Posted: March 28, 2014

Request for Proposal Project Development / Project Management Consultant Primary Care Quality Improvement Initiative: Improving Population Health Outcomes for Patients with Hypertension (HTN) and Diabetes A. Background Posted: March 28, 2014 Maine Quality Counts (QC), under a contract with the Maine Center for Disease Control and Prevention (Maine CDC), will provide quality improvement support for primary care practices in Maine to improve population health outcomes for patients with hypertension (HTN) and diabetes. QC will work with primary care practices, provider groups, and health systems to improve care through the implementation of quality improvement (QI) processes and the use of Electronic Health Records and Health Information Technology at the provider and system level to ensure reliable systems of care. In the initial phase of work, QC will work with 3-5 Maine Primary Care Practices (practices) to pilot the development of a QI initiative to provide technical support and guidance for improving population health outcomes for patients with HTN and diabetes. This effort is funded by a federal grant US CDC grant award DP13-1305 (Enhanced component) made to the Maine CDC; the complete federal funding opportunity announcement can be accessed at: http://www.grants.gov/search/search.do;jsessionid=bzylrvhv2dbkjr851jbyvr7g8rfrnsl2gfqf C2GWGypJQ8hYT2My!-917495793?oppId=221573&mode=VIEW Maine CDC project deliverables and measures are outlined in Appendix A. B. Project Description and Contract Overview QC is looking to contract with a consultant to provide project development and project management services to support the development and implementation of a QI initiative in which QC staff will provide technical support and QI assistance to primary care practices and provider groups to improve population health outcomes for patients with hypertension HTN and diabetes. C. Scope of Work, Tasks, and Deliverables The following describes the Services to be performed, any Materials that are to be delivered, and the schedule for delivery (if applicable): D. SERVICES TO BE PERFORMED The following services and deliverables are required. Applicants may bid on the full set of services, or on one or more of the categories of services outlined below: 1

I. Project Management (ongoing for contract duration) A. Develop, in conjunction with QC Project Leadership and in accordance with QC deliverables to the Maine CDC, a specific project workplan and timeline; provide project management services to manage the project in accordance with the workplan and timeline. B. Work with QC Project Leadership to identify and convene key stakeholders (including health system leaders, provider group leaders, providers, and consumers) to assess current opportunities and needs to support primary care practices in their efforts to improve care for patients with HTN and diabetes; C. Develop a set of target goals and outcomes for subsequent work by QC to support practice improvement for HTN and diabetes, to incorporate the following: Alignment with performance measures contained in DP13-130 (short, intermediate, and long-term measures) Align support and intervention with existing quality improvement efforts, including Maine PCMH Pilot, as well as with public and private payer requirements for PCMH, ACO, Meaningful Use initiatives (pay for outcomes/ performance incentives or shared savings) Align with current performance measurement and public reporting programs (e.g. Pathways to Excellence/Get Better Maine reporting); D. Support integration with other related initiatives Identify and facilitate opportunities to integrate this project with other QC initiatives (e.g. QC Learning Community, Maine PCMH Pilot, etc) Identify and work with relevant provider organizations and statewide groups, as applicable, to coordinate and align quality improvement efforts (e.g. Maine Cardiovascular Health Council, MaineCare, etc.) Participate in statewide meetings and conferences as appropriate Develop relationships and work with consumer organizations as appropriate E. Ensure appropriate communication with key stakeholders Work with QC staff to create and update web-based communications and information Make presentations to individuals and groups as indicated Contribute to QC and project communications as appropriate F. Develop a system and process for ensuring appropriate knowledge transfer of all project components to support successful implementation of subsequent grant deliverables. II. Primary Care Practice Environment Mapping (complete by June 30, 2014) Conduct a mapping of current primary care practice environment (Primary Care Practice Environment Map) that will include a catalog of practices, practice organization, and the state of current practice QI efforts and resources in order to better understand the current 2

organization of primary care practices in the state, and to identify the practices most likely to be interested in accessing QI/technical support to improve population health outcomes for HTN and diabetes. The outcomes of this mapping process will include the following: The distribution of primary care practices in Maine, and the affiliation of practices with major health systems and provider groups The current level of practice participation in PCMH and other QI efforts The proportion of Maine practices with EHR s that are appropriate for treating patients with hypertension and diabetes (definition TBD) The proportion of Maine practices currently reporting on National Quality Forum measures (HTN control, NQF 0018; and diabetes A1C control, NQF 0059); III. Data Measurement and Collection (complete by June 30, 2014) A. Create a plan for collecting required project data from participating practices that recognizes current EHR reporting capacity; B. Work collaboratively with QC Project Leadership and Maine CDC to conduct meetings with HealthInfoNet, Maine s Health Information Exchange (HIE), to begin discussions on HIE and health system data requirements needed to collect population health data related to HTN and diabetes; IV. QI Interventions for Practice Change (complete by August 31, 2014) A. Develop a QI change package for primary care practices that outlines the key changes needed to achieve the desired outcomes for HTN and diabetes, to include the following: a. Identify key changes for improving clinical practice of diabetes and HTN care b. Work collaboratively with Maine CDC DP13-1305 Team to incorporate targeted strategies - e.g. Tiered Team Based Care models, and evidencebased HTN and diabetes care algorithms and training models c. Work with QC to integrate effort with other QC learning opportunities; B. Develop structure for structure for piloting QI processes and protocols with 3-5 primary care practices that aligns with data plan and QI change package and allows measurement of outcomes after 10-month pilot period C. Develop a plan, including specific timeline and workplan, for obtaining Category I Continuing Medical Education (CME) credit for learning initiative webinars and learning sessions D. Develop a QI initiative that meets provider ABFM and ABIM Part IV Maintenance of Certification (MOC) requirements; obtain approval for MOC Part IV credit from ABFM and ABIM. Explore opportunities to align MOC credit with public quality reporting programs (e.g. Bridges to Excellence, NCQA Diabetes and Heart/Stroke programs) 3

E. Develop recruitment plan and package to recruit practices to participate in the initial/pilot QI initiative, to include the following: a. Project introduction b. Readiness assessment that identifies practices ready for technical support to enhance practice policies/protocols/workflows for evidence-based approaches to improve HTN and diabetes control c. Summary of expectations and benefits of participation d. Memorandum of agreement Establish agreements with the practices F. MATERIALS TO BE DELIVERED Primary Care Practice Environment Map, planning documents, technical assistance methodologies and materials, QI change package, measurement and data plans and tools, enduring educational materials, and recruitment plans and materials as described in #1 through #10 above. G. Contract Term and Contract Price The initial contract term is from the date of execution, which is to be no later than May 5, 2014, through September 1, 2014. The price for the full set of services described in this contract is $100,000. Bidders may bid for separate components of the work as described above, with price to be adjusted accordingly. Payment is contingent upon the contractor completing the Scope of Work, Tasks and Deliverables noted for each section above. Invoicing will include a report on completed deliverables in accordance with the agreed on timeline. Payments will be made within 30 days of completion of deliverables. H. Proposal Requirements Proposals submitted must describe how the contractor will achieve the deliverables described in the Scope of Work above, and must include the following elements: Description of overall approach to producing the report and achieving deliverables listed above (max. 5 pages) Description of specific products to be developed, at a minimum to include the following: o o o o o o Recommended approach to providing project development and management support for the development and pilot implementation of the QI initiative; Approach to the Primary Care Practice Environment Mapping deliverable; Approach to setting target goals, measures and data collection and analyses plan; Approach and components of QI Change Package; Approach and components of Pilot Plan and recruitment package; Tools, materials, methods that will accomplish the goal of this request. Timeline for completing the deliverables within required delivery date 4

Project budget Qualifications and relevant experience of the contractor/organization, including organizational background and qualifications and experience of key personnel who will be carrying out the tasks and providing the deliverables (please include CV/resume for lead staff for each major area of deliverables). If bidding on less than the full scope of services, describe how you will coordinate with other contractors to ensure coordination of project deliverables. Two or more examples of relevant materials previously produced that illustrate contractor s capacity to successfully meet contract deliverables I. Submission Process and Timeline Proposals should be submitted electronically in Microsoft Word or PDF format to ltuttle@mainequalitycounts.org. Paper proposals will not be accepted. Applications are encouraged as soon as possible; the deadline for submission is Friday, April 11, 2014 at 5PM. The successful contractor will be selected at or before Friday, April 25, 2014, with work expected to commence as soon as possible after, but no later than Monday, May 5, 2014. J. Proposal Review Procedure and Scoring Criteria The following criteria will be used to select the successful contractor: Demonstrated ability and experience with producing program development and management for QI interventions in primary care practices Strength of proposed approach Knowledge of evidence base and feasibility for adoption by primary care practices in approach Knowledge of and demonstration of prior experience working within the continuum of health care delivery system, including experience working with populations living with diabetes and HTN Efficient use of resources in relation to products proposed for delivery Confidence of ability to complete project in required timeline Evidence of collaboration and consistency with existing QI approaches in Maine Primary Care practices. K. Contact Information Clarifying questions related to this proposal should be submitted to Maine Quality Counts at either of the following: Lisa Tuttle MPH, ltuttle@mainequalitycounts.org, tel. 207.620.8526 X1015 Maine Quality Counts is an equal opportunity contractor and all qualified applicants shall receive consideration for contracting without regard to race, color, religious creed, sex, national origin, ancestry, age, physical or mental disability, or sexual orientation. 5

Strategy Basic Short Term Performance Measures Examples Settings Individuals Settings Individuals 4. Promote reporting of blood pressure and A1C measures; and as able, initiate activities that promote clinical innovations, team-based care, and self-monitoring of blood pressure: Engage Maine CDC Divisions to determine Population Health Data requirements for the creation of a chronic disease registry. Develop data sharing agreement(s) with Maine CDC Divisions to enable access to HIE. Collaborate with statewide programs and initiatives to promote the reporting of blood pressure and A1C measures among Maine health systems. This will have cross over between the work conducted with Health Systems/PCMH neighborhoods. Obtain invitation to provide TA with policy and protocol revisions to enhance use of EMR/EHR in better supporting patients with HTN and A1C not in control. Protocol tools developed and used by Maine CDC - DPH, will support NQF measure reporting. Develop Tiered educator certification programs for Blood Pressure & Diabetes for clinical and non-clinical healthcare professionals. These Tiered Team Bases Care systems will be designed for deployment in the new health care delivery model settings (PCMH & ACO) at the provider practice/specialist levels, supported with protocol/policies that employ their use to improve/support patient care for the entire health system. Will utilize existing staff as educator trainers. Collate and/or analyze performance measure data and prepare for CDC reporting based on guidance from CDC. Health care systems systems reporting on National Quality Forum (NQF) Measure 18 40 health care systems participating out of a total 100 health care systems in the state Health care systems systems with policies or systems to encourage a multidisciplinary team approach to blood pressure control Proportion of patients in health care systems with policies or systems to encourage a multidisciplinary team approach to blood pressure control 1 40/100 = 40% health care 40 health care systems health care systems in the state 40/80 = 50% health care 4000 patients out of a total of 10000 patients targeted 4000/10000 = 40% patients served 5. Promote awareness of high blood pressure among patients. Identify existing opportunities and events to provide support and guidance to PCMH neighborhoods on proper clinical diagnosis and self-monitoring strategies. HTN control in the provider and other health care settings can be standardized so that patients are supported consistently no matter where they enter the system. Protocols/policies for how to support and navigate patients with HTN. Training and implementation for the providers. Collaborate with state level agencies to provide training and tools to providers within PCMH neighborhoods on proper clinical diagnosis and self-monitoring strategies. Work with health care extenders (e.g. community pharmacists, public health nurses) in Maine communities to increase appropriate screening, follow-up and self-monitoring behavior.

Identify PCMH neighborhoods where health extenders are currently active in blood pressure screening, follow up and self-monitoring. Work with the DPH HCT to develop a brief that highlights the role of health care extenders in screening, follow up and self-monitoring of high blood pressure and provides Maine success stories. Collate and/or analyze performance measure data and prepare for CDC reporting based on guidance from CDC. Health care systems Proportion of adults in the state aware they have high blood pressure 175,000 adult patients out of a total of 250,000 adult patients targeted 175,000/250,000 = 70% adult patients served Strategy Basic Short Term Performance Measures Examples Settings Individuals Settings Individuals 6. Promote awareness of prediabetes among people at high risk for type 2 diabetes Collaborate with statewide programs and initiatives to increase the awareness of the pre-diabetes algorithm/ protocols to appropriately diagnose and refer to primary prevention community resources - available from DPCP, DPH as a free resource/tool to providers. Provide TA and resources to PCMH neighborhoods to implement the pre-diabetes algorithm/protocols. Work with health care extenders (e.g. community pharmacists, EMS, public health nurses) in Maine communities/worksites to administer the CDC Pre-diabetes Risk Quiz. Communities/worksites to increase appropriate screening, follow up and self-monitoring behavior. Collaborate and provide TA to statewide programs and initiatives to increase the awareness of the CDC Pre-diabetes Risk Quiz among health care extenders. Collaborate with statewide community programs and initiatives to increase the awareness of the CDC Pre-diabetes Risk Quiz. Work with DPH epidemiology/evaluation team to analyze data from the Diabetes module in BRFSS by risk factors, disparate and high risk populations. Prediabetes awareness Prevalence (%) of people with selfreported prediabetes 300 adults responding to the BRFSS survey said they had prediabetes out of the 3,000 adults who participated in the BRFSS survey. 300/3,000 = 10% people at high risk for type 2 diabetes reached 7. Promote participation in ADA-recognized, AADE-accredited, state-accredited/certified, and/or Stanford licensed DSME programs Collaborate with statewide programs and initiatives to increase the awareness of the diabetes algorithm/protocols to appropriately diagnose and refer to DSME - available from DPCP as a free resource/tool to providers. 2

Provide ongoing TA and resources to PCMH neighborhoods to implement diabetes algorithm/protocols. Facilitate a statewide learning collaborative between clinical and community providers to promote DSME and to establish DSMS systems for patients going through DSME. Collaborate with statewide community programs and initiatives to increase the awareness of benefits of DSME (community/worksite/health care extenders). DSME participation Proportion of people with diabetes in targeted settings who have at least one encounter at an ADArecognized, AADE-accredited, state accredited/certified, and/or Stanford licensed DSME program during the funding year 5,000 people with diabetes had a DSME encounter out of total of 30,000 targeted in FQHCs 5,000/30,000 = 17% of people with diabetes in targeted FQHCs reached Enhance begins here: Strategy Enhanced Short Term Performance Measures Examples Settings Individuals Settings Settings Domain 3 (Note: For Domain 3, strategies and interventions should be implemented at the state level, or highest level possible. Denominators represent the total number of systems in the state.) 1. Increase implementation of quality improvement processes in health systems. Engage Maine CDC Divisions and Maine s state HIE (HealthInfoNet) to determine population health data requirements. Participate in state level HIE leadership and learning collaboratives on improving Population Health Management utilizing tools and content created with partners from Basic work plan (D3 activities) such as policies/protocols to support the use of Tiered Team Based care. Work with MaineCare (Medicaid) to identify policy tools and effective incentives needed for health systems to implement policies that improve quality measures at the provider and systems level (connection to SIM grant). Work with Statewide partners to provide support and guidance in the PCMH neighborhoods to implement policy and protocols which supports JNC 2013 standards for high blood pressure. Work with Statewide partners to provide support and guidance in the PCMH neighborhoods to implement policy and protocols which supports the use of ADA Clinical Practice recommendations/standards of care for people with diabetes. Increase electronic health records (EHRs) adoption and the use of health information technology (HIT) to improve performance systems with EHRs appropriate for treating patients with high blood pressure Proportion of patients in health care systems with EHRs appropriate for treating patients with high blood pressure 15 health care systems participating out of a total 45 15/45 = 33.3% health care 1840 patients participating out of a total 4600 patients targeted 1840/4600 = 40% patients served 3

Increase the institutionalization and monitoring of aggregated/standardized quality measures at the provider and systems level systems with EHRs appropriate for treating patients with diabetes Proportion of patients in health care systems with EHRs appropriate for treating patients with diabetes 15 health care systems participating out of a total 45 15/45 = 33.3% health care 1840 patients participating out of a total 4600 patients targeted 1840/4600 = 40% patients served systems reporting NQF18 25 health care systems participating out of a total 50 systems reporting NQF59 25/50 = 50% health care 25 health care systems participating out of a total 50 25/50 = 50% health care 2. Increase use of team-based care in health systems Develop model policies utilizing Tiered Team Based Care approaches that encourage the engagement of non- clinical personnel in hypertension and diabetes control. Health systems policies will be developed/emended to now utilize the following health care professional (Pharmacists, RD/RN s, CDE s, MA s, CHW s) who will be deployed in the Tiered Team Based Care system developed in the Basic work plan. Levels of certified educators will follow a guide for the range of competency they provide patients who have been navigated to them via protocols. Existing staff from (recognized DSMT programs, or master blood pressure trainers) will be the tiered level trainers for health systems. Partner with select health systems to develop implementation procedures for model Tiered Team Based Care policies. Policies developed with route qualified (Pharmacists, RD/RN s, CDE s, MA s, CHW s) professionals in to tiered team based care trainings, they will be certified at curriculum identified appropriate level, and deployed for patient care as defined by the polices/protocols. Develop system for monitoring policy development and implementation, qualitative and quantitative evaluation. Increase engagement of nonphysician team members (i.e., nurses, pharmacists, and patient navigators) in hypertension (HTN) and diabetes management in health care systems systems with policies or systems to encourage a multidisciplinary team approach to blood pressure control Proportion of patients in health care systems with policies or systems to encourage a multi-disciplinary team approach to blood pressure control 4 30 health care systems 30/80 = 37.5% health care 4000 patients participating out of a total 10000 patients targeted 4000/10000 = 40% patients served

systems with policies or systems to encourage a multidisciplinary team approach to AIC control Proportion of patients in health care systems with policies or systems to encourage a multi-disciplinary team approach to AIC control 30 health care systems 30/80 = 37.5% health care 4000 patients participating out of a total 10000 patients targeted 4000/10000 = 40% patients served Increase use of self-measured blood pressure monitoring tied with clinical support systems with policies or systems to encourage selfmanagement of high blood pressure Proportion of patients that are in health care systems with policies or systems to encourage self-management of high blood pressure 20 health care systems 20/80 = 25% health care 3600 patients participating out of a total 10000 patients targeted 3600/10000 = 36% patients served Strategy Enhanced Short Term Performance Measures Examples Settings Individuals Settings Individuals Domain 4 1. Increase use of diabetes self-management program in community settings. Work with existing recognized DSME provider sites to expand the number of locations where DSME is offered (existing programs offer in more settings, new recognized sites example FQHC now offer recognized DSME. Work with DPH HCT to develop communication on the benefits of DSME to the following target audiences: providers, community agencies, employers, low literate adults, and the general public. Work with a minimum of 5 FQHCs and/or Tribal Health Centers to build capacity and achieve ADA or AADE recognition to deliver and receive reimbursement for DSME (consideration for populations at high risk). Increase access, referrals, and reimbursement for ADArecognized, AADE-accredited, state-accredited/certified, and/or Stanford licensed DSME programs Number of ADA recognized, AADE accredited, or state accredited/certified DSME programs during the funding year 5 20 DSME programs established in targeted settings out of 30 settings targeted 20/30 = 67% settings reached

Number of Stanford DSMP workshops offered during the funding year 20 Stanford DSMP workshops offered in targeted settings out of 30 settings targeted Proportion of counties with ADA recognized, AADE accredited, or state accredited/certified DSME programs Proportion of counties with Stanford DSMP workshops 20/30 = 67% of setting reached 30 counties with a new DSME program established out of a total of 50 counties in the state 30/50 = 60% of counties reached 30 counties with new Stanford DSMP workshops established out of a total of 50 counties in the state Number of Medicaid recipients with diabetes who have DSME as a covered Medicaid benefit 30/50 = 60% of counties reached 60,000 Medicaid recipients with diabetes 30,000 Medicaid recipients enrolled in traditional fee-for-service Medicaid have DSME as a covered Medicaid benefit 30,000 / 60,000 = 50% of Medicaid recipients served 2. Increase use of lifestyle intervention programs in community settings for the primary prevention of type 2 diabetes. Work with DPH HCT to develop and disseminate strategic communication targeting community agencies, employers, and the public on the benefits of NDPP participation and completion. Based on the pre-diabetes algorithm, develop model diagnostic and referral policies and protocols to CDC- recognized lifestyle change programs utilized in the PCMH neighborhoods to refer persons with pre-diabetes or at high risk for type 2 diabetes to a CDC- recognized lifestyle change program. Provide content expertise to MaineCare for the implementation of reimbursement structure for the delivery of the CDC-recognized lifestyle change program to beneficiaries (connection to SIM grant). Develop system for monitoring policy development and implementation. Develop system for tracking the number of reimbursable CDC-recognized lifestyle change programs. 6

Increase referrals to, use of, and/or reimbursement for CDC recognized lifestyle change programs for the prevention of type 2 diabetes systems with policies or practices to refer persons with prediabetes or at high risk for type 2 diabetes to a CDCrecognized lifestyle change program Proportion of participants in CDC-recognized lifestyle change programs who were referred by a health care provider 30 health care systems implemented referral policies out of 50 health care systems targeted 30/50 = 60% of health care systems reached 1,000 participants out of 5,000 patients targeted referred by a health care provider 1,000/5,000= 20% of participants referred by a health care provider Number of Medicaid recipients or state/local public employees with prediabetes or at high risk for type 2 diabetes who have access to evidence-based lifestyle change programs as a covered benefit 80,000 people in the state are enrolled in Medicaid across three types of plans (traditional fee-for-service Medicaid, Medicaid managed care and an innovation pilot, which includes evidence-based lifestyle change programs as a covered benefit) 15,000 people are enrolled in the innovation pilot 15,000 / 80,000 = 19% of Medicaid recipients served Strategy Enhanced Short Term Performance Measures Examples Settings Individuals Settings Individuals Domain 4 3. Increase use of health-care extenders in the community in support of self-management of high blood pressure and/or diabetes. Collaborate with Hannaford pharmacies to expand the role of community pharmacists in medication adherence among adults with high blood pressure and/or diabetes. Collaborate with health systems to expand team-based care to include staff pharmacists in medication adherence among adults with high blood pressure and/or diabetes (CHW s, Pharmacists). Collaborate with MCHC to provide professional development opportunities to pharmacists to build capacity to actively support self-management of high blood pressure and/or diabetes through medication adherence. Develop a Pharmacy Environmental Scan Survey to track pharmacists activities supporting medication adherence and self- management. Increase engagement community health workers (CHWs) in the provision of self-management programs Proportion of recognized/accredited DSME programs in targeted settings using CHWs in the delivery of 7 50 DSME programs of a total of 150 programs across a state use CHWs

and on-going support for adults with high blood pressure and/or adults with diabetes Increase engagement of community health workers (CHWs) to promote linkages between health systems and community resources for adults with high blood pressure Increase engagement of community pharmacists in the provision of medication- /self-management for adults with high blood pressure and/or adults with diabetes education/services systems that engage CHWs to link patients to community resources that promote selfmanagement Proportion of community pharmacists that promote medication-/self-management for adults with high blood pressure. Proportion of community pharmacists that promote medication-/self-management for adults with diabetes 50/150 = 33% of DSME Programs use CHWs 40 health care systems 40/80 = 50% health care systems reached 16 health care systems 16/80 = 20% health care systems reached 20 health care systems 20/80 = 25% health care systems reached 8