Questions and answers for HEDIS

Transcription

1 Questions and answers for HEDIS 1. General Question: Background information: Of the 250,000 Medi-Cal patients described on Pages 8 and10 (noting the potential growth to 300,000), how many of these patients does KHS plan to manage in programs based on HEDIS measures? KHS uses multiple conditions to build the criteria for active case and disease management. The results of HEDIS are typically not used to drive program management groups. 2. General Question: KHS issued an RFP in 2016 that stated that the resulting agreement would be three years with two additional year options. Why has KHS gone to RFP in 2018? In accordance with the policy KHS will publish an RFP every three years. 3. Regarding interfaces: Question: What EHR(s) and other data sources are in scope? KHS will normalize any EHR data it obtains to be used as supplemental or standard data based on the data in formats available by the HEDIS system. KHS uses EDIFECS as its EDI tool to translate and transform these data sets. 4. 3k: Tool must be NCQA certified prior to start of HEDIS. Question: Is KHS focused around physician or health plan measures? KHS reports California Medi-cal Managed Care measures which include adapted PCR (ACR) 5. 6c: All HEDIS related measure reporting with drill down. Question: What measures are included in KHS's programs? This is a feature that KHS desires with the HEDIS software. KHS should be able to drill down into the detailed member level information on each measure for compliant and non-compliant members. 6. Who is Kern s current vendor for HEDIS reporting? Verscend.

2 7. Are there any pain points that Kern has with the current vendor or the software? Please list out. None noted. 8. Please share if there are any strategic objective/business outcomes that this RFP will fullfil. KHS is required to perform HEDIS annually and is required to have a certified solution for the HEDIS system. 9. The submission Checklist indicates that every bid package must include answers to questions in Attachment A? If there are questions in Attachment A they will need to be answered. 10. Is it acceptable to state that we understand and agree to provide the service described under Attachment A Scope of Services and then to include a written response for the only question stated in #8? Yes. 11. For what HEDIS measurement year is Kern proposing to begin in contract for a HEDIS software reporting tool? KHS will being to use the tool in 2020 for the 2019 reporting year. 12. Please confirm anticipated contract term for services in 2019 for 2018 Dates of Service (DOS)? KHS will being to use the tool in 2020 for the 2019 reporting year. 13. Please confirm whether KHS is contemplating Self-Service Medical Record Recovery (MRR) and using the Plans internal clinical abstraction resources, Full- Service with an outsourced MRR/Abstraction Vendor Partner, OR a combination of both- Self-Service and a Vendor Partner? KHS plans on using the Self-Service MRR process with internal nurses for abstraction.

3 14. What was past year s chart chase volume for hybrid-measures? Approximately 4, Is KHS contemplating year-around/prospective HEDIS abstraction in the current year? KHS will run the HEDIS software monthly on its entire population and produce its annual certified submission. 16. Attachment A- Scope of Services: Which regulatory agencies do you currently submit HEDIS or other metrics to (e.g. NCQA, CMS, CA P4P)? We report to NCQA for CA DHCS via HSAG 17. Attachment A- Scope of Services: Can you share your HEDIS-like/custom measure list that we will need to support for state or custom reporting requirements? KHS creates custom measures based on the actual reportable measures. The most frequent customization is the removing of continuous enrollment. CA DHCS has modified the PCR measure (PCR/ACR) 18. Attachment A- Scope of Services: What are the business challenges you are trying to solve? Any pain points with existing technology and applications? None. 19. Attachment A- Scope of Services: Who is the current HEDIS vendor? Verscend. 20. Attachment A- Scope of Services: What are the number of regulatory submission reports to NCQA currently? KHS submits its annual HEDIS results to the California Department of Health Care Services (DHCS ) via HSAG. 21. Attachment A- Scope of Services: Please specify your data volume based on available history (example: approximately 5 million medical claims, 1.6 million pharmacy claims, ½ million lab claims)?

4 KHS loads eighteen months of data into the HEDIS system which is approximately 4 million medical claims, 200K immunization records, 3.7 million lab results, 6 million prescriptions, and 162K vision claims. 22. Also, share your daily incremental data volume by Claims (Med/Rx) and Clinical (HIE). We are assuming the clinical data are available in structured content? KHS receives approximately 8-10K medical claims per day and 8-10K Rx claims per day. 23. Attachment A- Scope of Services: Please describe the expected data refresh and measure-runs processing frequency (weekly, monthly, and quarterly)? KHS desires to run the software monthly. 24. Software (Medical Record Collection) tool to review data: Please specify if there is need for MRR software and services for regulatory reporting: A. Medical Record Review Software. B. Collection and Abstraction Services. There is a need for the Medical Record Review Software for local nurses to perform chart extractions on hybrid measures. 25. Software (Medical Record Collection) tool to review data: How many chases were performed during HEDIS 2018 MRR? Approximately 4, Attachment A-Scope of Services: Please describe the prospective care gap reporting requirements and timeframes followed? KHS describes potential care gaps in the ROADMAP, which must be completed by January. 27. Attachment A- Scope of Services: Is there a need to publish care gaps to providers and collect supplemental data to close those gaps within the system? KHS does not need to publish care gaps.

5 28. License Expectation(s): What is the expected number of technical and business users for the HEDIS, Star and Provider Platform? Please also provide number of concurrent users of the application? KHS has 10 concurrent users of the application. 29. Attachment A- Scope of Services: Are you looking for prospective and predictive analytics capabilities for Quality Improvement? No. KHS uses the John Hopkins ACG software for predictive analytics. 30. Attachment A- Scope of Services: Please specify if there is need for software and clinical services for supporting various quality improvement? KHS does not have a need for additional software to support quality measures at this time. 31. Complete the roadmap: Please elaborate on the statement Support completion of the roadmap. Also highlight the support expectation required for meeting this requirement from the selected vendor. In some cases there are question on the HEDIS roadmap that is provided by HSAG which will require some input from the HEDIS software manufacture. Typically, it is not extremely involved, but needed from a software system provider. 32. Required for Both Hosted and Non-Hosted: Please provide more information for the mentioned requirement statement: The proposed software will be able to calculate and provide reporting in a Continuous and Non Continuous mode and identify all numerator instances (first and last numerator event) and denominators for all measures. Can you please explain your understanding of the Continuous and Non Continuous mode? Currently, KHS would like the system to provide reporting that shows the entire population impacted by the measure with continuous and non-continuous enrollment. 33. Attachment A- Scope of Services: What are the existing data source for your HEDIS & CAHPS data collection and reporting process? Please list the systems and vendors involved. Also please highlight if the source data is extracted from single data lake or multiple data sources?

6 KHS has a very robust Operational Data Store (ODS) and aggregates data on a regular basis. KHS will be responsible for create the data input needed based on the software specification by the HEDIS system. 34. Attachment A- Scope of Services: How many customs or ad hoc reports have to be developed and what is the frequency for this? KHS would like the ability to dynamically retrieve member level data on each measure on demand. 35. Attachment A- Scope of Services: P4P- How many HEDIS-like measures should be created? Please share the list? KHS creates custom measures based on the actual reportable measures. The most frequent customization is the removing of continuous enrollment. 36. Attachment A- Scope of Services: What would be the tentative HEDIS Go-Live date? Can we assume the implementation to start on July 1 st 2019 and we will be ready for 2020 HEDIS season? KHS would like to start using the software by December 2019 for a June 1, 2020 reporting date. 37. Attachment A- Scope of Services: For 12 hours per day (PST) support, we will assume we will provide eight hours from onshore and 4 hours from offshore. Is this an acceptable arrangement to meet this criteria? Yes. 38. Attachment A- Scope of Services: Please share any available architecture diagram showing all integration points and high levels data flow (inbound and outbound)? Not available. 39. What is the number of reporting populations you anticipate for the 2020 season? KHS will managed K lives in the system. KHS will use all certified HEDIS measurements.

7 40. What is the number of runs/loads you anticipate doing? (Typically 12 or 24, once or twice per month)? KHS anticipates doing the loads monthly. 41. What is the anticipated chase you will run through the Abstraction Portal?