Attachment-D-Technical-Reply.xlsx

XLSX spreadsheet 147 KB Posted Apr 21, 2025

Attached to: ITN NO. DMS-2425-249 HEALTHCARE TRANSPARENCY SERVICES
Solicitation number: ITN-12365
Issued by: Florida

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Other files

File	Type	Posted
Attachment-F-PUR-7801.Vendor-Certification-Form.docx	DOCX document	Apr 21, 2025
DMS-2425-249.ITN.Healthcare-Transparency-Services.pdf	PDF	Apr 21, 2025
Attachment-E-Business-Assoc-Agreement.docx	DOCX document	Apr 21, 2025
DMS-2425-249 Q&A.docx	DOCX document	Apr 21, 2025
Attachment-A-Statement-of-Work.docx	DOCX document	Apr 21, 2025
Attachment-B-Cost-Reply.xlsx	XLSX spreadsheet	Apr 21, 2025
Attachment-C-Draft-Contract.docx	DOCX document	Apr 21, 2025

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D-1 Instructions

Invitation to Negotiate for the State of Florida, Department of Management Services.

DMS-24/25-249, HEALTHCARE TRANSPARENCY SERVICES

Worksheet D-1: Technical Reply Instructions

Instructions: In a separate PDF document, Respondents shall provide a Portfolio replying to each of the questions and/or requested information listed within the Technical Reply worksheet. Under Column C of each Technical Response table, Respondents shall indicate the page number their response appears within their Portfolio. Submitted Portfolios should be in at least 11-point type using Calibri, Arial, or Times New Roman font. Failure to submit a reply to any portion of the Technical Reply shall negatively impact the Respondent’s evaluation score.

This section will be scored pursuant to subsection 4.3 (“Evaluation of the Reply”) of this ITN. Evaluators may consider information contained in the other sections of the Respondent’s Reply, except pricing in the Cost Reply, to arrive at their evaluation scores.

&"-,Bold"Attachment D - Technical Reply D-2 Technical Reply

ITN No.: DMS -24/25-249, Healthcare Transparency Services &A &P of &N

D-2 Technical Reply

DMS-24/25-249, D-2 Technical Reply

Insert Respondent's Name

	1.	BUSINESS OPERATIONS AND INDUSTRY EXPERIENCE
	Number	Response Questions/Required Information	Portfolio Page Number	Maximum Point Value	Raw Points Awarded by Evaluator	Weight
(Raw Score multiplied by X)	Maximum Weighted Points Possible	Total Weighted Points Awarded by Evaluator
	1.1	The Respondent shall describe the characteristics of its business model, customer service, and any other operational functions that set it apart from other vendors. Topics include, but are not limited to:		5		3	15	0.0
	1.1.1	Approaches offered by the Respondent that could provide best value for the State;
	1.1.2	Sources and methods used by the Respondent to determine quality ratings of healthcare providers and facilities;
	1.1.3	How the vendor maximizes the use of its healthcare transparency services by plan participants
	1.2	The Respondent shall describe its experience in providing healthcare transparency services. Topics include, but are not limited to:
	1.2.1	Type and complexity/customization of the healthcare transparency services;
	1.2.2	Level of utilization and engagement by plan participants for non-State of Florida customers over a period of three years or more;
	1.2.3	The percentage, over a period of three years or more, of health plan participants for non-State of Florida customers who used the transparency service to receive a shoppable healthcare service;
	1.2.4	Ability to distribute the shared savings between employer group and Members;
	1.2.5	Respondent's approach to providing customer service, including online and by phone; and
	1.2.6	Number and size of previous and current accounts, including contract term and information regarding contract conclusion or termination.
	Subtotal			5			15	0

	2.	PROVISION OF HEALTHCARE TRANSPARENCY SERVICES
	Number	Response Questions/Required Information	Portfolio Page Number	Maximum Point Value	Raw Points Awarded by Evaluator	Weight
(Raw Score multiplied by X)	Maximum Weighted Points Possible	Total Weighted Points Awarded by Evaluator
	2.1	Respondent shall describe its healthcare transparency services and website options. Topics include, but are not limited to:		5		4	20	0
	2.1.1	The healthcare services participants can access via the website, mobile-optimized website, smartphone application, or other electronic devices.
	2.1.2	The available healthcare services that are currently shoppable, whether any shoppable healthcare services are currently bundled, and anticipated additions or changes.
	2.1.3	A description of the Reference-Based Price recommended and why it is the best value to the State of Florida.
	2.1.4	The geographic regions utilized in the Referenced-Based Price (e.g., county, ZIP code).
	2.1.5	Whether the transparency tool supports multiple vendors and multiple plan designs.
	2.1.6	How Members will use the transparency website, including how a Member searches for healthcare services (e.g., specific type of healthcare service, geographic region, provider, quality rating, etc.) and selects a healthcare service.
	2.1.7	How the Respondent actively directs participants to low-cost, High-Quality Providers.
	2.1.8	Whether the website includes a provider directory, including contact information.
	2.1.9	Describe the security of Members’ online activity, including securely logging into the website and the security of Members’ personal information.
	2.1.10	Any other features of the transparency website, including search capabilities, display of out-of-pocket accumulators or savings accounts, wellness initiatives, and targeted advertisements or communications.
	2.2	The Respondent shall describe how it determines the quality ratings of healthcare providers and facilities, including the use of an independent entity to determine quality ratings.
	2.3	The Respondent shall describe how cost sharing with Enrollees is accomplished, including the review or confirmation of adjudicated claims, the determination of the cost sharing amount, and notification processes. Topics include, but are not limited to:
	2.3.1	Necessary data feeds with the Department and/or its health plans;
	2.3.2	Training, minimum qualifications, experience, and turnover of reviewers;
	2.3.3	Number of processors assigned to this account;
	2.3.4	Protocols and/or tools to ensure adjudicated claims are reviewed accurately and timely for purposes of processing shared savings;
	2.3.5	Procedures for handling and resolving inquiries from Members; and
	2.3.6	Procedures for handling and resolving inquiries from the Department.
	2.4	The Respondent shall describe the average utilization rate of its services (i.e., the percentage of Members or Enrollees who utilize the vendor’s healthcare transparency services) and the return on investment experienced by the vendor’s users and provide examples of both. Include the methodologies the Respondent will use to achieve a high utilization rate with a return on investment for the State.
	2.5	The Respondent shall describe how its services meet the statutory requirements of section 110.12303(3), Florida Statutes.
	Subtotal			5			20	0

	3.	IMPLEMENTATION
	Number	Response Questions/Required Information	Portfolio Page Number	Maximum Point Value	Raw Points Awarded by Evaluator	Weight
(Raw Score multiplied by X)	Maximum Weighted Points Possible	Total Weighted Points Awarded by Evaluator
	3.1	The Respondent shall provide a detailed Implementation Plan that clearly demonstrates its ability to meet the Department's requirements for a fully functioning Healthcare Transparency program to be in place on January 1, 2025.		5		3	15	0
	3.1.1	Include a list of specific implementation tasks/transition protocols and a timetable for initiation and completion of such tasks, beginning with the Contract award and continuing through the Service Commencement Date (January 1, 2025). The Implementation Plan should be specific about requirements for information transfer as well as any services or assistance required from the State during implementation.
	3.1.2	Indicate the critical dates that must be met to keep the Implementation Plan on schedule. Include the processes that shall be reviewed, including system testing, information required from the Department or its contracted vendors, and historical claims data and format.
	3.1.3	Describe any anticipated major issues during implementation.
	Subtotal			5			15	0

	4.	SUPPORT AND CUSTOMER SERVICE
	Number	Response Questions/Required Information	Portfolio Page Number	Maximum Point Value	Raw Points Awarded by Evaluator	Weight
(Raw Score multiplied by X)	Maximum Weighted Points Possible	Total Weighted Points Awarded by Evaluator
	4.1	The Respondent shall provide a sample of an Enrollee communications package, including how to access and search for healthcare services, shared savings, and customer service.		5		4	20	0
	4.2	The Respondent shall provide a complete description (including a flowchart) of Respondent's proposed shared savings process.
	4.3	The Respondent shall describe its customer service center. Topics include, but are not limited to:
	4.3.1	Location of call center, hours of operation, and number of representatives;
	4.3.2	Training, minimum qualifications, experience, and turnover of representatives;
	4.3.3	Languages customer service unit can support (other than English) and how that support is provided (i.e., language line or vendor call center representatives);
	4.3.4	Year-to-date call targets and actual statistics (e.g., abandonment rate, speed to answer);
	4.3.5	Call recording system, documentation of calls, and timeframe and manner to furnish call recordings or notes to the department;
	4.3.6	Online chatting, email capabilities, and other electronic access capabilities;
	4.3.7	Customer satisfaction survey methodology and recent survey with results from a group similar in size and composition to the State; and
	4.3.8	Explain whether customer service representatives will be dedicated and exclusive. If not, explain the ratio of representatives to Members.
	Subtotal			5			20	0

	5.	WEBSITE, DATA PROCESSING, INTERFACE AND SECURITY
	Number	Response Questions/Required Information	Portfolio Page Number	Maximum Point Value	Raw Points Awarded by Evaluator	Weight
(Raw Score multiplied by X)	Maximum Weighted Points Possible	Total Weighted Points Awarded by Evaluator
	5.1	The Respondent shall describe its ability to maintain a website with minimal unplanned down time. Describe any experiences with unplanned down time in the last year, including how long the website was down for each incident. Describe the plan of action in an event the website experiences unplanned down time.		5		4	20	0
	5.2	The Respondent shall describe its website data upload and update process.
	5.3	The Respondent shall describe any website or system changes planned for the contract term.
	5.4	The Respondent shall provide details regarding the frequency the website and all related systems get backed up and disaster recovery procedures are tested.
	5.4.1	When were the website and related systems last tested and what were the results?
	5.5	The Respondent shall describe its online reporting tool ad hoc reporting capabilities.
	5.6	The Respondent shall explain its process for routine maintenance of the website and all related systems to be used for this Contract.
	5.7	The Respondent shall describe what the company does to prevent security incidents and its process for responding to security incidents.
	5.8	The Respondent shall provide detailed information regarding its ability to protect State of Florida Data including HIPAA-protected information. Identify the location of data and describe any instance of a data breach or security incident and how the Respondent responded to the circumstances. Also describe the protocols in place ensuring personal health information remains secure. Topics include, but are not limited to:
	5.8.1	Monitoring of all electronic systems and personnel;
	5.8.2	Established processes and fail safes to mitigate breaches;
	5.8.3	Resolution, notification, and reparation protocols when a breach is discovered;
	5.8.4	Protocols that ensure no offshoring of or offshore access to any protected data; and
	5.9	Security protocols for call center employees, correspondence tracking system and process, and electronic systems that access or store protected data.
	5.10	The Respondent shall describe its current and proposed data submission policies and procedures. Topics include, but are not limited to:
	5.10.1	Description of the current and/or proposed methods for exchanging data files with the Department and its contracted vendors;
	5.10.2	Description of current protocols for secure data submission;
	5.10.3	Monitoring for compliance with established data standards; and
	5.10.4	Identification of, and recommendation of solutions to overcome, any barriers to contract implementation.
	Subtotal			5			20	0

	6.	AUDITS
	Number	Response Questions/Required Information	Portfolio Page Number	Maximum Point Value	Raw Points Awarded by Evaluator	Weight
(Raw Score multiplied by X)	Maximum Weighted Points Possible	Total Weighted Points Awarded by Evaluator
	6.1	The Respondent shall describe its process and procedures, including frequency, for conducting audits of its transparency results in order to evaluate the accuracy of its methodologies. If the Respondent does not conduct audits, provide an explanation for not conducting audits of transparency results in order to evaluate the accuracy of its methodologies and whether it believes these types of audits would potentially benefit the State of Florida.		5		3	15	0
	6.2	The Respondent shall describe its policy and procedures for auditing the costs of healthcare transparency services and provider quality information.
	6.3	The Respondent shall describe its internal audit staff duties and how frequently internal audits are performed.
	Subtotal			5			15	0

	7.	CORPORATE INFORMATION
	Number	Response Questions/Required Information	Portfolio Page Number	Maximum Point Value	Raw Points Awarded by Evaluator	Weight
(Raw Score multiplied by X)	Maximum Weighted Points Possible	Total Weighted Points Awarded by Evaluator
	7.1	The Respondent shall provide an organizational chart identifying the names, area of expertise, functions, and reporting relationships of key employees directly responsible for implementing and providing support services for the State of Florida account.		5		1	5	0
	7.2	The Respondent shall provide a short professional biography about the employee(s) primarily responsible for planning, supervising, and implementing the program for the State. Topics include, but are not limited to:
	7.2.1	Description of other duties, if any, assigned to the employee(s) during implementation. Include the number and size of other accounts assigned to the employee(s) during the implementation phase.
	7.2.2	Include an estimated number of hours the employee(s) will commit to the State per day during implementation.
	7.3	The Respondent shall provide a short professional biography about the employee(s) primarily responsible for planning, supervising, and performing account services for the State.
	7.3.1	Description of other assigned duties, if any, the employee(s) perform. Include the number and size of any other accounts currently assigned to the employee(s) and any accounts the employee(s) anticipate being assigned concurrently as the State of Florida account.
	7.3.2	Include an estimated number of hours the employee(s) will commit to account services for the State per day.
	7.3.3	Describe the role and support provided by the account manager for the annual open enrollment process (e.g., meetings, communications).
	7.4	The Respondent shall complete 7.4 Profile of Healthcare Transparency Services for the last three calendar years.
	Subtotal			5			15	0

	Maximum Raw Points Possible	Total Raw Points Awarded by Evaluator	Maximum Weighted Points Possible	Total Weighted Points Awarded by Evaluator
Evaluation Total:	35	0	110	0

&G &"-,Bold"Attachment D - Technical Reply D-2 Technical Reply

ITN No.: DMS -23/24-032, Healthcare Transparency Services &A &P of &N

7.4 Profile of HC Trans Srvcs

7.4 Profile of Healthcare Transparency Services
Services	Calendar Year 2022	Calendar Year 2023	Calendar Year 2024
Total number of clients for employer groups
Total number of Enrollees covered
Number of public sector clients
Average size of public sector clients
Average percentage of utilization
Average employer savings
Employer’s return on investment

&G &"-,Bold"Attachment D - Technical Reply

7.4 Profile of Healthcare Transparency Services

ITN No.: DMS -23/24-032, Healthcare Transparency Services &A &P of &N image1.png image2.png

File details come from the government source that posted it. Updated Apr 28, 2025.