reports that can be generated within Theoria’s EHR system and submitted to ASVH.

In addition, Theoria will provide its COI for the required coverages upon contract award.

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 16

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 17

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 18

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 19

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 20

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 21

February 4, 2022

Elena Adame

Chief Procurement Officer

Arizona Department of Veterans’ Services

3839 N. 3rd Street

Phoenix, Arizona 85012

Telephone: (602) 350-1757

Email: eadame@azdvs.gov

Re: Confidential Treatment of Theoria Medical’s Confidential Business Information and Trade Secrets in its Bid in Response to RFP No. BPM004228

Dear Ms. Adame:

In compliance with the above referenced RFP Confidential Information Designation Form, Theoria Medical provides this letter and accompanying enclosures describing and identifying confidential business and trade secret information utilized in Theoria Medical proposal that it desires to keep confidential and protected from disclosure pursuant to Arizona’s Freedom Of

Information Act, (A.A.C. R2-7-C317). According to A.A.C. R2-7-101(50) (formerly A.A.C.

R2.7-101(52)), the following information is appropriately considered a “trade secret” and should be kept confidential.

Acute Illness Visits

Throughout this section, Theoria Medical outlines its clinical protocols, which it has developed to provide a high-level of care to patients in an acute care setting. This section also includes a model of Theoria Medical’s care coverage, and details regarding Theoria’s proprietary platform. Theoria Medical has taken steps to keep this information confidential, including the use of confidentiality clauses in its Employment Agreements. Theoria Medical has also not made these clinical protocols public. Theoria Medical has spent considerable time and resources in developing these clinical protocols and believes that these clinical protocols give Theoria Medical a competitive advantage in the marketplace. The information regarding Theoria Medical’s method of approach is not readily ascertainable or generally known to the public. It is this method of approach that derives independent economic value. If the information was public, the method of approach would lose economic value. Additionally, Theoria Medical has undertaken measures to maintain the confidentiality of its procedures and protocols by entering into various non-compete, non-solicitation, and confidentiality agreements with its employees, contractors and partners.

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 22

Theoria’s proprietary and trade secret information is password protected and may only be accessed by authorized users who have confidentiality, non-compete, non-solicitation and/or non-disclosure agreements with the Company. Theoria actively enforces these agreements and spends considerable time and money to keep its trade secret business processes confidential.

Initial Patient Care/Care Transitions This section includes proprietary information regarding Theoria Medical’s proprietary EMR system ChartEasy. ChartEasy was internally developed by Theoria at great expense. Theoria has not licensed ChartEasy nor has it made it publicly available for use. This fits the definition of a

“trade secret” as outlined in A.A.C. R2-7-101(50). Additionally, all Theoria medical employees, contractors and partners are bound by confidentiality agreements regarding ChartEasy, its features, development and use. The information regarding Theoria Medical’s method of approach is not readily ascertainable or generally known to the public. It is this method of approach that derives independent economic value. If the information was public, the method of approach would lose economic value. Additionally, Theoria Medical has undertaken measures to maintain the confidentiality of its procedures and protocols by entering into various non-compete, non-solicitation, and confidentiality agreements with its employees, contractors and partners. Theoria’s proprietary and trade secret information is password protected and may only be accessed by authorized users who have confidentiality, non-compete, non-solicitation and/or non-disclosure

Discharges and Transfers The information regarding Theoria Medical’s method of approach is not readily ascertainable or generally known to the public. It is this method of approach that derives independent economic value. If the information was public, the method of approach would lose economic value.

Additionally, Theoria Medical has undertaken measures to maintain the confidentiality of its procedures and protocols by entering into various non-compete, non-solicitation, and confidentiality agreements with its employees, contractors and partners. Theoria’s proprietary and trade secret information is password protected and may only be accessed by authorized users who have confidentiality, non-compete, non-solicitation and/or non-disclosure agreements with the

Company. Theoria actively enforces these agreements and spends considerable time and money to keep its trade secret business processes confidential.

Appropriate Care for Residents generally known to the public. It is this method of approach that derives independent economic value. If the information was public, the method of approach would lose economic value.

Additionally, Theoria Medical has undertaken measures to maintain the confidentiality of its procedures and protocols by entering into various non-compete, non-solicitation, and confidentiality agreements with its employees, contractors and partners. Theoria’s proprietary and trade secret information is password protected and may only be accessed by authorized users who have confidentiality, non-compete, non-solicitation and/or non-disclosure agreements with the

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 23

Appropriate, Timely Medical Orders and Documentation This section includes proprietary information regarding Theoria Medical’s internally developed

EHR system. Theoria has not licensed ChartEasy nor has it made it publicly available for use. This fits the definition of a “trade secret” as outlined in A.A.C. R2-7-101(50). The information regarding Theoria Medical’s method of approach is not readily ascertainable or generally known to the public. It is this method of approach that derives independent economic value. If the information was public, the method of approach would lose economic value. Additionally, Theoria

Medical has undertaken measures to maintain the confidentiality of its procedures and protocols by entering into various non-compete, non-solicitation, and confidentiality agreements with its employees, contractors and partners. Theoria’s proprietary and trade secret information is password protected and may only be accessed by authorized users who have confidentiality, non-compete, non-solicitation and/or non-disclosure agreements with the Company. Theoria actively enforces these agreements and spends considerable time and money to keep its trade secret business processes confidential.

Relationship with Residents and Families generally known to the public. It is this method of approach that derives independent economic value. If the information was public, the method of approach would lose economic value.

Additionally, Theoria Medical has undertaken measures to maintain the confidentiality of its procedures and protocols by entering into various non-compete, non-solicitation, and confidentiality agreements with its employees, contractors and partners. Theoria’s proprietary and trade secret information is password protected and may only be accessed by authorized users who have confidentiality, non-compete, non-solicitation and/or non-disclosure agreements with the

Policies, Procedures, and Quality Assurance and Process Improvement The information regarding Theoria Medical’s training, policies and procedures are not readily ascertainable or generally known to the public. It is this method of approach that derives independent economic value. If the information was public, the method of approach would lose economic value. Additionally, Theoria Medical has undertaken measures to maintain the confidentiality of its procedures and protocols by entering into various non-compete, non-solicitation, and confidentiality agreements with its employees, contractors and partners. Theoria’s proprietary and trade secret information is password protected and may only be accessed by authorized users who have confidentiality, non-compete, non-solicitation and/or non-disclosure

Medical Staff Training Throughout this section, Theoria Medical outlines its clinical training protocols, which it has internally developed with it team of highly trained post-acute care experts provide a high-level of care to patients in an acute care setting. This section also includes a model of Theoria Medical’s care coverage, and details regarding Theoria’s proprietary platform. Theoria Medical has taken

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 24 steps to keep this information confidential, including the use of confidentiality, non-compete and non-solicitation clauses in its Employment Agreements. The information regarding Theoria

Medical’s method of approach and training is not readily ascertainable or generally known to the public. It is this method of approach that derives independent economic value. If the information was public, the method of approach would lose economic value. Additionally, Theoria Medical has undertaken measures to maintain the confidentiality of its procedures and protocols by entering into various non-compete, non-solicitation, and confidentiality agreements with its employees, contractors and partners. Theoria’s proprietary and trade secret information is password protected and may only be accessed by authorized users who have confidentiality, non-compete, non-solicitation and/or non-disclosure agreements with the Company. Theoria actively enforces these agreements and spends considerable time and money to keep its trade secret business processes confidential.

Non-physician medical staff oversight Throughout this section, Theoria Medical outlines its clinical protocols, which it has developed to provide a high-level of care to patients in an acute care setting. This section also includes a model of Theoria Medical’s care coverage, and details regarding Theoria’s proprietary platform. Theoria

Medical has taken steps to keep this information confidential, including the use of confidentiality clauses in its Employment Agreements. The information regarding Theoria Medical’s method of approach is not readily ascertainable or generally known to the public. It is this method of approach that derives independent economic value. If the information was public, the method of approach would lose economic value. Additionally, Theoria Medical has undertaken measures to maintain the confidentiality of its procedures and protocols by entering into various non-compete, non-solicitation, and confidentiality agreements with its employees, contractors and partners. Theoria’s proprietary and trade secret information is password protected and may only be accessed by authorized users who have confidentiality, non-compete, non-solicitation and/or non-disclosure

Proprietary Electronic Health Record, ChartEasy system ChartEasy. ChartEasy was internally developed by Theoria at great expense. Theoria has not licensed ChartEasy nor has it made it publicly available for use. This fits the definition of a

“trade secret” as outlined in A.A.C. R2-7-101(50). The information regarding Theoria Medical’s method of approach is not readily ascertainable or generally known to the public. It is this method of approach that derives independent economic value. If the information was public, the method of approach would lose economic value. Additionally, Theoria Medical has undertaken measures to maintain the confidentiality of its procedures and protocols by entering into various non-compete, non-solicitation, and confidentiality agreements with its employees, contractors and partners. Theoria’s proprietary and trade secret information is password protected and may only be accessed by authorized users who have confidentiality, non-compete, non-solicitation and/or non-disclosure agreements with the Company. Theoria actively enforces these agreements and spends considerable time and money to keep its trade secret business processes confidential.

Theoria Medical, PLLC, Theoria Medical PLLC’s Proposal, RFP No. BPM004228 25

24/7 Coverage and Telemedicine This section includes proprietary information regarding Theoria Medical’s proprietary telemedicine cart system. This system was internally developed by Theoria at great expense.

Theoria has not licensed their telemedicine program, nor has it made it publicly available for use.

This fits the definition of a “trade secret” as outlined in A.A.C. R2-7-101(50). The information regarding Theoria Medical’s method of approach is not readily ascertainable or generally known to the public. It is this method of approach that derives independent economic value. If the information was public, the method of approach would lose economic value. Additionally, Theoria

Medical has undertaken measures to maintain the confidentiality of its procedures and protocols by entering into various non-compete, non-solicitation, and confidentiality agreements with its employees, contractors and partners. Theoria’s proprietary and trade secret information is password protected and may only be accessed by authorized users who have confidentiality, non-compete, non-solicitation and/or non-disclosure agreements with the Company. Theoria actively enforces these agreements and spends considerable time and money to keep its trade secret business processes confidential.

Transition of Services Upon Contract Award system…