Name of Company: Contact Name: Address: Telephone Number: Fax Number:

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1 DEFIANCE COUNTY REQUEST FOR PROPOSALS (RFP) ON-SITE CLINICAL SERVICES (On-site physician clinic which shall provide primary care, including episodic and preventive care; health risk assessments to adult members; and non-emergency convenient care) Name of Company: Contact Name: Address: Telephone Number: Fax Number: Please return your Request for Proposal to: Defiance County Commissioners c/o Sherry Carnahan Administrator 500 Court Street, Suite A Defiance, Ohio

2 INSTRUCTIONS Amendments and clarifications to this bid will be posted on the Defiance County Website It is the sole responsibility of all interested parties to monitor this website for those additional documents. Amendments and clarifications become a part of the bid and any subsequent awarded contract. Any questions regarding this document shall be directed in writing to: Defiance County Commissioners c/o Sherry Carnahan Administrator 500 Court Street, Suite A Defiance, Ohio Main Fax sc@defiance-county.com Scope of Work The Board of Defiance County Commissioners wishes to contract with an experienced firm to administer and provide on-site clinical services - an on-site physician clinic which shall provide primary care, including episodic and preventive care; health risk assessments to adult members; and non-emergency convenient care to their employees and dependents. This will include pharmaceutical and lab services and wellness and lifestyle management programs. Proposal Instructions Defiance County requires clear and concise proposals. Offerors should take care to completely answer questions and meet the RFP s requirements. Prosposal Format Each proposal must include sufficient data to allow for the verification of the total cost of the Offeror s ability to meet the RFP s requirements. Each proposal must respond to every request for information in this document whether the request requires a simple yes or no or requires a detailed explanation. Proposal Contents Each proposal must contain all information requested in the RFP. Submittal of Proposals Offeror s proposals should respond concisely and clearly to all of the inquiries contained in the proposal. All rates/fees should be provided as requested in the RFP and any additional costs should be clearly explained. Offerors will be evaluated only on the services it provides, or it provides in collaboration with subcontractors. Each proposal shall be submitted in a sealed envelope clearly marked with RFP for On-site Clinical Services. If an Offeror uses an express mail or courier service, the proposal must be enclosed in a sealed envelope inside the express mail or courier service envelope. 2

3 The County will not be liable for any costs incurred by a contractor prior to the award of any contract resulting from the Proposal. Proposal Opening Proposals are due on Thursday, January 30, 2013 prior to and no later than 11:45 a.m. EST. All sealed proposals received after this time and date, for any reason will be rejected. The opening of the sealed proposals will take place at the Defiance County Commissioner s Office, 500 Court Street, Suite A, Defiance, Ohio The Proposal opening will be public; however Proposal contents will not be read or made public. FAXED OR ED PROPOSALS WILL NOT BE ACCEPTED. Proposal Rejections Ohio Revised Code and permits Defiance County to reject all proposals and advertise for new proposals on the required items, products or services. Defiance County may reject any proposal, in whole or in part, if any of the following circumstances are true: 1. Proposals offer services that are not in compliance with the requirements, specifications, terms, or conditions stated in the Request for Proposal. 2. Defiance County determines that awarding any item is not in the best interest of the County. 3. Defiance County reserves the right to reject any or all of the proposals on any basis without disclosure of a reason. The failure to make such a disclosure will not result in the accrual of any right, claim, or cause of action by any unsuccessful contractor against Defiance County. Lowest and Best Offeror An Offeror is lowest and best if their proposal offers the best-cost and supply or service in comparison to all other Offerors as set forth in the evaluation process in the proposal. Defiance County reserves the right to award the contract to the Offeror that may have a higher price and by evaluation best meets the county s requirements. This is intended to be an all or none award; however, if it is in the best interest of Defiance County, the County reserves the right to, award to multiple vendors, to reject all proposals and re-bid, or not to make any award on an "ALL or NONE" basis. Evaluation Process Proposals are typically evaluated within 90-days. The evaluation process will consist of the following process: Phase 1 - Initial Review of Proposal Defiance County will review all proposals for their format, and completeness. Phase 2 - Evaluation of Proposal Documents Defiance County will evaluate each proposal and the requirements according to the non-financial and financial criteria contained in this part of the RFP. During the evaluation process, Defiance County may request clarifications from any Offeror under active consideration and may give any Offeror the opportunity to correct defects in its proposal if Defiance County believes doing so does not result in an unfair advantage for the Offeror and it is in Defiance County s interests to 3

4 do so. Proposal Evaluation Criteria Defiance County will rate the Proposals submitted in response to this RFP based on specific criteria. The specifications evaluation will result in a point total being calculated for each Proposal. Contract Negotiations Negotiations, if required, may be conducted with the Offeror who submits the lowest and best competitive proposal based on the rankings of all phases of the evaluation process. Any clarifications, corrections, or negotiated revisions that may occur during the negotiations phase will be reduced to writing and incorporated in the final contract document. At any time during the negotiation process, if an Offeror fails to provide the necessary information for negotiations in a timely manner, or fails to negotiate in good faith, Defiance County may terminate negotiations with that Offeror and proceed to the next ranked Offeror. Communication during Evaluation During the evaluation process, unless requested by County as part of the evaluation process, any attempt on the part of the Offeror, the Offertory's agent(s), or any party representing the Offeror, to submit correspondence that is determined by County to be an attempt to compromise the impartiality of the evaluation or any party on the part of the Offeror, the Offertory s agent(s), or any party representing the Offeror to communicate with any member of the County regarding the evaluation process may be ground for immediate disqualification of the Offeror. A determination to cease the evaluation or reverse an award determination will be at the sole discretion of the County. County may request additional information to evaluate an Offertory s responsiveness to the Request for Proposal or to evaluate an Offertory s responsibility. If an Offeror does not provide the requested information, it may adversely impact County s evaluation of the offertory s responsiveness or responsibility. 4

5 Defiance County Request for Proposal Please submit answers to the following questions and provide any additional information as needed. General Information 1. Name of your organization and corporate headquarter s address. 2. Provide a brief history of your organization. Include the number of years you have been in the business of providing on-site medical clinics, an overview of your ownership/corporate structure, as well as the name and duration of the client with whom you have had the longest relationship. 3. How long have you been operating on-site medical clinics? 4. How many clinics do you manage? Are they occupational, medical or both? 5. How many full-time employees do you have that are devoted solely to the employees and their dependents as described in the proposal? 6. How many on-site clinics do you have under contract that are scheduled to open between now and April 1, 2014? 7. How many clients have terminated their relationship with you or discontinued clinic operations in the last 24 months? Please describe the circumstances of each. 8. List all other outside vendors you partner with to manage your on-site clinics and/or wellness initiatives. 9. Defiance County may be interested in providing access to the on-site clinic to other employers in the near vicinity. Are you willing to participate in this kind of arrangement? 10. Are you anticipating any significant business model changes or new service offerings in the coming year? Please describe. 11. Provide the names and contact information for three companies that would be willing to serve as a reference for your services. 12. Provide the contact information of the individual authorized to answer questions related to this inquiry and response. 5

6 Operational Details Performance Standards & Quality Assurance 1. Describe your company s performance standards with respect to a) Employee Inquiries (both written and telephonic) b) Wait Time c) Patient Satisfaction Surveys. 2. Describe your company s quality assurance programs. 3. Do you employ an MD as a medical director? What are his/her credentials? 4. Describe your process and the timing of complaints sent for medical review. Privacy 1. Are patient medical records stored in a HIPAA compliant method? Please describe. 2. How do you insure the privacy of records and information? 3. How is your privacy policy communicated to participants? 4. What practices do you have in place to protect the confidentiality of individual information when electronically transferring or storing information? 5. Describe your policy relative to sharing, selling, or otherwise utilizing member usage and other member data. 6. Have you ever had a HIPAA violation? If yes, please explain and describe what corrective action was taken. Staffing 1. How would you propose staffing to meet Defiance County's needs? 2. What are the degrees and credentials of each person who would be providing care to Defiance County's employees? 3. Please describe the process you utilize to staff your clinics including the involvement of the client in staffing selection? 4. Are the medical professionals working at your on-site clinics your employees or independent contractors? 5. Who manages the staff and assures proper ongoing credentialing? 6

7 6. Which staff members are responsible for: a) Follow up encounters b) Follow up to check on compliance to prescribed medicines c) Follow up to monitor adherence to disease management or health promotion. 7. Please note the medical malpractice and liability coverage your organization has in place and note any employer coverage needed as a result of providing an on- site clinic. 8. What has your experience been with staff turnover in regards to those employed in the clinics? 9. How will the clinic be covered in order to maintain service and efficiency if a regularly scheduled staff member calls in sick, becomes disabled, or has some other need for leave of absence - especially if it is unplanned? 10. Describe how you will handle care and employees needs after hours. Data Management 1. Do you have a system in place to accept electronic eligibility files? 2. How often do you require eligibility files be submitted to you? 3. Can you pre-populate with medical claims activity from any period of time prior to your contract with Defiance County? 4. Describe the features and capabilities of your hardware and software systems, particularly your scheduling and electronic medical records. 5. Does your IT system have a tracking system that can report on patient adherence to a disease management or health promotion program prescribed by the medical staff? 6. Do you have the capabilities to set up an employee portal for Defiance County for their employees to communicate, research, and access data (i.e. lab results, HRA results)? 7. In the event of an outage, describe your client notification procedures. 8. Describe your Disaster Recovery procedures. 9. Do you store any client data overseas? 10. Do you leverage overseas staff that has access to client data? 11. Is client data reported against to outside entities? 7

8 12. Do you data mine client data and sell the anonymous results to any outside party? In the event this agreement is terminated by either party, how does Defiance County get their data and what are the procedures for scrubbing the data from your systems? 13. In the event this agreement is terminated by either party, how does Defiance County get their data and what are the procedures for scrubbing the data from your systems? Coordination with Outside Physicians, Other Medical Services and Health Plan Administrators 1. How do you integrate worker s compensation through the clinic? 2. How do you handle referrals to a specialist? 3. Please note your capabilities regarding reporting encounter data. Site Information 1. What are your minimum requirements (space, specific-use rooms, services, etc.) for an on-site or near site clinic based on the information provided regarding Defiance? 2. What are typical employer-provider infrastructure and technology requirements? 3. Please delineate the average start-up time line for the on-site clinic. Services Offered 1. Please provide your scope of covered medical services. 2. Please provide samples of all employee reports (health risk assessment, biometric screening, and wellness program). 3. Please provide samples of all employee reports and discuss the frequency of employer reports. If there is a charge, please state. 4. Describe your typical process for promoting the opening of the clinic. 5. Please discuss what type of on-going employee communications services provided once the clinic is operational. Also, what are your expectations from Defiance County? Pharmacy and Lab Services 1. With whom do you partner to provide discounted pharmaceuticals? 2. Does your pharmacy program cover generics commonly prescribed by primary care physicians or does it include a full range of pharmaceuticals? 3. What are the basic pharmaceutical contracted terms (admin. fees, mail order discount from AWP, number of drugs included in MAC pricing schedule, etc.)? 4. Does your firm retain manufacturer rebates or pass those rebates onto your client? 8

9 5. Is your formulary flexible enough to allow select drugs that your client may want included? 6. What has your demonstrated savings experience been when employers offer pharmacy fills through the on-site clinic? Savings for lab services? 7. With whom do you partner for lab testing services? 8. Does your lab have the ability to perform testing on remote employees located throughout the country? 9. Please provide pricing for the top 25 lab tests likely to be ordered in the clinic for reference purposes. 10. Please provide the following information for the top 25 drugs likely to be utilized by this clinic. (Drug name, NDC#, Quantity, Strength, Price) Wellness/Health Coaching/Behavior Change 1. Please describe in detail how the following wellness & lifestyle management programs would be integrated into your clinic model. 2. Please also detail how specific services are billed to Defiance County. A) Health Risk Assessments B) Biometric Screening C) Behavior Change Management D) Health Maintenance Programs. 3. How does your staff work with employees in integrating the care they receive in the clinic and the care they receive outside of the clinic? Who manages the condition/disease and how do you help improve their compliance and overall health? 4. Please describe how you impact individual behavior/lifestyle choices, as well as, chronic diseases and poor health status on both a population and individual level. 5. Please describe how you support mental health and behavior health needs through your clinic. How will you integrate with an EAP program already in place? 6. Describe how you integrate health coaching into your model. Who would be doing the health coaching, how often and with what method (telephonic, in person, etc.)? 7. Explain your experience designing incentive systems to drive participation, including your most successfully designed incentive program. 8. How will the clinic staff interact with doctors who are already working with the employees and their families? (i.e. share data, manage in between visits) Miscellaneous 1. Do you typically allow walk-in appointments? Why? 9

10 2. What is the average time allotted for each person who visits the clinic? 3. Can the clinic serve both employees and their dependents? 4. If dependents can utilize the clinic, is there a minimum age for children? 5. In addition to employer-sponsored on-site clinic services, please describe all revenue streams your organization, or any relevant parent-companies, have with respect to healthcare services (including, but not limited to laboratory, pharmacy, radiology, other diagnostic services, specialty physician, or hospital services). 6. Does your company have any formal affiliation or ownership by a hospital, multi-specialty physician group, pharmacy, pharmaceutical company, or health insurance carrier? 10

11 Pricing/ROI Analysis 1. Please provide estimated pricing for anticipated start-up costs and ongoing operational costs. Provide line item detail for the following categories if applicable to the services you are proposing. 2. Please indicate if they are included in your fee or if they are a pass through cost. a) Clinic healthcare personnel (list by position; hourly rate - including fringe benefits if applicable); attach a job description for each position. b) Other clinic personnel (list by position; hourly rate - including fringe benefits if applicable); attach a job description for each position. c) Management fee(s) d) Estimated start up equipment (clinical) by items and cost e) Estimated cost of facility build out/remodel f) Estimated monthly ongoing medical and office supplies g) Estimated monthly labs and Rx costs (including the cost for annual biometric screenings) 3. Please provide a sample return on investment analysis and document your assumptions. 4. Using your own format, provide a detailed savings analysis for the clinic. Please provide hard dollar savings for office visit replacement costs, wholesale pricing for supplies, staffing, etc., as well as, soft dollar savings such as health status improvement, lifestyle improvement, engagement, etc. 5. Describe your contingency plan/action steps should your projected utilization, shift in visits, and/or savings potential not come to fruition according to plan. Mandatory Requirements This section identifies all mandatory requirements which must be present in the proposal before further consideration will be given. Participant must prepare and submit a Guide to Mandatory Requirements which references the page(s) of the proposal where satisfaction of the Mandatory Requirements is substantiated. 1. The Participant must have at least three full years of experience in providing on-site clinic services. 2. The Participant must have provided on-site clinic services to at least 10 organizations of at least 750 people each. 3. The Participant shall provide, as a part of its proposal, a list of clients for whom these services have been provided during the past two years. The list must include: dates of service scope of services number of employees number of annual visits 11

12 name of contact person title of contact person phone number of contact person 4. The Participant shall provide client retention rate during the past 3 years. 12