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  • The following slides provide an overview of the RFP by reviewing the sections as listed on this slide. Read the sections off of the slide.
  • DSMT clients must be offered ten hours of self-management training, as well as three hours nutritional counseling in the first year. In subsequent years, clients should be offered two hours of self-management and two hours of nutritional counseling. Although, clients may repeat all or some of the offering as they wish. All program components apply to DSMT clients unless otherwise noted. In many cases, reporting should be categorized by DSMT and health management clients.
  • Time to coordinate activities, discuss issues and prepare for the operations phase. Meetings in Austin in Braker office. Project Work Plan will include changes to original proposal, report templates and communications material. Beginning of the advisory board including program champions. Systems testing must be completed 45 days prior to operational start date.
  • Customer service and adaptability are foundation for every program component. Staff must reflect a clear understanding of program’s mission. The program will evolve over time and we expect the vendor to evolve, too. Ability to implement new ideas and changes will be evaluated through the course of the contract. Must participate in associations to stay apprised of industry trends and issues. Program Manager is day-to-day contact for HHSC staff, although staff will likely often talk with all key personnel. Client Relations Manager should serve the client’s interests in the program the same way the Provider Relations Manager will serve the provider interests. Weekly meetings will serve to coordinate activities and discuss problems. Quarterly meetings will serve as program evaluation and planning meetings.
  • QA and QI will be joint efforts between HHSC and vendor. QA and QI will be constant and consistent as the problem evolves. There are some great materials out there; we do not want to re-invent the wheel. In cases where materials are not available, vendor must produce them. HHSC will have final approval. Communications materials tracking will give some idea of the reach of a given piece. We expect each mailing to be tracked. All lines need to employ Spanish speaking staff. Other languages should be available by translation. Customer service lines (for clients and providers) should strive to ensure resolution on the first call when possible. Barriers are common, but vendors should have contingency plans in place to reach and assist more clients.
  • High cost are those already incurring high costs. High risk are those at risk for developing chronic illness or who are at risk for becoming high cost. Behavioral modification skills on the part of vendor staff is key to determining what interventions will likely result in change HHSC must have an understanding of how many attempts are being made to which clients. Interventions should include coordinated care management with regional care teams. Care team should work closely with medical home to ensure consistency. Interventions will also include hospital discharge planning and intervening with clients who utilize the emergency department for non-urgent care.
  • Provider recruitment should focus not only on high performing providers, but also providers who show evidence of not using evidence-based care. PCCM and FFS providers should be offered interventions even if they are identified for intervention.
  • Transferred date must be HIPAA compliant
  • PowerPoint presentation

    1. 1. Texas Health and Human Services Commission (HHSC ) Texas Health Management Program Request for Proposals # 529-07-0178 Vendor Conference: August 18, 2009 (10 AM – Noon)
    2. 2. <ul><li>Introductions </li></ul><ul><ul><li>Steve Bailey , Enterprise Contract and Procurement Services (ECPS) </li></ul></ul><ul><ul><li>Ashley Fox , Medicaid & CHIP Division – Health Management </li></ul></ul><ul><ul><li>Elizabeth LaMair , Office of General Counsel </li></ul></ul><ul><ul><li>Carlos A. Balderas , HUB Program Administrator </li></ul></ul><ul><li>Housekeeping Items </li></ul>Welcome
    3. 3. HHSC Procurement Roles <ul><li>ECPS - Responsible for procurement activity </li></ul><ul><li>Program ( Health Management Programs ) - Responsible for project scope, requirements, performance, results, evaluation, and monitoring </li></ul><ul><li>HUB Program – Responsible for monitoring HUB activity </li></ul><ul><li>Legal – Questions and answers regarding legal issues </li></ul>
    4. 4. Vendor Conference Overview <ul><ul><li>1. Procurement Activities </li></ul></ul><ul><ul><li>2. RFP Overview </li></ul></ul><ul><ul><li>3. HUB Items </li></ul></ul><ul><ul><li>4. Question Submittal </li></ul></ul><ul><ul><li>=================== </li></ul></ul><ul><ul><li>Break </li></ul></ul><ul><ul><li>=================== </li></ul></ul><ul><ul><li>5. Preliminary Responses to Questions </li></ul></ul><ul><ul><li>6. Closing Comments </li></ul></ul>
    5. 5. <ul><ul><li>Source for questions & answers </li></ul></ul><ul><ul><li>Provides sole HHSC contact : Thomas Spears </li></ul></ul><ul><ul><ul><li>Send Thomas any questions (after today), and your completed RFP responses. </li></ul></ul></ul><ul><ul><li>ECPS handles / coordinates : </li></ul></ul><ul><ul><ul><li>Procurement schedule </li></ul></ul></ul><ul><ul><ul><li>Solicitation access ( copy of RFP , etc.) at www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.asp </li></ul></ul></ul><ul><ul><ul><li>Submission requirements </li></ul></ul></ul><ul><ul><ul><li>Solicitation changes </li></ul></ul></ul><ul><ul><ul><li>Oversees screening & evaluation </li></ul></ul></ul><ul><ul><ul><li>Award information </li></ul></ul></ul>ECPS Procurement Activities
    6. 6. Procurement Schedule <ul><ul><li>RFP Release Date </li></ul></ul><ul><ul><li>Vendor Conference </li></ul></ul><ul><ul><li>Vendor Questions Due </li></ul></ul><ul><ul><li>HHSC Posts Responses </li></ul></ul><ul><ul><li>Proposals Due (by 1pm Central) </li></ul></ul><ul><ul><li>Tentative Award Announcement </li></ul></ul><ul><ul><li>Anticipated Contract Start Date </li></ul></ul><ul><ul><li>August 3, 2009 </li></ul></ul><ul><ul><li>August 18, 2009 </li></ul></ul><ul><ul><li>August 19, 2009 </li></ul></ul><ul><ul><li>September 2, 2009 </li></ul></ul><ul><ul><li>October 1, 2009 </li></ul></ul><ul><ul><li>January 23, 2010 </li></ul></ul><ul><ul><li>April 9, 2010 </li></ul></ul>
    7. 7. RFP Overview <ul><li>Background </li></ul><ul><li>Procurement Mission </li></ul><ul><li>Objectives </li></ul><ul><li>Contract Terms </li></ul><ul><li>Scope of Work </li></ul><ul><li>Performance Measures </li></ul>
    8. 8. Background <ul><ul><li>Legislatively mandated program </li></ul></ul><ul><ul><li>Traditional disease management program since 2004 </li></ul></ul><ul><ul><li>Five diseases (Asthma, Coronary Artery Disease, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease and Diabetes) </li></ul></ul><ul><ul><li>Approximately 50,000 clients enrolled each month </li></ul></ul><ul><ul><li>Majority of clients receive mailings and access to Nurse Advice Line </li></ul></ul><ul><ul><li>Clients who are fully engaged also receive telephonic intervention </li></ul></ul><ul><ul><li>Small subset of clients receive face-to-face interaction </li></ul></ul>
    9. 9. Diabetes Self Management Training <ul><li>Clients enrolled in DSMT will receive the same level of service as clients in the overall Health Management program </li></ul><ul><li>DSMT will be tailored for those with diabetes (even as a co-morbidity) </li></ul><ul><li>Clients must be categorized as DSMT or Health Management clients, not both </li></ul>
    10. 10. Procurement 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.
    11. 11. Objectives <ul><li>The Vendor will help HHSC accomplish the following objectives: </li></ul><ul><li>to develop an innovative and comprehensive approach to health management; </li></ul><ul><li>to create a flexible and customer-oriented program; </li></ul><ul><li>to identify and engage clients, through a predictive modeling system, with high </li></ul><ul><li>cost utilizations that can be reduced by improved management of their </li></ul><ul><li>condition(s) and/or those who are at risk of becoming unstable or developing a </li></ul><ul><li>serious chronic condition(s); </li></ul><ul><li>to increase clients’ skills, knowledge and confidence in self-managing their health condition(s); </li></ul><ul><li>to encourage providers to evolve their practices by becoming advocates of </li></ul><ul><li>patient self-management, supporters of systems delivery change, and </li></ul><ul><li>promoters of clinically evidence-based interventions; </li></ul><ul><li>to utilize technology in supporting client and provider goals; and </li></ul><ul><li>to reduce inappropriate or duplicative costs to the State. </li></ul>
    12. 12. Contract Terms <ul><li>Initial contract period is three years </li></ul><ul><li>HHSC may extend the term of the contract: </li></ul><ul><ul><li>for three additional one year extensions as necessary to complete the mission of the procurement </li></ul></ul><ul><ul><li>subject to negotiation between the parties. </li></ul></ul><ul><li>Payment will be on a per-member, per-month basis: </li></ul><ul><ul><li>fees tied to number of clients enrolled and engaged in program </li></ul></ul>
    13. 13. Scope of Work <ul><li>Introduction and Background </li></ul><ul><ul><li>The Vendor will work with HHSC to design and implement a program that gives clients the tools needed to effectively manage their condition(s). This will be accomplished through the following: </li></ul></ul><ul><ul><ul><li>Educating clients and providers regarding the principles of self-management </li></ul></ul></ul><ul><ul><ul><li>Encouraging providers to view clients as managers of their own condition(s) </li></ul></ul></ul><ul><ul><ul><li>Developing and implementing new, innovative technological solutions that support the THM Program goals </li></ul></ul></ul><ul><ul><ul><li>Three phases: implementation, operations and turnover </li></ul></ul></ul>
    14. 14. <ul><li>Implementation Phase </li></ul><ul><ul><li>Vendor will hold weekly meetings </li></ul></ul><ul><ul><li>Project Work Plan due 15 days after contract effective date </li></ul></ul><ul><ul><li>Collaboration with outgoing vendor </li></ul></ul><ul><ul><li>Recruitment of members to Advisory Board </li></ul></ul><ul><ul><li>Completion of systems testing </li></ul></ul>Scope of Work
    15. 15. Scope of Work <ul><li>Operations Phase </li></ul><ul><ul><li>Customer Service and Adaptability </li></ul></ul><ul><ul><ul><li>Provide exceptional customer service </li></ul></ul></ul><ul><ul><ul><li>Be flexible and allow for innovation </li></ul></ul></ul><ul><ul><li>Associations </li></ul></ul><ul><ul><ul><li>Participate in conferences or trade organizations associated with health management </li></ul></ul></ul><ul><ul><li>Key Personnel </li></ul></ul><ul><ul><ul><li>Program Director – oversees THM program </li></ul></ul></ul><ul><ul><ul><li>Program Manager – coordinates activities </li></ul></ul></ul><ul><ul><ul><li>Program Administrator – provides reports </li></ul></ul></ul><ul><ul><ul><li>Provider Relations Manager – administrator of provider relations </li></ul></ul></ul><ul><ul><ul><li>Client Relations Manager – administrator of client relations </li></ul></ul></ul><ul><ul><li>Meetings </li></ul></ul><ul><ul><li>Outreach </li></ul></ul>
    16. 16. Scope of Work <ul><li>Operations Phase (continued) </li></ul><ul><ul><li>Quality Assurance and Improvement </li></ul></ul><ul><ul><li>Communications Materials </li></ul></ul><ul><ul><ul><li>Identify existing materials when appropriate </li></ul></ul></ul><ul><ul><ul><li>Create materials in an easily understood format </li></ul></ul></ul><ul><ul><li>Triage and Toll-free Numbers </li></ul></ul><ul><ul><ul><li>Nurse consultation line </li></ul></ul></ul><ul><ul><ul><li>Customer service line </li></ul></ul></ul><ul><ul><ul><li>Provider service line </li></ul></ul></ul><ul><ul><li>Overcoming Program Challenges </li></ul></ul><ul><ul><ul><li>Identifying and overcoming barriers </li></ul></ul></ul>
    17. 17. Scope of Work <ul><li>Technology, Predictive Modeling, and Data </li></ul><ul><ul><li>Innovative, progressive and adaptable </li></ul></ul><ul><ul><li>Identify clients who can benefit from program </li></ul></ul><ul><ul><li>HHSC must be able to access Vendor database </li></ul></ul><ul><ul><li>Maintain information in secure database warehouse </li></ul></ul><ul><ul><li>Disaster Recovery Plan </li></ul></ul><ul><li>Reporting </li></ul><ul><ul><li>Reports provide clear, accurate description of activities and status of program </li></ul></ul><ul><ul><li>HHSC will approve format and key metrics </li></ul></ul>
    18. 18. Scope of Work <ul><li>Operations Phase (continued) </li></ul><ul><ul><li>Client Recruitment and Enrollment </li></ul></ul><ul><ul><li>Client Interventions </li></ul></ul><ul><ul><ul><li>Health Risk Assessments (HRA) </li></ul></ul></ul><ul><ul><ul><li>“Cafeteria-style” </li></ul></ul></ul><ul><ul><ul><li>Self-management education </li></ul></ul></ul><ul><ul><ul><li>Health and wellness </li></ul></ul></ul><ul><ul><ul><li>Behavioral and mental health management </li></ul></ul></ul><ul><ul><ul><li>Pharmacy management </li></ul></ul></ul>
    19. 19. Scope of Work <ul><li>Operations phase (continued) </li></ul><ul><ul><li>Provider Recruitment and Enrollment </li></ul></ul><ul><ul><ul><li>Recruit providers who will be impacted by program </li></ul></ul></ul><ul><ul><ul><li>Encourage best practices </li></ul></ul></ul><ul><ul><li>Provider Interventions </li></ul></ul><ul><ul><ul><li>Tools and educational resources </li></ul></ul></ul><ul><ul><ul><li>Proactive, productive interactions </li></ul></ul></ul><ul><ul><ul><li>Practice facilitation </li></ul></ul></ul>
    20. 20. Scope of Work <ul><li>Operations Phase (continued) </li></ul><ul><ul><li>Compliance with Laws </li></ul></ul><ul><ul><li>Fraud and Abuse </li></ul></ul><ul><ul><ul><li>Cooperation and assistance </li></ul></ul></ul><ul><ul><ul><li>Must provide records as requested </li></ul></ul></ul><ul><ul><ul><li>Written fraud and abuse compliance plan </li></ul></ul></ul><ul><ul><ul><li>Mandatory training </li></ul></ul></ul><ul><ul><ul><li>Staff person must be assigned to carry out provisions in fraud and abuse compliance plan </li></ul></ul></ul>
    21. 21. Scope of Work <ul><li>Turnover Phase </li></ul><ul><ul><li>Data Transfer </li></ul></ul><ul><ul><li>Turnover Services </li></ul></ul><ul><ul><li>Post-Turnover Services </li></ul></ul>
    22. 22. Performance Measures <ul><li>HHSC will monitor the Vendor’s performance through a monitoring plan that includes, but is not limited to: </li></ul><ul><li>annual site visits (can be either announced or unannounced); </li></ul><ul><li>quarterly in-person reporting, quality assurance and planning meetings; </li></ul><ul><li>quarterly reports provided by the Vendor; </li></ul><ul><li>monthly status reports provided by the Vendor; </li></ul><ul><li>weekly status meetings with Vendor and other stakeholders; </li></ul><ul><li>accessing the vendor’s systems and databases; </li></ul><ul><li>chart review comparing provider records to the Vendor’s client records; </li></ul><ul><li>annual reconciliation process and report; </li></ul><ul><li>independent assessment of the THM Program by an independent quality review organization; and </li></ul><ul><li>routine contact and interaction with the Vendor and key personnel. </li></ul>
    23. 23. HUB Subcontracting Plan (HSP) Requirements
    24. 24. Agenda Topics <ul><li>RFP Section 4.0 Historically Underutilized Business </li></ul><ul><li>Participation Requirements </li></ul><ul><li>HUB Subcontracting Plan for the RFP is required </li></ul><ul><li>Self Performance HSP </li></ul><ul><li>HSP Prime Contractor Progress Assessment Report </li></ul>
    25. 25. <ul><li>HUB Participation Goals </li></ul><ul><li>Potential Subcontracting Opportunities </li></ul><ul><li>Vendor Intends to Subcontract </li></ul><ul><li>Minority or Women Trade Organizations </li></ul><ul><li>Self Performance </li></ul><ul><li>HSP Changes After Contract Award </li></ul><ul><li>Reporting and Compliance with the HSP </li></ul>RFP Section 4.0 - Historically Underutilized Business Participation Requirements
    26. 26. If HSP is inadequate, response will be rejected HSP Information Page
    27. 27. HSP Information Page HUB GOALS Special reminders and instructions Company Information
    28. 28. If more than 20 subcontracting opportunities, click the link provided to continue adding HSP Information Page Enter subcontracting opportunities Subcontracting Declaration
    29. 29. One page for each area subcontracted (listed on page 1) HSP Information Page
    30. 30. List Line # and Subcontracting Opportunity HSP Information Page
    31. 31. Protégé performing the work HSP Information Page Skip to Sections 8 and 10
    32. 32. Professional Services Category HSP Information Page
    33. 33. Good Faith Efforts to find/include Texas Certified HUB Vendors HSP Information Page
    34. 34. Contact HUB Trade Organization HSP Information Page
    35. 35. Written Notification Requirements HSP Information Page
    36. 36. List 3 HUBs Contacted for this Subcontracting Opportunity HSP Information Page
    37. 37. List Subs Selected (HUBs & Non-HUBs) for this Subcontracting Opportunity HSP Information Page
    38. 38. Reason why HUB was not selected for this Subcontracting Opportunity HSP Information Page
    39. 39. Self Performance Explanation HSP Information Page Signature Affirms that True and Correct Information is Provided
    40. 40. <ul><li>Required with </li></ul><ul><li>ALL Pay Requests </li></ul><ul><li>List ALL Sub payments </li></ul><ul><li>(HUBs & Non-HUBs) </li></ul>HSP Prime Contractor Progress Assessment Report ATTACHMENT “E”
    41. 41. 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)
    42. 42. Administrative Services Development HUB Program Office <ul><li>Robert L. Hall, C.P.M. </li></ul><ul><li>Director of Administrative Services Development </li></ul><ul><li>- (512) 424-6596 </li></ul><ul><li>- [email_address] </li></ul><ul><li>Sharon Addison </li></ul><ul><li>HUB Program/Procurement Services Team Leader </li></ul><ul><li>- (512) 487-3404 </li></ul><ul><li>- [email_address] </li></ul><ul><li>Carlos A. Balderas </li></ul><ul><li>ASD HUB Administrator </li></ul><ul><li>- (512) 424-6896 </li></ul><ul><li>- [email_address] </li></ul><ul><li>Sherice Williams-Patty </li></ul><ul><li>ASD HUB Administrator </li></ul><ul><li>- (512) 424-6903 </li></ul><ul><li>- [email_address] </li></ul>
    43. 43. Texas Health and Human Services Commission (HHSC ) Question Submittal Followed by Break
    44. 44. Tentative Responses to Vendor Questions <ul><li>Non-binding verbal answers to vendor questions may be provided here today. </li></ul><ul><li>Reminder: After today, any additional questions, requests for clarification, etc., are due to HHSC, in writing, by Thursday, August 19, 2009. (Send to Thomas Spears; see below.) </li></ul><ul><li>Vendor Questions/HHSC Responses should be posted by September 2, 2009, on the HHSC Contract Opportunities website at the URL below: http://www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.asp </li></ul><ul><li>Sole point of contact for further inquiries concerning this RFP is: </li></ul><ul><ul><li>Thomas Spears , Contract Administrator </li></ul></ul><ul><ul><li>Enterprise Contract and Procurement Services </li></ul></ul><ul><ul><li>Texas Health and Human Services Commission </li></ul></ul><ul><ul><li>4405 North Lamar Blvd. </li></ul></ul><ul><ul><li>Austin, Texas 78756 </li></ul></ul><ul><ul><li>Phone (512) 206-4570; fax (512) 206-5552 </li></ul></ul><ul><ul><li>Email [email_address] </li></ul></ul>
    45. 45. Closing Comments