PowerPoint presentation

Texas Health and Human Texas Health and Human Services Commission (HHSCServices Commission (HHSC))

Texas Health Management ProgramTexas Health Management ProgramRequest for Proposals # 529-07-0178Request for Proposals # 529-07-0178Vendor Conference: August 18, 2009 Vendor Conference: August 18, 2009

(10 AM – Noon) (10 AM – Noon)

IntroductionsIntroductions

• Steve BaileySteve Bailey, Enterprise Contract and , Enterprise Contract and Procurement Services (ECPS)Procurement Services (ECPS)

• Ashley FoxAshley Fox, Medicaid & CHIP Division – Health , Medicaid & CHIP Division – Health ManagementManagement

• Elizabeth LaMairElizabeth LaMair, Office of General Counsel, Office of General Counsel

• Carlos A. BalderasCarlos A. Balderas, HUB Program , HUB Program AdministratorAdministrator

Housekeeping ItemsHousekeeping Items

WelcomeWelcome

HHSC ProcurementHHSC Procurement RolesRoles

ECPSECPS - Responsible for procurement activity - Responsible for procurement activity

ProgramProgram ( (Health Management ProgramsHealth Management Programs) - Responsible for ) - Responsible for project scope, requirements, performance, results, project scope, requirements, performance, results, evaluation, and monitoringevaluation, and monitoring

HUBHUB Program – Responsible for monitoring HUB activity Program – Responsible for monitoring HUB activity

LegalLegal – Questions and answers regarding legal issues – Questions and answers regarding legal issues

Vendor ConferenceVendor Conference OverviewOverview

1. Procurement Activities1. Procurement Activities2. RFP Overview2. RFP Overview3. HUB Items3. HUB Items4. Question Submittal4. Question Submittal====================================== Break Break ======================================5. Preliminary Responses to Questions5. Preliminary Responses to Questions6. Closing Comments6. Closing Comments

• Source for questions & answers Source for questions & answers

• Provides Provides sole HHSC contactsole HHSC contact: Thomas Spears: Thomas Spears Send Thomas any questions (after today), and your Send Thomas any questions (after today), and your

completed RFP responses.completed RFP responses.

• ECPS handles / coordinatesECPS handles / coordinates:: Procurement schedule Procurement schedule Solicitation access (Solicitation access (copy of RFPcopy of RFP, etc.) at, etc.) at

www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.aspasp

Submission requirementsSubmission requirements Solicitation changesSolicitation changes Oversees screening & evaluationOversees screening & evaluation Award informationAward information

ECPS Procurement ActivitiesECPS Procurement Activities

Procurement ScheduleProcurement Schedule

RFP Release DateRFP Release Date

Vendor ConferenceVendor Conference

Vendor Questions DueVendor Questions Due

HHSC Posts ResponsesHHSC Posts ResponsesProposals Due Proposals Due (by 1pm Central)(by 1pm Central)

Tentative Award Tentative Award AnnouncementAnnouncement

Anticipated Contract Start Anticipated Contract Start DateDate

August 3, 2009August 3, 2009



September 2, 2009September 2, 2009

October 1, 2009October 1, 2009

January 23, 2010January 23, 2010

April 9, 2010April 9, 2010

RFP Overview

• Background

• Procurement Mission

• Objectives

• Contract Terms

• Scope of Work

• Performance Measures

BackgroundBackground Legislatively mandated programLegislatively mandated program Traditional disease management program since 2004Traditional disease management program since 2004 Five diseases (Asthma, Coronary Artery Disease, Five diseases (Asthma, Coronary Artery Disease,

Congestive Heart Failure, Chronic Obstructive Pulmonary Congestive Heart Failure, Chronic Obstructive Pulmonary Disease and Diabetes)Disease and Diabetes)

Approximately 50,000 clients enrolled each monthApproximately 50,000 clients enrolled each month Majority of clients receive mailings and access to Nurse Majority of clients receive mailings and access to Nurse

Advice LineAdvice Line Clients who are fully engaged also receive telephonic Clients who are fully engaged also receive telephonic

interventionintervention Small subset of clients receive face-to-face interactionSmall subset of clients receive face-to-face interaction

Diabetes Self Management Diabetes Self Management TrainingTraining

Clients enrolled in DSMT will receive the Clients enrolled in DSMT will receive the same level of service as clients in the same level of service as clients in the overall Health Management programoverall Health Management program

DSMT will be tailored for those with DSMT will be tailored for those with diabetes (even as a co-morbidity)diabetes (even as a co-morbidity)

Clients must be categorized as DSMT or Clients must be categorized as DSMT or Health Management clients, not bothHealth Management clients, not both

Procurement MissionProcurement Mission

HHSC’s mission in this procurement is to retain a qualified Vendor to design and operate a THM Program that improves the overall care and outcomes for Medicaid recipients who are chronically ill or at a high risk of becoming chronically ill. The Vendor must provide an innovative and complete approach to client care that is adaptive to the changing needs of HHSC, THM Program clients, and medical providers.

ObjectivesObjectives

The Vendor will help HHSC accomplish the following objectives: The Vendor will help HHSC accomplish the following objectives:

to develop an innovative and comprehensive approach to health to develop an innovative and comprehensive approach to health management; management;

to create a flexible and customer-oriented program; to create a flexible and customer-oriented program; to identify and engage clients, through a predictive modeling system, with to identify and engage clients, through a predictive modeling system, with

highhighcost utilizations that can be reduced by improved management of theircost utilizations that can be reduced by improved management of their

condition(s) and/or those who are at risk of becoming unstable or condition(s) and/or those who are at risk of becoming unstable or developing adeveloping aserious chronic condition(s); serious chronic condition(s);

to increase clients’ skills, knowledge and confidence in self-managing their to increase clients’ skills, knowledge and confidence in self-managing their health condition(s); health condition(s);

to encourage providers to evolve their practices by becoming advocates ofto encourage providers to evolve their practices by becoming advocates ofpatient self-management, supporters of systems delivery change, andpatient self-management, supporters of systems delivery change, andpromoters of clinically evidence-based interventions; promoters of clinically evidence-based interventions;

to utilize technology in supporting client and provider goals; and to utilize technology in supporting client and provider goals; and to reduce inappropriate or duplicative costs to the State. to reduce inappropriate or duplicative costs to the State.

Contract TermsContract Terms

Initial contract period is three yearsInitial contract period is three years

HHSC HHSC may extendmay extend the term of the contract: the term of the contract: for three additional one year extensionsfor three additional one year extensions as as

necessary to complete the mission of the necessary to complete the mission of the procurementprocurement

subject to negotiation between the parties.subject to negotiation between the parties.

Payment will be on a Payment will be on a per-member, per-month basis:per-member, per-month basis: fees tied to number of clients enrolled and fees tied to number of clients enrolled and

engaged in programengaged in program

Scope of WorkScope of Work Introduction and BackgroundIntroduction and Background

The Vendor will work with HHSC to design and The Vendor will work with HHSC to design and implement a program that gives clients the tools needed implement a program that gives clients the tools needed to effectively manage their condition(s). This will be to effectively manage their condition(s). This will be accomplished through the following:accomplished through the following:

Educating clients and providers regarding the principles of Educating clients and providers regarding the principles of self-managementself-management

Encouraging providers to view clients as managers of their Encouraging providers to view clients as managers of their own condition(s)own condition(s)

Developing and implementing new, innovative Developing and implementing new, innovative technological solutions that support the THM Program goals technological solutions that support the THM Program goals

Three phases: implementation, operations and turnoverThree phases: implementation, operations and turnover

Implementation PhaseImplementation Phase Vendor will hold weekly meetingsVendor will hold weekly meetings Project Work Plan due 15 days after contract effective Project Work Plan due 15 days after contract effective

datedate Collaboration with outgoing vendorCollaboration with outgoing vendor Recruitment of members to Advisory BoardRecruitment of members to Advisory Board Completion of systems testingCompletion of systems testing

Scope of WorkScope of Work

Scope of WorkScope of Work Operations PhaseOperations Phase

Customer Service and AdaptabilityCustomer Service and Adaptability Provide exceptional customer serviceProvide exceptional customer service Be flexible and allow for innovationBe flexible and allow for innovation

AssociationsAssociations Participate in conferences or trade organizations associated with Participate in conferences or trade organizations associated with

health managementhealth management

Key PersonnelKey Personnel Program Director – oversees THM programProgram Director – oversees THM program Program Manager – coordinates activitiesProgram Manager – coordinates activities Program Administrator – provides reportsProgram Administrator – provides reports Provider Relations Manager – administrator of provider relationsProvider Relations Manager – administrator of provider relations Client Relations Manager – administrator of client relationsClient Relations Manager – administrator of client relations

MeetingsMeetings OutreachOutreach

Scope of WorkScope of Work Operations Phase (continued)Operations Phase (continued)

Quality Assurance and ImprovementQuality Assurance and Improvement Communications MaterialsCommunications Materials

Identify existing materials when appropriateIdentify existing materials when appropriate Create materials in an easily understood formatCreate materials in an easily understood format

Triage and Toll-free NumbersTriage and Toll-free Numbers Nurse consultation lineNurse consultation line Customer service lineCustomer service line Provider service lineProvider service line

Overcoming Program ChallengesOvercoming Program Challenges Identifying and overcoming barriersIdentifying and overcoming barriers


Technology, Predictive Modeling, and DataTechnology, Predictive Modeling, and Data Innovative, progressive and adaptableInnovative, progressive and adaptable Identify clients who can benefit from programIdentify clients who can benefit from program HHSC must be able to access Vendor databaseHHSC must be able to access Vendor database Maintain information in secure database Maintain information in secure database

warehousewarehouse Disaster Recovery PlanDisaster Recovery Plan

ReportingReporting Reports provide clear, accurate description of Reports provide clear, accurate description of

activities and status of programactivities and status of program HHSC will approve format and key metricsHHSC will approve format and key metrics


Operations Phase (continued)Operations Phase (continued) Client Recruitment and EnrollmentClient Recruitment and Enrollment Client InterventionsClient Interventions

Health Risk Assessments (HRA)Health Risk Assessments (HRA) ““Cafeteria-style”Cafeteria-style” Self-management educationSelf-management education Health and wellnessHealth and wellness Behavioral and mental health managementBehavioral and mental health management Pharmacy managementPharmacy management


Operations phase (continued)Operations phase (continued) Provider Recruitment and EnrollmentProvider Recruitment and Enrollment

Recruit providers who will be impacted by Recruit providers who will be impacted by programprogram

Encourage best practicesEncourage best practices Provider InterventionsProvider Interventions

Tools and educational resourcesTools and educational resources Proactive, productive interactionsProactive, productive interactions Practice facilitationPractice facilitation


Operations Phase (continued)Operations Phase (continued) Compliance with LawsCompliance with Laws Fraud and AbuseFraud and Abuse

Cooperation and assistanceCooperation and assistance Must provide records as requestedMust provide records as requested Written fraud and abuse compliance planWritten fraud and abuse compliance plan Mandatory trainingMandatory training Staff person must be assigned to carry out Staff person must be assigned to carry out

provisions in fraud and abuse compliance provisions in fraud and abuse compliance planplan


Turnover PhaseTurnover Phase Data TransferData Transfer Turnover ServicesTurnover Services Post-Turnover ServicesPost-Turnover Services

Performance MeasuresPerformance Measures

HHSC will monitor the Vendor’s performance through a monitoring HHSC will monitor the Vendor’s performance through a monitoring plan that includes, but is not limited to: plan that includes, but is not limited to:

annual site visits (can be either announced or unannounced); annual site visits (can be either announced or unannounced); quarterly in-person reporting, quality assurance and planning meetings; quarterly in-person reporting, quality assurance and planning meetings; quarterly reports provided by the Vendor; quarterly reports provided by the Vendor; monthly status reports provided by the Vendor; monthly status reports provided by the Vendor; weekly status meetings with Vendor and other stakeholders; weekly status meetings with Vendor and other stakeholders; accessing the vendor’s systems and databases; accessing the vendor’s systems and databases; chart review comparing provider records to the Vendor’s client records; chart review comparing provider records to the Vendor’s client records; annual reconciliation process and report; annual reconciliation process and report; independent assessment of the THM Program by an independent quality independent assessment of the THM Program by an independent quality

review organization; and review organization; and routine contact and interaction with the Vendor and key personnel.routine contact and interaction with the Vendor and key personnel.

HUB Subcontracting PlanHUB Subcontracting Plan(HSP) Requirements(HSP) Requirements

Agenda TopicsAgenda Topics

• RFP Section 4.0 Historically Underutilized Business RFP Section 4.0 Historically Underutilized Business

Participation RequirementsParticipation Requirements

• HUB Subcontracting Plan for the RFP is requiredHUB Subcontracting Plan for the RFP is required

• Self Performance HSP Self Performance HSP

• HSP Prime Contractor Progress Assessment ReportHSP Prime Contractor Progress Assessment Report

• HUB Participation GoalsHUB Participation Goals

• Potential Subcontracting OpportunitiesPotential Subcontracting Opportunities

• Vendor Intends to Subcontract Vendor Intends to Subcontract

• Minority or Women Trade Organizations Minority or Women Trade Organizations

• Self PerformanceSelf Performance

• HSP Changes After Contract AwardHSP Changes After Contract Award

• Reporting and Compliance with the HSPReporting and Compliance with the HSP

RFP Section 4.0 - Historically Underutilized RFP Section 4.0 - Historically Underutilized

Business Participation RequirementsBusiness Participation Requirements

If HSP is inadequate, response will be rejected

HSP Information Page


HUB GOALS

Special reminders and instructions

Company Information

If more than 20 subcontracting

opportunities, click the link provided to

continue adding


Enter subcontracting opportunities

Subcontracting

Declaration

One page for each area

subcontracted(listed on page

1)


List Line # and Subcontracting Opportunity


Protégé performing the

work


Skip to Sections

8 and 10

Professional Services Category


Good Faith Efforts to

find/include Texas Certified HUB Vendors


Contact HUB Trade

Organization


Written Notification

Requirements


List 3 HUBs Contacted

for this Subcontractin

g Opportunity


List Subs Selected (HUBs & Non-HUBs)

for this Subcontracting

Opportunity


Reason why HUB was not selected

for this Subcontracting

Opportunity


Self Performanc

e Explanation


Signature Affirms that

True and Correct

Information is Provided

• Required with ALL Pay Requests

• List ALL Sub payments (HUBs & Non-HUBs)

HSP Prime Contractor Progress Assessment Report

ATTACHMENT “E”

HSP ASSISTANCE FROM TPASS

HUB Subcontracting Plan (HSP) Forms

Step-by-step instructions and an audio on “How to Complete an HSP ” is located on the Comptroller of Public Accounts (CPA) Texas Procurement and Support Services (TPASS) website at:

http://www.cpa.state.tx.us/procurement/prog/hub/hub-forms/

HUB Subcontracting Plan Instructional Video

Play Windows Media Version (7.7 MB download)

Play Quicktime (mp4) version (24 MB download)

Play Macromedia Flash version (10.8 MB download)

Read Video Transcript (.rtf file) (160 K download)

http://www.cpa.state.tx.us/procurement/prog/hub/hub-forms/

http://www.cpa.state.tx.us/procurement/prog/hub/hub-forms/hsp_project.wmv

http://www.cpa.state.tx.us/procurement/prog/hub/hub-forms/hsp_project.mp4

http://www.cpa.state.tx.us/procurement/prog/hub/hub-forms/hsp_project.swf

http://www.cpa.state.tx.us/procurement/prog/hub/hub-forms/hsp_project.rtf

Administrative Services Administrative Services Development HUB Program Development HUB Program

OfficeOffice Robert L. Hall, C.P.M.Robert L. Hall, C.P.M. Director of Administrative Services DevelopmentDirector of Administrative Services Development

- (512) 424-6596- (512) 424-6596- - [email protected]@hhsc.state.tx.us

Sharon AddisonSharon AddisonHUB Program/Procurement Services Team LeaderHUB Program/Procurement Services Team Leader- (512) 487-3404- (512) 487-3404- - [email protected]@hhsc.state.tx.us

Carlos A. BalderasCarlos A. Balderas ASD HUB AdministratorASD HUB Administrator


Sherice Williams-PattySherice Williams-Patty ASD HUB AdministratorASD HUB Administrator


mailto:[email protected]




Texas Health and Human Texas Health and Human Services Commission (HHSCServices Commission (HHSC))

Question SubmittalQuestion SubmittalFollowed by BreakFollowed by Break

Tentative Responses toTentative Responses to Vendor Questions Vendor Questions

Non-binding verbal answers to vendor questions may be provided Non-binding verbal answers to vendor questions may be provided here today.here today.

Reminder:Reminder: After today, any additional questions, requests for After today, any additional questions, requests for clarification, etc., are clarification, etc., are duedue to HHSC, in writing, by Thursday, August to HHSC, in writing, by Thursday, August 19, 2009. (Send to Thomas Spears; see below.)19, 2009. (Send to Thomas Spears; see below.)

Vendor Questions/HHSC Responses should be posted by September 2, Vendor Questions/HHSC Responses should be posted by September 2, 2009, on the HHSC Contract Opportunities website at the URL below:2009, on the HHSC Contract Opportunities website at the URL below: http://www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.asphttp://www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.asp

Sole point of contactSole point of contact for further inquiries concerning this RFP is: for further inquiries concerning this RFP is:

Thomas SpearsThomas Spears, Contract Administrator, Contract AdministratorEnterprise Contract and Procurement ServicesEnterprise Contract and Procurement ServicesTexas Health and Human Services CommissionTexas Health and Human Services Commission

4405 North Lamar Blvd.4405 North Lamar Blvd.Austin, Texas 78756Austin, Texas 78756

Phone (512) 206-4570; fax (512) 206-5552 Phone (512) 206-4570; fax (512) 206-5552 Email Email [email protected]@hhsc.state.tx.us

Closing CommentsClosing Comments