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REQUEST FOR INFORMATION (RFI) Issue date: 02/12/2015 Closing date: 03/06/2015 Subject: The State of Idaho’s Statewide Healthcare Innovation Plan’s (SHIP) Request for Information (RFI) on Health Information and Data Analytics. The State of Idaho, Department of Health and Welfare (DHW) and the Idaho HealthCare Coalition (IHC), has a requirement for information concerning the furnishing of services for acquiring health information from various providers and stakeholders pursuant to this innovation plan, and provide an analytics design and dashboard for evaluating outcomes specific to Idaho’s Performance Measure Catalog. Information obtained from the responses to this RFI may be used to refine the requirements for a formal Request for Proposal (RFP) which may be released at a later date, assist us in projecting a budget for acquiring the services, and also to identify potential vendors who may be interested in providing a competitive proposal. We highly encourage all respondents to read and review more detailed information regarding the SHIP. Please visit the website at: http://www.healthandwelfare.idaho.gov/Medical/StateHealthcareInnovationPlan/tabid/2282/Default.aspx It is important to note that this is a request for information only, not a solicitation. No award will be made based upon the information received. I. Introduction and Background Idaho envisions a statewide healthcare system transformation that changes the standard of practice for health care for the state, delivering integrated, efficient and effective primary care services through the patient-centered medical home (PCMH), which is integrated within the local medical community, and supported and incentivized by multi-payer, value-based reimbursement methodologies. Through this transformation, Idaho will improve the quality and experience of care for all Idahoans, improve health outcomes and control costs. Health information technology (HIT) will enhance patient care through shared patient information via the Idaho Health Data Exchange (IHDE), through coordination of care across delivery settings, through communication with patients across multiple formats, and by utilization of Electronic Health Records (EHRs), patient portals, and other HIT tools to provide integrated, effective, and efficient patient care. The model design will require incorporation of data sharing, interconnectivity, analytics and reporting for the sharing of critical information at the patient and population levels. 1 II. Description of Items or Services Required DHW and IHC are looking for information regarding vendors experience and expertise in architecting and building a statewide health care analytics system to track, analyze and report feedback to individual providers on selected performance and outcome measures to improve their practice. This includes the integration of clinical data, Medicaid claims and/or payer data at the patient and aggregate levels for reporting and analysis. This will not be an all-payer claims database, but rather a model that integrates clinical data with related claims –based data from payers. The data analytics system will also report on regional population management metrics which will be used to identify and address regional population management issues. At the state level data analysis will inform policy development and program monitoring for the entire healthcare system transformation. The preference is for vendors and companies responding to this RFI to have significant knowledge of the Healthcare industry and information technology, with the capability to extract data based on key performance measures, and develop an analytics dashboard. These key performance measures are identified along with their use in Idaho’s Initial Performance Measure Catalog (Attachment A). These measures may change over time. III. Requested information It is requested that interested vendors provide the following information: 1.) Briefly describe your company, services, history, ownership, financial information, and other information you deem relevant. Please provide a contact person’s name and telephone number for any clarifications. 2.) Is your organization capable of or interested in furnishing the items or services described in this RFI? Please describe both your history of furnishing the items or services and your capabilities for furnishing them in the future. Please provide the following information about your organization: Profile of vendor’s existing client base (e.g. # health systems: hospitals, clinics, labs, payers, providers, and their respective services / projects). Tenure (dates) of existing client (above). History of enrollments/terminations of client base. 3.) What issues do you feel need to be addressed in order to assure a successful project with regard to these items or services or preparation of an RFP? 4.) From your experience in providing these items or services, what lessons learned can you share with us? 5.) Cost estimate or range of cost (This is a cost estimate only. Any information provided will be used to assist us in developing a budget for the acquisition. You will not be held to any information or prices provided): a. What items or services need to be provided on a one-time basis? What is the estimated cost of each? 2 b. What items or services need to be provided on an on-going basis? estimated cost of each? What is the c. Are there any other items or services which will affect pricing? What is the estimated cost of each? d. Are there any volume discounts or payment options which may affect pricing? What are the estimated cost saving of each? 6.) How long do you estimate that it will take to provide each of the items or services describe in this RFI. What issues may affect the delivery or needs to be addressed in the preparation of an RFP? Clinical and Claims based Analytics --- at a minimum include detailed information on: The data management capabilities of your company’s system including support for SQL Server, DB2, Oracle, and others The provision and migration of clinical data, claims data, multi-dimensional clinical and claims data marts, and the generation and support of OLAP data cubes The ability to prevent the duplication of data resulting from extracting data from hospital and practice based EHRs and receiving direct data feeds from hospital and free-standing labs and imaging centers The ability to produce retrospective and prospective analysis of resource utilization and outcomes including predictive models of future resource utilization and projected outcomes The ability for authorized users to access their data at the repository and warehouse levels, create their own data marts and data cubes, and to produce their own canned or custom reports Identifying all nationally recognized quality measures that your offering supports “out of the box” or with some level of customization, and the capabilities of reporting on those measures for Patient Centered Medical Homes. The ability to utilize event triggers to connect to hospital and practice based systems to obtain and exchange information The ability for authorized users to copy and customize national quality measures and to be able to track and report on these custom measures The ability for authorized users to access and modify standard displays, dashboards and reports Support for the creation, interactive access, and distribution of diagnosis and treatment based patient registries (e.g. patient diabetes registry, smoking cessation registry, colorectal cancer screening registry, etc.) Support for the creation, viewing, and distribution of patient and physician quality measures and treatment protocol based score cards 3 Hosting Hardware and Software --- at a minimum include detailed information about: High Availability capabilities for all hardware, data storage, and network components. Hardware and operating systems architecture; include detail information related to the use of physical and virtual server configurations; identify whether or not there is sharing resources across customers. Data storage technologies utilized and database architectures utilized; include detail information related to data backup and recovery processes and practices; Idaho Health Data Exchange (IHDE) requirements prohibit the sharing of databases with other vendor customers. Hosting services qualifications and experience; include detailed information related to the hosting data center’s physical environment, and its SSAE 16 certification. Project Management (PM) --- at a minimum include detailed information related to: Project management processes, practices or methodologies used Provide examples of a project plan related to this type of RFI including: o Project staff – organizational structure o Project scoping process o Success metrics / ratings: deliverables, timelines, cost containment o PM tools used Support Services --- at a minimum include detailed information related to: Account Management Processes Help Desk Process and SLAs Service Level Agreement; include performance measures, monitoring, reporting, and penalties Procurement of Additional and New Services Product Maintenance and Support Process; include information related to frequency and timing of the application of product fixes Product Feature and Function Enhancement Process Product Release Process; include frequency and schedule for releases Involvement of DHW / IHDE / IHC and associated workgroups in the testing and verification of usability and serviceability of product fixes, enhancements, and new features and releases User Group Support; include the process description for users to submit requests and suggestions for changes and improvements in products and services, and your process for the review and response to these items Recommended staffing to support your company’s system (e.g. position types and quantity). 4 For multi-vendor a solution, provide details of each vendor’s role and support responsibilities related to the solution offered. Provide details if your solution includes first level support prior to involving a third-party vendor’s product support. Approach and goals towards knowledge transfer to customers in the areas of: o System Administration o Interface Development o Best Practices – Use of functionality Solution Programming Language and Browser Support --- at a minimum include detailed information on: Programming language(s) are utilized for each solution(s) offered Which browsers are supported for each solution(s) offered Privacy, Security, and Audit --- Please provide information regarding the following: Product features and functions HIPAA, HITECH, NIST and other security and privacy standards and requirements with which your offering is compliant Support for 2-factor user authentication Certification of the components of your offering including the identification of the certifying organizations (e.g. HITSP, ONC HIT Certification, etc.) Identifying the available reports, displays, and dashboards IV. Terms and Conditions A. All material submitted in response to this RFI becomes the property of the State of Idaho, Department of Health and Welfare, and shall not be returned to the responding vendor. B. At the sole discretion of the Department the information provided may be used for the following purposes: 1. Identify issues and refining the requirements for an RFP which may be released at a later date. 2. Assist in projecting a budget for acquiring the services. 3. Identifying potential vendors who may be interested in providing a future competitive proposal. 5 C. The Idaho Public Records Law, Idaho Code Sections 9-337 through 9-348, allows the open inspection and copying of public records. Public records include any writing containing information relating to the conduct or administration of the public's business prepared, owned, used, or retained by a state or local agency regardless of the physical form or character. All, or most, of the information contained in your response will be a public record and as such will be subject to disclosure under the public records law. Certain exemptions from disclosure can apply, one of which may be for “trade secrets” as defined in the Idaho Public Records Act, Idaho Code Section 9-340D(1), a copy of which is available for viewing on-line at: http://legislature.idaho.gov/idstat/Title9/T9CH3SECT9-340D.htm 1. Trade secrets include a formula, pattern, compilation, program, computer program, device, method, technique or process that derives economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by, other persons and is subject to the efforts that are reasonable under the circumstances to maintain its secrecy. 2. If you consider any element of your response to be a trade secret, or otherwise protected from disclosure, you must so indicate by marking each page of the pertinent document. Include the specific basis for your position that it be treated as exempt from disclosure. 3. Marking your entire response as exempt is not acceptable or in accordance with the Public Records Act and will not be honored. In addition, a legend or statement on one (1) page that all or substantially all of the response is exempt from disclosure is not acceptable or in accordance with the Public Records Act and will not be honored. Prices quoted in your response are not a trade secret. The Department, to the extent allowed by law and in accordance with these terms and conditions will honor a designation of nondisclosure. You will be required to defend any claim of trade secret or other basis for nondisclosure in the event of an administrative or judicial challenge to the Department’s nondisclosure. Any questions regarding the applicability of the Public Records Law should be addressed to the Department or should be presented to your own legal counsel - prior to submission. D. THIS IS NOT A BID, NO AWARD WILL BE MADE. 6 Response Information Your written response shall not exceed thirty (30) total pages and shall include a detailed architectural diagram delineating the components and their interactions and dependencies. However, you may attach other information and materials that you believe relevant to your RFI response and the thirty (30) page limit does not apply to such attachments. V. Address for Responses If you are interested in providing any of the information requested in this RFI, please submit your written response via E-mail or USPS, UPS, Fed Ex or hand deliver by close of business Friday, March 6, 2015 to: Idaho Department of Health & Welfare Attention: RFI1500409 Contracting & Procurement Services 450 W. State Street (9th Floor) Boise, ID, 83720-0036 Contact person: Mike Gwinn Title: Purchasing Agent e-mail: [email protected] Telephone: 208-334-5734 7 ATTACHMENT A - Idaho’s Initial Performance Measure Catalog Idaho’s Initial Performance Measure Catalog Measure Name (and Source) Screening for clinical depression. Measure pair: (a.) Tobacco use assessment. (b.) Tobacco cessation intervention (SIM) Measure Description Rationale for the Measure In Idaho, 22.5% of persons aged 18 or older had a mental illness and 5.8% had SMI in 2008–2009 while 7.5% of persons aged 18 or older had a major depressive episode (MDE). During the period 2005–2009, 9% of persons aged 12-17 had a past MDE. Suicide is the second leading cause of death for Idahoans aged 15–34 and for males aged 10–14. This measure aligns with Healthy People 2020. Percentage of patients who In Idaho, 16.9% of the adult population were were queried about tobacco smokers in 2010 (>187,000 individuals). Idaho ranks fifteenth in the country in use one or more times prevalence of adult smokers and its smokingduring the two-year attributable mortality rate is ranked eighth in measurement period. the country. Percentage of patients identified as tobacco users who received cessation intervention during the two-year measurement period. Percentage of patients aged 12 years and older screened for clinical depression using a standardized tool and follow up plan documented. Asthma ED visits. Percentage of patients with asthma who have greater than or equal to one visit to the ED for asthma during the measurement period. While asthma prevalence (those with current asthma) in Idaho was 8.8% in 2010, reduction of emergency treatment for uncontrolled asthma is a reflection of high quality patient care and patient engagement. Acute care hospitalization (risk-adjusted). Percentage of patients who had to be admitted to the hospital. While Idaho has one of the country’s lowest hospital admission rates (81/1000 in 2011), this measure is held as one of the standards for evaluation of utilization and appropriate use of hospital services as part of an integrated network. Data currently unavailable. Metric will be used to establish baseline. Readmission rate within 30 Percentage of patients who days. were readmitted to the hospital within 30 days of discharge from the hospital. 8 Measure Name (and Source) Measure Description Rationale for the Measure Avoidable emergency care without hospitalization (risk-adjusted). Percentage of patients who had avoidable use of a hospital ED. Elective delivery. Rate of babies electively delivered before full-term. While Idaho has one of the country’s lowest hospital ED utilization rates (327/1000, 2011), this measure is still held as one of the standards for evaluation of utilization and appropriate use of emergency services, as well as a reflection of quality and patient engagement in primary care related to avoidable treatment. Data currently unavailable. Metric will be used to establish baseline. While Idaho’s percentage of low birth weight babies is low compared to the national average, the opportunity to improve prenatal care across settings is an indicator of system quality. 1,355 babies in Idaho had low birth weights in 2011, compared to 1,160 in 1997. Idaho has a 100% shortage of mental health The percentage of individuals 18–64 years of providers statewide. Without these critical providers, there is little or no support for age during the patient engagement and medication measurement year with adherence. schizophrenia who were Improved adherence may be a reflection of dispensed and remained on improved access to care and patient an antipsychotic medication engagement. for at least 80% of their treatment period. Low birth weight rate (PQI This measure is used to 9). assess the number of low birth weight infants per 100 births. Adherence to antipsychotics for individuals with schizophrenia (HEDIS). Weight assessment and Percentage of children, two counseling for children and through 17 years of age, adolescents (SIM). whose weight is classified based on Body Mass Index (BMI), who receive counseling for nutrition and physical activity. 9 In 2011, 13.4% of children were overweight as defined by being above the 85th percentile, but below the 95th percentile for BMI by age and sex, while 9.2% were obese, i.e., at or above the 95th percentile for BMI by age and sex. Measure Name (and Source) Measure Description Rationale for the Measure Comprehensive diabetes care (SIM). The percentage of patients 18-75 with a diagnosis of diabetes, who have optimally managed modifiable risk factors (A1c<8.0%, LDL<100 mg/dL, blood pressure<140/90 mm Hg, tobacco non-use, and daily aspirin usage for patients with diagnosis of IVD) with the intent of preventing or reducing future complications associated with poorly managed diabetes. Adult diabetes prevalence in 2010 was 8.0%. Overall, this represented one in 12 people in Idaho had diabetes. Access to care. Members report adequate and timely access to PCPs, BEHAVIORAL HEALTH, and dentistry (measure adjusted to reflect shortages in Idaho). Idaho has a critical access shortage of primary care providers, behavioral health providers, and dentists across the State which impedes access to the appropriate level of care. Childhood immunization status. Percentage of children two years of age who had four DtaP/DT, three IPV, one MMR, three H influenza type B, three hepatitis B, one chicken pox vaccine, and four pneumococcal conjugate vaccines by their second birthday. The measure calculates a rate for each vaccine and two separate combination rates. While there have been significant improvements in immunization rates, Idaho ranks 43rd in the nation with an immunization rate of 87.33% in 2012. This measure aligns with Healthy People 2020. 10 Measure Name (and Source) Measure Description Rationale for the Measure Adult BMI Assessment. The percentage of members In 2010, 62.9% of adults in Idaho were overweight, and 26.9% of adults in Idaho 18 to 74 years of age who were obese. had an outpatient visit and who’s BMI was documented during the measurement year or the year prior to the measurement year. Non-malignant opioid use. Percent of patients chronically prescribed an opioid medication for noncancer pain (defined as three consecutive months of prescriptions) that have a controlled substance agreement in force (updated annually). From 2010–2011, Idaho had the fourth highest non-medical use of prescription pain relievers in the country among persons aged 12 or older at 5.73%. The timeline for developing a baseline and establishing performance reporting to achieve population health management is outlined below. The IHC will establish a baseline for each of these measures in Year 1 of model testing. Due to the lack of uniform reporting that exists today, the IHC will develop a baseline from the pockets of information that are currently available across payers and populations. An external organization with expertise in performance data collection, analysis, and reporting will assist the IHC in gathering and analyzing the data to establish a baseline by the end of Year 1. In Year 2, the IHC will select four core performance measures from the initial Performance Measure Catalog to be reported by all PCMHs in Year 2. The statewide performance measures for Year 2 will include the three SIM measures: tobacco cessation intervention, weight assessment and counseling for children and adolescents, and comprehensive diabetes care. In consultation with the IHC, Regional Collaborative (RCs) will identify additional performance measures from the Performance Measure Catalog to be collected from PCMHs in their respective regions in Year 3. The additional measures collected in Year 3 may vary from region to region depending on performance and regional health needs and will be informed by community health assessments and regional specific clinical data. During the first year of implementation and model testing, the IHC will analyze the current system capabilities and constraints regarding statewide data collection and reporting. By the end of Year 1, decisions regarding construction of the statewide database and protocols for PCMHs to report on 11 performance measures will have been developed. The IHC will engage stakeholders in this discussion to ensure that a statewide solution is viable and acceptable to the different communities in Idaho. The development of a Performance Measure Catalog and reporting of statewide performance measures across multiple payers and populations is a major first step for Idaho as we move toward population health management. 12