MIDDLESEX COUNTY JOINT HEALTH INSURANCE FUND ONSITE HEALTH CENTER MANAGEMENT REQUEST FOR PROPOSAL

Transcription

1 MIDDLESEX COUNTY JOINT HEALTH INSURANCE FUND ONSITE HEALTH CENTER MANAGEMENT REQUEST FOR PROPOSAL

2 MIDDLESEX COUNTY JOINT HEALTH INSURANCE FUND ONSITE HEALTH CENTER MANAGEMENT REQUEST FOR PORPOSAL Selection Criteria The selection criteria to be used by the Fund s Contracts Committee in making its recommendation to the Fund Commissioners as to which proposal is most advantageous to the Fund, price and other factors considered, shall include: 1. The name and qualifications of the individual(s) who will perform the services; 2. Experience and reputation in the particular field of endeavor; 3. Ability to perform the required services in a timely manner (including familiarity with the subject matter, attendance at meetings, etc.) 4. Ability to electronically communicate with the Unicorn HRO eligibility system; 5. Competitiveness of rates (fees and expenses); and 6. Other factors, if determined to be in the best interests of the Fund. If, after receipt of any proposals as described above and prior to any recommendation to the Fund Commissioners, the Contracts Committee determines to revise the required services or to seek more favorable terms, all vendors who have submitted proposals shall be given an equal opportunity to resubmit or modify their proposal. Applicants will be eliminated from competition if they do not meet applicable Federal, State or County legal requirements. Where Federal or State law regulations require a procedural step(s) at variance with these procedures, the Federal or State requirements shall govern. All contracts pursuant to the fair and open process will be awarded by a majority vote of the Fund Commissioners at a public meeting. The term and services for which proposal is sought: ONSITE HEALTH CENTER MANAGEMENT TERM: January 1, 2017 to December 31,

3 DETAIL SPECIFICATIONS 1.0 INTENT It is the intent of these specifications to identify the requirements for qualified and experienced vendors to provide an Onsite Health Centers services to the MIDDLESEX COUNTY JOINT HEALTH INSURANCE FUND hereinafter referred to as the FUND. The Middlesex County Joint Health Insurance Fund is comprised of seven separate Middlesex County entities and covers approximately 2,900 active employees and 1,500 retirees. These entities include: Middlesex County Administration, Middlesex County Board of Social Services, Middlesex County College, Middlesex County Improvement Authority, Middlesex County Utilities Authority, Middlesex County Mosquito Commission, and the Roosevelt Care Center. 2.0 SCOPE OF SERVICE The Fund Background Statement for bidders The Fund provides healthcare benefits for 2900 active employees and their dependents, as well as 1500 retirees that live in or around Middlesex County NJ. Retirees covered under the plan may be dispersed primarily throughout the eastern seaboard but also throughout the country. While taking an aggressive approach to benefits and health care costs has always been a priority for the Fund, there remains the element of not being able to control costs in a way that allows for more hands-on innovative approach to controlling costs and less reliance on insurance carriers to control such costs. To support this need, the Fund is interested in providing an onsite health care center for the provision of comprehensive primary medical services to its constituency. The Fund has member organizations located within the county of Middlesex New Jersey, and is made up of the following entities: The County of Middlesex : New Brunswick NJ Middlesex County College: Edison NJ Middlesex County Utility Authority: Sayreville NJ Middlesex County Improvement Authority: Cranbury NJ Middlesex County Board of Social Services: New Brunswick NJ Middlesex County Mosquito Commission: Edison NJ Roosevelt Care Center: Edison NJ 3

4 The Fund provides health benefits through the following insurance carriers on a self-insured basis, (the latter of which is fully insured): Cigna Horizon Aetna Oxford Health Plans The Fund also provides prescription benefits through CVS Caremark. A limited number of members have prescription benefits through Cigna. All plans are provided on a managed care platform, with a variety of plans offered; with all plans generally having a higher level of benefits compared to the local marketplace. Please obtain plan information and census data from Fund Administrator s office. Please contact Lynn Collins (l.collins@naimc.com) or Dave Hissey (d.hisses@naimc.com) at The Fund anticipates that the Health Center will reside in a space located at 75 Bayard Street, New Brunswick NJ The Fund is committed to provide project funding for office build out, all site improvements, security systems, computers, power sources, permits and other resources needed to ensure proper build out of facility. The space to be allotted for the onsite health center will be based on the recommendation of the onsite health center management company. The winning bidder will be awarded a contract of three (3) years in length, with an option for one year at the discretion of the Fund. I QUALIFICATIONS OF PROFESSIONAL SERVICES ENTITIES Please respond to the following questionnaire in the format and order in which it is outlined: Section A: Firm Qualifications 1. Please include the following information about your firm in the proposal. a) Qualifications and experience of the respondent, including type of business entity, organizational size, structure and history of the organization and experience in the provision of services. b) List at least two current contracts for the services described in this RFP indicating the type of entity, the name and telephone number of the officer in charge of the contract, and the years in which the services have been provided. Indicate clearly any New Jersey entities that you have provided services. Also indicate any Public Entities you have provided services. 4

5 c) Identify whether the medical services were performed onsite in a facility that was dedicated to the particular employer group only or if the services were performed in an off-site facility owned and operated by the company. d) Have any contracts been terminated for any reason? If so, please elaborate. e) Key Person Designation Identify the individual who will be the primary contact. Please provide a resume or biography for this individual. f) Claims and Complaint History List any claims filed against the respondent (or its agents or employees) with the respondent s liability insurance carrier for professional error and omissions, including the nature and resolution of such claims; list all written complaints filed with local, state or federal regulatory agencies, business organizations, or other outside agencies against the respondent or any of its agents or employee within the past five (5) years, together with an explanation of their resolution. g) List of credentials of your staff managing two similar existing clinics. h) Where will the office management be located? i) Provide insight on how the vendor manages timeliness of visits and the usage of staff downtime (if any). j) Provide a staffing model you feel is optimal to increase utilization and increase the return on investment based upon the Fund s current utilization patterns (provided). k) Provide a full description of the provider recruitment process for the onsite health center staff. l) Provide contingency plans for when a provider is on vacation, sick, etc. A provider must always be on the premises. m) Provide the Fund with how you manage your employees and the providers to ensure that the Client has the confidence in your employment management practices. n) Indicate the success of provider in hitting critical deadlines to become operational within agreed upon period. Section B: Worksite Health Care 1. How are appointments scheduled? Is the appointment scheduling process available online? Describe alternate methods of scheduling appointments if the primary method is not available (e.g. if online system is not accessible). 2. Describe the types of medical issues that can be addressed on-site. 5

6 a. Describe why the Fund should or should not include behavioral health and pain management medicine within the HC model. 3. Will medications be dispensed on-site? If so, please elaborate on the selection process, scope and type to be administered, as well as the cost and/or claims filing process for dispensed medications. 4. What is the standard procedure to be utilized when a disease process escalates? 5. Will your physician(s) have hospital privileges? At what facilities and/or locations? 6. Please provide the following information on your proposed medical staff: a) Minimum qualifications b). List the job duties for each individual 7. Describe the primary care case management process. 8. Describe the disease management process. 9. What is the standard procedure if the medical team is not available on the day the care is needed? 10. What is the standard procedure if a problem occurs after hours? 11. Confirm that charges will not be on a Fee-for-Service basis and will not be billed to the medical plan. Identify any deviations. 12. Are medical staff salary rates guaranteed for the length of the contract? If not, please provide details on increases during the contract term. 13. Please indicate whether you recommend the nurse practitioner / medical assistant model or the medical physician model and why. Section C: Communication Plan & Member Services Explain your marketing plans and how you are going to increase utilization. Please provide a proposed communication plan for introducing the on-site healthcare and wellness program and reference the ongoing communication process. Outline your company s responsibilities in these processes. Please include copies of your educational materials and timelines for distribution. 1. How can employees communicate with the onsite medical team? 6

7 2. How are locations of service and standard hours of operation for member services determined? 3. How many hours are you recommending for the proposed onsite medical program? 4. Will the company s website be linked with the Fund s website? To each of the separate entities website? 5. Describe your ability to communicate with an employee and retiree population that is geographically dispersed. Provide examples if appropriate. 6. Describe your company s ability to communicate with a bilingual population (Spanish). 7. Discuss the frequency and type of communications that eligible persons will receive throughout the program period. 8. How will an employee access your company for Member services after hours? 9. Provide your web address and any access codes needed to explore your services. 10. Are you willing to allow the Fund to use its own branding in communication and program materials? 11. Describe the Wellness initiatives that will be used and how they may integrate with the current Wellness programs offered by the Client. 12. Describe the Preventive Service initiatives (i.e., biometric screenings, physicals, other) that will be implemented and how they can integrate with the current healthcare program offered by the Fund. 13. Provide your customer service solution. 14. Please describe your understanding of public sector employee populations, including reference to potential obstacles to achieving desired utilization at HC. Section D: Identification of High Risk Individuals 1. How will your company identify high-risk members (i.e. health risk assessment, member services calls, medical claims data, pharmacy claims data, etc.)? 2. Please describe your methodology for tracking and intervening with high-risk members on an on-going basis. 7

8 3. What Health Risk Assessment (HRA) will your company use and how long have you used it? List all risk factors you identify in your profile. Please provide a sample HRA in your response. 4. How often do you recommend distributing the HRA? Is your health risk assessment available both on-line and off-line? 5. Please describe turnaround time for each of the following areas: a) Providing the HRA results to individuals. b) Contacting individuals for possible interventions. c) Providing Client with a summary report of the initial HRA results. 6. Please describe how your organization would provide a system to assist HRA participants in completion of their questionnaires and in the interpretation of their personal profile. 7. Please describe your plan to involve new employees in the HRA process. 8. Explain how your HRA monitors and reports individual change from year to year? Are these results in aggregate form to the Fund? If so, please provide an example report. 9. Describe the process for engaging an individual with a targeted health condition. 10. Describe how any disease management programs you offer will integrate with those offered by the medical insurance carrier. 11. Describe the process for persons you are unable to reach. Section E: Utilization Projections and Guarantees If you plan to respond to this Request for Proposal, please contact Dave Hissey (d.hissey@naimc.com) or Lynn Collins (l.collins@naimc.com) to obtain a Confidentiality Agreement. When the Confidentiality Agreement is signed and returned, we will send you census data including the home ZIP Code for every active employee and retiree eligible to receive care in the Health Facility. In addition, we will provide a listing of all buildings (including address and number of employees) where active employees are eligible for care at the Health Facility work. 1. Using the census data provided, please provide utilization projections for Years One, Two and Three of the contract. 2. In addition, please provide a Geo Access report mapping the distance from the home ZIP code to the proposed Health Center in New Brunswick. 8

9 3. Using your projections, will you guarantee a minimum level of utilization? Are you willing to place a percentage of your fee at risk in the event projections are not met? If so, please explain in detail. Section F: Measurement Tools & Results Address how you will review clinic operations and its effectiveness? This should include standards and measurement criteria for healthcare activities, costs, outcomes, Health Risk Assessment, disease management, member services, member intervention, and educational materials. 1. How would you propose measuring outcomes and success of the overall program? 2. Describe your standard management reports. Describe your custom reporting capabilities and the associated costs. Please provide a recommendation and examples of reports that you would provide to the Fund. 3. Provide examples of the following, if applicable: a) Clinic healthcare activity report b) HRA and member profile report c) Member participation report d) Member intervention report e) Financial summary/savings report f) Management reports online g) Other available reports 4. Describe how your Plan specifically evaluates the effectiveness of primary care case management. Include any results of the evaluation as an attachment. 5. Provide all clinical indicators used to track the success of the program and the results, if any, by year since inception of the program. Please include the following, if applicable: a) Program Outcomes b) Utilization Measures (list measures) c) Changes in the Cost of Care d) Productivity/Absenteeism (list indicators) 6. Describe how employee satisfaction with the provided services is measured. On what frequency is employee satisfaction measured? 7. Describe the process for reporting employee satisfaction results to the Fund. Provide an example of this. 9

10 8. The Fund would like the vendor to provide performance guarantees and to have a vested interest in increasing utilization and increase return on investment. Provide a fare performance measure proposal including having a vested interest (i.e. financially) for increasing utilization and return on investment. 9. What level of participation can the Fund expect in years one, two and three of this program? What level of success have you displayed with other entities regarding this? 10. Do you recommend using participation incentives? If so, please describe the incentives your organization recommends. Section G: HIPAA Compliance 1. Is your firm HIPAA compliant? 2. Describe your system for the assurance of personal health data security. 3. Have your network security systems ever been breached? Describe. Section H: Proposed Program Costs and Estimated Savings 1. Please include the following in your detailed pricing proposal: a) Administration fees b) Start-up costs / fees c) Staff costs (include proposed hours for each staff position, hourly rates, workers comp, payroll tax, and benefit costs) d) Supply costs e) Pharmacy costs (if applicable) f) Equipment costs (including occupational health equipment) g) Indicate all payment terms and conditions h) Detailed savings projections, including savings in the following areas: Primary care visits/specialist visits Prescription Drugs i) Sample health center drawings j) Performance guarantees k) ROI projections- explain how you arrive at your ROI projection 2. Numbers of year s baseline fees are guaranteed. 3. Explain the procedure for adding future clinic/medical staff hours. Describe any additional administration cost to the Fund associated with an increase in future hours. 10

11 4. Please provide a detailed listing of all services included in your administrative fee. a) If the cost of medical malpractice insurance is not included in your administrative fee, please outline expected costs for this coverage. 5. Please provide a listing of the top ten supplies your onsite health center will stock and the price the Fund will pay for each of these supplies. 6. Provide costs for the following services: a) Cholesterol Test b) Blood Sugar Test c) Lab Processing Fees d) Strep Test e) Flu Test f) Flu Shot g) EKG 7. What other services should the Fund consider, that you may offer? Please provide details? 8. What is your experience for build out, set up and implementation, specific to timelines? 3.0 ELECTRONIC TRANSMISSION OF DATA An eligibility file will be sent to the vendor on a weekly basis from Unicorn, the eligibility vendor. The vendor would need to able to accept and maintain the eligibility for member verification upon arriving at the Health Clinic. Please indicate in the response to this RFP whether or not you are currently receiving electronic data from Unicorn. If not, please contact Dave Hissey or Lynn Collins at the phone number or provided in order to discuss the electronic transmission of data requirements. 4.0 INVOICING The Contractor shall mail to the Fund Administrator, the hard copy of the invoice summary along with detail support. These invoices shall be generated and mailed to the FUND on a monthly basis. Invoices should be received by the Fund by the 10 th of each month. The FUND will submit payment to the Contractor on a monthly basis. 5.0 CONTRACT The Contract shall consist of the specifications prescribed in this RFP, the signed proposal from the vendor and the resolution of the FUND accepting the proposal unless an alternate Contract is specifically set forth in the bidding documents. 11

12 The Proposers shall supply, with their proposal submission, a sample of all company-specific contracts, service agreements, etc. that the FUND may be required to sign, if applicable. All additional required attachments noted at the end of this document should be included in the electronic version of the response. Failure to provide all documentation may result in rejection of proposal. 6.0 INFORMATION / PROJECT All reports, surveys, tables, charts, diagrams, design work, product recordings and other data (including electronic, audio and video) or documentation prepared or compiled by Proposer in connection with the performance of its obligations under the contract, shall be the sole and exclusive property of the FUND. Proposer shall retain in its files sufficiently detailed working papers relevant to its engagement with the FUND. Proposer further agrees that its working papers will be held in the strictest confidence and will not be disclosed or otherwise make available to outside sources, except as required by law, without the written consent of the FUND. 7.0 CONFIDENTIALITY Proposers must agree to keep confidential any and all information concerning the plans, operations or activities of the FUND which may be divulged by the FUND or ascertained by Proposer in the course of performing services under any contract with the FUND. In the event Proposer is required to disclose confidential information pursuant to a subpoena, order of a court, or other legal process, Proposer shall, upon notice of such required disclosure and prior to disclosure, immediately notify the FUND and allow the FUND the opportunity to inspect the information subject to disclosure, and in the event such disclosure is objectionable under any standard or rule of the court, Proposer shall exhaust all legal means to prevent disclosure. 8.0 QUALIFICATIONS AND EXPERIENCE The names and resumes of representative sample personnel who would be providing COBRA administration and Direct Bill Retiree administration services shall be provided. Indicate whether the individual is a full time employee of Proposer s organization (and if so for how long) or a subcontractor. If the individual is a subcontractor, list the engagements (and the particular responsibilities on each engagement) that the subcontractor has previously worked for Proposer. Proposer shall include list of three (3) persons or businesses, which have knowledge of the Proposer s ability to successfully perform the services for which this Proposal is submitted. Name of company, contact name, phone number and shall be provided. The Proposers shall indicate if, during the past five (5) years, any contract and/or agreement has been cancelled or terminated due, in whole or in part, to the fault of Proposer, or a default or breach of contract on the part of the Proposer. Details shall be submitted with the proposal. 12

13 9.0 FINANCIAL STABILITY The Proposer must provide financial statements for the most recent two year period. For the purposes of organization and potential claims of non-disclosure, Proposers should include their financial statements as an appendix to their proposal. The Proposer shall describe in detail any current or past bankruptcy proceedings involving the Proposer, its predecessors, its affiliates or its principals LITIGATION HISTORY The bidders shall provide a list of all current and closed litigation that it has been involved within the past five (5) years. The causes of action shall be specified in each case. Where settlements are subject to a non-disclosure agreement, the case may simply be identified by cause of action. If no litigation or notice of claim has commenced against the bidder, it must be so specified. If the bidder has been subjected to liquidated damages or penalties for contract non-compliance in other, the details of that action, including cause, cost and corrective measures shall be included with the bid. If no such action has occurred against the bidder, it must be so specified CONSIDERATIONS The major considerations that will enter into the FUND S decision-making process include the following: 1. Contract Terms provided by Proposer. 2. Competitive Fees. 3. Proposer s size, financial stability, industry track record, and capacity to provide the managerial, technical, and physical resources to deliver the required services. 4. Quality of communications and professionalism of Proposer s personnel, presentations and documentation during the RFP process. 5. Demonstrated quality of the product and/or services during delivery center site visits, product demonstrations, customer reference calls, etc. 6. Proposer must identify its quality processes and procedures mandated by both business and regulatory needs. 7. Demonstrated technical competence as a market leader in innovations and investment in technology to deliver exceptional service to participants and clients PRICING Please provide a detailed listing of all pricing, start up fees, reporting fee, i.e. all additional costs. Please include the pricing summary in a separate section of the RFP response. 13

14 13.0 SUBMISSION OF PROPOSAL One (1) original, five (5) hard copies of the proposal shall be submitted. Proposals must be signed in ink by the vendor; Proposals must also be submitted with an electronic copy; Proposals submitted shall be valid for a minimum of 60 days from the date of opening. The FUND assumes no responsibility for delays in any form of carrier, mail or delivery service causing the proposal to be received after the above mentioned due date and time. Submission by fax, telephone or is not permitted. Any questions regarding the submission of the proposals shall be directed to Dave Hissey or Lynn Collins at or to d.hissey@naimc.com or l.collins@naimc.com. Failure to answer all questions completely, furnish all information required in these Proposal Documents and include an electronic version of the response may result in disqualification of the Proposer. 14

15 ATTACHMENT A QUALIFICATIONS AND EXPERIENCE Attach the names and resumes of representative sample personnel who would be providing medical services to the FUND. Indicate whether the individual is a full time employee of Proposer s organization (and if so for how long) or a subcontractor. If the individual is a subcontractor, list the engagements (and the particular responsibilities on each engagement) that the subcontractor has previously worked for Proposer. Attached: yes no List three (3) persons or businesses, which have knowledge of the Proposer s ability to successfully perform the services for which this Proposal is submitted. Name of company, contact name, phone number and shall be provided During the past five (5) years, has any contract and/or agreement been cancelled or terminated due, in whole or in part, to the fault of Proposer, or a default or breach of contract on the part of the Proposer? (Please X the appropriate answer and initial after the X ) No Yes If yes, attach details 15

16 FINANCIAL STABILITY ATTACHMENT B FINANCIAL STATEMENT & LITIGATION HISTORY Attach financial statements for the most recent two year period. For the purposes of organization and potential claims of non-disclosure, Proposers should include their financial statements as an appendix to their proposal. Attached: yes no Have there been any current or past bankruptcy proceedings involving the Proposer, its predecessors, its affiliates or its principals? (Please X the appropriate answer and initial after the X ) No Yes If yes, attach details LITIGATION HISTORY Attach a list of all current and closed litigation in which the Proposer has been involved within the past five (5) years. The causes of action shall be specified in each case. Where settlements are subject to a non-disclosure agreement, the case may simply be identified by cause of action. If no litigation or notice of claim has commenced against the bidder, it must be so specified. Attached: yes no If the Proposer has been subjected to liquidated damages or penalties for contract noncompliance in other correctional health care contracts, the details of that action, including cause, cost and corrective measures shall be included with the bid. If no such action has occurred against the bidder, it must be so specified. Attached: yes no 16