AttachK_Point Solutions Guidelines.pdf
PDF 172 KB Posted
- Attached to
- RFP for Medical & Pharmacy Benefits
- Solicitation number
- S-44300-00014758
- Issued by
- Marion County, Oregon
About this file
This is an Attachment K guideline document for the Public Employees' Benefit Board (PEBB) of Oregon's Request for Proposal for Medical and Pharmacy Benefits Services, identified as OregonBuys Bid No. S-44300-00014758. The document establishes vendor expectations for point solution pricing, reporting requirements, performance guarantees, evidence-based program standards, and equity considerations. Vendors must propose engagement-based and outcomes-based pricing models and provide PEBB-specific reporting on metrics including total eligible and registered members, engagement rates, appointment scheduling and completion, assessment completion, average wait times, care modality, visit frequency, activity completion, participant satisfaction scores, member demographics, and clinical outcomes with demonstrated impact such as weight loss percentages, A1C reductions, and return on investment. Performance guarantees should place meaningful fees at risk, with PEBB suggesting a minimum of 20 percent of fees at-risk tied to PEBB-specific metrics and outcomes, using diabetes management programs as an example with suggested risk allocations for enrollment targets, program completion rates, and clinical outcome improvements.
Vendors must demonstrate evidence-based programming aligned with best-practice guidelines, such as CDC-recognized programs for diabetes prevention, while acknowledging that evidence-based medicine selection involves subjective processes that can perpetuate health disparities. PEBB prioritizes health equity and requires vendors to align with specific equity standards including website and app compliance with WCAG 2.0 accessibility requirements, demonstrated organizational diversity, equity, and inclusion policies with cultural competence and implicit bias training, gender-inclusive language and identification markers, diverse representation across all materials, screening for social determinants of health with closed-loop community referrals, and multilingual support in English and Spanish with a roadmap to expand to Oregon's additional prevalent languages and provision of language line and translation services.
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Text version
PEBB Medical & Pharmacy Benefits RFP OregonBuys Bid No. S-44300-00014758 Attachment K
Attachment K
Point Solution Guidelines
- Pricing: PEBB has worked with their vendor partners to implement engagement-based pricing; In your responses in Attachment A please propose engagement- and/or outcomes-based pricing using the guidelines in this Attachment.
- Reporting: PEBB has developed a set of minimum reporting standards for their vendor partners, which should be provided on a PEBB-specific basis, if applicable:
o Total eligible members o Total registered members o Total engaged (total unique members and percentage); vendor and PEBB to agree on definition of engaged o Total number of appointments scheduled and completed o Total number of members that completed an assessment o Average wait time to appointment first appointment offered o Modality of care (in-person, virtual, chat) o Average number of visits or interactions/sessions o Total # of activities completed; vendor and PEBB to agree on definition of activities and completion o Participant satisfaction, including percent of engaged members that completed the satisfaction survey (preference given to 5-point CSAT score versus NPS) o Demographics of members engaging: gender, preferred language, age, geographic designation, race/ethnicity o Outcomes and impact of the program (top conditions, clinically significant improvement (i.e.
5% weight loss, 5 pt reduction on PHQ-9/GAD 7, A1C, ROI, etc.)
- Performance Guarantees: PEBB values partners who back their solutions and are willing to place meaningful fees at risk. For example, here are some sample suggested Performance Guarantees for a Diabetes Management Program:
o PEBB-specific metrics and outcomes include the below for a total of 20% of fees at risk.
Carrier can enroll 15% of eligible population (3%)
Carrier reports program completion at or above 25% of eligible population (3%)
Carrier demonstrates ≥0.5% reduction in HgBA1c over 1 year for prediabetes population (7%)
Carrier demonstrates ≥5% reduction in weight (7%)
PEBB Medical & Pharmacy Benefits RFP OregonBuys Bid No. S-44300-00014758 Attachment K
- Evidence-based: PEBB requires their vendor programs be developed using best-practice guidelines and use evidence-based interventions. As an example, PEBB would expect that any proposed diabetes prevention programs be a CDC-recognized program. PEBB’s strategic pillars addresses their position on different evidence bases: “The Board recognizes that evidence-based medicine may seem objective, but the process of study selection, design, and evidence utilization is subjective and prone to bias that perpetuates economic and racial inequalities. Community-based participatory research approaches represent an important strategy for ensuring the validity of intervention research.”
- Equity Standards: PEBB centers their programs and decisions on health equity and wants vendors who are committed to eliminating health disparities and inequities. Please propose vendors that align with the following:
o Website and app meet latest WCAG accessibility requirements (minimum 2.0) o Vendor demonstrates cultural competence and diversity as evidenced by:
Required organizational DEI policies and procedures and cultural competence and implicit bias training
Gender inclusive language and identification markers
Websites/photos/audio/video and all other internal and external materials representing a diversity of race, ethnicity, gender identity, levels of physical ability, age, etc. This also includes incorporating diverse lived experiences.
o Vendor supports PEBB members by screening for social determinants of health and making closed-loop referrals to community or other organizations o Vendor communications (digital, verbal, and written) will follow the standard as indicated in Exhibit C, SOW, of Attachment I, Sample Group Benefit Contract o Program and all available resources and communications should be available in English and Spanish, with a roadmap to expand to Oregon’s other top languages o Program supports members with the use of a language line and/or other translation services
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