Oklahoma Health Care Authority (OHCA) Decision Support System (DSS) Planning and Procurement Request for Information (RFI)

Transcription

1 Oklahoma Health Care Authority (OHCA) Decision Support System (DSS) Planning and Procurement Request for Information (RFI) Version 1 Date: August 25, i

2 Contents 1.0 INTRODUCTION PURPOSE OF REQUEST FOR INFORMATION (RFI) OKLAHOMA MEDICAID ENTERPRISE (OME) MEDICAID MANAGEMENT INFORMATION SYSTEM (MMIS) CURRENT DSS/DW ENVIRONMENT OHCA OBJECTIVES SCOPE OF WORK (SOW) EXTRACT, TRANSFORM, LOAD (ETL) SOLUTION BUSINESS INTELLIGENCE (BI) SOLUTION DECISION SUPPORT SYSTEM (DSS) SOLUTION DATA WAREHOUSE (DW) SOLUTION RESPONSE FORMAT VENDOR IDENTIFICATION COVER PAGE SUMMARY OF VENDOR ORGANIZATION RESPONSES TO SOW TIMELINE COST ESTIMATE OTHER COMMENTS VENDOR DEMONSTRATIONS INFORMATION ABOUT RESPONDING TO THIS RFI POINT OF CONTACT QUESTIONS REGARDING THIS RFI CLOSING DATE ACCEPTANCE OF RESPONSES COST OF PREPARING RESPONSES RETENTION OF RESPONSES ALL RESPONSES SUBJECT TO PUBLIC DISCLOSURE APPENDIX A VENDOR RESPONSE COVER PAGE APPENDIX B ACRONYMS ii

3 Tables Table 1: RFI Response Outline Table 2: RFI Schedule of Events Figures Figure 1: Current As Is Data Warehouse... 5 iii

4 1.0 INTRODUCTION The Oklahoma Health Care Authority (OHCA) is the state agency that administers the Oklahoma Medicaid Program, known as SoonerCare. Medicaid is a federal and state entitlement program that provides funding for medical benefits to low-income individuals who have inadequate or no health insurance coverage. Medicaid guarantees coverage for basic health and long term care (LTC) services based upon income and/or resources. Created as Title XIX of the Social Security Act in 1965, Medicaid is administered at the federal level by the Centers for Medicare and Medicaid Services (CMS) within the United States Department of Health and Human Services (HHS). CMS establishes and monitors certain requirements concerning funding, eligibility standards, and quality and scope of medical services. States have the flexibility to determine some aspects of their own programs, such as setting provider reimbursement rates and the broadening of the eligibility requirements and benefits offered within certain federal parameters. 1.1 Purpose of Request for Information (RFI) The OHCA, which operates Oklahoma s Medicaid program and other health benefit programs, is issuing this Request for Information (RFI) to assist the agency in fully understanding the functionality and associated services that are available in the marketplace as it relates to state-of-the-art Business Intelligence (BI) Tools/Data Analytics software products and service capabilities. Of particular interest are Software as a Service (SaaS), overlay, or full services solutions for the data mining and analysis process including: Data collection Warehousing Cleaning Normalizing Mining Visualization Manipulation Modeling OHCA is seeking available solutions related to data analytics software, applications, and tools that analyze large, complex structured, semi-structured, and/or unstructured data from multiple data sources, including mainframe platforms. These analytic tools shall have the ability to store, mine, analyze, aggregate, and visualize large amounts of data to support the agency s decision-making and planning. OHCA is looking for Vendors to suggest replacement, enhanced tools, or the purchase of services for data warehouse (DW) restructure and extract, transform, and load (ETL) functionality. OHCA is asking Vendors to provide tools or solutions that analyze data with the objectives of: Drawing conclusions Creating summarized data Identifying trends Predicting future behavior that would otherwise be difficult or impossible to obtain Following industry standards Being scalable, flexible, and customizable 2.0 OKLAHOMA MEDICAID ENTERPRISE (OME) Proposed solutions will need to support the information needs of the various programs and populations across the Oklahoma Medicaid Enterprise (OME). The program is supported by four business areas where 1

5 various users will require access to information provided through proposed decision support, BI, and data warehousing solutions. The following agencies comprise the OME: Oklahoma Health Care Authority (OHCA) Oklahoma Department of Human Services (OKDHS) Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) Oklahoma State Department of Health (OSDH) To provide an understanding of program size, a summary of SoonerCare statistics for State Fiscal Year (SFY) 2013 (June 2012 through June 2013 are provided below: 1 in 4 Oklahomans were enrolled in SoonerCare There were 1,040,332 unduplicated members enrolled in the SoonerCare or Insure Oklahoma programs A total of 1,015,939 SoonerCare members received services 49,470,567 claims were processed, 94% of which were filed electronically On average, 809,904 members were enrolled each month of the SFY. Females comprised 58 % of the unduplicated enrollees. Age of SoonerCare enrollees: o Children age 18 and younger 57% o Adults age 19 to 64 36% o Adults age 65 and older 7% OHCA administers Oklahoma s Medicaid program, SoonerCare, which, through the programs outlined below, cover a wide range of services including: Behavioral Health Services Child Health Services (Early Periodic Screening, Diagnosis, and Treatment (EPSDT)) Dental Services Physician Services Hospital Services Nursing Home Services Pharmacy Services School-Based Services Family Planning Services Non-Emergency Transportation Services SoonerCare Choice is a patient-centered medical home program in which each member has a medical home that provides basic health care services. SoonerCare Choice primary care providers are paid a monthly case management/care coordination fee. Visit-based services remain compensable on a fee-forservice basis. SoonerCare Traditional is a comprehensive medical benefit plan that purchases benefits for members not eligible for SoonerCare Choice. The member accesses services from contracted providers, and OHCA pays the provider on a fee-for-service basis. SoonerCare Traditional provides coverage for members who are institutionalized, in state or tribal custody, covered under a health maintenance organization (HMO), or enrolled under one of the Home and Community-Based Services (HCBS) waivers. SoonerCare Supplemental is a benefit plan for dual eligible enrolled in both Medicare and Medicaid. SoonerCare Supplemental pays the Medicare coinsurance and deductible and provides medical benefits that supplement those services covered by Medicare. 2

6 Long-Term Care Services is a system of health care providing long-term care and support in home and community settings, in nursing homes, in small and large residential care facilities or group homes and in the workplace. This includes Living Choice, PACE, Focus on Excellence, Oklahoma Long Term Care Partnership, Certified Nurse Aid Training program and more. These benefits could include medical and other supportive services as an alternative to a member entering a nursing home. SoonerPlan is a benefit plan covering limited services related to family planning. SoonerPlan provides family planning services and contraceptive products to women and men age 19 and older who do not choose or typically qualify for full SoonerCare benefits. Soon-to-be-Sooners is a limited benefit plan providing pregnancy-related medical services to women who do not qualify for benefits due to their immigration status. Insure Oklahoma Employer-Sponsored Insurance (ESI) is a benefit plan providing premium assistance to qualified employees and spouses of an Oklahoma small business that has 99 or fewer workers. With ESI, the cost of health insurance premiums is shared by the employer, the employee, and OHCA. Children of the ESI members between 185 and 200 percent of federal poverty level are covered through their family s private insurance plan, and Insure Oklahoma subsidizes a portion of the family s premium costs. Insure Oklahoma Individual Plan (IP) is a health insurance option for qualified Oklahomans. This benefit plan offers some basic health services to uninsured adults up to age 64, and their qualifying children, whose household income is no more than 200 percent of federal poverty level, and who are not receiving Medicaid or Medicare. The IP is available to people who meet the definition in one of the following groups: 1) Working adults who do not qualify for ESI and work for an Oklahoma business with 99 or fewer employees, 2) Temporarily unemployed adults who qualify to receive unemployment benefits, 3) Working adults with a disability who work for any size employer and have a ticket to work, or 4) Adults who are self-employed. College students age 19 through 22 who meet financial requirements may also receive benefits under Insure Oklahoma. 2.1 Medicaid Management Information System (MMIS) OHCA utilizes the services of a fiscal agent (FA), currently Hewlett Packard Enterprise Services (HPES), to operate and maintain the State s Medicaid Management Information System (MMIS), known as the interchange (ice). This CMS-certified system is based on a relational data model. In 2010 Oklahoma purchased several of the Oracle Middleware tools including the SOA and Business Process Orchestration manager to serve as the integration framework for the Oklahoma MMIS environment. The Decision Support System (DSS)/Data Warehouse (DW) system infrastructure resides on a partition of the main VM server running on Oracle relational database. Data access and reporting are enabled through the integration of the following software tools: 1. The Executive Information System (EIS) tool, HPES Navigator, functions as the report library. 2. The Business Intelligence (BI) Tool, BusinessObjects. 3. The data modeling tool, Erwin. 4. The statistical analysis tool, Statistical Package for Social Sciences (SPSS ) ). 5. The geographic analysis tool, MapInfo. Further details of the DSS/DW environment are provided below. 3

7 2.2 Current DSS/DW Environment OHCA s DSS/DW is built on a design that uses open, nonproprietary components. The Oklahoma DSS/DW function provides user access to MMIS data, including several non-traditional MMIS related systems, such as Insure Oklahoma and various external data sources, such as immunizations and vital records, for the creation of ad hoc reports, as well as canned reports. The data is stored in an Oracle Relational Data Base Management System (RDBMS) and is accessed through the BusinessObjects application. There are currently 158 active licensed users utilizing BusinessObjects. The information from the DSS is used for program evaluation, financial and operational statistical information, quality of care analysis, monitoring, program and policy development, and evaluation of medical assistance programs administered by OHCA. However, the current version of BusinessObjects is one major version behind (3.1SP3 vs. 4.1), meaning that many of the tools that OHCA utilizes for data warehousing cannot take advantage of the latest features on their current platform. The DSS/DW provides deficient BI and lacks DSS functionality to support efficient and accurate business reporting. OHCA does not have a legacy database, but the data within its database is organized like a legacy database, and ETL tools are purpose built to deal with this issue. The current ETL capability of OHCA is a structured query language (SQL)-driven batch job using custom SQL queries to extract data from the MMIS. There is no standardized method for ETL of data from operational systems, and modifications of the current data extracted from the MMIS require manual modification of complex SQL queries. There is no assurance that the data is properly de-normalized to level 0 for reporting and monitoring purposes. Additionally, there is poor integration with several Commercial of the Shelf (COTS) products, including Atlantes, the current case management system and MEDai, the current predictive health status modeling tool. It has been difficult to extract data into a warehouse environment to derive operational metrics for monitoring or reporting. Other workflow processes, such as claims exception resolution workflow, depend on Oracle Business Process Management (BPM) and have no interconnection to the EDW at all, thwarting the ability to report on long-running processes. The following graphic provides an illustration of the current DW environment. Data is currently stored within the DW of a period of seven (7) years. 4

8 Production Processes Atlantes Warehouse Business Objects SQL Extract Process Program Integrity MMIS Figure 1: Current As Is Data Warehouse The following operational functions provide data feeds into the DSS/DW: Insure Oklahoma -- Determine employer eligibility; manage employer data files, and track correspondence and telephone inquiries. It is also the vehicle used to issue the employer subsidy payments and record those financial transactions according to the correct funding source. The employer data flows through to the DW and is available for ad hoc reporting purposes. Third Party Liability (TPL) Data Match -- Standard reports that have been developed by OHCA and HPES staff are available in Computer Output-to-Laser-Disk (COLD). All current employer data in the MMIS flows through to the DW, and is available for ad hoc reports. Insure Oklahoma data also can be gathered in the MMIS Management Administrative Reporting (MAR) system for CMS quarterly reporting purposes. Qualified Health Plan (QHP) Reporting -- The current MMIS has the ability to capture and store QHP and associated carrier data, and allows manual entry of new insurance company and QHP information. Changes can be made to this information in real-time and an audit trail is available. Required QHP and carrier data entered is validated for existence and format as defined by OHCA. Current QHP and carrier data captured in MMIS flows through to the DW and is available for ad hoc reporting. 5

9 Pre-Admission Screening and Resident Review (PASRR) Information Data concerning providers for LTC, including PASRR and LTC-300R forms. This information is accessed and reviewed by OHCA and other extranet users. Data warehouse capabilities are to analyze and report data, automate the process for Drug Rebate online, and to access online invoices and payment suppliers. Call Tracking Data Data about SoonerCare Call Tracking for phone calls received by contracted and OHCA call centers is uploaded to the DSS/DW so that either structured or ad hoc queries can be performed for decision support needs. Managed Care Information -- Managed care database tables are loaded weekly to the DSS and DW. HPES provides reports in several formats paper, COLD, and file for export. Audit trail reports in the form of error and log reports are fully integrated and provided by the MMIS. Reports include federal and state requirements needed to support the 1115(a) waiver. Monthly reports include identifying enrollees by their source of enrollment, roster listings containing a Primary Care Physician s (PCP) members for the following month, listings of PCPs, and managed care providers are available. Managed care enrollment statistics are available by program. Weekly reports include a listing of members who are eligible for but not enrolled in managed care and open prior authorizations (PAs) for members who are new to managed care. Encounter remittance advices are provided as part of the financial process. Provider Data Maintenance The MMIS has the following outputs from the Provider Data Maintenance function for retrieval through the DSS/DW. Some of the outputs include the following: All provider tables in DSS available for retrieval Reports in data format for import and export purposes and through multiple media as defined by OHCA; all reports available in COLD Reports that meet federal and state reporting requirements; new reports added easily as directed by OHCA Status of provider applications in process List of providers to be flagged because of inactivity Alphabetic and numeric provider listings that can be generated by specific selection parameters PCPs by county Information required for institutional rate setting Reports giving unduplicated count of provider additions, re-enrollments, and active and inactive by enrollment status Provider cross-reference listing for Social Security Number (SSN)/Federal Employer Identification Number (FEIN), state tax identification (ID), Clinical Laboratory Improvement Amendment (CLIA), ZIP code, city, and license numbers Listing of newly enrolled providers in need of training, with the report PRV-0300-D run daily and displaying newly enrolled providers Provider 1099 statements, the Internal Revenue Service (IRS) 1099 tape, the Oklahoma Tax Commission (OTC) tape, and associated payment reports Enrollment approval/denial or other correspondence letters Mailing labels for newly enrolled providers Mailing by labels provider type, provider specialty on request through online panel, subspecialty, and geographical location A full provider file, provided to OHCA on an agreed-on periodic basis Group mailings and provider labels based on state-specific selection parameters An indicator when a provider accepts communication 6

10 Drug Rebate Program The drug rebate program stores the following outputs for reporting. The MMIS generates reports to meet federal and state reporting requirements as defined by the state. The system generates audit trail reports showing the before and after image of changed data, the ID of the person making the change, and the change date. Other reports, such as batch interest reports and zero payment made reports are generated: CMS-related reports Claims-related reports Dispute resolution reports Report of billed and received compared to the amount paid by the manufacturer Invoice report Labeler-related reports, dispute detail resolutions Public health service (PHS) listing report Invoice cover letters Transmit quarterly utilizations to CMS Data to DW Quarterly invoices Daily reports including financial Weekly and monthly cash exception reports Amount billed and collected report Credit due, outstand balance, and quarterly reports Collection letter Interest detail report Statements to manufacturers Reconciliation reports, disposition amount by program, and disposition balance discrepancy reports Prospective Drug Utilization Review (Pro-DUR)/ Point of Sale (POS) The MMIS produces periodic CMS required reports, summary reports of alert statistics (such as total number of alerts, alerts by conflict type, and responses to alerts), audit trail reports of the Pro-DUR/POS transactions, an updated parameter data set report, and audit trail reports showing changed data, the ID of the person making the change, and the change date. Program Integrity (PI) The Program Integrity and Accountability/Provider Audits Department of the OHCA is responsible for program compliance, auditing, and fraud and abuse, as well as potential misuse by providers and members. This could also include, but is not limited to, exception profiles, queries using BusinessObjects against the DSS/DW, results from any of the appeals levels (including the Medical Advisory Committee), provider site notes and questionnaires, CMS alerts, outside referrals, or any scanned images. In addition, the user is able to extract member demographic, eligibility, and other information needed about a member under review. MAR Reports The MAR report from the DSS/DW shows the following information: Processing timeframes for claims, adjustments, and other financial transactions are within the timely processing guidelines specified in state and federal regulations Claim filing information based on comparisons of date of service to date of receipt and date of receipt to date of payment Types and numbers of errors occurring during claims processing (suspended claim analysis) by: o Program 7

11 o o o o o Provider Provider type Provider specialty Provider subspecialty Category of service CMS 64 and 37 reporting and report line categorization. OHCA supports roughly three dozen sources of information in the current DW: 1. Employer data files. 2. TPL data. 3. QHP Reporting. 4. Pharmaceutical consultants. 5. Developmental Disabilities Services Division (DDSD)/OKDHS. 6. State Wide Area Network (WAN) for access by counties and OKDHS Aging Services. 7. Member, providers, employers, and insurance agents access through the Internet. 8. Outside agents of the state for updating PA data. 9. Public users/stakeholders. 10. Any third party deemed necessary and approved by OHCA; insurance agents and other contracted vendors. 11. PASRR forms. 12. LTC-300R forms. 13. Drug rebate forms. 14. Call tracking forms. 15. Member data from OHCA's eligibility systems. 16. Managed Care enrollment information from OHCA's enrollment agent. 17. Online updates of member data. 18. PCP selections/assignments from health plans. 19. Beneficiary and Earnings Data Exchange (BENDEX) data. 20. Medicare Modernization Act (MMA) file. 21. External data files such as Child Support, TPL, Office of Juvenile Affairs (OJA), and ODMHSAS. 22. SSN verification (Social Security Administration (SSA)). 23. BENDEX (SSA). 24. Supplemental Data Exchange (SDX) (SSA). 25. Citizenship (OSDH). 26. Employment wage (Oklahoma Employment Security Commission (OESC)). 27. Unemployment (OESC). 28. Absent parent information (Oklahoma Child Support Services (OCSS)). 29. Eligibility determination. 30. Drug rebate program data. 31. Pro-DUR/POS. 32. Vital Records Death Registry 33. MEDai COTS Database 34. Atlantes COTS Database 35. Prior Authorization Data 36. Claims Resolution Workflow Data (Including workflow information) 37. Claims Rules Engine Data 38. PI Case Tracking. 8

12 3.0 OHCA OBJECTIVES Results of the recently completed Medicaid Information Technology Architecture (MITA) Framework 3.0 State Self-Assessment (SS-A) indicate that OHCA is targeting Level 2 and Level 3 MITA maturity for the functions supported by DSS/BI/DW. This means the state will focus on automation, standard data models, standard business rules, and collaboration with data trading partners. These will be key considerations as OHCA reviews RFI responses. As described in Section 1.1 Purpose of RFI, OHCA is looking to enhance or replace current DSS/BI/DW functionality. While meeting time, funding, and resource constraints, OHCA is interested in looking at many alternatives, including the following: 1. Single vendor solution that provides all front end query and data management. 2. A suite of commercial off-the-shelf (COTS) products that support front end query and data management. 3. Component vendors that can bid on one or more pieces of front end access, query management, and data maintenance. OHCA goals and objectives for the DSS/DW include the following: 1. Acquire and utilize BI tools within the OME for enhanced monitoring and decision making. a. Restructure information to accommodate the business user needs and implement more robust dashboard reporting to summarize information so stakeholders can quickly respond with appropriate decisions. 2. Enhance reporting capabilities for stakeholders within the OME. OHCA will use qualitative and quantitative data to guide and evaluate our actions and improve our performance in a purposeful way over time. a. Implement interactive dashboard reporting across state agencies, Native American tribes, providers, and members (e.g., allow providers to profile themselves against other providers in their specialty or service area). b. Provide a user-friendly and intuitive ad-hoc reports creation tool where OHCA staff may access previously created reports and easily change parameters for reuse. c. Close reporting gaps in case management. d. Robust query and reporting via the Internet and mobile devices. 3. Provide a single, centralized Enterprise Data Warehouse (EDW) with timely, accessible, and usable information that meets reporting and decision support needs of the OME. a. Congregate information from multiple sources into a single DSS/DW for the OME to include additional DW imports from OKDHS, ODMHSAS, OSDH, Oklahoma State Department of Education (OSDE), Native American tribes, Health Information Exchanges, provider EHRs, Clinical Quality Measures and other entities, as well as detailed Medicare Part A, B and D data pertaining to members who are eligible for both Medicare and Medicaid (dual eligible) in Oklahoma and population data on National Medicare Part A, B and D data. b. Refresh the EDW from MMIS and all other data sources more than once a week, possibly real-time, to optimize trending reports and have other information imports synchronized with MMIS imports at equal intervals. 9

13 c. Incorporate information from CMS on Medicaid in surrounding states/medicare population to obtain a more accurate and early trending analysis of population health. Regional (i.e., Southwest Region of United States) pooling of Medicaid information with standard studies for comparison and ability to perform ad hoc analysis with multiple states information. d. Combine Case Management, HIE, EHR, Meaningful Use data and other clinical data to create a universe of clinical outcome data on the member and the provider. 4. Wherever possible, leverage existing infrastructure, sourcing solutions, and vendors who can work with HPES to add functionality with targeted solutions within current budget constraints. Additionally, the updated DSS/BI must meet all Medicaid Enterprise Certification Toolkit (MECT) checklist items for the DSS checklist, which can be accessed through the following link: Systems/MMIS/Downloads/mectchecklist.zip 4.0 SCOPE OF WORK (SOW) OHCA is looking for Vendors to suggest replacement, enhanced tools, or the purchase of services for DW restructure and ETL. This section has been designed to allow Vendors to respond in part or in full to any of the following solutions (ETL, BI, DSS, or DW) they wish to propose. OHCA is interested in RFI responses being applied to actual past implementations of similar size and scope by the vendor. For this reason, as you respond to the objectives provided below, please frame your response around a recent implementation of your solution. 4.1 Extract, Transform, Load (ETL) Solution This solution will provide enhanced functionality in addition to current state functionality. 1. User Interface Describe how your solution will provide robust, easy-to-use analysis of OME data using tools to identify and analyze defined or undefined types of data such as data discovery, pattern recognition, statistical analysis, and population comparisons in reasonable processing times. 2. Ability to Query Describe how your solution manages the frequency and complexity of enduser queries. Does the solution allow for elements to be added or modified without impacting the data outcomes? 3. Comprehensive Mapping Tools Provide a screen shot of your tool s ability to maintain a graphical database schema that shows cardinality and specific data elements. 4. Privacy and Security Describe your solutions security model. Explain how you intend to protect the privacy/confidentiality of data. 5. Standard Data Model Describe your solutions ability to integrate, normalize, and link external data from various sources. The combined data should appear seamless to the end user. 6. Data Model Tables Describe the functionality available to define the logical and physical data models, including data model tables. 7. Delivery Method or Platform Describe the platform and system requirements of your solution. 10

14 8. Integration and Support The current support infrastructure underneath the DW has problems in data timeliness, accuracy, and completeness, partially due to the underlying toolsets for ETL and the MMIS system s legacy data structure. How will your solution address this? 4.2 Business Intelligence (BI) Solution This solution will provide enhanced functionality in addition to current state functionality. 1. Functionality Provide a description of your proposed BI solution, including the key features of your BI solution and products, as well as what makes your solution unique. Detail and describe the dashboard component to your solution or product. Does the product or solution have mobile application capabilities? 2. User Interface Describe how your solution will provide robust, easy-to-use analysis of OME data using tools to identify and analyze defined or undefined types of data such as data discovery, pattern recognition, statistical analysis, and population comparisons in reasonable processing times. Does the solution contain normalized and defined data views that enable users of all skill levels to complete a report with accurate, consistent results? 3. Ability to Query Describe how your solution manages the frequency and complexity of enduser queries. Does the solution allow for elements to be added or modified without impacting the data outcomes? 4. Comprehensive Mapping Tools Provide a screen shot of your tool s ability to maintain a graphical database schema that shows cardinality and specific data elements. 5. Reporting Please describe how data and reports are organized and displayed in the tool. Can end-users customize an automatically generated report (e.g., add/delete columns, etc.)? Can endusers save such changes for future report generations? 6. Privacy and Security Describe your solutions security model. Explain how you intend to protect the privacy/confidentiality of data. 7. Standard Data Model Describe your solutions ability to integrate, normalize, and link external data from various sources. The combined data should appear seamless to the end user. 8. Data Model Tables Describe the functionality available to define the logical and physical data models, including data model tables. 9. Data Analysis Describe the statistical analysis functions that your solution supports. Do the analysis features of your solution allow users to be self-sufficient and slice and dice data in a friendly, flexible, and timely manner? Does your solution have the ability to detect or discover trends in the data? If so, how is such trend discovery configured? 10. Delivery Method or Platform Describe the platform and system requirements of your solution. 11. Integration and Support Please list all systems and tools that your solution successfully integrates with (e.g., ETL tools, Microsoft Excel, Microsoft Access, Oracle RDBMS, etc.), including the level of integration. Describe the training and support methodology for your solution. 11

15 4.3 Decision Support System (DSS) Solution This solution will provide enhanced functionality in addition to current state functionality. 1. Functionality Provide a description of your proposed solution, including the key features of your solution and products, as well as what makes your solution unique. Detail and describe the dashboard component to your solution or product. Does the product or solution have mobile application capabilities? 2. User Interface Describe how your solution will provide robust, easy-to-use analysis of OME data using tools to identify and analyze defined or undefined types of data such as data discovery, pattern recognition, statistical analysis, and population comparisons in reasonable processing times. Does the solution contain normalized and defined data views that enable users of all skill levels to complete a report with accurate, consistent results? 3. Ability to Query Describe how your solution manages the frequency and complexity of enduser queries. Does the solution allow for elements to be added or modified without impacting the data outcomes? 4. Comprehensive Mapping Tools Provide a screen shot of your tool s ability to maintain a graphical database schema that shows cardinality and specific data elements. 5. Reporting Please describe how data and reports are organized and displayed in the tool. Can end-users customize an automatically generated report (e.g., add/delete columns, etc.)? Can endusers save such changes for future report generations? 6. Privacy and Security Describe your solutions security model. Explain how you intend to protect the privacy/confidentiality of data. 7. Standard Data Model Describe your solutions ability to integrate, normalize, and link external data from various sources. The combined data should appear seamless to the end user. 8. Data Model Tables Describe the functionality available to define the logical and physical data models, including data model tables. 9. Data Analysis Describe the statistical analysis functions that your solution supports. Do the analysis features of your solution allow users to be self-sufficient and slice and dice data in a friendly, flexible, and timely manner? Does your solution have the ability to detect or discover trends in the data? If so, how is such trend discovery configured? 10. Delivery Method or Platform Describe the platform and system requirements of your solution. 11. Integration and Support Please list all systems and tools that your solution successfully integrates with (e.g., ETL tools, Microsoft Excel, Microsoft Access, Oracle RDBMS, etc.), including the level of integration. Describe the training and support methodology for your solution. 4.4 Data Warehouse (DW) Solution This solution would replace the current DW. 1. Infrastructure/Functionality Describe the proposed solution, including an overview summary of all hardware, software, network, and database components used in the solution. Include the key 12

16 features of your solution and products, as well as what makes your solution unique. Detail and describe the dashboard component to your solution or product. Does the product or solution have mobile application capabilities? 2. User Interface Describe how your solution will provide robust, easy-to-use analysis of OME data using tools to identify and analyze defined or undefined types of data such as data discovery, pattern recognition, statistical analysis, and population comparisons in reasonable processing times. Does the solution contain normalized and defined data views that enable users of all skill levels to complete a report with accurate, consistent results? 3. Ability to Query Describe how your solution manages the frequency and complexity of enduser queries. Does the solution allow for elements to be added or modified without impacting the data outcomes? 4. Comprehensive Mapping Tools Provide a screen shot of your tool s ability to maintain a graphical database schema that shows cardinality and specific data elements. 5. Reporting Please describe how data and reports are organized and displayed in the tool. Can end-users customize an automatically generated report (e.g., add/delete columns, etc.)? Can endusers save such changes for future report generations? 6. Privacy and Security Describe your solutions security model. Explain how you intend to protect the privacy/confidentiality of data. 7. Standard Data Model Describe your solutions ability to integrate, normalize, and link external data from various sources. The combined data should appear seamless to the end user. 8. Data Model Tables Describe the functionality available to define the logical and physical data models, including data model tables. 9. Data Analysis Describe the statistical analysis functions that your solution supports. Do the analysis features of your solution allow users to be self-sufficient and slice and dice data in a friendly, flexible, and timely manner? Does your solution have the ability to detect or discover trends in the data? If so, how is such trend discovery configured? 10. Delivery Method or Platform Describe the platform and system requirements of your solution. 11. Integration and Support Please list all systems and tools that your solution successfully integrates with (e.g., ETL tools, Microsoft Excel, Microsoft Access, Oracle RDBMS, etc.), including the level of integration. Describe the training and support methodology for your solution. 12. Business Continuity Describe how your solution will support the OME DW and reporting culture with onsite and offsite expertise. 5.0 RESPONSE FORMAT The following subsections provide instructions on response format. To facilitate evaluation and review, OHCA requests that Vendors prepare their responses according to the outline below, which provides section numbering that should be used in responses, as well as page limits. Respondents are encouraged to provide all requested information to ensure that their response is most useful to OHCA. 13

17 Vendors and OHCA acknowledge that providing a response does not bind nor obligate either party in any way. The response is simply a tool to be utilized by OHCA to determine the cost effectiveness of issuing a RFP in the future. Table 1: RFI Response Outline Section # Section Page Limit 1.0 Vendor Identification Cover Page Summary of Vendor Organization Responses to SOW 3.1 Response to ETL SOW (if applicable) Timeline Cost Estimate Response to BI SOW (if applicable) Timeline Cost Estimate Response to DSS SOW (if applicable) Timeline Cost Estimate Response to DW SOW (if applicable) Timeline Cost Estimate Other Comments 2 Total: Vendor Identification Cover Page A cover page has been provided in Appendix B for Vendors to include with their response submittal. 5.2 Summary of Vendor Organization Vendors should provide a brief description of their organization, including the following: A general description of the primary business of the organization and its client base The organization s areas of specialization Any current or recent experience working with state Medicaid agencies Size of the organization, including structure Vendor support staff qualifications including experience working with DW, clinical data, Medicaid systems, and care management Length of time the organization has been in business, as well as how long the organization has been providing DSS/BI/DW solutions 5.3 Responses to SOW Vendors may respond to any of the solution subsections within Section 4.0 Scope of Work. Vendors should provide responses to each of the questions within any subsections they choose to provide solution information. Should a vendor choose not to respond to all scope of work requirements, page limits shall remain static for each individual scope of work as defined above. Each solution the Vendor responds should also contain information outlined in the following subsections. 14

18 5.3.1 Timeline Vendors should provide an estimated timeline for the implementation and rollout of each solution proposed Cost Estimate Vendors should provide a general estimate of how they would calculate costs for each of the products and services they have chosen to propose. Vendors and OHCA acknowledge that providing a cost range does not bind nor obligate either party in any way. The cost range is simply a tool to be utilized by OHCA to determine the cost effectiveness of issuing a bid in the future. The following information has been provided to assist Vendors as they produce cost estimates. As OHCA proceeds with procurement activities, they will be looking to potentially award a seven-year contract. The DW should store a minimum of ten years of data, after which it will be archived in COLD. There are currently no anticipated changes in the MMIS that might have a downstream effect on DSS data extracts and mapping. Additionally, cost estimates should consider the following Design, Development, and Implementation (DDI) components: 1. Partnership establishment with Integrator. 2. Install and configure ETL. 3. Professional services to enhance current forms of ETL. 4. Professional services to pull in clinical data. 5. Install and configure BI/DSS functionality. 6. Professional services to target, create, and enhance BI/DSS reporting. 7. Expected deliverables during System Development Life Cycle (SDLC): a. ETL Software. b. DSS Software. c. BI Software. d. Specification of ETL Enhancements. e. Specification of DSS Enhancements. f. Specification of BI Enhancements g. Work plan to split DW. h. Work plan for ETL Enhancements. i. Work plan for DSS Enhancements. j. Work plan for BI Enhancements. k. DDI for all enhancements. 8. Dedicated staff or resources to operate, train and maintain the EDW and BI platforms. The following general expectations for responsibilities of OHCA, as well as the Vendor, can also be assumed as part of the potential contract opportunity. OHCA Responsibilities: Provide and coordinate data governance across enterprise business units. Provide state staff knowledgeable of program and operation s needs. Provide clear and detailed technical, functional, and operational requirements. Provide timely review, comments, and approval of deliverable. Vendor Responsibilities: 15

19 Provide a standard data model used within the proposed system to optimize data management, query, and reporting functions. Provide system support and maintenance to ensure system availability in a 24 x 7 environment. Provide training to state users at least monthly to ensure system functionality is communicated. Maintain web enabled system documentation providing updates at least quarterly. Provide staff or resource estimates to maintain, enhance, train and operate the EDW and BI platforms. 5.4 Other Comments Vendors may provide additional comments or issues regarding any aspect of the DSS project that OHCA should consider. 6.0 VENDOR DEMONSTRATIONS Based on review of RFI responses, OHCA may invite some Vendors to make oral presentations and demonstrations about their proposed solutions, capabilities, and approaches to OHCA staff. OHCA may also request telephone interviews with key personnel at the Vendor organization prior to or for follow-up after the demonstrations. Only Vendors who demonstrate experience and requirement functionality in their proposed solutions, due by Monday, October 6, 2014, will be considered for demonstrations. OHCA appreciates all responses and may review incomplete responses or those received after the deadline at their discretion. Vendors chosen for phone interviews and/or demonstrations will be notified by the week of November 17, 2014, with demonstrations expected to take place between November 8, 2014 through December 29, 2014, at the OHCA office in Oklahoma City. Members of the OHCA steering committee will select demonstration vendors based on the quality of the RFI responses. Since this RFI is not a negotiation for services, should a vendor be selected to perform a demonstration, no discussions about services shall be entertained between OHCA and the vendor that could be construed as a negotiation for services. 7.0 INFORMATION ABOUT RESPONDING TO THIS RFI 7.1 Point of Contact The point of contact for this RFI is: Kimberely Helton Oklahoma Health Care Authority 4345 N Lincoln Blvd Oklahoma City, OK Phone: (405) Kimberely.helton@okhca.org 7.2 Questions Regarding this RFI Questions regarding this RFI should be submitted to the address listed above. Questions must be received by 5:00 PM Central Daylight Time (CDT) on Monday, July 21 st, Answers to questions will be addressed in writing and posted on the OHCA website, for all Vendors to review on Thursday, July 24 th,

20 The following table provides a quick view of the RFI schedule of events. Table 2: RFI Schedule of Events Calendar Event RFI Schedule Date RFI Posting and Release Monday, August 25, 2014 Vendor Questions Due Monday, September 15, 2014 Answers to Vendor Questions Posted Monday, September 29, 2014 RFI Responses Due Monday, October 6, 2014 Invitations to Vendor Demonstrations Week of November 17, 2014 Demonstrations Scheduled between Between November 8 and December 29, Closing Date Responses submitted in accordance with this RFI must be received by OHCA no later than 5:00 PM CDT on Monday, October 6, OHCA may consider responses received after this deadline at their discretion. 7.4 Acceptance of Responses OHCA will accept all responses submitted according to the requirements and deadlines outlined in this RFI. Responses must be complete when submitted and should clearly describe the Vendor s ability to meet the requirements of the RFI and the needs of the State. Information gathered in this process could potentially be incorporated in a Request for Proposal (RFP). Any resulting RFP will be openly competitive and should therefore not be exclusive or restrict competition. This RFI does not obligate OHCA to issue an RFP nor to include information submitted by Vendors. 7.5 Cost of Preparing Responses All costs incurred by the Vendor for response preparation and demonstration are the sole responsibility of the Vendor. OHCA will not reimburse for any such costs. OHCA reserves the right to withdraw the RFI at any time during the RFI process. Issuance of this RFI in no way obligates the State to award or issue a contract or to pay any costs incurred by any Vendor as a result of such withdrawal. 7.6 Retention of Responses All responses submitted in response to this RFI become the property of OHCA and will not be returned. 7.7 All Responses Subject to Public Disclosure a) Responses submitted are subject to Oklahoma Open Records Act, 51 Okla. Stat. 24A.1 et seq. No responses will be released under this Act until OHCA awards a contract for these services pursuant to Oklahoma Administrative Code (OAC) or determines that no contract will be awarded. 17

21 b) Respondents may mark portions of their responses proprietary and indicate that they should not be released under the Act. If a respondent considers part of its response proprietary, it should an additional copy of its response with the proprietary information removed or blacked out. c) If the respondent provides a copy of its response with proprietary information redacted and OHCA appropriately supplies the redacted response to another party under the Oklahoma Open Records Act or other statutory or regulatory requirements, the respondent agrees to indemnify OHCA and step in to defend its interest in protecting the referenced redacted material. 18

22 Appendix A Vendor Response Cover Page Respondent s Name Click here to enter text. Physical Address Click here to enter text. City Click here to enter Click here to enter State text. text. Contact Person and Title Click here to enter text. Phone Number & Area Code Click here to enter text. Address Click here to enter text. Respondent Authorized Signature Click here to enter text. Typed Name Website Address Zip Code Click here to enter text. Certified this Date Click here to enter text. Title Click here to enter text. Click here to enter text. The information below shall be used by OHCA to categorize responses, and to quickly identify available capabilities. Selecting or not selecting capabilities below do not pre-empt a Respondent from attaining a Demo. For the proposed solution, please select all applicable criteria below: The Respondent has the capability and interest to provide the following (check as many as apply): Extract, Transform, Load (ETL) Solution Business Intelligence (BI) Solution Decision Support System (DSS) Solution Data Warehouse (DW) Solution Respondent s suggested solution is as follows (check as many as apply): Replacement Enhanced Tools Services Does the Respondent comply with the Federal regulations on audited processes (SAAS 70)? Choose an item. Describe the recent similar project implementation below (check as many as apply): 1. Client size: Click here to enter text. 2. Implementation timeline from project initiation through operations start: a. Total months: Click here to enter text. b. Significant milestones: Click here to enter text. 3. Project total cost: a. Implementation costs: Click here to enter text. b. Operations costs for most recent full year period of operations: Click here to enter text. 19

23 Level of support available / recommended (check as many as apply): Onsite: Full Time As Needed Offsite: Full Time As Needed Indicate Respondent s Market Experience (check as many as apply): Healthcare Experience Outcome Analysis Healthcare Analytics Predictive Analytics Financial Analytics and/or Reporting Other, please describe below: Click here to enter text. Indicate ability to provide the following capabilities and/or services (check as many as apply): Real-time and distributed in-memory data platform Data virtualization / data services Tiered licensing levels Dashboards, including: real time static Corporate Documents Governance process Does the Respondent s system meet all the requirements in the Medicaid Enterprise Certification Toolkit (MECT)? Choose an item. 20

24 Appendix B Acronyms The following acronyms are used within this document. Acronym BENDEX BI BPM CDT CLIA CMS CMYK COLD COTS DDI DDSD DSS DW EDW EHR EIS EPSDT ESI ETL FA FEIN HCBS HHS HMO HPES HTML ice ID IP Definition Beneficiary and Earnings Data Exchange Business Intelligence Business Process Management Central Daylight Time Clinical Laboratory Improvement Amendment Centers for Medicare and Medicaid Services Cyan-Magenta-Yellow-Black Computer Output-to-Laser-Disk Commercial Off-the-Shelf Design, Development, and Implementation Developmental Disabilities Services Division Decision Support System Data Warehouse Enterprise Data Warehouse Electronic Health Record Executive Information System Early Periodic Screening, Diagnosis, and Treatment Employer-Sponsored Insurance Extract, Transform, and Load Fiscal Agent Federal Employer Identification Number Home and Community-Based Services United States Department of Health and Human Services Health Maintenance Organization Hewlett Packard Enterprise Services Hypertext Markup Language interchange (The current MMIS management by HPES) Identification Individual Plan 21