RFI for Population Health Platform for Statewide Provider Network

Sample Health System of Network Physicians Request for Information

Population Health Management

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Sample Health System of Network Physicians

Request for Information


July 2014



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1 INTRODUCTION TO “SAMPLE PROVIDER NETWORK” .......................................................3

1.1 BACKGROUND ......................................................................................................................... 3

1.2 “SAMPLE PROVIDER NETWORK” VISION ............................................................................... 3

1.3 ANTICIPATED STAKEHOLDER GOALS ............................................................................................ 5

2 INSTRUCTIONS ...............................................................................................................5

2.1 QUESTIONS AND CLARIFICATIONS ............................................................................................... 5

2.2 RECEIPT AND INTENT ................................................................................................................ 5

2.3 CONTENT DELIVERY .................................................................................................................. 5

2.4 RESPONSE TO SPECIFIC INFORMATION REQUESTS .......................................................................... 6

2.5 PRICING .................................................................................................................................. 6

2.6 CONFIDENTIALITY ..................................................................................................................... 6

2.7 RFI CANCELLATION .................................................................................................................. 6

3 “SAMPLE PROVIDER NETWORK” REQUIREMENTS ............................................................6

3.1 FUNCTIONAL ........................................................................................................................... 6

3.2 TECHNICAL ............................................................................................................................ 11

3.3 DATA SOURCES ...................................................................................................................... 11

3.4 SECURITY .............................................................................................................................. 12

3.5 IMPLEMENTATION .................................................................................................................. 13

3.6 DEVELOPMENT & SUPPORT ..................................................................................................... 13

4 VENDOR SPECIFICS ....................................................................................................... 15

4.1 BACKGROUND AND QUALIFICATIONS ......................................................................................... 15

4.2 VISION ................................................................................................................................. 15

4.3 CUSTOMERS .......................................................................................................................... 15

4.4 VIABILITY .............................................................................................................................. 16

4.5 WARRANTIES AND CONTRACTS ................................................................................................. 16

5 PRICING........................................................................................................................ 16

CURRENT LIFE AND POPULATION FIGURES: ......................................................................................... 17

5.1 SOLUTION COSTS ................................................................................................................... 17



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1 INTRODUCTION TO “SAMPLE PROVIDER NETWORK”

1.1 BACKGROUND “Sample Provider Network”(“SAMPLE PROVIDER NETWORK”) is a company based in Anywhere,

US. “SAMPLE PROVIDER NETWORK” was established at the end of 2012 by State University

Medical Center for the purposes of developing a clinically integrated network (CIN) among its

affiliated physicians and institutions. “SAMPLE PROVIDER NETWORK” formed to help all entities

deal with the changes in healthcare as we move from a fee for service world into a value-based

purchasing world. The Network’s focus is to enable the network to provide high quality care on

an integrated basis in order to lower costs and provide higher patient and employer satisfaction.

“SAMPLE PROVIDER NETWORK” is the largest provider-organized network of doctors, regional

health systems, and other health care providers in state and surrounding states. “SAMPLE

PROVIDER NETWORK” has grown beyond a statewide network and is quickly becoming a regional

network. We currently have 44 hospitals (in 8 health systems) with over three-thousand (3,000)

physicians, and more than four-hundred (400) practices. “SAMPLE PROVIDER NETWORK”

providers actively collaborate to provide patients with high-quality, efficiently coordinated, and

cost-effective health care services. “SAMPLE PROVIDER NETWORK”’s objective is to create value

in healthcare by raising quality of care and reducing the total cost of care for populations through

clinical initiatives.

General Locations of Affiliate Facilities

Map Placeholder

1.2 “SAMPLE PROVIDER NETWORK” VISION “SAMPLE PROVIDER NETWORK” supports two different functions. First it helps providers

measure the quality of patient care. Second, for some health plans, “SAMPLE PROVIDER



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NETWORK” will support financial and clinical measurement for managed lives. “SAMPLE

PROVIDER NETWORK” is managing more than 100,000 risk lives in our network of over 3,000,000

total patients. We seek a vendor supported Population Health Management (PHM) solution that

will provide flexible connectivity with the capabilities of sending, receiving, normalizing, and

analyzing data between multiple HIE solutions and various disparate systems.

“The goal of population health management (PHM) is to keep a patient population as healthy as

possible, minimizing the need for expensive interventions such as emergency department visits,

hospitalizations, imaging tests, and procedures. Population health management is the key to

accountable care and healthcare reform.” 1

“SAMPLE PROVIDER NETWORK” is planning to create the infrastructure required to collect

electronic health information across affiliated providers; access longitudinal clinical information

needed for patient care, population health management, and clinical effectiveness research.

This diagram provides a simplified perspective of the technical architecture supporting our vision.

The dotted line represents our immediate area of focus on Population Health Management.

1 Suzanna Felt-Lisk and Tricia Higgins, “Exploring the Promise of Population Health Management Programs to Improve Health,” Mathematica Policy Research Issue Brief, August

2011, accessed at http://www.mathematica-mpr.com/publications/pdfs/health/PHM_brief.pdf.



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1.3 ANTICIPATED STAKEHOLDER GOALS

1.3.1 Providers

Improve the quality of care, provide access to information for better decision

making, increased patient engagement, and increased staff efficiencies. For every

provider, this means having an automated plan of care for their patients and

taking proactive action to achieve the best outcomes.

1.3.2 Care Coordinators

Improve the quality of care through more effective management of care

transitions, support quality reporting, strengthen patient engagement, provide

automated dashboards, task lists, and increase care efficiency. Care Coordinators

need access to automated reports, alerts and patient communications to

minimize manual tasks, reaching more patients successfully and devote more

clinical and coaching talent to patients who need them most.

1.3.3 Patients

Receive higher quality personalized care by engaging through convenient and

immediate communication and information sharing. The ability for patients to

engage in personal care planning necessitates use of electronic technologies.

2 INSTRUCTIONS

2.1 QUESTIONS AND CLARIFICATIONS Any questions or requests for clarification in connection with this request should be

directed to:

CJ Fulton

[email protected]

618-579-9192

Receipt and Intent

Please respond by email to [email protected].

2.2 CONTENT DELIVERY Please submit an electronic version by September 12, 2014 of your completed RFI to:

([email protected])

mailto:[email protected]





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2.3 RESPONSE TO SPECIFIC INFORMATION REQUESTS Provide a response to questions and requirements as outlined in Section 4 (Vendor

Specifics). An item by item response is requested using the format provided.

2.4 PRICING Provide pricing and estimated implementation costs in Section 5 (Pricing). An item by item

response is requested using the format provided.

2.5 CONFIDENTIALITY In order to participate in the response process; you must have executed a Confidentiality

Agreement. We have included a copy for your convenience.

2.6 RFI CANCELLATION “SAMPLE PROVIDER NETWORK” reserves the right to not proceed with the project and to

not choose a solution, if it so elects.

3 “SAMPLE PROVIDER NETWORK” REQUIREMENTS

Included below are a set of requirements describing the desired PHM solution.

Prospects are being asked to provide available system functionality that exists TODAY (in

production at a client site) when responding to requirements. If systems functionality does not

exist today but is already in development, include that information in the Appendix.

Prospects do not have to meet every requirement to be considered as the PHM solution provider,

however, prospects should respond to each requirement and identify system capabilities and

limitations.

Responses should, at a minimum, include the following information:

Module or modules required to deliver requested functionality

Key features or attributes of the system related to the desired functionality

Recommendations for providing optimal value to “SAMPLE PROVIDER NETWORK”

stakeholders (see section 1.3)

Examples (where appropriate) from client implementations

3.1 FUNCTIONAL 3.1.1 Configuration and Rules Management

a. Describe how system rules are used for:

i. Identification

ii. Stratification

iii. Worklist Items (Tasks)

iv. Care Plan



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v. Assessments

b. Define your standard rule-set by category.

c. Explain the flexibility of your solution with respect to user configuration.

d. How many rules are in your standard set?

3.1.2 Identification:

a. Explain the features and functionality related to population analytics.

b. Describe how your solution identifies conditions, diseases, specific issues,

and gaps in care.

c. Describe how your product enables case management and management of

patients, using rules-based protocols to identify and manage patients at risk.

d. How does your solution track and report health care maintenance, chronic

care-related outcomes, and gaps in care?

e. Describe your preparation for the next level release of the International

Disease Classifications, Version 10 (ICD 10).

3.1.3 Stratification

a. Describe how your product prioritizes;

i. Issues

ii. People

iii. Risk

b. What predictive models are used in your solution today?

c. Briefly describe each model.

3.1.4 Work List / Items Management

a. What roles are supported related to task assignments?

b. Can roles be added without support or programming?

c. How can tasks be assigned to the added roles?

d. Describe the level of customization available without programmer or solution

vendor support.

e. Explain your capability to provide real-time prioritization or reprioritization of

assigned tasks.

f. How is clinical data and evidence delivered to clinicians while providing

services i.e. computer screens, alerts, mobile devices?

g. What features are provided that assist in encouraging patient Involvement?

h. Describe your solution’s capability to escalate tasks in real-time based on

predefined criteria.

i. How are real-time alerts managed and communicated?

j. Discuss messaging functionality across the care team (physician, care

coordinators, dietician, etc).

k. Explain how care tools are used to indicate what patient related needs are

scheduled to be accomplished for the date accessed.



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l. How are work lists and tasks audited throughout the day/shift/month?

m. How are tasks used to update EMRs and how to EMRs update tasks?

3.1.5 Care Plan & Items

a. Describe how you create a care plan.

b. Describe the functionality used by the care team to personalize or tune care

plans for their patients’ needs.

c. Explain the various methods a patient can engage with their care plan and

care team i.e. mobile device, web-portal, text, etc.

d. Describe the process of providing an automated prioritization list for care

plans.

e. How does the system work proactively to support the care team i.e.

automated escalation, alerts, etc?

f. How are care plans and individual items linked to ‘work list’ items?

g. Explain the referral process used when referring to PAC Facilities/HH

Care/DME, another care team member (social worker, post-acute,

community resources).

h. Describe the system’s ability to implement automated reminders; call, email,

text message or letters to patients.

i. Describe how the care plan updates the EMR and how the EMR updates the

care plan.

3.1.6 Assessments

a. List the standard assessments provided.

b. Discuss the functionality provided to customize assessments.

c. Describe how the needs for assessments are determined.

d. Explain the process used to identify patients with specific needs at the point

of care including alerts on lab values, pharmacy information, missed

appointments, etc.

e. Describe the system’s capability to use branching logic.

f. Explain your proposed solution method for handling expiring assessments.

g. Explain the process to sort patient data by specific requirements.

h. How does your system use evidence-based data to provide clinical decision

support? Is this data downloadable to mobile devices as a standard feature?

i. Describe your solution’s capability to pre-populate data fields from all

available sources.

3.1.7 Documentation

a. Describe the functionality associated with updating and reviewing patient

charts.

b. Explain how notes can be added, where they can be added and by whom.



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c. How does documentation update EMRs and EMRs update documentation?

d. Describe the system’s journaling capabilities (e.g. patients capability to

journal their blood pressure readings).

3.1.8 Operations Management

a. Describe audit capabilities and management access to audit data.

b. Describe your personnel coverage models.

c. Provide detail on how resources are managed and utilized in real-time (as

situations change and tasks are reassigned/delegated). How does the system

help manage resources to maximize utility?

d. Describe how users filter patient data by specific requirements allowing

comparisons of individual patient data or subgroups within the total group,

as well as comparisons by providers and clinics.

e. How does your solution achieve load-balancing of tasks?

f. Describe management dashboards, reports, and analytic capabilities.

g. Explain how managers can assign tasks to individuals and/or groups.

3.1.9 Patient Engagement

a. Describe the patient portal’s capability for patients to communicate with

their care team via a secure method.

b. List the various modalities (text, email …) used to engage patients. Provide

brief examples and capabilities of each.

c. What are the minimum system requirements for a patient to use the portal

as intended?

d. How many clients do you have currently using remote patient monitoring

with your proposed solution?

e. Provide a list of remote monitoring devices you connect with today.

f. Describe the functionality and capability available to patients based on each

method of access. Be specific about the patient’s ability to:

i. View personal care plans

ii. Pay bills

iii. Check insurance payment status

iv. Journal and share their journal

v. Send and receive messages across different providers

vi. Exchange messages with Care Coordinators

vii. Designate access by other Caregivers i.e. Family

viii. Access educational materials

ix. Interact in a multi-lingual manner

3.1.10 Provider Engagement

a. Describe how you support an embedded care model today.



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b. Explain how you support a centralized model.

c. Discuss how you are supporting Hybrid models today.

d. Explain your secure messaging capabilities to and from providers.

e. Describe your referral tracking process, including how the loop is closed with

the referring provider.

f. Explain the various modalities used to alert providers.

g. Discuss how specific data integration is handled with respect to:

i. Population Manager to EMR

ii. EMR to Population Manager

iii. HIE Integration to and from Pop Manager

3.1.11 Third Party Integration

a. Describe your solution’s capability to connect with local community care

resources, such as Meals-on-Wheels.

b. Explain and list those connections that are operational with the proposed

solution today.

3.1.12 Reporting

a. What are the standard reports available by role?

b. What is your product’s ability to store, retrieve, and re-run queries on a

scheduled or ad hoc basis?

c. Describe your high-level summary reports for evaluation and quality

improvement at the population and provider levels. Can these reports be

run aggregated and de-identified for outside reporting?

d. Describe your dashboard capabilities and connectivity to reports.

e. Describe your capabilities to generate ad hoc reports that can be defined by

users.

f. Explain how your product produces a “patient report” card for providers and

patients to include problem list, list of medications, recent vital signs, health

maintenance updates, and pertinent chronic care measures.

g. Discuss the system’s capabilities to produce graphical reports.

h. Explain your analytical capabilities to drill, slice, and dice …

i. How does your product support Federal “Meaningful Use Criteria” for clinical

Decision Support Rules relevant to the clinical metrics that providers are

responsible to report or activates a trigger for the system to activate a

feature or function.

j. List the standard metrics & measures reports provided with the proposed

solution. Specifically explain metrics regarding:

i. Outcomes

ii. System Performance

iii. Provider Performance



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iv. Quality

3.2 TECHNICAL

a. Provide a diagram of, and describe your product, architecture.

b. Describe how your solution connects to disparate patient care data in

multiple HIE repositories.

c. How do you aggregate, normalize, analyze, and report on actionable data

from disparate data sources?

d. Describe how your system protects database records while it is being

accessed by one user, so that multiple users will not attempt to change the

record at the same time.

e. Define the scalability of the proposed system.

i. Can the system be purchased in modules and expanded?

ii. How scalable is the proposed software regarding the number of

users?

f. How many concurrent users can access the proposed system?

g. Describe the maximum number of database records that can be stored with

the configuration being proposed.

h. How does your system perform automated data validation checks to ensure

data integrity and provide audit trails for errors?

i. List third party reporting tools compatible with the proposed system.

j. Provide the data dictionary and schema used by the system.

k. Describe how the client software components are able to coexist with other

software and applications on end-user workstations.

l. Describe any special networking requirements, i.e. dedicated/segregated

network segments, VLANs, etc.

m. Define the system’s capability to support multiple browser types (i.e.

Internet Explorer, Mozilla Firefox …) on different platforms, and the

minimum version of each browser supported.

n. Specify all browser plug-ins necessary to utilize web-based features.

3.3 DATA SOURCES

3.3.1 Describe how your solution handles the following data sources:

a. Paid claims

b. Provider submitted claims

c. Lab results

d. EMR data

e. HIE community record

f. HRA

g. Registries



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h. Wellness

i. Devices

3.4 SECURITY

3.4.1 Security, Anti-Virus, Authentication

a. Describe how you authorize and authenticate the identities of providers and

patients.

b. Does your solution support federated LDAP model where our providers can

manage their own users?

c. Does your solution support SSO (single sign on)?

d. Describe the Antivirus software used to protect data in real-time on the

vendor’s servers.

e. Describe known issues that may occur when running Antivirus software in

real-time on the workstations.

f. Specify whether the system establishes user identity via:

i. A user ID and password; or

ii. Two-factor authentication, such as a smart-card and a PIN. If two-

factor authentication is available or used, describe the hardware

requirements, the authentication process, and any supplies needed

for ongoing implementation.

g. Discuss security measures to prevent data breaches and if a data breach

were to occur, how would it be identified and addressed?

h. How does your product support HIPAA standards (access control, automatic

user logoff, etc.)?

i. How does your product support state laws in sharing patient portal data?

j. Describe your audit log architecture and your approach to auditing.

k. Specify if a “user inactivity timeout” feature is available that forces a user to

re-authenticate if idle for a preconfigured amount of time.

l. Describe how the system utilizes electronic signatures and electronic

confirmation (if applicable).



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3.5 IMPLEMENTATION

3.5.1 Describe your implementation work plan/methodology.

3.5.2 Describe the make-up of your implementation team.

3.5.3 What is the typical implementation timeframe?

3.6 DEVELOPMENT & SUPPORT

3.6.1 Software

a. What’s the most current release of software and how long has it been in

production?

b. How often do you put out releases?

c. When is the next expected release?

d. Describe your company’s testing/QA processes and your expectations for

data providers. Specifically, what roles must data providers play to ensure

data integrity and what resources will they require?

e. Is your product ICD-10 ready? If so, when was it certified?

3.6.2 Support

a. List the HIEs & EMRs (in production) you currently support. To what extent

do you use federal data standards and to what extent do you use HL7 feeds?

b. Describe the typical fee arrangements you see from EMR vendors when you

connect to their system.

c. What internet browsers do you support?

d. Describe your approach to connecting to platforms that you do not routinely

support.

e. Describe your post implementation support.

f. Does your product have the capability of being upgraded without incurring a

system outage?

3.6.3 Training

a. Describe the training you provide for users, administrators and technical

support personnel. Please address length of training, location, contents, size

and structure of each class and/or forum.

b. Are training materials available to students after training?

3.6.4 Help Desk Capabilities

a. What are your technical support help-desk hours of operation?

b. How is the support staff accessed? (e.g., pager, phone, e-mail).

c. Who can access the help desk i.e. anyone with a provider, etc?



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d. Do you have Service Level Agreements (SLAs)? If so, please explain.

e. What is the average response time to a customer’s request for support?

f. What tools are available to help desk personnel in assisting them in providing

customer service?

g. What role do you propose the help desk have in supporting “SAMPLE

PROVIDER NETWORK” during implementation?

3.6.5 Documentation

a. Provide a brief description of the available product documentation.

b. Is the documentation in electronic format?

c. Can copies of documentation be printed on demand?

3.6.6 Staff

a. What percentage of staff (defined by total number of employees) does your

company have engaged in supporting your PHM product?

b. Describe the profile of your implementation personnel (minimum

requirements such as education, hands-on experience, time in current role).

c. How many full-time developers are currently assigned to this product?

3.6.7 User Groups / Customer Feedback

a. Describe any regularly held seminars or user group meetings available to

users of your system.

b. Is there a formal process for considering enhancements based on the input

from these user group meetings?

c. Are additional software modules and modifications available through a user

group program exchange or on-line user community? Is this free? If not,

what is the charge?

3.6.8 Ability to Execute

a. Describe the customers comparable in size and function to “SAMPLE

PROVIDER NETWORK” with respect to:

i. Implementation

ii. Training

iii. Support

b. How many live instances of your company’s product suite have been

implemented over the past three years?

c. What are the average and largest sizes of these implementations?

d. Describe your typical implementation (team size, duration, etc.)

e. Describe your methodology for remote monitoring and troubleshooting of

equipment / applications.



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4 VENDOR SPECIFICS

In order to determine your ability to complete this project, please complete the following

sections.

4.1 BACKGROUND AND QUALIFICATIONS

4.1.1 Please provide the following information about your company:

a. Company name, address, city, state and zip, phone number

b. Primary contact name, email and phone number

4.1.2 Provide a brief overview of your organization and the products/ services you offer.

4.1.3 How long has your company been in the business of developing and supporting

software for PHM?

4.1.4 What percentage of your company’s revenue is generated by PHM software and

services?

4.1.5 Where is the company located? List the locations of the following company

facilities:

a. Headquarters

b. Operations center(s)

c. Development center(s)

d. Training center(s)

e. Support center(s)

4.2 VISION

4.2.1 Describe the vision of your organization. In what direction is the company moving?

4.2.2 What is its origin and how has it developed since its founding?

4.2.3 Please describe in detail your long-term vision (i.e. your five-year development

plan) for your software product(s). Provide enough information to explain:

a. Current state of the application

b. The planned migration toward your long-term vision

4.3 CUSTOMERS

4.3.1 Please provide information on current software clients, including:

a. Total number of current clients



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b. A list of clients with similar needs using the same software

c. Evidence of successful completion of a project of a similar size and

complexity

d. Provide a minimum of three customer references that have gone live with

your product suite within the past three years. Provide contact names,

phone numbers, addresses, and a brief description of the implementation.

Please indicate which of these customers would accommodate a visit by

“SAMPLE PROVIDER NETWORK”.

4.4 VIABILITY

4.4.1 Financials

Provide evidence of your financial strength and long-term viability. Include a copy

of your annual report, Form 10-K, and any other supplemental financial

statements for the most current fiscal year.

4.4.2 Litigation

Are there any active or pending litigation related to your products and services?

If so, please explain.

4.5 WARRANTIES AND CONTRACTS

4.5.1 Warranties

Please provide warranty documentation and/or summaries for all products and

services proposed.

4.5.2 Contracts

Please include a sample of your standard agreements for proposed products and

services.

4.5.3 Describe your ability to provide business continuity and disaster recovery (what is

and is not included).

5 PRICING

“SAMPLE PROVIDER NETWORK” prefers a vendor-hosted solution. We are open to alternative

arrangements.

This section should clearly identify all software costs, including recommended third-party

software and interfaces. Including, but not necessarily limited to, all software license fees,

maintenance fee schedules, as well as implementation costs.



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In addition, “SAMPLE PROVIDER NETWORK” requires an estimated, detailed cost breakdown of

the proposed system, including description of both one-time and ongoing costs. Prices should

also include any add-on costs of supplemental modules required (or potentially required) to

provide a total solution for this specific opportunity.

Prices contained within the Response should be inclusive of all and any costs to be charged, such

as training, maintenance, software upgrades, supplies, tools, taxes and any other item that could

be interpreted as the real costs of procurement and any ongoing expenses due. Please provide a

description of the contents within each cost category.

Please describe, in detail, the types of licenses and software components needed for the

implementation. Please ensure that the recommended licenses are included in the cost.

Please complete the following Solutions Costs section within the following context:

CURRENT LIFE AND POPULATION FIGURES: ~100,000 at Risk Lives

~3M Total Population

5.1 SOLUTION COSTS

5.1.1 Software

a. List all software required including total package cost and annual

maintenance expense for each application (excluding installation, freight,

and anticipated customization). Please breakdown costs when possible

(limit bundling). Include all software warranty information in the

Appendix.

b. Describe licenses required for the software (concurrent / per seat and

the numbers associated).



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5.1.2 Hardware Equipment

a. List all hardware or equipment required. We strongly prefer a hosted

solution that does not require hardware. Please indicate where the

recommended hardware sits in the product lifecycle for that category of

equipment. If applicable, please breakdown costs when possible to

include versions of firmware, etc. (limit bundling). Include all hardware

warranty information in the Appendix.

5.1.3 Other Implementation Costs

a. List and describe all other cost items that are, or could be, associated

with the implementation of your solution, including supplemental

modules required (or potentially required) to provide a total solution for

this specific opportunity.

b. List all 3rd party providers you typically use as well as associated costs.

c. Do overtime rates and other special rates (after 5, before 8, weekends,

holidays) apply and, if so, under what conditions?

d. What are those rates as of today?

e. Please include your travel / expense policy.

Health & Medicine

RFI for Population Health Platform for Statewide Provider Network