RFP # 18-066
Attachment F3
Technical Proposal Template for Clinic Services

Instructions: Please provide a narrative response, addressing each of the following topics. Where appropriate, supporting documentation may be referenced by specific page and/or paragraph number(s). Failure to provide responses that address all topics may result in the proposal being eliminated from consideration.

PROPOSED SCOPE OF WORK

Clinic Objectives:

  • Improve employee health and wellbeing
  • Improve workplace productivity and engagement
  • Provide a relevant and valuable benefit to employees

Requested Onsite Clinic Services
  • Primary Care
  • Preventive Care
  • Immunizations & Injections (excluding flu shots)
  • Health and Nutrition Coaching
  • Lab tests
  • Immediate/Acute Care
  • Prenatal Services
  • Behavioral Health Services
  • Dispensing of Prescription Drugs (limited scope)
  • Face to Face Counseling Services that can be billed through the EAP program with Anthem
  • Dental Services
  • Vision Exams
  • Massage Therapy
  • Physical Therapy
  • Dermatology (limited scope)
Employment related drug and alcohol testing are not covered services provided in the Clinic.
General Information
Eligible population (on campus / near campus) /
  • Enrolled EE 7,559
  • Medical Waived Employees ,1,387
  • 58% Female
  • Average Age 47

Vendor partners /
  • Anthem for Medical, Dental, Vision and EAP
  • CVS Caremark for Pharmacy

Facility Location /
  • Room W041 in the basement of the Indiana Government Center South (IGCS), 402 W. Washington Street, Indianapolis, IN 46204

Facility Size /
  • Approximately 8,700 square feet

Plan Design /
Chronic Conditions (Enrolled Employees) /
  • Depression (12%)
  • Diabetes (23%)
  • Overweight (30%)
  • Obese (46%)

GENERAL ORGANIZATION

  1. Please provide information about your company’s future vision, strategic objectives, philosophy/approach to employer sponsored health/clinical service provision.
  2. Please describe the most innovative programs, features, and functionality currently in place today.
  3. What is your value proposition compared to your competitors?
  4. Do you have formal partnerships or other business affiliation with any hospital systems or provider groups? If yes, please list system/group name, length of partnership and explain nature of partnership.
  5. Please list the number of clinics by type, by year or geography.

Retail (Open to Public Full-time) / Employer Shared Full-time / Employer Worksite Full-time / Employer Worksite Acute Care / Employer Worksite PCMH* / Total Clinic Locations
2018 Total (YTD)
2017 Total
2016 Total
Indiana

*Patient Centered Medical Home: Sites accredited as PCMH by AAAHC or NCQA

  1. Please list the number of CLIENTS.

Employer onsite Full-time / Employer near-site/shared
Total
Public Entities/Municipal Services
  1. How many employer sponsored non-occupational clinics that you have managed closed in the past 36 months? Please list and provide the reason for closure.
  2. Please list any employer-sponsored non-occupational clinics that you have managed in the past 36 months that have transitioned away from you to a new vendor or operator, and a brief reason for the change?
  3. Please describe your partners and other third parties or sub-contractors with whom you collaborate for provision of services. Along with your description, complete the table below to include the following information about your partners or subcontractors:

Companies with Whom you
Partner and Subcontract Services / Number of Years of Partnership / Service(s) Provided by Partner / Number of Years Providing Medical Clinic Services to Employers / Number of
Full-time Employees / Number of
Part-time Employees / Location of
Headquarters
  1. Provide your organization's full time employee count. Enter “0” if none or not applicable.

Year / Number of Full-time clinical employees (staffed at clinics) / Number of Full-time Back-office/Support Staff
2016
2017
2018/Current
  1. How many clinicians are employed as part of leadership/management/oversight? E.g. medical directors not delivering services at clinics.
  2. Please describe your implementation and roles/responsibilities in the process. What is the projected length of time between contract award and the clinic opening? Please provide a detailed sample plan.

Administration / Integration

Payment

  1. What methods can you use to collect payment for clinic services?

Methods / Y/N
Point-of-Sale system
Third-party billing system
Bill insurance company on behalf of patient
Other (Describe):
  1. Please explain in detail the process flow for charging members who are on a High Deductible Health Plan (HDHP) with an HSA. Address the following topics: eligibility confirmation, patient status towards deductible, method of collecting payment, claim adjudication, EOB processing, reconciliation.
  2. Will the clinic be able to accept insurance payments for members not on the employer plan including Medicare and Medicaid? If yes, explain
  3. Could the clinic and its providers be in-network and credentialed as part of the medical plan? Outline your experience in this area.
  4. Does your clinic have embedded cost and transparency tools? If yes, who/which entity provides your transparency services?
  5. Confirm your ability to submit claims including CPT and ICD-10 codes to the State’s medical TPA.

Administration

  1. Confirm your ability to arrange and pay for maintenance of the onsite clinic including services such as cleaning, trash removal, changing and replacing the lights.

Care Coordination

  1. Do you have a systematic process and criteria for identifying patients who may benefit from onsite clinical care management? Please provide a process flow map.
  2. How will the clinic proactively identify previous patients with unplanned hospital admissions and emergency department visits?
  3. Does the clinic care team collaborate with the patient to:

Yes/No / If yes, explain:
Develop patient preferences and functional/lifestyle goals
Identify treatment goals
Assess and address potential barriers to meeting goals
Include a self-management plan
  1. Outline how the clinic provides instructions to members for obtaining care and clinical advice when the office is closed?
  2. Is clinical information available to on-call staff when the office is closed? If so, how is it accessed?
  3. Will you assign members of The State of Indiana clinic care team to coordinate care for individual patients? If so, explain.
  4. Are patients provided with a clinical summary of their office visit?
  5. Does the clinic generate lists of patients and proactively remind patients of needed preventive/follow-up care? What is your method for contacting patients and how frequently is this done?
  6. Do you annually identify populations of prior patients and proactively remind them of needed care based on patient information, clinical data, health assessments and evidence-based guidelines?

Collaboration with Community Providers

  1. Do you utilize specialist referral services?
  2. How is a list of eligible community providers developed for referral? How frequently is the list reviewed and updated?
  3. Please describe how you will coordinate care and collaborate with community primary care providers.
  4. Will the clinic document inbound and outbound referrals and care coordination in the patient’s medical record?
  5. Will the clinic track referrals until the referral provider/specialist’s report is available, flagging and following up on overdue reports?
  6. Will the clinic share clinical information with admitting hospitals and emergency departments? What is your standard process for doing so?
  7. What follow-up process does your clinic have in place if a patient is referred to an ER or an urgent care from your clinic?
  8. Does your model have follow up processes in place if a patient is referred to specialist or community resource from your clinic? If so, outline.

Integration with the State of Indiana Health Management

  1. Outline your experience integrating your services with an employer’s other third party vendors (e.g., medical plan, population health/disease management, wellness) to provide a seamless, efficient, and effective patient management experience?
  2. Do you refer patients to external structured health education programs, such as group classes, peer support, and lifestyle management coaching?
  3. What incentives/disincentives do you recommend to optimize clinic utilization?

Lifestyle & Condition Management

  1. Describe your organization’s capabilities around delivering lifestyle management programing (i.e., health coaching/education to address modifiable risks) via the onsite clinic.
  2. What sources do you utilize to determine which members are eligible for your lifestyle management programs/coaching program?
  3. How do your providers/coaches ensure they have a complete understanding of a member’s medical history before undertaking any lifestyle management interventions?
  4. How does your Electronic Medical Records (EMR) support the coach in managing the member’s lifestyle risks?
  5. How does the clinic provide the patient with educational materials?
  6. How do you determine which members are eligible for your chronic condition management program?
  7. How does your clinic staff ensure they have a complete understanding of the member’s medical history before undertaking any interventions?
  8. How does your EMR support the clinic staff in managing the member’s chronic condition(s)?

QUALITY MANAGEMENT

  1. Describe your quality assurance and performance improvement plan?
  • How frequently is the plan reviewed and updated?
  • What entities have responsibility for developing and updating the plan?
  • Is there a written Risk Management Program?
  • If “yes”, what areas are addressed within it?
  • How frequently are the program criteria reviewed/modified?
  • What entities have responsibility for developing and updating the plan?
  • What processes exist for rectifying quality control issues (e.g. what is the feedback loop to the staff, what are the consequences of continued poor quality, how is the improvement monitored)?
  • Please complete the following table describing your standard clinic audit processes (e.g. scope, frequency, benchmarks, reporting).

Audit Type / Person/Group Performing / Site-based/Remote / Scoring Criteria (e.g. AAAHC, NCQA, etc.) / Frequency (i.e. monthly, annual)
Facility
Organizational Policies & Procedures
Risk Management
Provider Chart (1.O NP)
Data Security
HIPAA
Coding
Financial
  1. How many days following receipt of a patient complaint is the client notified?
  2. Explain your organization’s grand round approach to discuss high risk/high cost patients? Address how cases are selected and the frequency of grand round sessions

Legal, Compliance, and Liability

  1. Describe how you comply with GINA as it pertains to onsite clinics.
  2. Explain processes in place to assure patient privacy and confidentiality. How do you ensure compliance with HIPAA/HITECH?
  3. How many days following a data breach is a client notified?
  4. How many medical malpractice cases have you had in the past 5 years?
  5. Identify any past, pending, or threatened litigation or administrative or state ethics board proceedings to which you or any of your employees are a party, including physicians, NPs, PAs under your control.
  6. How many HIPAA breaches have you had in the past 5 years? If any, please describe what safeguards were put I place to prevent future breaches.
  7. Please describe your approach to data security.
  8. How many data security breaches have you had in the past 5 years? If any, please describe what safeguards were put I place to prevent future breaches.
  9. Do you employ an in-house, full-time regulatory compliance officer?
  10. Do you employ an in-house full-time privacy and security official?

Services, Communications, and Marketing Support

General Services

# Clinics Current Delivering / Subcontractor / Notes
  • Acute/Urgent Care

  • Primary Care Provider Services

  • After-hours Care

  • Pharmacy

  • Lab Services

  • Prenatal Services

  • Health & Nutritional Coaching

  • Dental Service

  • Vision Services

  • Massage Therapy

  • Physical Therapy

  • Behavioral Health

  • Onsite EAP

  • Dermatology

Clinic Access

  1. Do you allow same-day appointments for routine care and/or urgent care?
  2. Do you allow routine and urgent-care appointments outside regular business hours? If so, explain the process
  3. Can patients request and/or schedule an appointment online? Describe your system for scheduling appointments.
  4. How would you communicate (for scheduling and care) with a deaf employee?
  5. What is your philosophy on time allocated for length of office visits? What do you recommend as optimal?

Communications

  1. What communications do you provide to employees to optimize utilization of onsite clinics? Please provide samples
  2. The State of Indiana will be looking for its vendor partner to design a communication and promotion plan. Outline how your organization would work with The State of Indiana to design the communications strategy for launch and ongoing campaigns to promote onsite services and other health and wellness initiatives based on your standard level of marketing support.
  3. Describe how your organization would work with The State of Indiana to implement this strategy.

Telemedicine

  1. Describe the scope of services for telemedicine (i.e. real-time sessions where providers can diagnose and treat select conditions) and mode of care delivery (e.g. video, telephonic, web based).
  2. Do you distinguish between Telehealth and Telemedicine? How do you define the terms?
  3. How many employers currently contract directly with you for telemedicine services?
  4. What percentage of your clients have contracted for telemedicine services?

Response
Provider to provider
Patient to clinic provider
Patient to telemedicine provider network
  1. Telemedicine services available:

Visit Type / Y/N
1: Acute care
2: Behavioral health (via psychologist)
3: Health coaching
  1. Are patients able to complete telemedicine visits via a mobile application (Yes/No)?

Visit Type / Y/N
1: Acute care
2: Behavioral health via psychologist
3: Health coaching
4. Health Advocacy
5. Routine follow-ups
6. Dermatology
  1. Do you measure and report patient utilization of TeleHealth?
  2. What decision support tools are available through your offering? Please give specific examples of tools and how patients or providers can use them?
  3. What current processes exist today between your organization and your preferred telemedicine partner to ensure any after-hour care and/or clinical recommendations are communicated to and forwarded to the clinic staff and included in the member’s file?
  • How do you handle this process with other telemedicine vendors?
  • How would the Telemedicine partner communicate after-hour care to assure continuity of care?

Pharmacy

  1. What approach do you recommend for The State of Indiana?
  2. Does the clinic have a process for managing medications? If yes, does this process:
  • Monitor if a patient has had their prescription filled
  • Monitor if a patient has re-filled their prescription medications on schedule
  • Review and reconcile medications
  • Provide information about new prescriptions
  • Assess understanding of medications
  • Assess response to medications and barriers to adherence
  • Document over-the-counter medications, herbal therapies, and supplements
  • Do any triggers exist if medication reconciliation does not take place? If yes please describe.
  • Are you currently a provider in the CVS Caremark network? If not, will you become a provider in order to serve State employees?
  • Does the clinic use electronic prescribing? If yes:
  • Are prescriptions written by the clinic compared to drug formularies and electronically sent to pharmacies?
  • Are medication orders entered electronically into the medical record?
  • Are patient-specific checks for drug-drug and drug-allergy interactions performed?
  • Are prescribers altered to generic alternatives?

STAFFING

  1. Please describe how you will ensure the staff considered for hire will fit The State of Indiana’s culture and are best suited to support The State of Indiana’s objectives.
  2. What is your organizational philosophy regarding the use of physicians or mid-level providers to staff clinics?
  3. Provide your minimum credentials for the staff below:

Physician / Physician Assistant / Nurse Practitioner / Registered Nurse/ Health Coach / Licensed Practical Nurse (LPN) / Medical Assistant / Collaborative Physician
Minimum Credentials
  1. What senior leadership within your organization has turned over in the past two years?
  • CEO
  • CMO
  • CIO
  • Presidents
  • Vice Presidents
  1. What staffing model do you recommend for The State of Indiana?

FTE / Roles and Responsibilities
Position 1
Position 2
Position 3
Position 4
Position 5
  1. Please provide the following information regarding your onsite clinical staff

Percentage Turnover 2016 / Percentage Turnover 2017 / Percentage Turnover in the first year of clinic Operations / Average Tenure
Physician
Physician Assistant (PA)
Nurse Practitioner
Registered Nurse
Licensed Practical Nurse (LPN)
Medical Assistant
Administrative Staff
  1. Do you require providers (physician and mid-level practitioners) to receive training on behavior change theory or motivational interviewing? Describe any ongoing behavior change/ motivational interviewing training providers go through
  2. Describe the process of ongoing provider staff peer review and evaluation of current competency and performance.
  3. What is your days-to-fill ratio?

Physician
Physician Assistant
Nurse Practitioner
Medical Assistant
  1. How will you manage temporary or per diem staffing for clinic employees’ absences due to illness, vacation, etc.?
  2. Please describe The State of Indiana’s proposed account management team. Provide Curriculum Vitaes (CVs) if available.
  3. Please describe The State of Indiana’s proposed implementation team. Provide CVs if available.
  4. Will your providers all be in the Anthem Blue Access PPO network?

Technology

  1. Which of the following data sources will be automatically loaded (no manual input) into the technology platform in discrete searchable form?
  2. Diagnostic values from Wellness Center medical equipment. If yes, which equipment
  3. Reference lab (external)
  4. Radiology (external)
  5. Biometric screening (external)
  6. HRA (external)
  7. Data warehouse (external)
  8. Other?
  9. What EMR/PM system does your organization use?
  • Is it proprietary?
  • Certifications:
  • Please describe features/functionality of the provider dashboard within the electronic medical record. Please provide a screen shot.
  • Please describe how the technology platform presents daily opportunities for the health center team.
  • How is behavior change theory incorporated into the technology platform?
  • Have you implemented remote condition monitoring? If so, for what conditions?
  • Are remote monitoring kits fully integrated with the electronic medical record?
  • Is your system compliant with ICD-10?
  • Does your technology platform conduct predictive modeling? Please describe in detail.
  • Can patients and providers send a secure message to each other?Can patients request prescription refills through the technology platform?
  • How does your standard technology platform use external patient claims data to identify gaps-in-care?
  • Can patients receive test results through the technology platform? Can patients send their health information to a third party? Can health records be downloaded by the patient?
  • Do you record all clinical advice in patient records?
  • Do you have a documented process for diagnostic test tracking and follow-up that:

Process Functions / Y/N
1: Tracks lab tests until results are available, flagging and following up on overdue results
2: Tracks imaging tests until results are available, flagging and following up on overdue results
3: Flags abnormal lab results, bringing them to the attention of the clinician
4: Flags abnormal imaging results, bringing them to the attention of the clinician
5: Notifies patients of normal and abnormal lab and imaging test results
6: Are clinical lab test results incorporated into structured fields in the medical record
7: Are scans and tests that result in an image accessible electronically
  1. Please list all electronic data exchange formats that you cannot support.
  2. Will the clinic have capacity for electronic exchange of key clinical information and provide an electronic summary of the care record to external providers?
  3. Can your technology platform automatically assist in the billing of a patient for care rendered and check the patient’s status toward their deductible? (e.g. the clinic staff can bill the patient at the time of service according to medical plan design)
  4. Are patients able to pay onsite clinic bills via the portal? Mobile application?
  5. Does your mobile application send patients onsite clinic reminders? If so, provide examples.
  6. Does your system notify the patient automatically when a script is available for pick-up?

Reporting