IME DATA ANALYTICS SERVICES AND TOOLS REQUEST FOR INFORMATION (RFI) MED

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1 IME DATA ANALYTICS SERVICES AND TOOLS REQUEST FOR INFORMATION (RFI) MED

2 TABLE OF CONTENTS 1 GENERAL INFORMATION ANNOUNCEMENT POINT OF CONTACT RFI CLOSING DATE ACCEPTANCE OF REPONSES COST OF PREPARING RESPONSES RETENTION OF RESPONSES BACKGROUND SCOPE OF WORK RESPONSE SUBMISSION CONTENT / REQUIREMENTS SUBMISSION OF RESPONSES RESPONSE FORMAT...5 Page i

3 1 GENERAL INFORMATION 1.1 Announcement The State of Iowa (State) Department of Human Services (DHS), by and through its designated Medicaid agency, the Iowa Medicaid Enterprise (IME), is issuing this Request for Information (RFI) to obtain information from prospective bidders related to the demonstration of systems, software or services that will provide business intelligence decision support capabilities to IME s existing data warehouse. Respondents may include public and/or private companies within the healthcare industry. Interested parties may submit a response outlining their products and services available to identify solutions related to the scope of work in Section Point of Contact This RFI is issued by DHS and IME is the sole point of contact from the date of release of this RFI through the closing date as follows: Iowa Medicaid Enterprise 100 Army Post Road Des Moines, IA Attention: Dave Musgrove dmusgro@dhs.state.ia.us 1.3 RFI Closing Date Responses submitted in accordance with this RFI must be received by IME no later than 4:30 PM Central Daylight Time (CDT) on Thursday, September 3, Responses must be mailed or ed to the addresses above. Responses delivered or received after the closing time and date will not be accepted. Respondents may send a query to the address above to ensure that their submissions were received. Page 1

4 1.4 Acceptance of Reponses A. The Department will accept all responses submitted according to the requirements and deadlines specified in this RFI. Responses must be complete when submitted and should clearly describe the Respondents ability to meet the requirements of the RFI and the needs of the Department. B. The IME may ask any Respondent for written clarification of their response. 1.5 Cost of Preparing Responses A. All costs incurred by the Respondent for Response preparation and participation in this competitive process will be the sole responsibility of the Respondent. The Department will not reimburse any Respondent for any such costs. B. Issuance of this RFI in no way obligates the Department to award or issue a subsequent Request for Proposal (RFP). 1.6 Retention of Responses All responses submitted in response to this RFI become the property of the State and will not be returned. All material submitted by Respondents becomes the irrevocable and sole property of the State of Iowa. Page 2

5 2 BACKGROUND Iowa Medicaid Enterprise (IME): The Iowa Department of Human Services (DHS) is the single state agency responsible for administering the Medicaid program in Iowa. The Iowa Medicaid Program reimburses providers for delivery of services to eligible Medicaid recipients under Title XIX of the Social Security Act through enrolled providers and health plans. DHS maintains the Iowa Medicaid Enterprise (IME), which comprises state management of the Iowa Medicaid Program and the third-party professional services and systems services contractors that jointly administer the Iowa Medicaid Program. Page 3

6 3 SCOPE OF WORK To meet the Iowa legislative requirement SF 478, Section 180, IME is releasing this Request for Information (RFI). This RFI will serve as the mechanism to identify the availability of data mining, data analytics, predictive modeling and post payment review tools or services within the healthcare market. The products reviewed must be capable of monitoring Medicaid claims to determine provider overpayments, underpayments, fraud and identification of strategies to assist in the improvement of healthcare for members of the Medicaid program. IME is seeking information for a comprehensive solution addressing this scope of work. This solution may be comprised of a single product addressing all aspects of the scope of work, or individual software products that could be integrated to provide the required functionality. IME is therefore interested in having vendors demonstrate their comprehensive systems or individual software products, as the case may be. 3.1 The vendor should demonstrate tools and or services that encompass the following functions: Data mining Data analytics Predictive modeling Automated claim overpayment and underpayment review Fraud and abuse detection 3.2 The vendor should demonstrate the benefits of their solution(s) in the following areas: Substantial cost savings to the Iowa Medicaid Program Identification of strategies to assist in the improvement of healthcare for members of the Medicaid program Budget forecasting A scalable solution that will support multiple health insurance related products and multiple types of users (members, contractors and Department stakeholders) Extensive standard and ad-hoc reporting capabilities to meet IME and CMS requirements The ability to export data to IME s data warehouse in accordance with IME and CMS requirements Full compliance with all HIPAA security and privacy provisions is absolutely essential Page 4

7 4 RESPONSE SUBMISSION CONTENT / REQUIREMENTS Responses shall be prepared in accordance with the requirements stated in this section. 4.1 Submission of Responses All responses shall include the name, title, mailing address, address, fax and telephone number of the authorized agent with the authority to submit the response and to answer questions concerning the response Respondents mailing their proposals or using a commercial delivery service should allow sufficient time for delivery of their responses by the time specified in Section 1.3 above. Delivery of the responses shall be at the Respondents expense Due to legislative and programmatic requirements, timing is critical on this RFI. Responses received after the deadline will not be considered. It is the intent of the Department to conduct vendor demonstrations the week of September 14, This RFI does not obligate the Department to release a bid to procure services for a solution related to the scope of work. 4.2 Response Format Formatting Responses shall be organized as follows: A. Cover page with organization name and contact information as described in Cover page must be signed by the authorized agent B. Table of contents C. Statement of intent to demonstrate a system or software product D. Product overview E. Answers to written questions as numbered in Section below F. Attachments Respondents are limited to 20 pages in responding to the written questions. The page limit does not include the cover page, table of contents, or attachments. Attachments may be included in the response if they clarify or elaborate on the answers to written questions. Please do not attach marketing or other material for your Page 5

8 organization that does not directly respond to the written questions in Section Please mark envelopes of responses sent via US Mail as DO NOT SCAN Written Questions Respondents must provide answers to the following questions by the closing date specified under Section 1.3 of this RFI. A. How will this solution deliver substantial cost savings to the Iowa Medicaid Program? B. Which States are using the product(s) that you will demonstrate? C. Please describe what you think makes this solution of unique value within the industry. D. Describe how this solution accommodates the unique needs of the Medicaid patient population and Medicaid payors. E. Describe the architecture of this solution, including client installation requirements (e.g., web-based, thin client, etc.). F. Describe the inputs, throughputs and outputs of this solution, including connection to client-based system(s). Include the type of connection and processing method (e.g. batch vs. real time). G. What is the vendor s process for enhancements and fixes? What is a typical turn around time? Describe the extent of system changes over the last two years. H. Describe the structure of a proposed implementation project for this solution, and the composition and working method of the project team. I. Describe the data mining capabilities of this solution and its ability to identify both high-level and granular patterns from historical data of inpatient admissions, surgeries, high dollar encounters and comorbidities. J. Describe the data analytics capabilities of this solution and its ability to identify specific conclusions from existing data. K. Describe the predictive modeling capabilities of this solution, and its ability to: a. forecast the frequency and intensity of clinical encounters for specified patient populations 12 to 24 months into the future b. provide a basis for budget forecasting of expenses in specified categories 12 to 24 months into the future Page 6

9 L. Describe the capabilities of this solution to detect fraud and abuse. M. Describe the capabilities of this solution to retrospectively evaluate paid Medicaid claims for coding and payment errors for the current year and three years prior. N. Describe the HIPAA privacy protection features of this solution Demonstration of products and services and key personnel interviews A. Based on the response to RFI, and in accordance with the terms stated in Section 1.4, IME may invite one or more Respondents to make oral presentations and conduct demonstrations of their products and services. At the Respondent s option, presentations may by made either electronically (via webcast or other means over the internet) or in person. Respondents selected by IME to make presentations will be notified as to the scheduled day and time of the presentation. B. To ensure IME staff has the opportunity to observe complete system or software product capabilities, a comprehensive demonstration of system or product functionality should be done either in a live production environment or a test/development environment with representative data. C. Any expense related to demonstrations, whether electronic or in person, are the responsibility of the Respondent. Page 7

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