Michael Boyer, Human Resources/Risk Management Director CITY OF FORT MORGAN P.O. BOX 100 FORT MORGAN, COLORADO (970)

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1 For Capitated On-Site Clinic and/or Wellness & Population Health Management Services For the City of Fort Morgan, Colorado July 19, 2013 Michael Boyer, Human Resources/Risk Management Director CITY OF FORT MORGAN P.O. BOX 100 FORT MORGAN, COLORADO (970) Prepared in part by th Street, Suite 900, Denver, CO Phone:

2 The City of Fort Morgan is accepting sealed proposals for Capitated On-Site Clinic Services. There is no expressed or implied obligation for the City of Fort Morgan to reimburse responding firms for any expenses incurred in preparing proposals in response to this request. During the evaluation process the City of Fort Morgan reserves the right, where it may serve the City of Fort Morgan's best interest, to request additional information or clarifications from the firms, or to allow corrections of errors or omissions. At the discretion of the City of Fort Morgan firms submitting proposals may be requested to make oral presentations as part of the evaluation process. Nothing herein implies or guarantees that any proposal will be accepted. The City of Fort Morgan reserves the right to award contracts to any firm or no firm submitting proposals, where it may serve the City of Fort Morgan s best interest. The City of Fort Morgan reserves the right to retain all proposals submitted and to use any ideas in a proposal regardless of whether that proposal is selected. Submission of a proposal indicates acceptance by the firm of the conditions contained in this request for proposals, unless clearly and specifically noted in the proposal submitted and confirmed in the contract between the City of Fort Morgan and the firm selected. Proposals will be accepted at City Hall until 4:00 p.m. on August 14, 2013, at Historic City Hall located at 110 Main Street, Fort Morgan, Colorado If delivered, they are to be sent to 110 Main Street, Fort Morgan, CO If mailed, the address is P.O. Box 100, Fort Morgan, CO Proposals must be received at City Hall prior to 4 p.m. (our clock) on August 14, All questions regarding this bid should go to Michael Boyer, Human Resources Director, at (970) Questions must be in writing and can be ed to mboyer@cityoffortmorgan.com or faxed to The cut-off date and time for questions is August 9, 2013, at 5 p.m. It is the responsibility of the prospective bidders to contact Michael Boyer to verify receipt of questions. Based upon such inquiry, the City may choose to issue an Addendum. A copy of the request for proposal and associated documentation may be obtained as follows: 1. The City Website at 2. City Hall located at 110 Main Street, Fort Morgan 2

3 Background The City of Fort Morgan is a home-rule municipality of approximately 12,000 residents located on the Eastern Plains of Colorado, about 80 miles northeast of Denver. It is the county seat of Morgan County and a commercial, industrial, and recreational hub for Northeast Colorado. For greater depth of the City s demographics and areas of civic involvement, please visit the City s website: The City is interested in proposals for on-site capitated medical services for utilization by City employees and dependents covered by the City s self-insurance. As health costs have increased as a result of various expenses and regulations, the City is entertaining all options to ensure quality care for employees and reducing overall costs to the City for coverage. The City is most interested in holistic health and wellness driven approaches to encourage healthier employee habits and behavior as a method of reducing health care costs. General Statement The City of Fort Morgan is looking for innovative ways to address rising health care costs through a wellness approach related to its plan design. The original concept that was considered was a capitated plan. The City is seeking a proposal that focuses on the savings of a capitated plan with services focused on increasing the wellness of the employee. The goal is to reduce costs to the City s self-insurance fund by reducing negative health factors that lead to expensive disease control. One concept that the City wants to see fleshed out is a clinic on City property or other facility. The clinic would serve City employees primary care needs and dispense pharmaceuticals that are regularly needed by employees. Utilization Data To Assist in Quoting The following data can be obtained by contacting Shawne Cihak with HUB International. (Data sent via secure ). shawne.cihak@hubinternational.com or CPT breakout for 2011 & 2012 plan years. CPT Code by Name & Place of Service for 2011 & 2012 plan years. Detailed RX utilization for 2011 & 2012 plan years. Universal claim files for medical & RX utilization for 2011 & 2012 plan years. Census listing of current enrolled, salary information and benefit eligible. Please base pricing on current medical enrolled population and 2012 membership demographic information. 3

4 Specifications The Proposal should address all the points outlined in this request for proposals. The Proposal should be prepared simply and economically, providing a straightforward, concise description of the firm s capabilities to satisfy the requirements of the request for proposal. While additional data may be presented, the following items must be included, as they represent the criteria against which the proposal will be evaluated. If you are not quoting on-site clinic services, please submit your General Information (page 4, below) and then skip to the Wellness & Population Health Management Services section (page 12-14). On-site clinic proposals, please submit information to address pages GENERAL INFORMATION Business Background and Customer Base 1. Provide a name, title, address, phone number and address for the individual authorized to answer questions regarding your response to this RFP. 2. List your account management team. Who will be responsible for the account and who will be its day-to-day contact? Where are these individuals located? Provide a brief description of their onsite clinic experience and years with your organization. 3. Provide a brief description of your organization including history, business philosophy, and management structure. 4. Describe your firm s experience related to the services to be provided in response to this RFP, with specific emphasis on the operation of an employee health clinic, health risk assessments and disease management/lifestyle programs. 5. Provide three references from among your clients of similar size, with 4 or more years using your services. 6. Describe any litigation, pending or in the past, arising from the performance of your firm or parent company. 7. How many full serviced primary care on-site clinics do you manage nationally (if applicable)? 8. How many full serviced primary care on-site clinics have you managed for 5 or more years (if applicable)? 9. What percentage of your clients operates under an inter-local agreement, or more than one client sharing clinic/multiple clinics (if applicable)? 4

5 ON-SITE CLINIC SERVICES Health Clinic Operations If part of your proposal includes an on-site clinic, please answer the following: 1. How much space do you recommend for a clinic that would serve the City? 2. Provide an inventory and estimated cost of medical equipment that will be needed in the clinic. Do you propose to provide the equipment? Be clear as to who will be responsible for the initial purchase of equipment, its maintenance and insurance. 3. How many hours per week do you recommend the clinic operate and what are the proposed hours? 4. Do the proposed hours per week include appointment slots for dependents? 5. How many appointment slots will be available per week? 6. How long will it take for the clinic to be at the full utilization of the weekly hours? 7. Describe the staffing model you are proposing, including the weekly hours proposed for each position. 8. Is there a mark-up on any of the costs associated with staffing the clinic? If so, what is the markup? 9. List the minimum qualifications you propose for each position in your staffing model, including licenses, certifications and experience. Will we have input in the selection of the medical staff? 10. Will your medical staff have hospital privileges at area hospitals? 11. Provide a list of primary care services that you propose to perform. 12. At what age will dependent care begin? 13. Describe the extent to which your clinic would be able to dispense any prescription medication. How will you determine the class and types of drugs you will offer? 14. Provide the cost/fee structure to dispense medication on-site? 15. Is there any mark-up on the medication dispensed on-site? If so, what is the mark-up percentage? 16. Describe the ROI that can be anticipated as a result of dispensing medication on-site? Provide examples of the medication dispensed from current clients. 5

6 17. List the diagnostic lab tests you would perform at the clinic. 18. Is there any mark-up in cost for the labs that are conducted at the on-site clinic? 19. Describe the conditions under which you refer patients to specialists for X-rays or other diagnostic testing. How is it determined which specialists to use and/or where to have X-rays and other tests conducted? 20. How are health clinic/wellness center appointments scheduled? 21. How many on-site clinic appointments are scheduled via an online appointment scheduler? 22. How do you balance seeing scheduled appointments and walk-in clients at the same time? What is the typical wait-time for patients that have a scheduled appointment? 23. Do you have a toll-free telephone number or other means (i.e. website, , text) for participants who have medical questions after hours 24/7? Is there an additional charge for this service? 24. Do you currently have telemedicine capabilities at your on-site clinics? If so, what is the cost providing the telemedicine service? 25. What percentage of employees considers the on-site clinic provider their primary care provider? Pharmacy Services 1. How would you address pharmaceutical costs if the prescriptions are not provided through a clinic setting? 2. Will any costs created at the clinic be required to be submitted through the self-funded health plan s third party administrator in addition to prescriptions that are written, not dispensed, by on-site clinic providers? 2. Do you dispense medications to patients that are seen in the wellness center for them to take at home? If so, are these medications for acute use, or do you also dispense maintenance medications? 3. Do you dispense maintenance medications? If so, what is your average days supply for maintenance medications? Chronic Disease Management Services and Wellness 1. Describe your philosophy in promoting wellness through the on-site clinic. How would this work in an on-site clinic? Detail how your on-site clinic would educate participants on wellness and encourage healthy behaviors. 6

7 2. Describe step-by-step your disease management program starting with how you identify individuals with high-risk health conditions. 3. Is the clinic physician part of the process? Why or why not? 4. Do you provide on-site wellness educational programs (i.e. tobacco cessation, weight management, etc.)? Describe the services and provide the cost associated with the wellness programs. 5. What is the cost of providing a full scale wellness program including, but not limited to tobacco cessation, weight management, diabetes management, cholesterol management, etc? 6. Explain the types and frequency of communication a patient would receive as they progress through a wellness program. 7. Explain the tobacco cessation program that you currently offer to clients. Health Risk Assessments (HRA)/Biometric Screening 1. Describe the biometric HRA tool your organization offers. Attach a sample. 2. Is the biometric HRA a questionnaire or a blood draw? 3. If the HRA includes a blood draw, is this conducted on-site or at a facility other than the on-site clinic? 4. List all of the criteria that is analyzed through the HRA/Biometric Screening and provide an example of the results a patient would receive. 5. What is the turnaround time for providing the HRA results to plan participants? 6. Can the results be provided both electronically and in booklet form? Is there an additional fee for the booklet form? 7. Can the patients access their HRA/Biometric 24/7? 8. How soon can new employees complete an HRA? 9. Are you willing to send HRA data to the data analytic provider for analysis to develop health improvement initiatives and incentives? At no additional charge? 10. Are follow up appointments scheduled to go over the results with the patients? 11. Can you identify the high risk categories of the employee population based on the HRA results? 7

8 12. What is the cost to provide the biometric HRA to employees? 13. What is the cost to provide the biometric HRA to dependents? Data Management and Data Access 1. Describe the information system/electronic Medical Record. 2. Do you have an electronic Personal Health Record system? If so, please identify and describe. 3. Describe your website services. 4. If you offer any on-line health support tools to clients, provide us the URL, a user name and password to navigate the site. 5. What is your ability and willingness to share data and receive data feeds with our medical and pharmacy administrators and other relevant business partners? Please describe your processes. 6. Will you require data feeds from the medical and RX carrier. Please specify requested information and frequency of data feeds. Clinical Integration 1. Describe in detail how you plan to integrate and coordinate care with our health management programs including, but not limited to, how you coordinate care with the patient s health/wellness coach/nurse, primary care physician, specialist and community referrals as well as what level of coaching your clinical staff provides. 2. Provide a detailed description of your specialist referral management process. Explain your approach to assessing referrals and choosing which physicians to refer. Detail how you identify referral resources and utilize published quality indicators. Referrals to in-network providers are preferred when possible. 3. Provide an example of client(s), with existing wellness and disease management programs, for which you provide referrals and integrate with the associated vendor(s). Please describe the processes and integration support you provide including the movement of data from biometric screenings, health assessments, and disease management activities. Implementation and Communication Strategy 1. How long would it take to open the clinic once the contract is awarded assuming that a location is secured? Attach an implementation timetable. Include specific activities and responsible parties. 2. How would you communicate to employees and their families the services provided through the clinic and the benefits it provides? 3. How do you continue to promote the program after the initial rollout? 8

9 4. Provide samples of promotional material you would use to encourage use of the clinic. 5. Can your website be linked with the employer s website(s)? 6. Provide your web address and any access codes needed to explore your services. 7. Describe the communication methods used throughout the disease management process. Technology 1. Describe your Electronic Medical Records System? Was the EMR designed in-house or is it third party vendor used? 2. What clinic vendor employees will have access to the EMR files? 3. What is the cost associated with the use of the EMR? 4. Can the EMR be sent to outside healthcare providers? Is there any charge associated with sending the EMR data? Measurement Tools & Results 1. How would you propose measuring the outcomes and success of the overall health clinic/wellness program? Specifically, how would you track the following: a. Primary Care/Disease Management Program Outcomes b. Clinic Utilization c. Participant Satisfaction d. Changes in Cost of Care e. Productivity/Absenteeism 2. Describe your standard management reports and provide capabilities for custom reports with associated costs. Provide examples of the reports that you would provide. 3. Provide a full list of all reports that will be provided. Detail all costs associated with generating the reports? 4. What predictive modeling tools do you incorporate into your data analysis? 5. How do you measure ROI? Describe your methodology. 6. Provide examples of ROI that you have provided to clients in the following categories: a. Cost per visit b. Medication c. Overall Claims Spend 9

10 7. What type of Return on Investment can be shown with a client in Year 1, 2, 3 and beyond? 8. Are you willing to guarantee a return on investment? If so, describe the fees you will put at risk and the criteria you would propose to measure your attainment of the objectives. 9. How does your company track Wellness participation? Confidentiality/Privacy 1. Is your firm HIPAA compliant? 2. How is patient and record-keeping confidentiality assured? How is it communicated to participants? 3. What practices do you have in place to protect the confidentiality of individual information when electronically transferring or storing information? 4. Have your network security systems ever been breached? If so, describe the situation. Accounting and Billing 1. How do you propose to bill for medical services and administrative costs? Include a sample of your billing. Would you be willing to customize the information contained on this (these) forms? Would there be an additional cost? 2. Describe internal procedures that will be in place to make sure the client is billed correctly for qualified employees, their dependents, and retirees. 3. How often are participant numbers adjusted to calculate management fees? 4. Is your entire program completely transparent regarding all costs and fees? Program Operating Costs 1. Describe the nature of the contract your firm would propose, indicating: a. Length of time administrative/management fees are guaranteed b. Description of the fee structure for medical services, lab tests and pharmacy c. Frequency of clinic performance evaluations d. Termination notices required e. Payment terms and conditions 10

11 2. Provide a detailed proposal including the year-over-year cost for ALL services and features of the on-site clinic? Include every cost category in the proposal. Also, include the anticipated ROI both with and without the productivity savings. 3. Submit a copy of your standard contract for clinic/wellness services. 11

12 WELLNESS & POPULATION HEALTH MANAGEMENT SERVICES If your proposal does not include an on-site clinic, please answer the following questions: Wellness & Health Population Management 1. Please explain the components of your program. 2. Please detail how your program would support the City s goal of reducing the cost of health care. Chronic Disease Management Services and Wellness 1. Please explain your philosophy in promoting wellness. Detail how you would educate participants & encourage healthy behaviors. 2. How does your company track Wellness participation? 3. Please detail the cost of providing a full scale wellness program including, but not limited to tobacco cessation, weight management, diabetes management, cholesterol management, etc. 4. Do you provide wellness educational programs (i.e. tobacco cessation, weight management, etc.)? Describe the services and provide the cost associated with the wellness education programs. 5. Explain the types and frequency of communication a patient would receive as they progress through a wellness program. 6. Explain the aggregate report the City would receive. 7. Describe your disease management program. How do you identify individuals with high-risk health conditions? 8. Describe the biometric HRA tool your organization offers. Attach a sample. 9. Is the biometric HRA a questionnaire or a blood draw? 10. If the HRA includes a blood draw, is this conducted on-site or at another location? 11. List all of the criteria that is analyzed through the HRA/Biometric Screening and provide an example of the results a patient would receive. 12. What is the turnaround time for providing the HRA results to plan participants? 13. Can the results be provided both electronically and in booklet form? Is there an additional fee for the booklet form? 12

13 14. Can the patients access their HRA/Biometric 24/7? 15. How soon can new employees complete an HRA? 16. Are you willing to send HRA data to the data analytic provider for analysis to develop health improvement initiatives and incentives? At no additional charge? 17. Are follow up appointments scheduled to go over the results with the patients? 18. Can you identify the high risk categories of the employee population based on the HRA results? 19. What is the cost to provide the biometric HRA to employees? 20. What is the cost to provide the biometric HRA to dependents? Technology 1. Describe your website services. 2. If you offer any on-line health support tools to clients, provide us the URL, a user name and password to navigate the site. 3. What is your ability and willingness to share data and receive data feeds with our medical and pharmacy administrators and other relevant business partners? Please describe your processes. 4. Will you require data feeds from the medical and RX carrier. Please specify requested information and frequency of data feeds. Measurement Tools and Results 1. Describe your standard management reports and provide capabilities for custom reports with associated costs. Provide examples of the reports that you would provide. 2. Provide a full list of all reports that will be provided. Detail all costs associated with generating the reports? 3. What predictive modeling tools do you incorporate into your data analysis? 4. How do you measure ROI? Describe your methodology. 5. What type of Return on Investment can be shown with a client in Year 1, 2, 3 and beyond? 6. Are you willing to guarantee a return on investment? If so, describe the fees you will put at risk and the criteria you would propose to measure your attainment of the objectives. Confidentiality / Privacy 13

14 1. Is your firm HIPAA compliant? 2. What practices do you have in place to protect the confidentiality of individual information when electronically transferring or storing information? 3. Have your network security systems ever been breached? If so, describe the situation. Pharmaceutical Costs 1. How would you address pharmaceutical costs? 14

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