Statewide Resilience Plan

Our Vision

We propose the first in the nation, comprehensive and integrated system to early detect, manage and mitigate infectious outbreaks. Moreover, parts of the system will be of use to mitigate other extreme public health emergencies within the State of Arizona. This is accomplished by broad-based coalition among all key constituents across the State including public health, first responders, integrated health systems, employer networks and consumers via digital tools and messaging.  By ensuring immediacy of action and consistent communication, this system will serve as the entity to ensure a safe and healthy Arizona against any threat. 

At the present, the State of Arizona has no integrated system of this type. Some of the elements are in place, but will require modernization, retooling and/or integration to make them fully operational.  While complimentary in structure to existing Federally funded emergency operation centers which coordinate large-scale disaster responses, our model is focused primarily on health ecosystem partners, including hospitals, public health agencies, alternate care site providers and the public. The model embodies a 24/7 operation which continuously monitors for emerging disease outbreaks via new and expanded early detection, warning and surveillance systems and simultaneously disseminates this information to key decisionmakers, audiences, providers and public via all consumer digital platforms and text apps, reaching rural and vulnerable populations across the state.  At the core, a command center staffed with clinically based personnel offers rapid response decision-making to any threat.  Had this system been in operation prior to the pandemic, it would have easily identified emerging hotspots across communities and provided significant guidance for early disease mitigation and management.  By empowering all consumer audiences with useful, pertinent and actionable information, it will provide increased individual engagement and greatly minimize mis/disinformation typically experienced during extreme public health emergencies. 

Overall, this model integrates, upgrades and/or generates the missing major components of existing response networks, i.e., a focus on local rapid disease outbreaks with a unified team, constantly at the ready, with tools to manage, mitigate and inform others immediately.  Work is tasked in a matter of minutes once known versus hours or days by traditional approaches/systems.  It is simply a better, more comprehensive system.

The Plan

The pandemic shocked the world.  But the next pandemic is lurking just over the horizon, ready to unleash its fury.  We had no early warning systems, coordinated community responses or mitigation strategies.  We must be prepared and ready to act. 

We can be ready for the next pandemic unlike never before.  The solution – a bold and new innovative response network, which is quick, comprehensive and offers rapid solutions for any public health crisis.   

The initial infrastructure components of this network are considered minimal requirements for start-up and daily management.  As others are engaged and subject matter expertise is embraced across many disciplines, the model will naturally evolve, like a living ecosystem, thus, it will always be very dynamic in scope and use.  We are openly collaborative and realize it will require the work of many to accomplish it and ensure its success.  But this is a model that can be implemented and provide significant value to any State or community thru improved responsiveness to events and the ability to minimize morbidity and mortality when they occur. 

We have a unified engagement with key constituents that led the statewide pandemic response to embrace this implementation, thus, Arizona is the natural focus of our efforts at this time.   Key priority areas for funding and development include the following:

(1) Statewide Public Health Emergency/Pandemic Command Center

Scope:  Develop a definitive command center which serves as the “go to” navigation center for response coordination and information dissemination of all public health emergencies statewide.  This center is essentially a national weather service-like system or air traffic control-like system that provides comprehensive “at a glance” coordination of services.  It should also be a mobilizing and coordinating center to implement a statewide response, including coordination between AZ government agencies, Inter Tribal Council of Arizona, businesses, health care providers, universities and other entities. It should be a planning entity that defines points of action based on data from the ground for infectious and non-infectious emergencies. 

Demonstration funds required: in partnership with ADHS, Aegis Arizona will establish a pilot version of the proposed command center and conduct simulation modeling to illustrate how it performs during a series of mock public health emergencies across the State.

Full program implementation costs: based on demonstration project results, if implemented, a statewide command center operation would require a minimum of $5M in start-up funding for programmatic functional design, IT functions, infrastructure build, equipment, personnel and $5M in annual recurring funding for 24/7 operations. Final determination of full project requests is dependent on final design scope and associated costs.

ROI: creation of an exportable (turnkey) command center model i.e., “ system ” to develop a comprehensive resilience monitoring center for use by other States and countries, valued at $500M  minimum annually in recurring sales/licensing revenue; if adopted, center implementation creates a minimum of 50 new FTE jobs: 1 FTE Executive Director, 1 FTE Assistant Director, 1 FTE Medical Director, 1 FTE Assistant Medical Director, 1 FTE COO, 4 FTE Center Administrators, 36 FTE’s for 9 surveillance desk functions and 5 shared Administrative Assistant positions.

(2) Statewide Early Warning System – Real-Time Wastewater Surveillance Network

Scope:  Develop a definitive early warning system for infectious diseases within Arizona via all-County wastewater surveillance network.  Command/control of the network led by ADHS with coordination support by Aegis Consortium.

Demonstration funds required: in partnership with ASU, NAU, and UArizona Yuma Center of Excellence for Desert Agriculture (Wastewater Based Epidemiology Lab), we will establish a pilot version of the center.  A formal 24/7 surveillance “desk” is also a key function of the proposed comprehensive command center.

Full program implementation costs: based on demonstration project results, if implemented, a statewide wastewater surveillance network operation would require a minimum of $5M in start-up funding for programmatic functional design, IT functions, infrastructure build, equipment, personnel and $2M in annual recurring funding for 24/7 operations.  Final determination of full project requests is dependent on final design scope and associated costs.

ROI: creation of an exportable (turnkey) wastewater surveillance network model i.e., “playbook” to develop a comprehensive monitoring program for use by other States and countries, valued at $3M-$5M minimum; if adopted, center implementation creates a minimum of 10 new FTE jobs: 1 FTE Director, 1 FTE Assistant Director, 4 FTE surveillance desk functions and 4 FTE regional field managers. Additional field personnel may be required depending on local availability of existing county staff resources.

(3) Statewide Early Warning System – Real-Time Surveillance Network for New Disease Outbreaks 

Scope:  Develop a definitive early warning system for new infectious diseases (cases/symptoms) within Arizona via computerization links with Arizona-based healthcare providers. 

Demonstration funds required: in partnership with ADHS and AZ public universities and MEZCOPH, Aegis Arizona will establish a pilot version of the center, to include development of community-based symptom criteria and system modeling of criteria to simulate early notification and hot spotting of emerging disease outbreaks within select communities and across State. New microbial pathogen identification would be done in a distributed manner at the three ABOR universities, and knowledge eventually outsourced to state ADH labs when applicable.  A formal 24/7 surveillance “desk” is also a key function of the proposed comprehensive command center.

Full program implementation costs: based on demonstration project results, if implemented, a real-time surveillance network for new disease outbreaks across Arizona would require a minimum of $5M in start-up funding for programmatic functional design, IT functions, infrastructure build, equipment, personnel and $2M in annual recurring funding for 24/7 operations.  Final determination of full project requests is dependent on final design scope and associated costs.

ROI: creation of an exportable (turnkey) real-time surveillance network model for new disease outbreaks i.e., “playbook” to develop a comprehensive monitoring program for use by other States and countries, valued at $40M-$50M minimum; if adopted, center implementation creates a minimum of 8 new jobs: 4 FTE surveillance desk functions and 4 FTE regional field managers.  Additional personnel may be required depending on local availability of project resources.

(4) Statewide Pandemic and Emergency Care Coordination Network 

Scope:  In partnership with ADHS, expand the Arizona surgeline (800# for hospital/care transfers) which proved invaluable for small/rural hospitals and even metro areas during pandemic by directing patients to health care providers that had capacity to care for them.  Scope expansion includes simulation of a statewide transfer facilitation network during simulated pandemic periods.

Demonstration funds required: provides funding to expand current ADHS rural hospital transfer center model to demonstrate the effectiveness of a 24/7 statewide transfer center during pandemics (simulation exercise).

Full program implementation costs: based on demonstration project results, if implemented, a real-time care coordination network for facilitating patient transfers across Arizona would require a minimum of $2M in start-up funding for programmatic functional design, IT functions, infrastructure build, equipment, personnel and $2M in annual recurring funding for 24/7 operations.  Final determination of full project requests is dependent on final design scope and associated costs.

ROI: creation of an exportable (turnkey) transfer center network model i.e., “playbook” for facilitating requests for higher level/lateral care transfer navigation for use by other States and countries, valued at $40M-$50M minimum; if adopted, center implementation creates a minimum of 20 new jobs: 4 FTE surveillance desk functions, 4 FTE regional field managers and 12 additional FTE’s for care coordination.  Additional personnel may be required depending on local availability of project resources.

(5) Consumer Digital Engagement Platform – Informing, Engaging and Caring for our Communities 

Scope:  Develop a new community model of information on pandemic/emergencies including information on healthcare delivery in which consumers have on-line digital access and assisted navigation to needed resources on a 24x7 basis. Consumers, via new digital app and live talk/chat with healthcare navigators, will have visualization and direct scheduling for same-day/next-day episodic health care services. 

Demonstration funds required: provides funding to create an IT architectural framework using commercial (Vibrent, Inc.) or non-profit (WeHealth, Inc.) partners, for an all-consumer digital platform in which consumers have 24/7 on-line access to healthcare resources, providing both digital navigation as well as live chat with community-based resource navigators; includes training and staffing for a maximum of 30 healthcare navigators. 

Full program implementation costs: based on demonstration project results, if implemented, a real-time consumer digital engagement platform would require a minimum of $2M in start-up funding for programmatic functional design, IT functions, infrastructure build, equipment, personnel and minimum of $1M in annual recurring funding for 24/7 statewide operations.  Final determination of full project requests is dependent on final design scope and associated costs.

ROI: creation of an exportable (turnkey) consumer digital platform to improve healthcare navigation for consumers i.e., “software” for use by other States and countries, valued at $500M minimum annually in recurring sales/licensing revenue; this new product offering creates a new business line to license, sell, implement and operate for any contracting entity/organization. 

(6) Universal Access Arizona - Informing, Engaging and Caring for Vulnerable and Difficult-to-Reach Communities 

Scope:  Develop models from #5 above with a particular focus on vulnerable and difficult-to-reach communities with lower access to technology and health care. Provide information on pandemic/emergencies including information on healthcare delivery in which consumers have phone or other access and assisted navigation to needed resources on a 24x7 basis. Consumers should have visualization and direct scheduling for same-day/next-day episodic health care services. 

Demonstration funds required: in partnership with ADHS social services, Inter Tribal Council of Arizona, senior living providers and communities and others to identify bottlenecks and pilot-demonstrate the approaches to reach out and integrate vulnerable populations into the emergency response.  Use UA cooperative extension as a dissemination/reach out network. Workforce training programs will be included in the pilot (50 trainees).

Full program implementation costs: based on demonstration project results, if implemented, a multi-channel communication and digital engagement platform, as an extension of #5 above, would require $2M in funding to provision the system for the unique needs of vulnerable communities, $2M recurring.  Final determination of full project requests is dependent on final design scope and associated costs.

ROI: creation of an exportable (turnkey) consumer digital platform (module) to improve healthcare navigation for difficult to reach consumers i.e. “software” for use by other States and countries, valued at $50M minimum annually in recurring sales/distribution revenue; this new product offering creates a new business to license, sell, implement and operate for any contracting entity/organization. 

(7) Bedside, Specialty-Based Telemedicine for Small/Rural Communities

Scope:  Develop a multi-specialty “virtual” consult model prototype to aid small/rural hospitals in providing bedside care.  Recruit participating tertiary and quaternary hospitals from the Phoenix and Tucson areas. Project demonstrates the viability of remote, bed-side specialty consults for small/rural hospitals versus traditional patient transfers to higher level care facilities.

Demonstration funds required: provides funding using the UArizona telemedicine program in partnership with 3 rural area hospitals (suggested) - Whiteriver Indian Hospital, Whiteriver, AZ (40 beds); Yavapai Regional Medical Center - East, Prescott Valley, AZ (56 beds); and Valley View Medical Center, Fort Mohave, AZ (84 beds) to provide telehealth consults in endocrinology/metabolic diseases, cancer and heart diseases for acute, bed-side patients.

Full program implementation costs: based on demonstration project results, if implemented, a statewide multi-specialty virtual consult network for rural, small and vulnerable healthcare communities would require $5M in funding to provision the system for the unique needs of small, rural and vulnerable communities and $5M for annual recurring operations.  Final determination of full project requests is dependent on final design scope and associated costs.

ROI: improved financial viability for small/rural hospitals by providing healthcare consults virtually at small/rural facility versus transfer of patients to higher level care facilities; improved transfer acceptance at urban destination centers as more patients are cared for at local facilities; creation of an exportable (turnkey) virtual specialty consult program (software and system) to improve acute care services for rural hospitals for use by other States and countries, valued at $100M minimum annually in recurring sales/distribution revenue; this new product offering creates a new business to license, sell, implement and operate for any contracting entity/organization. 

(8) Rapid Response, University-Based “Volunteer” Public Health & Clinical Workforce

Scope:  Train a rapid-deployment student force across Arizona’s public universities to assist with data collection, data entry, low-level analysis and other tasks to assist ADHS, county DHS and health providers in evaluating and tracking of clinical/non-clinical events during extreme public health emergencies; includes certificate program for 1,000 students.

Demonstration funds required: to train 50 undergraduate students in relevant skills sets. 

Full program costs: $1M, one-time, to stand up certificate programs at three ABOR universities; certificates in emergency preparedness will become part of the curriculum and will be administered annually to 500 students at ASU and UA, and 50-100 students at NAU. The numbers will be scalable.

ROI: generates a standing workforce that does not need to be permanently employed and paid; can be deployed readily at the time of emergencies. Can be scaled nationally and internationally via microcampus and online programs. Will generate 10-15 new jobs statewide in Y1, and $48/student/hr. (x3h/wk. x16/wk.) in tuition income going forward.

(9) Rapid Response, Employer-Based “Volunteer” Emergency-Trained Workforce Network 

Scope:  Develop a rapid deployment force for Arizona’s businesses/employers and their employees to assist with logistical/support tasks during extreme public health emergencies.  Employers benefit from integrated communications, specific pandemic playbooks, lower or no shutdowns/work interruptions and single source of truth regarding information dissemination.

Demonstration funds required: to train 50 employees in relevant skills sets.

Full program costs: $500,000, one-time, to stand up certificate programs in collaboration with all three ABOR universities; certificates in emergency preparedness for employees will be partially subsidized by this state investment and will be administered to 500 employees across the state.  Demand would be gauged at that time and offerings adjusted. Refresher courses would be offered every 3 years. The numbers will be scalable.  We will directly engage with the business community to develop this work.

ROI: generates a standing workforce within each business, that is not separately paid or is provided a small incentive by employers. This workforce can be readily deployed at the time of emergencies.  Can be scaled nationally and internationally via microcampus and online programs. Will significantly improve resilience of AZ businesses and economy overall.  Will generate 3-6 new jobs statewide in Y1 and tuition income going forward.