& RESPONSES 1. Scope of services is very broad and staffing is minimal for both OH & PC. Question 9 in the staffing section asks for your recommendation on We feel a.2 MD /1 NP /1 RN /1 LPN model would be better served given staffing configuration. Please provide your response in this item. the details of managing an OH offering along with a PC plan. Is this Alternative staffing model recommendations will be considered and acceptable? may be acceptable. Note: the financial proposal submitted must be 2. Where is the site to be located given city services tend to be spread out, we are concerned about reasonable access for all employees and dependents? 3. What type of promotion/incentive is the City considering to motivate participation? 4. What participation are you expecting percentagewise for employees and dependents? 5. Is there a census available with zip codes to see the access of people to the site? 6. Can the size identified, 1,000 sq. ft., for the clinic be expanded? If yes, what is the maximum size of the space available? 7. The benefit plans provided are any of the high deductible plans HSA qualified? 8. Under Quality Management are two audits required/mandated or will one suffice? 9. In determining staffing can you share the utilization and assumptions you used in developing the RFP? 10. Please provide the expected utilization numbers for biometric screens, fitness for duty exams extent of, DOT and other physicals and if there are annual requirements. based on the Mercer recommended staffing model. This has not yet been decided. The clinic will offer a discounted $5 co-pay as compared to the medical plan design. Incentive design considerations are still being discussed. Based on your experience and the available information, please provide your estimate of participation. Please see the census that was provided as an attachment. The location identified will allow room for future expansion of services. No A minimum of two audits are required. The staffing model provided is preliminary and will be reevaluated during implementation. The City has had 90% in their wellness program, which requires completion of a biometric screening with Corporate Care or physical with a physician. For occupational health data, please refer to the report previously provided.
Page 2 11. In the State of Kansas pharmacy dispensing laws are restrictive and we do not believe dispensing is possible so would there still be a need for Realtime bi-directional integration and/or claims support? Our understanding is that physician s assistants are allowed to prescribe under dependent authority and dispense samples. Please confirm this is consistent with your interpretation of the law. 12. Term of the contract is stated at five years with annual renewal options Will the city be willing to enter into an agreement longer than 1 year without an out clause for convenience? This can be problematic when recruiting and retaining staff to have this language or term in a contract. 13. Is the city willing to increase the 30 day notice if a termination is given to 90 days? 14. The salaries identified for the staff are these the desired budgeted amounts or the required amounts? 15. Does the city offer incentives for a wellness program or a FSA/HRA? If yes, what type of incentives. Based on your experience in Kansas and understanding of the law, please recommend the optimal level of data integration. No. Due to the Cash Basis restrictions in item number 22 of the RFP, the City must always have an option to terminate an agreement at the end of a budget year. Subject to negotiation. The salaries identified are based on salaries at the 75 th percentile in the Kansas City area for each provider. These are estimates for quotation purposes only. Any variation from estimates experienced during implementation (actual hiring) will be passed on to the City at actual cost. Employees that completed a health assessment and biometric screening in 2012 are eligible for a lower deductible in 2013. The City has rolled out a points based wellness program in 2013. Those that earn 250 points through a number of activities will be eligible for an incentive in 2014, which will either be a premium differential or lower deductible. 16. Please provide a utilization report for the top providers? This information is included in the UHC medical claim file. 17. What is your annual projected employee growth rate? Approximately one percent (1%). 18. What is your annual attrition rate? The City doesn t track attrition however the turnover rate for 2012 was 4.1%. 19. What is your average employee wage? Average annual salary = $60,744 20. What are your desired hours of operation? This information is provided in section 1 of the RFP
Page 3 21. Can you provide any additional claims data? Specifically: Please review claims data provided with your intent to bid. 2012 Physician Office Visits per 1,000 Average community cost of physician office visit Average community cost of specialty office visit 2012 Inpatient visits per 1,000 Average cost per inpatient visit 2012 ER visits per 1,000 Average cost per ER visit 2012 Urgent Care visits per 1,000 Average cost per urgent care visit 2012 Outpatient visits per 1,000 Average cost per outpatient visit 2012 Biometric Screening/ wellness participation percentage Any condition management information such as % of population with condition or expected participation rate 2012 Bomb Squad Physicals 2012 DOT Drug Screens 2012 DOT Physicals 2012 Fitness for Duty Exams 2012 Lead Level Tests 2012 Non-DOT Post Offer Physical & Drug Screens 2012 Non-DOT Post Offer Drug Screens 2012 Post Offer Physical & Drug Screens (PD Dispatch/Office)
Page 4 22. Does the City intend to waive co-pays at the clinic for those covered by the The City is still discussing whether to waive co-pays or collect a health plan? If no, how much does the City intend to charge? reduced co-pay for enrolled employees. Preliminarily, the City is 23. Is it the City s preference that the clinic be open to non-enrolled employees on a cash pay basis? considering a $5 co-pay, which is a discount. Yes, the City would like to offer services to non-enrolled employees. 24. What is the estimated annual budget for this project? The City has not finalized their budget for this project. 25. Is the City interested in dispensing medications from the clinic? Yes, while the City is not planning on dispensing medications in year 1, they are open to exploring the opportunity as a future service expansion. 26. What is the participation level in the current HRAs? Participation in the health risk assessment is 90%. Enrollment in the HDHP with HRA is approximately 40%. 27. Please clarify if the City s contract terms, discussed on page 11, A requirement of this RFP is that the vendor selected must agree to the City s contract terms. The submission of alternative contract terms will be considered as a statement that the vendor does not agree to the City s contract terms, are referring to the business requirements section that begins on page 12. 28. Regarding the uni-direction ghost claims, we can file these claims; however, we prefer to receive a remit file back from the TPA to close out each claim. Would that be possible? 29. Regarding the bi-directional requirements found on page 5, could the City please define bi-directional for each of the following: a. Pharmacy: Real-time bi-directional b. Lab: Real-time bi-directional c. Workers Compensation: Monthly bi-directional 30. What specific information is the City interested in receiving through the bidirectional feed with the pharmacy benefits manager? 31. Can Mercer please provide the metrics that exist on the Mercer dashboard? 32. Does the City have any employees that are members of a union? If so, how many? Contract terms include all requirements outlined in Section E as well as requirements outlined in the business requirements. This will be evaluated during implementation. Bi-directional is defined as sending and receiving data. A City is seeking the on-site provider to be an advocate for the plan by working with the benefits, formulary, and members. An important benefit of pharmacy integration is utilization and quality management (e.g. drug-drug interactions, adherence). Not at this time. No
Page 5 33. Has the City identified the clinic space? If so, can a proposed layout of the A clinic space has been identified but the layout of the clinic has yet to space be provided? be determined. The City will look for any recommendations on design 34. Does the City have specific company paperwork that is required for occupational health exams? from the selected bidder. No, paperwork is provided by vendor. 35. Is the City a member of the Kansas Drug-Free Workplace program? No 36. Does the City have a zero tolerance breath alcohol policy? Yes 37. Does the City plan to offer a comprehensive wellness program? If so, is Yes. The City plans to continue to offer a comprehensive wellness there a dedicated budget and a plan to offer incentives? program with incentives. They currently offer a points based wellness program for completing a variety of activities. The wellness incentive for 2014 will either be through a premium differential or plan design 38. Please clarify which tests the treadmills are expected to be used for? Please provide estimated usage. 39. Will the City of Overland Park be the contracting party or will it be the health plan? 40. Can the pricing adjust at all during the contract, such as based on changes in staffing, and which would include a process where the parties periodically meet to review, etc.? 41. P. 13, Number 8, will the City obtain or assist vendor in obtaining the necessary licenses? Will the vendor be responsible only for the medicalrelated licenses? differential. Fit-for-duty exams for fire and possibly for age based exams. The City of Overland Park will be the contracting party. Yes. Staffing levels are expected to change. If you have a different financial model than cost-plus, please explain in detail. The vendor is responsible for obtaining all necessary licenses related to the onsite clinic.
Page 6 42. P. 19, Miscellaneous Legal Issues Does the City indemnify the vendor if the problem relates to City owned property, maintenance or employees? What dispute resolution process does the City use? No, the City will not indemnify the vendor due to statutory restrictions. As indicated in item number 36 of the RFP, the City does not resolve disputes through arbitration. Below please find the City s standard contractual language regarding dispute resolution: 43. P. 21, Insurance Item 39 What obligations to members would the providers have that are to be covered by insolvency insurance? 44. Are we able to get age information on the eligible population? Provided with census information. 45. Are we able to get employee/dependent identifiers added to the claims files? This will help us in generating our savings assumptions. City and Consultant agree that disputes relative to the project should first be addressed by negotiations between the parties. If direct negotiations fail to resolve the dispute, the party initiating the claim that is the basis for the dispute shall be free to take such steps as it deems necessary to protect its interests; provided, however, that notwithstanding any such dispute Consultant shall proceed with the work as per this Agreement as if no dispute existed; and provided further that no dispute will be submitted to arbitration without the City's express written consent. To be determined. We recognize that you will not be able to distinguish between employees and dependents from the file. Please apply general assumptions related to different utilization patterns, recognizing that the average cost for each group will be the same. At this time we are not able to provide a new claim file. 46. Are we able to get gender and age data added to the claims files? This These date fields are included in the census file. will help us better understand the populations overall health. 47. In the RFP it states that there are 784 employees eligible to use the clinic. Non-enrolled employees are a subset of the total 784 employee Can you confirm that the non-enrolled employees are a subset of the total population. 784 employee population? 48. Are we able to get an estimate on how many sick hours were taken in the 2012 sick hours taken: 60,933 last 12 to 24 months? This will help us improve our productivity and absenteeism savings projections. 49. Does the Client have a preference regarding mid-level provider type? Yes, the client would prefer to have a mid-level provider staffed at the clinic with physician oversight. 50. What percentage of the total potential patient population is within 10 Please refer to the zip codes included in the census. Minutes (2.5 miles)of the intended location?
Page 7 51. What claims engines would the winning organizations need to interface We will expect that you interface with UHC. This will be discussed in with? more detail during implementation. 52. If the "IT room" is not required, will that space be returned to the remaining floor plan? Yes 53. Does the Client have any plans to expand services beyond the stated scope after the program's first 5 years? There is a potential for future expansion based on demand. 54. Are any special security clearances required by management and staff? Currently there are certain departments that require a badge for entry. 55. Please define the scope of "primary care" (urgent care only, medical Please refer to section 1, Planned Clinic Services. The clinic is not home, etc.) intended to replace member s PCP. All services provided at the clinic would support the primary care provider relationship. If the member does not have a PCP and prefers the clinic provider, they would not be 56. Please define the scope of "minor Workers Compensation diagnoses and treatment" (suturing, eye injuries, etc.) discouraged from utilizing the clinic for available services. Minor Injury/Illness is defined as any accident meeting the definition of an injury or illness and involves medical costs with the total of all losses up to one thousand five hundred dollars ($1,500).