State of Wisconsin
DOA-3261 (R08/2003)
s.16.75, Wis. Statutes
PROPOSALS MUST BE SEALED AND ADDRESSED TO:
AGENCY ADDRESS:Department of Administration
Division of Enterprise Operations
State Bureau of Procurement
101 East Wilson Street, 6th Floor
Madison, WI 53703
If using PO Box, P.O. Box 7869, 53707-7869 / Proposal envelope must be sealed and plainly marked in lower corner with due date and Request for Proposal # 28154-BD. Late proposals will be rejected. Proposals MUST be date and time stamped by the soliciting purchasing office on or before the date and time that the proposal is due. Proposals dated and time stamped in another office will be rejected. Receipt of a proposal by the mail system does not constitute receipt of a proposal by the purchasing office. Any proposal which is inadvertently opened as a result of not being properly and clearly marked is subject to rejection. Proposals must be submitted separately, i.e., not included with sample packages or other proposals. Proposal openings are public unless otherwise specified. Records will be available for public inspection after issuance of the notice of intent to award or the award of the contract. Proposer should contact person named below for an appointment to view the proposal record. Proposals shall be firm for acceptance for one hundred eighty (180) days from date of proposal opening, unless otherwise noted. The attached terms and conditions apply to any subsequent award.
REQUEST FOR PROPOSAL
#28154-BD
THIS IS NOT AN ORDER / Proposals MUST be in this office no later than
July 14, 2014 2:00 PM CT
PROPOSER (Name and Address) / No Public Opening
Name (Contact for further information)
Brenda Derge,
Phone Date
608-266-8613 May 23, 2014
Quote Price and Delivery FOB
Services - Destination
Description
Wisconsin Department of Employee Trust Funds (ETF)
Health Care Benefits Consultant
Faxed and e-mailed Proposals are not accepted.
This page must be signed and included with your Proposal.
Please provide the information listed below.
We claim minority bidder preference [Wis. Stats. s. 16.75(3m)]. Under Wisconsin Statutes, a 5% preference may be granted to CERTIFIED Minority Business Enterprises. Bidder must be certified by the Wisconsin Department of Administration. If you have questions concerning the certification process, contact the Wisconsin Department of Administration, 101 E. Wilson St.,
6th Floor, Madison, Wisconsin 53703, (608) 261-2510. Does Not Apply to Printing Bids.
We claim certified disabled veteran-owned business preference. Under Wisconsin Statutes, a 5% preference may be granted to CERTIFIED disabled veteran-owned business. Bidder must be certified by the Wisconsin Department of Administration. If you have questions concerning the certification process, contact the Wisconsin Department of Administration, 101 E. Wilson St.,
6th Floor, Madison, Wisconsin 53703, (608) 261-2510. Does Not Apply to Printing Bids.
We are a work center qualified under Wis. Stats. s. 16.752. Questions concerning the qualification process should be addressed to the Work Center Program, State Bureau of Procurement,
6th Floor, 101 E. Wilson St., Madison, Wisconsin 53703, (608) 266-2605.
Wis. Stats. s. 16.754 directs the state to purchase materials which are manufactured to the greatest extent in the United States when all other factors are substantially equal. Materials covered in our bid were manufactured in whole or in substantial part within the United States, or the majority of the component parts thereof were manufactured in whole or in substantial part in the United States.
Yes No Unknown
In signing this proposal we also certify that we have not, either directly or indirectly, entered into any agreement or participated in any collusion or otherwise taken any action in restraint of free competition; that no attempt has been made to induce any other person or firm to submit or not to submit a proposal; that this proposal has been independently arrived at without collusion with any other proposer, competitor or potential competitor; that this proposal has not been knowingly disclosed prior to the opening of proposals to any other proposer or competitor; that the above statement is accurate under penalty of perjury.
We will comply with all terms, conditions and specifications required by the state in this Request for Proposal and all terms of our proposal.
Name of Authorized Company Representative (Type or Print) / Title / Phone ( )
Fax ( )
Signature of Above / Date / E-mail
This form can be made available in accessible formats upon request to qualified individuals with disabilities.
Request for Proposal #28154-BD
Wisconsin Department of Employee Trust Funds (ETF) Health Care Benefits Consultant
TABLE OF CONTENTS
1.0 GENERAL INFORMATION 3
2.0 PREPARING AND SUBMITTING A PROPOSAL 9
3.0 PROPOSAL SELECTION AND AWARD PROCESS 12
4.0 MANDATORY PROPOSAL QUALIFICATIONS 16
5.0 MANDATORY CONTRACT PERFORMANCE REQUIREMENTS 17
6.0 GENERAL REQUIREMENTS 18
7.0 TECHNICAL REQUIREMENTS 19
8.0 PROPOSER REFERENCES 20
9.0 COST 20
10.0 CONTRACTUAL TERMS AND CONDITIONS 21
11.0 FORMS AND ATTACHMENTS 29
ADDITIONAL REQUEST FOR PROPOSAL DOCUMENTS
Appendix A1: WHIO Data Use Agreement
Appendix A2: WHIO Data Use Agreement for Contractors
Appendix B: ETF Business Association Agreement
Appendix C: ETF Building Access Policy
Appendix D: Data Auditing Policy
Appendix E: Data Classification Policy
Appendix F: Data Logging Policy
Standard Terms and Conditions (DOA-3054)
Supplemental Standard Terms and Conditions for Procurements for Services (DOA-3681)
Attachment A: Cost Sheet
Attachment B: Mandatory Proposal Qualifications
Attachment C: Mandatory Requirements Verification
Form DOA-3261: Request for Proposal
Form DOA-3477: Vendor Information
Form DOA-3478: Vendor Reference
Form DOA-3027: Designation of Confidential & Proprietary Information
Proposer Checklist
1.0 GENERAL INFORMATION
1.1 Introduction
The purpose of this Request for Proposal (RFP) is to provide interested parties with information to enable them to prepare and submit a proposal for health care benefits consulting services. The Wisconsin Department of Employee Trust Funds (ETF), as represented by the Wisconsin Department of Administration (DOA) State Bureau of Procurement, intends to use the results of this solicitation to award a contract for such services.
The Contract will be administered and managed by ETF, with oversight by the Group Insurance Board (the “Board”). This RFP document and the awarded Proposer’s (“Contractor’s”) Proposal response shall be incorporated into the Contract.
The State makes no express or implied warranties whatsoever that any particular quantity or dollar amount of Services will be procured from the resulting Contract.
1.2 Project Scope and Objectives
ETF is requesting consulting services to perform a full range of services related to the analysis, design, management, and communication of the State of Wisconsin health insurance program.
The primary objective of this solicitation is to analyze data from a variety of sources to develop and recommend strategies to improve health outcomes and increase the efficient delivery of quality health care to participants in the state employee health insurance program.
Project Deliverables
· Within 6 months of the beginning of the contract, the vendor will provide a documented report (“Report 1”) and a presentation to the Board outlining potential benefit design changes and strategies for the 2016 plan year.
· Within 12 months of the beginning of the contract, the vendor will provide a documented report (“Report 2”) and a presentation to the Board outlining potential benefit design changes and strategies for the 2017 plan year.
Background and Current Operations
ETF is a Wisconsin agency that administers retirement, health, life, income continuation, disability, and other insurance programs for 570,000 state and local government employees and annuitants. ETF’s Division of Insurance Services administers the state employee health insurance program.
The Group Insurance Board sets policy and oversees administration of the group health, life insurance, and income continuation insurance plans for state employees and retirees and the group health and life insurance plans for local employers who choose to offer them. The Board also can provide other insurance plans, if employees pay the entire premium.
The Board has eleven members. Six members are appointed by the Governor. The remaining positions are ex-officio members occupied by the following officials or their designees: Governor, Attorney General, Secretary of the Department of Administration, Director of the Office of State Employment Relations, and the Commissioner of Insurance.
The State and local health insurance programs cover over 240,000 lives. This includes 72,000 active state employees and 22,000 retired state employees and their dependents, and 12,000 active local employees and 2,000 retired local employees and their dependents. The program administers nearly $1.5 billion in annual insurance premiums.
Most health insurance benefits (98%) are administered through 18 competing, fully insured health plans. Health insurance benefits follow a “uniform benefit” design, in that all participating health plans are offering the same benefits package. The pharmacy benefit has been administered through a Pharmacy Benefits Manager (PBM) since 2003.
Also in 2003, the State implemented a three-tier system for plans and employee contributions. Most plans are offered in Tier 1.
· Tier 1 – includes the top plans in efficiency and quality, and has the lowest employee contribution.
· Tier 2 – includes lower ranking plans in efficiency and/or quality, and has a higher employee contribution.
· Tier 3 – are the lowest ranking plans in efficiency and quality, and highest employee contribution.
The State also administers a small self-insured offering through the “Standard Plan” and “State Maintenance Plan”.
ETF has identified the following priority issue areas to research and develop for the state employee health insurance program:
• Data Analytics / Measurement
• Steerage Models: Tiering, Reference Pricing, Centers of Excellence
• Prevention / Wellness
• Disease Management / Chronic Care
• Shared Decision Making
• Pharmacy and Specialty Pharmacy
• Consumer Driven Health Care Design
• Insured vs. Self-insured Plan Design
• Multi-year Contracting
• Depression / Behavioral Health
One data resource available to the state employee health insurance program is from the Wisconsin Health Information Organization (WHIO), a database source of health claims information. The data is a resource for improving health care transparency, quality and efficiency. Fifteen of the state employee health plans submit data to WHIO.
The WHIO Health Analytics Data Mart functions as a data-driven marketplace that enables members to submit information and receive reports that analyze health system and physician performance based on hundreds of variables. The Data Mart can be used to identify gaps in care for treatment of chronic conditions, costs per episode of care, population health, preventable hospital readmissions and variations in generic prescribing.
The Data Mart contains a volume and depth of data that spans multiple health care systems and settings including physician’s offices, outpatient services, pharmacy claims, labs, radiology and hospitals. The data encompasses services provided by health systems across the state.
The Data Mart holds a rolling 27 months of claims data that comprises the experiences of more than 4 million people and 255 million treatment services. A total of 21.5 million episodes of care are currently in the database and its scope will grow as new members join and contribute to the cooperative effort. An episode of care is defined as the series of treatments and follow-up related to a single medical event, such as a broken leg or heart surgery or the year-long care of a diabetic patient. Each successive version of the database, refreshed every six months, will capture the most recent health care experiences of additional consumers. The current version of the database contains more than $70 billion of health care expenditures and allows comparisons of those expenditures by region, county, 3-digit ZIP code and medical system. The WHIO database is Health Insurance Portability and Accessibility Act (HIPAA) compliant.
1.3 Procuring and Contracting Agency
This RFP is issued by DOA, State Bureau of Procurement, on behalf of ETF. The DOA State Bureau of Procurement is the SPOC for the State of Wisconsin during the selection process unless otherwise noted. The Procurement Manager responsible for managing the procurement process is Brenda Derge. The Contract resulting from this RFP will be administered by the ETF.
The contractor managers are responsible for the daily administration and contract issues. The Contractor will receive the contract manager information at the time of the award.
1.4 Definitions and Acronyms
Words and terms shall be given their ordinary and usual meanings. Where capitalized in the RFP, the following definitions and acronyms shall have the meanings indicated unless otherwise indicated. The meanings shall be applicable to the singular, plural, masculine, feminine, and neuter of the words and terms.
“Agency” means the Wisconsin Department of Employee Trust Funds.
“Board” means the Group Insurance Board unless otherwise noted.
“Business Day” means each Calendar Day except Saturday, Sunday, and official State of Wisconsin holidays (see also: Calendar Day, Day).
“Calendar Day” refers to a period of twenty-four hours starting at midnight.
“Calendar of Events” means the schedule of events in RFP, Section 1.8.
“Confidential Information” means all tangible and intangible information and materials being disclosed in connection with the Contract, in any form or medium without regard to whether the information is owned by the State or by a third party, which satisfies at least one of the following criteria: (i) Personally Identifiable Information; (ii) Proprietary Information; (iii) non-public information related to the State’s employees, customers, technology (including data bases, data processing and communications networking systems), schematics, specifications, and all information or materials derived therefrom or based thereon; or (iiii) information expressly designated as confidential in writing by the State. Confidential information includes all information that is restricted or prohibited from disclosure by state or federal law.
“Contract” means the written agreement resulting from the successful Proposal and subsequent negotiations that shall incorporate, among other things, the RFP and successful Vendor's Proposal, and all modifications hereto and thereto, and in addition shall contain such other terms and conditions as may be required by the State.
“Contracted Personnel” means personnel who works under contract for the Contractor or other personnel (including officers and agents).
“Contractor” means a Proposer that is awarded a Contract under this RFP and its employees or other personnel (including officers, agents and subcontractors) provided by the Contractor to perform work under this Contract.