Texas Health and Human Services Commission HHSC

1
Texas Health and Human Services Commission (HHSC)

• Texas Health Management Program
• Request for Proposals 529-07-0178
• Vendor Conference August 18, 2009
• (10 AM Noon)

2
Welcome

• Introductions
• Steve Bailey, Enterprise Contract and Procurement
  Services (ECPS)
• Ashley Fox, Medicaid CHIP Division Health
  Management
• Elizabeth LaMair, Office of General Counsel
• Carlos A. Balderas, HUB Program Administrator
• Housekeeping Items

3
HHSC Procurement Roles

• ECPS - Responsible for procurement activity
• Program (Health Management Programs) -
  Responsible for project scope, requirements,
  performance, results, evaluation, and monitoring
• HUB Program Responsible for monitoring HUB
  activity
• Legal Questions and answers regarding legal
  issues

4
Vendor Conference Overview

• 1. Procurement Activities
• 2. RFP Overview
• 3. HUB Items
• 4. Question Submittal
• Break
• 5. Preliminary Responses to Questions
• 6. Closing Comments

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ECPS Procurement Activities

• Source for questions answers
• Provides sole HHSC contact Thomas Spears
• Send Thomas any questions (after today), and your
  completed RFP responses.
• ECPS handles / coordinates
• Procurement schedule
• Solicitation access (copy of RFP, etc.) at
  www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportun
  ities.asp
• Submission requirements
• Solicitation changes
• Oversees screening evaluation
• Award information

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Procurement Schedule

• RFP Release Date
• Vendor Conference
• Vendor Questions Due
• HHSC Posts Responses
• Proposals Due (by 1pm Central)
• Tentative Award Announcement
• Anticipated Contract Start Date

• August 3, 2009
• August 18, 2009
• August 19, 2009
• September 2, 2009
• October 1, 2009
• January 23, 2010
• April 9, 2010

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RFP Overview

• Background
• Procurement Mission
• Objectives
• Contract Terms
• Scope of Work
• Performance Measures

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Background

• Legislatively mandated program
• Traditional disease management program since 2004
• Five diseases (Asthma, Coronary Artery Disease,
  Congestive Heart Failure, Chronic Obstructive
  Pulmonary Disease and Diabetes)
• Approximately 50,000 clients enrolled each month
• Majority of clients receive mailings and access
  to Nurse Advice Line
• Clients who are fully engaged also receive
  telephonic intervention
• Small subset of clients receive face-to-face
  interaction

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Diabetes Self Management Training

• Clients enrolled in DSMT will receive the same
  level of service as clients in the overall Health
  Management program
• DSMT will be tailored for those with diabetes
  (even as a co-morbidity)
• Clients must be categorized as DSMT or Health
  Management clients, not both

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Procurement Mission
HHSCs mission in this procurement is to retain a
qualified Vendor to design and operate a THM
Program that improves the overall care and
outcomes for Medicaid recipients who are
chronically ill or at a high risk of becoming
chronically ill. The Vendor must provide an
innovative and complete approach to client care
that is adaptive to the changing needs of HHSC,
THM Program clients, and medical providers.
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Objectives

• The Vendor will help HHSC accomplish the
  following objectives
• to develop an innovative and comprehensive
  approach to health management
• to create a flexible and customer-oriented
  program
• to identify and engage clients, through a
  predictive modeling system, with high
• cost utilizations that can be reduced by
  improved management of their
• condition(s) and/or those who are at risk of
  becoming unstable or developing a
• serious chronic condition(s)
• to increase clients skills, knowledge and
  confidence in self-managing their health
  condition(s)
• to encourage providers to evolve their practices
  by becoming advocates of
• patient self-management, supporters of systems
  delivery change, and
• promoters of clinically evidence-based
  interventions
• to utilize technology in supporting client and
  provider goals and
• to reduce inappropriate or duplicative costs to
  the State.

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Contract Terms

• Initial contract period is three years
• HHSC may extend the term of the contract
• for three additional one year extensions as
  necessary to complete the mission of the
  procurement
• subject to negotiation between the parties.
• Payment will be on a per-member, per-month basis
• fees tied to number of clients enrolled and
  engaged in program

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Scope of Work

• Introduction and Background
• The Vendor will work with HHSC to design and
  implement a program that gives clients the tools
  needed to effectively manage their condition(s).
  This will be accomplished through the following
• Educating clients and providers regarding the
  principles of self-management
• Encouraging providers to view clients as managers
  of their own condition(s)
• Developing and implementing new, innovative
  technological solutions that support the THM
  Program goals
• Three phases implementation, operations and
  turnover

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Scope of Work

• Implementation Phase
• Vendor will hold weekly meetings
• Project Work Plan due 15 days after contract
  effective date
• Collaboration with outgoing vendor
• Recruitment of members to Advisory Board
• Completion of systems testing

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Scope of Work

• Operations Phase
• Customer Service and Adaptability
• Provide exceptional customer service
• Be flexible and allow for innovation
• Associations
• Participate in conferences or trade organizations
  associated with health management
• Key Personnel
• Program Director oversees THM program
• Program Manager coordinates activities
• Program Administrator provides reports
• Provider Relations Manager administrator of
  provider relations
• Client Relations Manager administrator of
  client relations
• Meetings
• Outreach

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Scope of Work

• Operations Phase (continued)
• Quality Assurance and Improvement
• Communications Materials
• Identify existing materials when appropriate
• Create materials in an easily understood format
• Triage and Toll-free Numbers
• Nurse consultation line
• Customer service line
• Provider service line
• Overcoming Program Challenges
• Identifying and overcoming barriers

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Scope of Work

• Technology, Predictive Modeling, and Data
• Innovative, progressive and adaptable
• Identify clients who can benefit from program
• HHSC must be able to access Vendor database
• Maintain information in secure database warehouse
• Disaster Recovery Plan
• Reporting
• Reports provide clear, accurate description of
  activities and status of program
• HHSC will approve format and key metrics

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Scope of Work

• Operations Phase (continued)
• Client Recruitment and Enrollment
• Client Interventions
• Health Risk Assessments (HRA)
• Cafeteria-style
• Self-management education
• Health and wellness
• Behavioral and mental health management
• Pharmacy management

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Scope of Work

• Operations phase (continued)
• Provider Recruitment and Enrollment
• Recruit providers who will be impacted by program
• Encourage best practices
• Provider Interventions
• Tools and educational resources
• Proactive, productive interactions
• Practice facilitation

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Scope of Work

• Operations Phase (continued)
• Compliance with Laws
• Fraud and Abuse
• Cooperation and assistance
• Must provide records as requested
• Written fraud and abuse compliance plan
• Mandatory training
• Staff person must be assigned to carry out
  provisions in fraud and abuse compliance plan

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Scope of Work

• Turnover Phase
• Data Transfer
• Turnover Services
• Post-Turnover Services

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Performance Measures

• HHSC will monitor the Vendors performance
  through a monitoring plan that includes, but is
  not limited to
• annual site visits (can be either announced or
  unannounced)
• quarterly in-person reporting, quality assurance
  and planning meetings
• quarterly reports provided by the Vendor
• monthly status reports provided by the Vendor
• weekly status meetings with Vendor and other
  stakeholders
• accessing the vendors systems and databases
• chart review comparing provider records to the
  Vendors client records
• annual reconciliation process and report
• independent assessment of the THM Program by an
  independent quality review organization and
• routine contact and interaction with the Vendor
  and key personnel.

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HUB Subcontracting Plan(HSP) Requirements
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Agenda Topics

• RFP Section 4.0 Historically Underutilized
  Business
• Participation Requirements
• HUB Subcontracting Plan for the RFP is required
• Self Performance HSP
• HSP Prime Contractor Progress Assessment Report

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RFP Section 4.0 - Historically Underutilized
Business Participation Requirements

• HUB Participation Goals
• Potential Subcontracting Opportunities
• Vendor Intends to Subcontract
• Minority or Women Trade Organizations
• Self Performance
• HSP Changes After Contract Award
• Reporting and Compliance with the HSP

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If HSP is inadequate, response will be rejected
HSP Information Page
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HUB GOALS
Special reminders and instructions
Company Information
HSP Information Page
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HSP Information Page
Subcontracting Declaration
Enter subcontracting opportunities
If more than 20 subcontracting opportunities,
click the link provided to continue adding
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One page for each area subcontracted (listed on
page 1)
HSP Information Page
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List Line and Subcontracting Opportunity
HSP Information Page
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HSP Information Page
Protégé performing the work
Skip to Sections 8 and 10
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HSP Information Page
Professional Services Category
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HSP Information Page
Good Faith Efforts to find/include Texas
Certified HUB Vendors
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HSP Information Page
Contact HUB Trade Organization
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HSP Information Page
Written Notification Requirements
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HSP Information Page
List 3 HUBs Contacted for this
Subcontracting Opportunity
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HSP Information Page
List Subs Selected (HUBs Non-HUBs) for this
Subcontracting Opportunity
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HSP Information Page
Reason why HUB was not selected for this
Subcontracting Opportunity
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Self Performance Explanation
Signature Affirms that True and Correct
Information is Provided
HSP Information Page
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HSP Prime Contractor Progress Assessment Report
ATTACHMENT E

• Required with
• ALL Pay Requests

• List ALL Sub payments
• (HUBs Non-HUBs)

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HSP ASSISTANCE FROM TPASS
HUB Subcontracting Plan (HSP) Forms Step-by-step
instructions and an audio on How to Complete an
HSP is located on the Comptroller of Public
Accounts (CPA) Texas
Procurement and Support Services (TPASS) website
at http//www.cpa.state.tx.us/procurement/prog/
hub/hub-forms/ HUB Subcontracting Plan
Instructional Video Play Windows Media Version
(7.7 MB download) Play Quicktime (mp4) version
(24 MB download) Play Macromedia Flash version
(10.8 MB download) Read Video Transcript (.rtf
file) (160 K download)
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Administrative Services Development HUB Program
Office

• Robert L. Hall, C.P.M.
• Director of Administrative Services
  Development
• - [phone]
• - robert.hall_at_hhsc.state.tx.us
• Sharon Addison
• HUB Program/Procurement Services Team Leader
• - [phone]
• - sharon.addison_at_hhsc.state.tx.us
• Carlos A. Balderas
• ASD HUB Administrator
• - [phone]
• - carlos.balderas_at_hhsc.state.tx.us
• Sherice Williams-Patty
• ASD HUB Administrator
• - [phone]
• - sherice.williams-patty_at_hhsc.state.tx.us

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Texas Health and Human Services Commission (HHSC)

• Question Submittal
• Followed by Break

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Tentative Responses to Vendor Questions

• Non-binding verbal answers to vendor questions
  may be provided here today.
• Reminder After today, any additional questions,
  requests for clarification, etc., are due to
  HHSC, in writing, by Thursday, August 19, 2009.
  (Send to Thomas Spears see below.)
• Vendor Questions/HHSC Responses should be posted
  by September 2, 2009, on the HHSC Contract
  Opportunities website at the URL below
  http//www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_o
  pportunities.asp
• Sole point of contact for further inquiries
  concerning this RFP is
• Thomas Spears, Contract Administrator
• Enterprise Contract and Procurement Services
• Texas Health and Human Services Commission
• 4405 North Lamar Blvd.
• Austin, Texas 78756
• Phone [phone] fax [phone]
• Email thomas.spears_at_hhsc.state.tx.us

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Closing Comments