HCM ERP System Replacement - Phase 1 (RFP 758 2700000012 4): ATTACHMENT I - KEHP - Living Well Promise Questionairre -… – Elliott County, Kentucky, due Sep 11, 2026

File	Type	Posted
ATTACHMENT E - Mandatory Requirements Checklist - RFP 758 2700000012.xlsx	XLSX spreadsheet	Aug 26, 2026
ATTACHMENT C - Annual Affidavit and Other Affidavits (NEW).docx	DOCX document	Aug 26, 2026
ATTACHMENT G - Model Statement of Work - RFP 758 2700000012.docx	DOCX document	Aug 26, 2026
Final_RFP_758_2700000012_1_SO_FORM.PDF	PDF	Aug 26, 2026
ATTACHMENT F - Business & Technical Questionnaire - RFP 758 2700000012.xlsx	XLSX spreadsheet	Aug 26, 2026
ATTACHMENT A - Terms and Conditions - RFP 758 2700000012.pdf	PDF	Aug 26, 2026
Addendum Three - ATTACHMENT A - Terms and Conditions - RFP 758 2700000012.pdf	PDF	Aug 26, 2026
ATTACHMENT B - Cost Proposal Form - RFP 758 2700000012 - REV 8-26-2026.xlsx	XLSX spreadsheet	Aug 26, 2026
Final_RFP_758_2700000012_3_SO_FORM.PDF	PDF	Aug 26, 2026
Addendum Two - ATTACHMENT A - Terms and Conditions - RFP 758 2700000012.pdf	PDF	Aug 26, 2026
ATTACHMENT J - Commonwealth's Response to Vendor Written Questions - RFP 758 2700000012.xlsx	XLSX spreadsheet	Aug 26, 2026
ATTACHMENT D - Vendors' Question Form - RFP 758 2700000012.xlsx	XLSX spreadsheet	Aug 26, 2026
Final_RFP_758_2700000012_2_SO_FORM.PDF	PDF	Aug 26, 2026
ATTACHMENT H - DEI Business Associates Agreement - RFP 758 2700000112.docx	DOCX document	Aug 26, 2026
ATTACHMENT K - Vendor Conference Attendees - RFP 758 2700000012.xlsx	XLSX spreadsheet	Aug 26, 2026
ATTACHMENT E - Mandatory Requirements Checklist - RFP 758 2700000012 - REV 7-28-2026.xlsx	XLSX spreadsheet	Aug 26, 2026
Addendum One - ATTACHMENT A - Terms and Conditions - RFP 758 2700000012.pdf	PDF	Aug 26, 2026
ATTACHMENT E - Mandatory Requirements Checklist - RFP 758 2700000012 - REV 7-28-2026, 8-26-2026.xlsx	XLSX spreadsheet	Aug 26, 2026
ATTACHMENT B - Cost Proposal Form - RFP 758 2700000012.xlsx	XLSX spreadsheet	Aug 26, 2026

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Health Goal Selection

21

50

Old

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No

0

Question

Which health goals would you like to focus on?

Yes

NA

Multiple Select

46

50

5

a

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Get stronger & fitter

1

21

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Manage my weight

1

16

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c

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Feel happier

1

12

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d

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Master my finances

1

18

50

e

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Manage stress

1

13

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f

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Eat healthier

1

13

50

g

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Quit smoking

1

12

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h

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Improve my sleep

1

16

50

i

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Lower my cholesterol

1

j

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Improve my blood pressure

1

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General Health

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In general, would you say your health is:

Yes

NA

No

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41

115

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Excellent

2

0

positive

9

50

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Very Good

2

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positive

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Good

2

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neutral

4

50

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Fair

2

1

negative

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Poor

2

negative

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Demographics

Same

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Question

What is your age?

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18-20

3

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21-29

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30-39

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40-49

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50-59

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60-69

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1

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70-79

3

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80 years or older

3

2

Old

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3

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What is your race?

Yes

NA

Yes

N/A

Multiple Select

18

0*

a

Answer

American Indian or Alaska Native

4

neutral

18

*well accepted longer words inflate score. Replaced with "null" results in above score.

b

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Asian

4

neutral

5

c

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Black or African American

4

neutral

25

d

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Native Hawaiian or Other Pacific Islander

4

neutral

41

e

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White

4

neutral

5

f

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Other

4

neutral

5

g

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Prefer not to say

4

neutral

17

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What is your ethnicity?

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NA

Yes

N/A

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23

6

a

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Hispanic or Latino

6

neutral

18

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Not Hispanic or Latino

6

neutral

22

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Prefer not to say

6

neutral

22

New

Yes

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What is your gender?

Yes

N/A

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a

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Female

7 if 40 years of age or older, OR question 8a if 21-29, OR question 8b if 30-39, OR question 11 if 18-20

b

Answer

Male

9 if 50 years of age or older OR question 11 if 18-50

c

Answer

Unspecified

7 if 40 years of age or older, OR question 8a if 21-29, OR question 8b if 30-39, OR question 11 if 18-20

Topic

Health Screenings

Changed

N

Yes

7

Question

How long has it been since you were last screened for breast cancer (mammogram)?

No

Yes

positive

Single Select

80

4

a

Answer

I have never had a mammogram

8b

2

b

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Within the last 2 years

8b

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23

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Answer

More than 2 years ago

8b

1

21

d

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Not sure

8b

1

ERROR:#REF!

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My past medical or surgical history means I no longer need mammogram.

8b

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Changed

N

Yes

8a

Question

How long has it been since you were last screened for cervical cancer (pap smear)?

No

Yes

positive

Single Select

82

2.9

a

Answer

I have never had a pap smear

11

2

b

Answer

Within the last 3 years

11

0

23

c

Answer

More than 3 years ago

11

1

21

d

Answer

Not sure

11

1

8

Answer

My past medical or surgical history makes me not eligible for a pap smear.

11

0

New

N

Yes

8b

Question

How long has it been since you were last screened for cervical cancer (pap smear)?

No

Yes

positive

Single Select

82

2.9

a

Answer

I have never had a pap smear

9 if 50 years of age or older, OR question 11 if less than 50 yo

2

b

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Within the last 5 years

9 if 50 years of age or older, OR question 11 if less than 50 yo

0

23

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More than 5 years ago

9 if 50 years of age or older, OR question 11 if less than 50 yo

1

21

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Not sure

9 if 50 years of age or older, OR question 11 if less than 50 yo

1

8

Answer

My past medical or surgical history makes me not eligible for a pap smear.

9 if 50 years of age or older, OR question 11 if less than 50 yo

0

Changed

N

Yes

9

Question

Have you ever been screened for colon cancer?

No

Yes

N/A

Single Select

45

5

a

Answer

I have never had a colon cancer screening

11

2

a

Answer

Yes, I have had a colonoscopy

10

0

positive

29

b

Answer

Yes, I have had a sigmoidoscopy

10

0

positive

31

c

Answer

Yes, I have had a FIT test

10

0

positive

26

d

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Yes, I have had a Cologuard

10

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f

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Not sure

11

1

Negative

8

Answer

I do not get colon cancer screenings because of my past medical or surgical history.

11

0

Changed

N

Yes

10

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How long has it been since you were screened?

No

NA

Yes

positive

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0

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1 year or less

11

14

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1-3 years

11

9

c

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3-10 years

11

10

d

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More than 10 years

11

18

e

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Not sure

11

8

Same

N

Yes

11

Question

Have you received a flu vaccine in the past 12 months?

Yes

N/A

Single Select

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3

a

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Yes, I have received a flu vaccine in the past 12 months

12

0

positive

56

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No, I have not received a flu vaccine in the past 12 months

12

2

59

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No, I have never received a flu vaccine

12

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39

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Not sure

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I am not eligible to receive a flu vaccine

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Chronic Illness

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12

Question

Do you have any of the chronic conditions below?

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ERROR:#REF!

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Diabetes

13

1

8

50

1

*well accepted longer words inflate score. Replaced with "null" results in above score.

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13

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11

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Cardiac condition

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Asthma or COPD

13

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14

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High blood pressure

13

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19

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High cholesterol

13

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16

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Spine or joint issues (e.g. knee, hip, shoulder)

13

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48

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Cancer

13

1

6

1

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Migraines

13

1

k

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Thyroid conditions

13

1

l

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Gastrointestinal condition

13

1

m

Answer

Allergies

13

1

n

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Chronic pain (e.g. arthritis, migraine)

13

1

6

1

o

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Depression

13

1

10

1

p

Answer

Anxiety

13

1

q

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Other chronic condition

13

1

23

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r

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None

14

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Yes

13

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Are you receiving treatment for any of the conditions below? (For example, medication or regular care from a doctor)

No

NA

Yes

Multiple Select

No

8

a

Answer

Diabetes

14

*well accepted longer words inflate score. Replaced with "null" results in above score.

b

Answer

Prediabetes

14

c

Answer

Cardiac condition

14

d

Answer

Asthma or COPD

14

f

Answer

High blood pressure

14

g

Answer

High cholesterol

14

h

Answer

Spine or joint issues (e.g. knee, hip, shoulder)

14

i

Answer

Cancer

14

j

Answer

Migraines

14

k

Answer

Thyroid conditions

14

l

Answer

Gastrointestinal condition

14

m

Answer

Allergies

14

n

Answer

Chronic pain (e.g. arthritis, migraine)

14

o

Answer

Depression

14

p

Answer

Anxiety

14

q

Answer

Other chronic condition

14

r

Answer

Not currently receiving any treatment

14

Old

N

No

14

Question

Have you received care in an emergency room in the past year?

Yes

No

Single Select

4

a

Answer

Yes

15

1

b

Answer

No

15

0

Old

N

Yes

15

Question

Have you missed work in the past month due to a health issue?

Yes

No

N/A

Single Select

61

115

Ask of every user

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0

a

Answer

Yes, I missed more than 10 days

16

2

b

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Yes, I missed 4-10 days

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1

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Answer

Yes, I missed 1-3 days

16

0

d

Answer

Yes, I missed less than a full day

16

0

e

Answer

No

16

0

Topic

Mental Wellbeing

Old

Y

Yes

16

Question

In the last 2 weeks, how often have you been bothered by having little interest or pleasure in doing things?

Yes

No

N/A

Single Select

109

115

Ask of every user

YES

4

a

Answer

Not at all

17

0

10

50

b

Answer

Several days

17

1

10

50

c

Answer

More than half the days

17

2

23

50

d

Answer

Nearly every day

17

3

16

50

2

Changed

Y

Yes

17

Question

In the last 2 weeks, how often have you been bothered by feeling down, depressed, or hopeless?

Yes

No

N/A

Single Select

94

115

Ask of every user

YES

2

a

Answer

Not at all

19 if careguides feature is OFF else (If 16 &17 score >2, 17a; If 2 or less,else 19)

0

10

50

b

Answer

Several days

19 if careguides feature is OFF else (If 16 &17 score >2, 17a; If 2 or less,else 19)

1

12

50

c

Answer

More than half the days

19 if careguides feature is OFF else (If 16 &17 score >2, 17a; If 2 or less,else 19)

2

23

50

d

Answer

Nearly every day

19 if careguides feature is OFF else (If 16 &17 score >2, 17a; If 2 or less,else 19)

3

16

50

2

New

Y

Yes

17a

Question

In the last 2 weeks, how often have you been bothered by trouble falling or staying asleep, or sleeping too much?

No

N/A

Single Select

113

115

Ask of every user

YES

4

a

Answer

Not at all

17b

0

10

50

b

Answer

Several days

17b

1

10

50

c

Answer

More than half the days

17b

2

23

50

d

Answer

Nearly every day

17b

3

16

50

2

New

Y

Yes

17b

Question

In the last 2 weeks, how often have you been bothered by feeling tired or having little energy?

No

N/A

Single Select

95

115

Ask of every user

YES

3

a

Answer

Not at all

17c

0

10

50

b

Answer

Several days

17c

1

10

50

c

Answer

More than half the days

17c

2

23

50

d

Answer

Nearly every day

17c

3

16

50

2

New

Y

Yes

17c

Question

In the last 2 weeks, how often have you been bothered by poor appetite or overeating?

No

N/A

Single Select

85

115

Ask of every user

YES

3

a

Answer

Not at all

17d

0

10

50

b

Answer

Several days

17d

1

10

50

c

Answer

More than half the days

17d

2

23

50

d

Answer

Nearly every day

17d

3

16

50

2

New

Y

Yes

17d

Question

In the last 2 weeks, how often have you been feeling bad about yourself or that you are a failure or have let yourself or your family down?

No

N/A

Single Select

139

115

Ask of every user

YES

3

a

Answer

Not at all

17e

0

10

50

b

Answer

Several days

17e

1

10

50

c

Answer

More than half the days

17e

2

23

50

d

Answer

Nearly every day

17e

3

16

50

2

New

Y

Yes

17e

Question

In the last 2 weeks, how often have you had trouble concentrating on things such as reading the newspaper or watching television?

No

N/A

Single Select

129

115

Ask of every user

YES

5

a

Answer

Not at all

17f

0

10

50

b

Answer

Several days

17f

1

10

50

c

Answer

More than half the days

17f

2

23

50

d

Answer

Nearly every day

17f

3

16

50

2

New

Y

Yes

17f

Question

In the last 2 weeks, how often have you been moving or speaking so slowly that other people have noticed? Or the opposite - being so figety or restless that you have been moving around a lot more than usual?

No

N/A

Single Select

207

115

Ask of every user

YES

4

a

Answer

Not at all

19

0

10

50

b

Answer

Several days

19

1

10

50

c

Answer

More than half the days

19

2

23

50

d

Answer

Nearly every day

19

3

16

50

2

New

Y

No

19

In the last 2 weeks, how often have you felt nervous, anxious, or on edge?

Yes

Single Select

2

a

Answer

Not at all

20

0

b

Answer

Several days

20

1

c

Answer

More than half the days

20

2

d

Answer

Nearly every day

20

3

New

Y

No

20

In the last 2 weeks, how often were you not able to stop or control your worry?

Yes

Single Select

2

a

Answer

Not at all

21 if careguides feature is OFF else (19 &20 score >2, 20a; If 2 or less, 21)

0

b

Answer

Several days

21 if careguides feature is OFF else (19 &20 score >2, 20a; If 2 or less, 21)

1

c

Answer

More than half the days

21 if careguides feature is OFF else (19 &20 score >2, 20a; If 2 or less, 21)

2

d

Answer

Nearly every day

21 if careguides feature is OFF else (19 &20 score >2, 20a; If 2 or less, 21)

3

New

Y

No

20a

In the last 2 weeks, how often were you worrying too much about different things?

No

Single Select

3

a

Answer

Not at all

20b

0

b

Answer

Several days

20b

1

c

Answer

More than half the days

20b

2

d

Answer

Nearly every day

20b

3

New

Y

No

20b

In the last 2 weeks, how often did you have trouble relaxing?

No

Single Select

3

a

Answer

Not at all

20c

0

b

Answer

Several days

20c

1

c

Answer

More than half the days

20c

2

d

Answer

Nearly every day

20c

3

New

Y

No

20c

In the last 2 weeks, how often were so restless that is it hard to sit still?

No

Single Select

1

a

Answer

Not at all

20d

0

b

Answer

Several days

20d

1

c

Answer

More than half the days

20d

2

d

Answer

Nearly every day

20d

3

New

Y

No

20d

In the last 2 weeks, how often did you become easily annoyed or irritable?

No

Single Select

4

a

Answer

Not at all

20e

0

b

Answer

Several days

20e

1

c

Answer

More than half the days

20e

2

d

Answer

Nearly every day

20e

3

New

Y

No

20e

In the last 2 weeks, how often did you feel afraid, as if something awful might happen?

No

Single Select

3

a

Answer

Not at all

21

0

b

Answer

Several days

21

1

c

Answer

More than half the days

21

2

d

Answer

Nearly every day

21

3

Topic

Sleep

25

YES

New

Y

No

21

Question

Over the last month, how would you rate your nightly sleep quality?

Yes

No

N/A

Single Select

67

115

YES

Ask of every user

YES

1

a

Answer

Very good

22

0

9

50

b

Answer

Good

22

0

4

50

c

Answer

Fair

22

1

4

50

YES

d

Answer

Poor

22

2

4

50

YES

e

Answer

Very poor

22

2

9

50

YES

2

Old

N

No

22

Question

Would you like to work on improving your sleep?

No

NA

No

Negative

Single Select

47

115

Ask if user selects 9c, 9d, or 9e

3

a

Answer

Yes, I need to work on it

23

25

50

go to question 11b

b

Answer

I'm already working on it, but need some help

23

45

50

c

Answer

I'm already working on it, and don't need help

23

46

50

d

Answer

No, it's not a priority for me right now

23

40

50

1

Topic

Stress

25

YES

Old

Y

Yes

23

Question

In general, what's your typical stress level?

Yes

No

N/A

Single Select

46

115

YES

Ask of every user

YES

NA

3

a

Answer

Very low

26

0

8

50

0

b

Answer

Low

26

0

8

50

0

c

Answer

Fair

24

1

4

50

YES

0

d

Answer

High

24

2

4

50

YES

1

e

Answer

Very high

24

2

9

50

YES

2

Old

N

Yes

24

Question

Based on how you rated your stress level, why do you think that is?

No

n/a

No

Negative

Multiple Select

ERROR:#REF!

115

Ask if user selects 13c, 13d, or 13e

5

a

Answer

Financial concerns

25

18

50

b

Answer

Work-life balance

25

17

50

c

Answer

Family concerns

25

15

50

d

Answer

Chronic pain

25

12

50

1

e

Answer

Health Concerns

25

f

Answer

Other

25

5

50

Old

N

No

25

Question

Would you like to work on improving your stress?

Yes

Single Select

3

a

Answer

Yes, I need to work on it

26

b

Answer

I'm already working on it, but need some help

26

c

Answer

I'm already working on it, and don't need help

26

d

Answer

No, it's not a priority for me right now

26

Topic

Nutrition

25

YES

Old

Y

Yes

26

Question

In general, how healthy is your diet?

Yes

No

N/A

Single Select

37

115

YES

Ask of every user

YES

NA

3

a

Answer

Very healthy

29

0

Positive

12

50

0

*well accepted longer words inflate score. Replaced with "null" results in above score.

b

Answer

Healthy

29

0

Positive

7

50

0

c

Answer

Fair

27

1

Negative

7

50

YES

0

d

Answer

Unhealthy

27

2

Negative

9

50

YES

1

e

Answer

Very unhealthy

27

2

Negative

14

50

YES

2

Changed

Y

Yes

27

Question

Based on how you rated your diet, why do you think that is?

No

NA

No

Negative

Multiple Select

59

115

Ask if user selects 16c, 16d, or 16e

3

a

Answer

Eating out

28

10

50

b

Answer

Frequent snacking

28

17

50

c

Answer

Eating processed foods or food with added sugar

28

47

50

d

Answer

Just who I am

28

13

50

e

Answer

I don't know how to eat healthier

28

f

Answer

I cannot afford healthy options

28

Old

N

No

28

Question

Would you like to work on improving your diet?

Yes

NA

No

Negative

Single Select

ERROR:#REF!

115

YES

Ask if user selects 16c, 16d, or 16e

3

a

Answer

Yes, I need to work on it

29

25

50

YES

b

Answer

I'm already working on it, but need some help

29

45

50

YES

c

Answer

I'm already working on it, and don't need help

29

46

50

d

Answer

No, it's not a priority for me right now

29

40

50

Topic

Weight

25

YES

Changed

Y

Yes

29

Question

What is your weight?

Yes

BMI?

Yes

Free text entry (restrict to numbers)

0

Answer

[text entry for number] pounds

30

if BMI >=25 and <30 OR <=18.5, 1. If >=30, 2. Else, 0

2

Old

Y

Yes

30

Question

What is your height?

Free text entry (restrict to numbers)

0

Answer

[text entry for number] feet [text entry for number] inches

31

Yes

(see above)

Yes

Old

N

No

31

Question

How healthy is your current weight for you?

N/A

Single Select

43

115

YES

Ask of every user

YES

5

a

Answer

Very healthy

34

Yes

0

No

12

50

b

Answer

Healthy

34

0

7

50

c

Answer

Fair

32

1

4

50

YES

d

Answer

Unhealthy

32

2

9

50

YES

e

Answer

Very unhealthy

32

2

14

50

YES

2

Changed

N

Yes

32

Question

Based on how you rated your weight, why do you think that is?

No

NA

No

Negative

Multiple Select

61

115

Ask if user selects 20c, 20d, 20e

5

a

Answer

Current eating habits

33

21

50

b

Answer

Current physical activity level

33

21

50

c

Answer

Medical Condition or Medications

33

32

50

d

Answer

Poor Sleep

33

e

Answer

Just who I am

33

13

50

f

Answer

High stress

33

11

50

Changed

N

Yes

33

Question

Which way to improve your weight seems best for you?

No

NA

No

Single Select

52

115

4

a

Answer

Join a weight loss program

34

26

50

b

Answer

Change my nutrition

34

19

50

c

Answer

Increase my activity

34

20

50

d

Answer

Track my eating

34

15

50

e

Answer

Manage my Stress

34

f

Answer

Discuss medical intervention with my PCP

34

g

Answer

Other

34

5

50

Topic

Activity

YES

Old

Y

Yes

34

Question

In general, how often are you physically active?

Yes

No

N/A

Single Select

48

115

YES

Ask of every user

YES

3

a

Answer

Daily

35 if activity is health goal, otherwise 37

0

5

50

b

Answer

Multiple days per week

35 if activity is health goal, otherwise 37

0

22

50

c

Answer

A few days per month

35 if activity is health goal, otherwise 37

1

20

50

YES

d

Answer

Less than once a month

35 if activity is health goal, otherwise 37

2

22

50

YES

2

Changed

N

35

Question

Would you like to change your level of activity?

No

NA

No

Negative

Single Select

48

115

Ask if user selects 23c, 23d

3

a

Answer

Yes, I need to work on it

36

25

50

b

Answer

I'm already working on it, but need some help

36

45

50

c

Answer

I'm already working on it, and don't need help

36

46

50

d

Answer

No, it's not a priority for me right now

36

40

50

e

Answer

Other

36

5

50

Old

N

Yes

36

Question

Which way of changing your activity level seems best for you?

No

NA

No

N/A

Single Select

61

115

4

a

Answer

Find a friend to be active with

37

32

50

b

Answer

Find healthy activities nearby

37

30

50

c

Answer

Go to the gym more

37

18

50

d

Answer

Track my activity

37

17

50

e

Answer

Other

37

5

50

Topic

Blood Pressure

YES

Old

N

No

37

Question

What was your blood pressure last time you had it checked?

No

N/A

Single Select

115

YES

Ask of every user

YES

3

a

Answer

In normal range (lower than 120/80) or below

38 if blood pressure is health goal, otherwise 39

0

50

b

Answer

Above normal range (above 120/80)

38

1

50

YES

2

c

Answer

I'm not sure

38

0

50

YES

Old

N

No

38

Question

Would you like to work on improving your blood pressure?

No

Negative

Single Select

115

YES

3

a

Answer

Yes, I need to work on it

39

50

YES

b

Answer

I'm already working on it, but need some help

39

50

YES

c

Answer

I'm already working on it, and don't need help

39

50

d

Answer

No, it's not a priority for me right now

39

50

Topic

Cholesterol

YES

Old

N

No

39

Question

What was your total cholesterol level last time you had it checked?

No

N/A

Single Select

115

YES

if a go to question 31a, if b or c go to question 30

YES

4

a

Answer

In normal range (total lower than 200)

40 if cholesterol is health goal, otherwise 41

0

50

b

Answer

Out of normal range (total higher than 200)

40

1

50

YES

2

c

Answer

I'm not sure

40

0

50

YES

Old

N

No

40

Question

Would you like to work on managing your cholesterol?

No

Negative

Single Select

115

YES

3

a

Answer

Yes, I need to work on it

41

50

YES

b

Answer

I'm already working on it, but need some help

41

50

YES

c

Answer

I'm already working on it, and don't need help

41

50

d

Answer

No, it's not a priority for me right now

41

50

Topic

Tobacco Use

YES

New

Y

Yes

41

Question

Have you ever used tobacco or nicotine products?

Yes

No

N/A

Single Select

49

115

YES

6

a

Answer

Yes

42

1

negative

3

50

YES

1

b

Answer

No

45

0

positive

2

50

Old

Y

Yes

42

Question

How often do you currently use tobacco or nicotine products?

No

Single Select

2

115

YES

if user answers yes in 9a

4

a

Answer

Daily

43

2

negative

5

50

YES

2

b

Answer

Less than daily

43

1

negative

15

50

YES

c

Answer

Don't know

43

0

positive

10

50

positive response

d

Answer

Not at all

43

0

neutral

10

50

New

N

No

43

Question

Are you interested in reducing your tobacco or nicotine use?

No

NA

No

Negative

Single Select

ERROR:#REF!

115

YES

4

a

Answer

Yes, I need to work on it

44

positive

25

50

YES

b

Answer

I'm already working on it, but need some help

44

positive

45

50

YES

c

Answer

I'm already working on it, and don't need help

44

negative

46

50

d

Answer

No, it's not a priority for me right now

44

negative

40

50

Changed

N

Yes

44

Question

Which way to reduce tobacco use seems best for you?

No

NA

No

Multiple Select

51

115

7

a

Answer

Nicotine replacement

45

positive

20

50

b

Answer

Medication (e.g. Chantix)

45

positive

25

50

c

Answer

A quit smoking app

45

positive

18

50

d

Answer

Meditation or stress reduction

45

positive

30

50

e

Answer

Group or individual health coaching

45

f

Answer

Other

45

neutral

30

50

Topic

Alcohol Use

New

Y

No

45

Question

How often did you have a drink containing alcohol in the past year?

Yes

Single Select

67

1

a

Answer

Never

48

0

5

2

b

Answer

Monthly or less

46

1

15

c

Answer

2-4 times a month

46

2

17

d

Answer

2-3 times a week

46

3

16

e

Answer

4 or more times a week

46

4

22

New

Y

No

46

Question

How many drinks did you have on a typical day when you were drinking in the past year?

No

Single Select

6

b

Answer

1 or 2

47

0

c

Answer

3 or 4

47

1

d

Answer

5 or 6

47

2

e

Answer

7 to 9

47

3

f

Answer

10 or more

47

4

New

Y

Yes

47

Question

How often did you have 5 or more drinks on one occasion in the past year?

No

Single Select

3

a

Answer

Never

48

0

b

Answer

Less than monthly

48

1

c

Answer

Monthly

48

2

d

Answer

Weekly

48

3

e

Answer

Daily or almost daily

48

4

Topic

Financial Health

YES

Old

N

No

48

Question

In general, how would you describe your financial health?

Yes

No

Single Select

57

115

YES

3

a

Answer

Very good

49 if financial health is health goal, otherwise 50

0

9

50

b

Answer

Good

49 if financial health is health goal, otherwise 50

0

4

50

c

Answer

Neutral

49 if financial health is health goal, otherwise 50

0

7

50

YES

d

Answer

Poor

49

1

4

50

YES

e

Answer

Very poor

49

2

9

50

YES

2

Old

N

49

Question

Would you like to work on improving your finances?

No

NA

No

Single Select

50

115

YES

3

a

Answer

Yes, I need to work on it

50

25

50

YES

b

Answer

I'm already working on it, but need some help

50

45

50

YES

c

Answer

I'm already working on it, and don't need help

50

46

50

d

Answer

No, it's not a priority for me right now

50

40

50

Topic

Safety

YES

New

Y

No

50

Question

Do you ever drive after drinking or ride with a driver who has been drinking?

Yes

Single Select

77

2

a

Answer

Yes

51

1

3

b

Answer

No

51

0

3

1

Old

Y

Yes

51

Question

Do you always wear a seatbelt when driving or riding in a car?

Yes

Single Select

62

2

a

Answer

Yes

53

0

3

b

Answer

No

53

1

3

1

Topic

Social Determinants of Health

New

Y

53

Question

Do you have significant stress with any of the following?

Yes

Multiple Select

7

a

Answer

Financial

54

1

b

Answer

Work

54

1

c

Answer

Legal

54

1

d

Answer

Housing

54

1

e

Answer

Medical Care

54

1

f

Answer

Relationships

54

1

g

Answer

None of those above

54

0

New

Y

54

Question

Are you worried or concerned that in the next two months you may not have stable housing that you own, rent or stay in as part of a household?

Yes

single select

3

a

Answer

Yes

55

1

3 with answers

		b	Answer	No	55		0
New	Y	55	Question	Within the past 12 months have you been unable to get utilities (water/ heat/ electricity) when it was really needed?		Yes		single select	6
		a	Answer	Yes	56		1		6 with answers

		b	Answer	No	56		0
New	Y	56	Question	In the past 12 months, there were times when the food you bought just didn't last and you didn't have enough money to get more?		Yes		single select	1
		a	Answer	Yes	57		1		1 with answers

		b	Answer	No	57		0
New	Y	57	Question	In the past 12 months, have you had trouble paying for basics like food, housing, medical care and/or heating?		Yes		single select	3
		a	Answer	Yes	58		1		3 with answers

		b	Answer	No	58		0
New	Y	58	Question	In the past 12 months, has the lack of reliable transportation kept you from medical appointments?		Yes		single select	6
		a	Answer	Yes	59		1		5.6 with answers

		b	Answer	No	59		0
New	Y	59	Question	Do problems affording childcare make it difficult for you to work or study?		Yes		single select	4
		a	Answer	Yes	61		1		4.1 with answers

	b	Answer	No	61		0
New	61	Question	Within the past 12 months, have you ever experienced any form of discrimination against your race or gender that made it difficult for you to access healthcare services?		Yes		single select	7.2
		Answer	Yes	63 if careguides feature is OFF else 62		1		7.2 with answers

			Answer	No	63 if careguides feature is OFF else 62		0
New	Y	62	Question	Would you like help with any of these needs?		Yes		single select	0
			Answer	Yes	63		1		0 with answers

Answer

No

63

0

Topic

Accessibility

YES

Old

Y

63

Question

How confident are you filling out medical forms by yourself?

Yes

Single Select

61

4

a

Answer

Extremely

64

0

9

b

Answer

Quite a bit

64

0

11

c

Answer

Somewhat

64

0

8

d

Answer

A little bit

64

1

12

e

Answer

Not at all

64

2

10

2

Old

N

64

Question

Are you a caregiver?

Yes

No

N/A

Multiple Select

ERROR:#REF!

115

Ask of every user

YES

6

a

Answer

Yes, I am a caregiver for a healthy child

65

b

Answer

Yes, I am a caregiver for a child with health challenges or special needs

65

1

c

Answer

Yes, I am a caregiver for an adult with health challenges or special needs

65

1

d

Answer

No, I am not a caregiver

65

New

Y

65

Question

Do you have a primary care provider (PCP)?

Yes

Single Select

5

Answer

Yes, I have a PCP that I trust

67

0

Answer

Yes, I have a PCP, but I haven't been recently and am interested in exploring my options

66 if care guide eligible, else 67

1

Answer

No, I visit the ER or Urgent Care

66 if care guide eligible, else 67

2

New

N

66

Question

Would you like help from a care guide connecting with a PCP for a free annual wellness visit?

No

Single Select

2

Answer

Yes

67

1

Answer

No

67

0

Old

Y

Yes

67

Question

Are you blind or do you have vision problems that interfere with your activities?

Yes

NA

Yes

Single Select

81

4

a

Answer

Yes

68

3

b

Answer

No

68

2

c

Answer

Prefer not to say

68

17

Old

Y

Yes

68

Question

Are you deaf or do you have hearing problems that interfere with your activities?

Yes

NA

Yes

Single Select

81

3

a

Answer

Yes

69

3

b

Answer

No

69

2

c

Answer

Prefer not to say

69

17

Old

Y

Yes

69

Question

What is the primary language you speak at home?

Yes

NA

Yes

Single Select

47

3

a

Answer

English

END

7

b

Answer

Spanish

70

7

c

Answer

Chinese

70

7

d

Answer

French

70

6

e

Answer

German

70

6

f

Answer

Tagalog

70

8

g

Answer

Vietnamese

70

10

h

Answer

Italian

70

7

i

Answer

Korean

70

6

j

Answer

Russian

70

7

k

Answer

Other

70

5

.../........≥

Y

70

Question

Would having an interpreter help you for your healthcare needs?

single select

3

Yes

END

No

END

Health Topic	Questions that contribute to score	Good Health (On Track)	Room for Improvement (To Consider)	Needs Improvement (To Focus on)
Preventive care	7, 9, 10, 11	0	1	2 or higher
Dynamic text		You told us you’re up to date on recommended preventive care.	You told us that you might be late for recommended preventive care.	You told us that you’ve never gotten preventive care that may be recommended for you.
Chronic Conditions	12, 15	0	1	2 or higher
Dynamic text		You told us you don’t have any chronic conditions.	You told us you have a chronic condition and/or have missed work due to a health issue.	You told us you have a chronic condition and/or have missed work due to a health issue.
Mental Wellbeing	16, 17, 19,20	0	1	2 or higher
Dynamic text		You told us that you have been feeling pretty good lately.	You told us that you may be feeling a bit down or anxious lately.	You told us that you are not feeling your best lately.
Mental Health Risk Management	18	0	n/a	1 or higher
Dynamic text		You told us you have not had thoughts of hurting yourself recently.	N/A	You told us you have had thoughts of hurting yourself in the last 2 weeks.
Sleep	21	0	1	2 or higher
Dynamic text		You told us that you are getting adequate sleep.	You told us that your sleep quality isn't great.	You told us that your sleep quality is poor.
Stress	23	0	1	2 or higher
Dynamic text		You told us that your stress level isn’t very high.	You told us that you’re feeling stressed.	You told us that your stress level is high.
Nutrition	26	0	1	2 or higher
Dynamic text		You told us that your diet is pretty healthy.	You told us that your diet is okay.	You told us that your diet is unhealthy.
Weight	29,30,31	0 OR BMI<25.0	1 OR BMI>25	2 or BMI>25
Dynamic text		You told us that your BMI is in a healthy range and you feel your weight is pretty healthy for you.	You told us that your BMI is outside of a healthy range and/or you don’t feel your weight is healthy for you.	You told us that your BMI is outside of a healthy range and/or you don’t feel your weight is healthy for you.
Activity	34	0	1	2
Dynamic text		You told us that you are frequently physically active.	You told us that you are occasionally physically active.	You told us that you are rarely physically active.
Blood pressure	37	0	N/A	1
Dynamic text		You told us that your blood pressure is in the recommended range or below.	N/A	You told us that your blood pressure is above the recommended range.
Cholesterol	39	0	N/A	1
Dynamic text		You told us that your cholesterol is in the recommended range.	N/A	You told us that your cholesterol is above the recommended range.
Tobacco	41, 42	0-1	2	3 or Higher
Dynamic text		You told us that you do not use tobacco products.	You told us that you are currently using tobacco products.	You told us that you are currently using tobacco products daily.
Alcohol (woman)	45,46,47	0-2	3-5	6 or Higher
Dynamic text		You told us you rarely drink heavily.	The amount of drinking you reported is at a moderate risk level.	The amount of drinking you reported puts you at higher risk for health problems.
Alcohol (man)	45,46,47	0-3	4-6	7 or Higher
Dynamic text		You told us you rarely drink heavily.	The amount of drinking you reported is at a moderate risk level.	The amount of drinking you reported puts you at higher risk for health problems.
Financial health	48	0	1	2
Dynamic text		You told us that your financial health is pretty good.	You told us that your financial health is poor.	You told us that your financial health is very poor.
Safety	50,51,52	0		1 or Higher
Dynamic text		You told us that you engage in safe behaviors as it relates to driving and firearms.	N/A	You told us that you have some unsafe behaviors as it relates to driving and firearms.
Life Stressors	53, 54, 55,56,57,58,59, 61	0	1	2 or higher
Dynamic text		You told us you are not currently experiencing any stress with things like utilities, housing or finances.	You told us you had some challenges meeting some of your needs in the last 12 months.	You told us you had challenges meeting your needs in the last 12 months.
Primary Care Provider	65	0	1	2 or Higher
Dynamic text		You told us that you have a PCP who you see for primary care and preventative services.	You told us that you have a PCP who you have not seen recently and/or you'd like help connecting for an annual wellness visit.	You told us that you do not have a PCP.

NCQA Required

0

Topic/Question

Next Question

Shown to Everyone

Health Topic Score

Net new Q

Positive or Negative

Single Select

Length

Character Limit

Used for Personalization

Rule (old - do not use)

Mandatory

0

New Question or Old Question

Conditional

Flesch-Kincaid Grade Level (question & answers):

ERROR:#REF!

0

Topic

General Health

0

NO

0

YES

0

ERROR:#REF!

REMOVE

Question

Which health goals would you like to focus on?

Yes

KEEP

1

Question

In general, would you say your health is:

0

Yes

NA

No

N/A

Single Select

41

115

0

Ask of every user

YES

0

2

ERROR:#REF!

0

a

Answer

Excellent

2

0

positive

0

9

50

0

ERROR:#REF!

0

b

Answer

Very Good

2

0

positive

0

9

50

0

ERROR:#REF!

0

c

Answer

Good

2

0

neutral

0

4

50

0

ERROR:#REF!

0

d

Answer

Fair

2

0

1

0

negative

0

4

50

0

ERROR:#REF!

0

e

Answer

Poor

2

0

2

0

negative

0

4

50

0

2

0

ERROR:#REF!

REMOVE

Question

Based on how you rated your general health, why do you think that is?

REMOVE

Question

In general, what is your quality of life?

ERROR:#REF!

NEW

ERROR:#REF!

NEW

ERROR:#REF!

0

Topic

Demographics

0

ERROR:#REF!

NEW STRUCTURE

ERROR:#REF!

Yes

KEEP

3

Question

What is your race?

0

Yes

NA

Yes

N/A

Multiple Select

18

0

0*

ERROR:#REF!

0

a

Answer

American Indian or Alaska Native

4

0

neutral

0

18

0

*well accepted longer words inflate score. Replaced with "null" results in above score.

ERROR:#REF!

0

b

Answer

Asian

4

0

neutral

0

5

0

ERROR:#REF!

0

c

Answer

Black or African American

4

0

neutral

0

25

0

ERROR:#REF!

0

d

Answer

Native Hawaiian or Other Pacific Islander

4

0

neutral

0

41

0

ERROR:#REF!

0

e

Answer

White

4

0

neutral

0

5

0

ERROR:#REF!

0

f

Answer

Other

4

0

neutral

0

5

0

ERROR:#REF!

0

g

Answer

Prefer not to say

4

0

neutral

0

17

0

ERROR:#REF!

Yes

KEEP

4

Question

What is your ethnicity?

0

Yes

NA

Yes

N/A

Single Select

23

0

6

ERROR:#REF!

0

a

Answer

Hispanic or Latino

6

0

neutral

0

18

0

ERROR:#REF!

0

b

Answer

Not Hispanic or Latino

6

0

neutral

0

22

0

ERROR:#REF!

0

c

Answer

Prefer not to say

6

0

neutral

0

22

0

ERROR:#REF!

KEEP

ERROR:#REF!

Yes

NEW

6

Question

What is your gender?

0

Yes

N/A

0

Single Select

0

3

ERROR:#REF!

ATTACHMENT I - KEHP - Living Well Promise Questionairre - RFP 758 2700000012.xlsx

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