Request for Proposals Baltimore Accountable Health Communities - Technical Infrastructure 1
1. BACKGROUND / PURPOSE Addressing health-related social needs is essential to driving population health and wellness in Baltimore. Although Baltimore City is home to some of the best healthcare institutions in the country, it also experiences enormous health disparities. Medical literature shows that more than 70 percent of health outcomes are driven by social factors, not clinical care. As Medicare and Medicaid beneficiaries make up nearly 60% of the total population in Baltimore, the Baltimore City Health Department (BCHD), in partnership with HealthCare Access Maryland (HCAM), Maryland Medicaid, Baltimore City health systems, federally qualified health centers (FQHCs), and community-based organizations (CBOs), is committed to identifying and addressing the health-related social needs of Baltimore City s Medicare and Medicaid beneficiaries via clinical-community linkages that will impact total health care costs, reduce utilization, and improve health outcomes for this vulnerable population. The Baltimore City Health Department has been awarded a $4.3M grant from the Center for Medicaid and Medicare Innovation (CMMI) over five years to design, implement, and evaluate a city-wide Accountable Health Communities (AHC) model that will both address beneficiaries health-related social needs as well as drive stakeholder alignment with social needs resources. The core components of the Baltimore City AHC model will include: Health-related social needs screening for Medicaid and Medicare beneficiaries at all participating healthcare providers Referral of qualifying beneficiaries to an AHC navigation hub housed at HCAM, to receive navigation support in accessing social needs-related services Comprehensive technology, data, and quality improvement infrastructure to support resolution of health-related social needs, track outcomes, and drive ongoing program improvement Convening of healthcare and community stakeholders and city/state agency partners to drive alignment around both enabling and evaluating clinic-community linkages within Baltimore City Beneficiaries entering into a participating clinical delivery site will be screened for their social needs. When a beneficiary screens positive, they are stratified into either a low-risk or high-risk intervention group. Based on stratification, beneficiaries may receive either a tailored community referral summary at point of care or be referred to the AHC navigation hub at HCAM for full navigation and resource connection services. In order to avoid duplication of program services, in accordance with principles stated in the FOA and existing initiatives led by Maryland Medicaid and our hospital partners, we have designed our screening, referral, and navigation processes to contain several 2
checkpoints around existing case management and/or social needs services that a beneficiary may already be receiving through their provider or managed care organization. Healthcare Access Maryland along with our partner the Baltimore City Health Department are seeking a technology partner to implement the technical infrastructure required for the Accountable Health Communities Grant. This document outlines those requirements which vendors must meet to be selected as a partner in this effort and will include: the capacity for social needs screening, referrals, and a community resource directory within their platform, as well as backend integrations to CRISP (regional HIE) and other relevant systems as needed. 2. TIMELINE November 20, 2017 December 30, 2017 January 1-15, 2017 January 15-30, 2017 February 2018 March 2018 April 2018 RFP released RFP submission deadline RFP committee scores and identifies 5 finalists for follow-up review Finalists will be reviewed Selected vendor will be notified Vendor develops technical infrastructure Vendor develops technical infrastructure April 30, 2018 Vendor is expected to launch technical infrastructure to support 5 pilot sites 3. SUBMISSION AND EVALUATION Vendors are asked to submit responses using as much space as is necessary to address each aspect of the scope of work within this RFP. A review team comprising members of the HCAM leadership team along with representatives from BCHD, CRISP, and other key stakeholders will review each proposal and engage the vendors for further review as needed. Due to the expected volume of proposals, no direct feedback will be provided for vendors not selected. 3
4. PRICING There is $577,480 available to support this work as awarded by CMS to support the scope of this RFP. Additional use-cases will be defined and supported separately. RFP submissions should include a breakdown of costs by category of work for each of 5 years as well as outline long-term costs. 5. PHASES The Accountable Health Communities grant is a 5-year grant. We are seeking a partner who can both expeditiously meet the requirements of phase 1 of this project as well as demonstrate the ability and willingness to expand their scope as further use-cases become defined and funding becomes available. This RFP focuses on the requirements for phase 1 and 2, and those requirements necessary to provide scalability into future phases. A brief description of the phases is below: Phase 1: To be completed by April 30, 2018, this phase includes the deployment of a system to support social needs screening and integrated community resource referrals at 5 selected pilot sites across Baltimore City. Phase 2: To be completed by November 1, 2018, this phase involves the scaling of the AHC model across all of Baltimore City, such that social needs screenings are happening at all emergency departments, labor and delivery, and inpatient psychiatric facilitates at every hospital system in Baltimore. This phase also includes the deployment of a public-facing resource directory that is freely accessible to Baltimore City residents. Phase 3: To be completed by January 1, 2019, this phase focuses on sharing information from the vendor s system back to the HIE and partnering institution s medical record and case management systems. This will be accomplished through API integration and will involve configuration such that providers can view a beneficiary s social needs history and the community resources they are accessing alongside their medical record. This integration may be done with the Chesapeake Regional Information System for our Patients (CRISP), Maryland s health information exchange and align with their offerings and integration structure. - This phase is included here to be illustrative of our vision for an integrated care ecosystem, not as a requirement for RFP submission. Our goal is to identify a vendor who is willing and capable of scaling as we grow our program. 4
6. SCOPE OF WORK The selected vendor will implement a system that conforms to the requirements outlined below. These requirements will satisfy the initial phase of the grant award described above and guide any development or procurement efforts at the selected vendor for future growth. Additional requirements for future phases will be included as addendums to this agreement. A. SYSTEM REQUIREMENTS i. System Hosting and Management 1. The selected vendor will be responsible for all implementation, management, monitoring, and customization of their system for the duration of the grant period 2. The selected vendor will implement security controls to meet all federal and state regulations and industry standards, including at a minimum SOC 2 Type 2 compliance for the data center 3. The vendor will list all supported platforms and operating systems 4. The client side of the system will be web-based 5. The vendor will provide backup methodology and disaster recovery/business continuity outlines for each deployment scenario 6. The vendor will support a test environment for changes 7. The system can be cloud-based or deployed on-premise to BCHD, CRISP, or another partner. The vendor s preferred deployment scenario should be outlined and be inclusive of all supporting technology and security controls, including all technical infrastructure, all servers, network equipment, log file management, compliance, patching, upgrades, etc. ii. Access Control 1. The platform will support role-based access control 2. The platform will support authentication and authorization through an integration with the HIE such that credentialed providers within the HIE could have single sign-on access to the vendor s platform 3. The vendor will outline how data breach reporting and unauthorized access will be handled, including logging, auditing, and reporting 4. Access to the screening tool and resource directory features can be separately credentialed such that users in social service agencies without access to the selected vendor query portal can access these features with a username/password provided by the selected vendor 5
iii. Consent Management 1. The selected tool will include an informed consent that the beneficiary will complete 2. The tool will support digitally signing a consent on a screen 3. This information must be stored with the screening record and included in the backend data storage iv. System Features and Functionality 1. Social Needs Screening a. The selected vendor will implement the capability for social needs screening to collect those questions in Appendix A and B of this document b. The vendor s platform will allow for updates to be made to the screening without the need for vendor services (administrative customization capabilities) c. Ability to support multiple screens as defined by organization d. Ability to make different screening questions mandatory e. Ability to track user, date, and time of assessment f. Support Social Needs Screening Within EMR for those hospital systems that want to implement the social needs screening within their existing EMR, the selected vendor will facilitate the collection of that data and the backend insertion of that data into their tool such that referrals and reporting can be supported g. Such integration will be facilitated through the HIE via bi-directional HL7 / FHIR interfaces 2. Patient registration a. The vendor will employ a master person index functionality such that the same beneficiary entered into the system at multiple distinct sites will share a common record for reporting purposes v. Referrals 1. The system will support the full referral workflow from screening to suggested community resources available in the resource directory, including suggestion of resources based on the screen results 2. The system will be able to send notifications of a completed screen, through email and web services integration 3. The system will support sending referrals electronically to HCAM via their web interface (eclinicalworks) 4. The system will allow for intelligent connections between the results of a social needs screen and the availability/geography of resources 6
vi. vii. 5. The system will support cases for clients within the system, including maintaining of various case states (open, closed, referred) 6. Participating organizations will be notified of any referrals and will have the ability to log into the system and view incoming referrals a. Providers and care managers can mark referrals as anonymous so community-based providers are not passed the identifying information of the beneficiary Reporting 1. The system will allow for self-service reporting, including the extraction of raw data 2. The selected vendor will facilitate monthly reporting to BCHD to include the below items, this can be through offline data files or via a dashboard provided to BCHD program contacts 3. Point level data from each completed social need screen, including all collected demographics, screening results, and any other disposition 4. Reporting requirements can be satisfied by the selected vendor providing a reporting portal for BCHD to download their own data and reports; in this case, raw data must also be able to be downloaded from the system 5. The system will support site productivity reports measuring the number of beneficiaries screened and referred at each location 6. The vendor will address how they can support reporting on required CMS data elements as attached in Appendix B of this document 7. The vendor will supply a list of all reports available within their platform as well as any ad-hoc reporting capabilities 8. Data must be able to be extracted from the platform in CSV format 9. System will report on referrals and resource connections 10. System will track and report on case worker referrals, workload, and rates of referrals to particular social needs programs Resource Directory 1. The selected vendor will deploy a community resource directory with the following features: a. Comprehensiveness the tool must contain a baseline level of content for at least 200 community resources in the Baltimore City area, including name, address, phone number, services offered, date of last contact information update, and eligibility criteria. b. Ability to sort resource directory is sortable at minimum by zip code but ideally also by the categories listed above c. Ongoing quality control vendor outlines a clear plan of action for maintaining freshness of the database, to include at minimum a sweep for accuracy on a monthly basis 7
d. Analytics capability tool should also log information regarding services needed and/or accessed, with reporting capability, etc. e. Community view the resource directory will have a public view where a public website can be queried for a listing of resources in a specific geographic area f. Resource categorization resources can be grouped and queried by categories such as Food Access, Housing, etc. g. Support for program eligibility criteria (such as insurance requirements, physical requirements [wheelchair access, men only shelter, etc.], and other programmatic requirements [financial hardship, etc.]) h. Support for credentialing, such that types of resources defined within a category can be required to have specific defined credentials (I.E. trauma-informed care certification for a level 3.7 facility under the category or behavioral health) i. Result prioritization resources results should be prioritized based on needs identified by the beneficiary s social needs screening i. Results should be displayed in an easy to read format, be printable for distribution, and users should have the ability to customize lists of patient populations j. Resource referrals should be presented to support various levels of health literacy, the vendor should address this in their response k. Feedback the resources directory should allow for users with the proper permissions to add feedback about a specific resource, including indications of quality if the resource is still open, their capacity, notes on experience, and other fields as defined by BCHD l. Follow-up the system should track referrals made for beneficiaries such that case managers can update if services were received at the community organization and any notes around an individual s care and outcomes m. Support for resource rating such that beneficiaries can provide feedback directly on their experience with community organizations and services provided n. Patient access for phase 1 the system does not need to provide a patient portal or authorized patient access, however, the ideal vendor will demonstrate a strategy to meet this goal in future phases 8
viii. Mobile interfaces 1. The selected system will support mobile interfaces for screening completion, referral management, and the resource directory ix. GIS Capabilities 1. The selected system will support GIS capabilities, including geocoding of all entered addresses, resource searching based on a radius around the beneficiary s address, and mapping of available resource in a given area x. Multilingual 1. The vendor will supply a list of languages their platform supports xi. Integration Capabilities 1. The platform should have API access for all main functions, including: a. Completing screenings b. Updating resources c. Pushing referral information d. Updating resource characteristics e. Adding resources f. Providing feedback on community resources 2. The system must support FHIR integration 3. In future states partner organizations will use their EMR to drive this process, the vendor should address how they would support 2-way integration into EMR systems via an HIE 4. For providers who choose to implement social needs screenings in their EMR systems, the selected vendor must demonstrate the ability to ingest completed screens - This integration will be through CSV uploads and ultimately via a direct integration with CRISP (HIE) xii. Participant Dashboard 1. Organizations that are included in the resource inventory should have the ability to interact with their listing, including: a. Metrics reporting organizations should be able to view the number of times their resource has been searched, viewed, recommended, etc., as well as quality scores or other feedback entered by users of the platform. b. Capacity and capability updating organizations should be able to update their credentials, description of services offered, and capacity measures (ideally this can happy programmatically through API access or via a direct system logon) xiii. Partner Characteristics 1. Have at least 5 years experience of successful sales/partnerships beyond pilot phase, 2. Demonstrate financial solvency a. Able to show 2 prior years gross revenue 9
b. Have a paying client base, preferably including 5+ healthcare institutions/health systems 3. Have a proven track record to scale to similar end user volumes and characteristics 4. Have a clear articulation of the connection between the screening, referral, and community resource directory components of the platform 5. Have an existing community resource inventory 6. Have demonstrated success with a strategy for updating the resource inventory 7. Have a demonstrated understanding of the impact social needs have on medical care as well as the specific role of their platform, as indicated via evaluations, studies, data reporting, or other 8. Have a legacy technology platform with a demonstrated maturity to include: a. Development pipeline b. Strong product management to include: process for identifying new development needs, prioritizing those requests, estimating effort, and pushing new releases c. Change management procedures d. Documented security policies and practices e. The platform should maintain an audit history of transactions made by individual users that is compliant with HIPAA practices f. Experience with federal laws governing protected health information, including HIPAA, FERPA, and relevant behavioral health statutes g. Experience handling PII and PHI h. Integration capabilities and successful integration projects 9. Be able to demonstrate the capability to expand their platform to achieve future requirements as outlined in the phases portion of this RFP 10. Incorporating available resource directory information from designated partners through custom integrations 11. Integration with the selected vendor clinical platform as determined necessary in the above-outlined phases 12. Provide a public-facing resource directory which is freely available that enables citizens to explore available community resources 13. Comply with or have a strategy to address open data standards for storage of data, integration with partners, authentication, etc. 14. Provide platform documentation and support for onboarding of endusers, including video materials. 15. Vendor should outline all associated costs for initial deployment as well as scaling to meet the needs of this program, including costs for 10
interface development, licensing, implementation, user training, technical support, upgrades, customization, and maintenance. 16. Vendor should submit an architectural diagram outlining all software modules, hosting options, and integration points. 17. Vendor should estimate user training hours required for deployment 18. Vendor should submit their standard SLA including process for problem resolution and escalation 19. Vendor will outline how changes will be requested, tracked, evaluated, and executed over the grant period 7. HCAM RESPONSIBILITIES In order to implement a successful Accountable Health Community, HCAM and our partners will support the selected vendor in the following: a. Manage all grant requirements including all reporting to CMS b. Serve as subject matter experts and points of contact for social needs screening, referrals, and community resource inventory c. Provide final approval on timelines, work phases, and success criteria d. Convene all needed partners, including workgroups to focus on development of technical standards, clinical workflows, and community members e. Support the selection of a selected vendor f. Provide funding for the work 11