IN.gov | The Official Website of the State of Indiana



RFP # 18-066Attachment F3 Technical Proposal Template for Clinic ServicesInstructions: Please provide a narrative response, addressing each of the following topics. Where appropriate, supporting documentation may be referenced by specific page and/or paragraph number(s). Failure to provide responses that address all topics may result in the proposal being eliminated from consideration.PROPOSED SCOPE OF WORKClinic Objectives:Improve employee health and wellbeingImprove workplace productivity and engagementProvide a relevant and valuable benefit to employeesRequested Onsite Clinic ServicesPrimary CarePreventive CareImmunizations & Injections (excluding flu shots)Health and Nutrition CoachingLab testsImmediate/Acute CarePrenatal ServicesBehavioral Health ServicesDispensing of Prescription Drugs (limited scope)Face to Face Counseling Services that can be billed through the EAP program with AnthemDental ServicesVision ExamsMassage TherapyPhysical TherapyDermatology (limited scope)Employment related drug and alcohol testing are not covered services provided in the Clinic.General InformationEligible population (on campus / near campus)Enrolled EE 7,559Medical Waived Employees ,1,38758% FemaleAverage Age 47Vendor partnersAnthem for Medical, Dental, Vision and EAPCVS Caremark for PharmacyFacility LocationRoom W041 in the basement of the Indiana Government Center South (IGCS), 402 W. Washington Street, Indianapolis, IN 46204Facility SizeApproximately 8,700 square feetPlan Design Conditions (Enrolled Employees)Depression (12%)Diabetes (23%)Overweight (30%)Obese (46%)GENERAL ORGANIZATIONPlease provide information about your company’s future vision, strategic objectives, philosophy/approach to employer sponsored health/clinical service provision.Please describe the most innovative programs, features, and functionality currently in place today.What is your value proposition compared to your competitors?Do you have formal partnerships or other business affiliation with any hospital systems or provider groups? If yes, please list system/group name, length of partnership and explain nature of partnership.Please list the number of clinics by type, by year or geography. ?Retail (Open to Public Full-time)Employer Shared Full-timeEmployer Worksite Full-timeEmployer Worksite Acute CareEmployer Worksite PCMH*Total Clinic Locations2018 Total (YTD)2017 Total2016 TotalIndiana?*Patient Centered Medical Home: Sites accredited as PCMH by AAAHC or NCQAPlease list the number of CLIENTS.Employer onsite Full-timeEmployer near-site/sharedTotalPublic Entities/Municipal ServicesHow many employer sponsored non-occupational clinics that you have managed closed in the past 36 months? Please list and provide the reason for closure.Please list any employer-sponsored non-occupational clinics that you have managed in the past 36 months that have transitioned away from you to a new vendor or operator, and a brief reason for the change?Please describe your partners and other third parties or sub-contractors with whom you collaborate for provision of services. Along with your description, complete the table below to include the following information about your partners or subcontractors:Companies with Whom youPartner and Subcontract ServicesNumber of Years of PartnershipService(s) Provided by PartnerNumber of Years Providing Medical Clinic Services to EmployersNumber ofFull-time EmployeesNumber ofPart-time EmployeesLocation ofHeadquarters?Provide your organization's full time employee count. Enter “0” if none or not applicable.YearNumber of Full-time clinical employees (staffed at clinics)Number of Full-time Back-office/Support Staff201620172018/CurrentHow many clinicians are employed as part of leadership/management/oversight? E.g. medical directors not delivering services at clinics.Please describe your implementation and roles/responsibilities in the process. What is the projected length of time between contract award and the clinic opening? Please provide a detailed sample plan.Administration / Integration PaymentWhat methods can you use to collect payment for clinic services?MethodsY/NPoint-of-Sale systemThird-party billing systemBill insurance company on behalf of patientOther (Describe): Please explain in detail the process flow for charging members who are on a High Deductible Health Plan (HDHP) with an HSA. Address the following topics: eligibility confirmation, patient status towards deductible, method of collecting payment, claim adjudication, EOB processing, reconciliation. Will the clinic be able to accept insurance payments for members not on the employer plan including Medicare and Medicaid? If yes, explainCould the clinic and its providers be in-network and credentialed as part of the medical plan? Outline your experience in this area.Does your clinic have embedded cost and transparency tools? If yes, who/which entity provides your transparency services?Confirm your ability to submit claims including CPT and ICD-10 codes to the State’s medical TPA.AdministrationConfirm your ability to arrange and pay for maintenance of the onsite clinic including services such as cleaning, trash removal, changing and replacing the lights. Care CoordinationDo you have a systematic process and criteria for identifying patients who may benefit from onsite clinical care management? Please provide a process flow map.How will the clinic proactively identify previous patients with unplanned hospital admissions and emergency department visits?Does the clinic care team collaborate with the patient to:?Yes/NoIf yes, explain:Develop patient preferences and functional/lifestyle goalsIdentify treatment goalsAssess and address potential barriers to meeting goalsInclude a self-management plan?Outline how the clinic provides instructions to members for obtaining care and clinical advice when the office is closed?Is clinical information available to on-call staff when the office is closed? If so, how is it accessed?Will you assign members of The State of Indiana clinic care team to coordinate care for individual patients? If so, explain. Are patients provided with a clinical summary of their office visit?Does the clinic generate lists of patients and proactively remind patients of needed preventive/follow-up care? What is your method for contacting patients and how frequently is this done?Do you annually identify populations of prior patients and proactively remind them of needed care based on patient information, clinical data, health assessments and evidence-based guidelines?Collaboration with Community ProvidersDo you utilize specialist referral services?How is a list of eligible community providers developed for referral? How frequently is the list reviewed and updated?Please describe how you will coordinate care and collaborate with community primary care providers.Will the clinic document inbound and outbound referrals and care coordination in the patient’s medical record?Will the clinic track referrals until the referral provider/specialist’s report is available, flagging and following up on overdue reports?Will the clinic share clinical information with admitting hospitals and emergency departments? What is your standard process for doing so?What follow-up process does your clinic have in place if a patient is referred to an ER or an urgent care from your clinic?Does your model have follow up processes in place if a patient is referred to specialist or community resource from your clinic? If so, outline. Integration with the State of Indiana Health Management Outline your experience integrating your services with an employer’s other third party vendors (e.g., medical plan, population health/disease management, wellness) to provide a seamless, efficient, and effective patient management experience?Do you refer patients to external structured health education programs, such as group classes, peer support, and lifestyle management coaching?What incentives/disincentives do you recommend to optimize clinic utilization?Lifestyle & Condition Management Describe your organization’s capabilities around delivering lifestyle management programing (i.e., health coaching/education to address modifiable risks) via the onsite clinic. What sources do you utilize to determine which members are eligible for your lifestyle management programs/coaching program?How do your providers/coaches ensure they have a complete understanding of a member’s medical history before undertaking any lifestyle management interventions?How does your Electronic Medical Records (EMR) support the coach in managing the member’s lifestyle risks?How does the clinic provide the patient with educational materials?How do you determine which members are eligible for your chronic condition management program? How does your clinic staff ensure they have a complete understanding of the member’s medical history before undertaking any interventions? How does your EMR support the clinic staff in managing the member’s chronic condition(s)? QUALITY MANAGEMENTDescribe your quality assurance and performance improvement plan?How frequently is the plan reviewed and updated?What entities have responsibility for developing and updating the plan?Is there a written Risk Management Program?If “yes”, what areas are addressed within it?How frequently are the program criteria reviewed/modified?What entities have responsibility for developing and updating the plan? What processes exist for rectifying quality control issues (e.g. what is the feedback loop to the staff, what are the consequences of continued poor quality, how is the improvement monitored)? Please complete the following table describing your standard clinic audit processes (e.g. scope, frequency, benchmarks, reporting).Audit TypePerson/Group PerformingSite-based/RemoteScoring Criteria (e.g. AAAHC, NCQA, etc.)Frequency (i.e. monthly, annual)FacilityOrganizational Policies & ProceduresRisk Management Provider Chart (1.O NP)Data SecurityHIPAACodingFinancial?How many days following receipt of a patient complaint is the client notified?Explain your organization’s grand round approach to discuss high risk/high cost patients? Address how cases are selected and the frequency of grand round sessionsLegal, Compliance, and LiabilityDescribe how you comply with GINA as it pertains to onsite clinics. Explain processes in place to assure patient privacy and confidentiality. How do you ensure compliance with HIPAA/HITECH?How many days following a data breach is a client notified?How many medical malpractice cases have you had in the past 5 years?Identify any past, pending, or threatened litigation or administrative or state ethics board proceedings to which you or any of your employees are a party, including physicians, NPs, PAs under your control.How many HIPAA breaches have you had in the past 5 years? If any, please describe what safeguards were put I place to prevent future breaches. ?Please describe your approach to data security.How many data security breaches have you had in the past 5 years? If any, please describe what safeguards were put I place to prevent future breaches. ?Do you employ an in-house, full-time regulatory compliance officer?Do you employ an in-house full-time privacy and security official?Services, Communications, and Marketing SupportGeneral Services?# Clinics Current DeliveringSubcontractorNotesAcute/Urgent CarePrimary Care Provider ServicesAfter-hours CarePharmacyLab ServicesPrenatal ServicesHealth & Nutritional CoachingDental ServiceVision ServicesMassage TherapyPhysical TherapyBehavioral HealthOnsite EAPDermatologyClinic AccessDo you allow same-day appointments for routine care and/or urgent care?Do you allow routine and urgent-care appointments outside regular business hours? If so, explain the processCan patients request and/or schedule an appointment online? Describe your system for scheduling appointments.How would you communicate (for scheduling and care) with a deaf employee?What is your philosophy on time allocated for length of office visits? What do you recommend as optimal?CommunicationsWhat communications do you provide to employees to optimize utilization of onsite clinics? Please provide samplesThe State of Indiana will be looking for its vendor partner to design a communication and promotion plan. Outline how your organization would work with The State of Indiana to design the communications strategy for launch and ongoing campaigns to promote onsite services and other health and wellness initiatives based on your standard level of marketing support. Describe how your organization would work with The State of Indiana to implement this strategy.TelemedicineDescribe the scope of services for telemedicine (i.e. real-time sessions where providers can diagnose and treat select conditions) and mode of care delivery (e.g. video, telephonic, web based).Do you distinguish between Telehealth and Telemedicine? How do you define the terms??How many employers currently contract directly with you for telemedicine services?What percentage of your clients have contracted for telemedicine services??ResponseProvider to providerPatient to clinic providerPatient to telemedicine provider network?Telemedicine services available:Visit TypeY/N1: Acute care2: Behavioral health (via psychologist)3: Health coaching?Are patients able to complete telemedicine visits via a mobile application (Yes/No)?Visit TypeY/N1: Acute care2: Behavioral health via psychologist3: Health coaching4. Health Advocacy5. Routine follow-ups6. DermatologyDo you measure and report patient utilization of TeleHealth?What decision support tools are available through your offering? Please give specific examples of tools and how patients or providers can use them? What current processes exist today between your organization and your preferred telemedicine partner to ensure any after-hour care and/or clinical recommendations are communicated to and forwarded to the clinic staff and included in the member’s file?How do you handle this process with other telemedicine vendors?How would the Telemedicine partner communicate after-hour care to assure continuity of care?PharmacyWhat approach do you recommend for The State of Indiana?Does the clinic have a process for managing medications? If yes, does this process:Monitor if a patient has had their prescription filledMonitor if a patient has re-filled their prescription medications on scheduleReview and reconcile medicationsProvide information about new prescriptionsAssess understanding of medicationsAssess response to medications and barriers to adherenceDocument over-the-counter medications, herbal therapies, and supplementsDo any triggers exist if medication reconciliation does not take place? If yes please describe.Are you currently a provider in the CVS Caremark network? If not, will you become a provider in order to serve State employees?Does the clinic use electronic prescribing? If yes:Are prescriptions written by the clinic compared to drug formularies and electronically sent to pharmacies?Are medication orders entered electronically into the medical record?Are patient-specific checks for drug-drug and drug-allergy interactions performed?Are prescribers altered to generic alternatives?STAFFINGPlease describe how you will ensure the staff considered for hire will fit The State of Indiana’s culture and are best suited to support The State of Indiana’s objectives. What is your organizational philosophy regarding the use of physicians or mid-level providers to staff clinics?Provide your minimum credentials for the staff below: PhysicianPhysician AssistantNurse PractitionerRegistered Nurse/ Health CoachLicensed Practical Nurse (LPN)Medical AssistantCollaborative PhysicianMinimum Credentials FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????What senior leadership within your organization has turned over in the past two years?CEOCMOCIOPresidentsVice PresidentsWhat staffing model do you recommend for The State of Indiana?FTERoles and ResponsibilitiesPosition 1 FORMTEXT ????? FORMTEXT ?????Position 2 FORMTEXT ????? FORMTEXT ?????Position 3 FORMTEXT ????? FORMTEXT ?????Position 4 FORMTEXT ????? FORMTEXT ?????Position 5 FORMTEXT ????? FORMTEXT ?????Please provide the following information regarding your onsite clinical staffPercentage Turnover 2016Percentage Turnover 2017Percentage Turnover in the first year of clinic OperationsAverage TenurePhysician FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Physician Assistant (PA) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Nurse Practitioner FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Registered Nurse FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Licensed Practical Nurse (LPN) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Medical Assistant FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Administrative Staff FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Do you require providers (physician and mid-level practitioners) to receive training on behavior change theory or motivational interviewing? Describe any ongoing behavior change/ motivational interviewing training providers go through Describe the process of ongoing provider staff peer review and evaluation of current competency and performance.What is your days-to-fill ratio??PhysicianPhysician AssistantNurse PractitionerMedical Assistant?How will you manage temporary or per diem staffing for clinic employees’ absences due to illness, vacation, etc.? Please describe The State of Indiana’s proposed account management team. Provide Curriculum Vitaes (CVs) if available.Please describe The State of Indiana’s proposed implementation team. Provide CVs if available.Will your providers all be in the Anthem Blue Access PPO network?TechnologyWhich of the following data sources will be automatically loaded (no manual input) into the technology platform in discrete searchable form?Diagnostic values from Wellness Center medical equipment. If yes, which equipmentReference lab (external)Radiology (external)Biometric screening (external)HRA (external)Data warehouse (external)Other?What EMR/PM system does your organization use? Is it proprietary?Certifications:Please describe features/functionality of the provider dashboard within the electronic medical record. Please provide a screen shot.Please describe how the technology platform presents daily opportunities for the health center team.How is behavior change theory incorporated into the technology platform?Have you implemented remote condition monitoring? If so, for what conditions?Are remote monitoring kits fully integrated with the electronic medical record?Is your system compliant with ICD-10?Does your technology platform conduct predictive modeling? Please describe in detail.Can patients and providers send a secure message to each other? Can patients request prescription refills through the technology platform?How does your standard technology platform use external patient claims data to identify gaps-in-care?Can patients receive test results through the technology platform? Can patients send their health information to a third party? Can health records be downloaded by the patient?Do you record all clinical advice in patient records?Do you have a documented process for diagnostic test tracking and follow-up that:?Process FunctionsY/N1: Tracks lab tests until results are available, flagging and following up on overdue results2: Tracks imaging tests until results are available, flagging and following up on overdue results3: Flags abnormal lab results, bringing them to the attention of the clinician4: Flags abnormal imaging results, bringing them to the attention of the clinician5: Notifies patients of normal and abnormal lab and imaging test results6: Are clinical lab test results incorporated into structured fields in the medical record7: Are scans and tests that result in an image accessible electronicallyPlease list all electronic data exchange formats that you cannot support.Will the clinic have capacity for electronic exchange of key clinical information and provide an electronic summary of the care record to external providers?Can your technology platform automatically assist in the billing of a patient for care rendered and check the patient’s status toward their deductible? (e.g. the clinic staff can bill the patient at the time of service according to medical plan design)Are patients able to pay onsite clinic bills via the portal? Mobile application?Does your mobile application send patients onsite clinic reminders? If so, provide examples.Does your system notify the patient automatically when a script is available for pick-up?ReportingPlease provide a sample of your standard reporting packages (monthly, quarterly & annual).Does your organization report on financial return on investment? If so, please describe.Provide your book-of-business onsite clinic utilization and penetration rates (number of unique visitors compared to the location population). In addition to completing the table, you may also add a report: MetricsNumberSpecify or define the unit (e.g., numerator, denominator) Notes, Comments Utilization Rate (average per site)Penetration rate (average per site)Describe the client's online access to reporting and any on-demand reporting capabilities. Does the reporting package offer online access to real-time utilization data? Does the clinic regularly obtain feedback from patients on their experiences at the clinic? If so, explain the timing and process. How and at what frequency is your patient satisfaction survey administered? ? Please provide your book-of-business patient satisfaction results for 2017 and 2018 YTD.Confirm your ability and willingness to transmit data to the State of Indiana’s data warehouse.Financials & Performance GuaranteesDescribe your financial model(s).?ModelY/N1: Fee-for-service: Reimbursement through employer medical plan2: Variable Cost-plus, Staffing Based: Variable expenses with fixed management fee, based on the staffing costs. Majority of costs passed through as incurred3: Variable Cost-plus, Population Based: Variable expenses with fixed management fee, based on the size of eligible population. Majority of costs passed through as incurred4: Fixed: All Inclusive: All costs included, guaranteed not to change5: Fixed Staffing, Supplies Variable: Staffing costs and management fee guaranteed, supplies variable6: Shared Risk: Fees are dependent on savings to medical plan7: Capitation Variable Cost-plus: All variable expenses with fixed management fee8: Capitation Fixed Cost-plus: Operational costs include management fee, but annual costs are fixed9: Membership: Fixed monthly fee per member, reimbursed through fee-for-service insurance charges10: Other, explain:What is the formula for calculating the contract management fee?What is the formula for calculating the contract general and administrative expenses?If clinic staffing changes during the contract do management fees or general and administrative dollar amounts change?Do you put fees at risk? (Yes/No)If staff salaries exceed projected budgets, who pays for the cost overrun?For variable cost models, what controls are in place to limit the State’s cost?Provide your standard performance guarantees. Include as a separate attachment.Provide your standard contract. Include as a separate attachment.Would you be willing to put fees at risk based on risk reduction as measured by the State’s data warehouse?Please provide a feasibility study for The State of Indiana, using your model/format including the fee proposal. Please request necessary data to make assumptions specific to the State of Indiana. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download