Exhibit C- Business Requirements Response Workbook .xlsx

XLSX spreadsheet 145 KB Posted Dec 8, 2022

Attached to: RFP 2022-27 Care Coordination Software Platform
Solicitation number: S-X26083-00005140
Issued by: Multnomah County, Oregon

About this file

Written by GovTribe AI · Apr 3, 2024

This document is an Exhibit C - Business Requirements Response Workbook related to a Request for Proposal (RFP) issued by CareOregon, a healthcare organization, for the acquisition of a new care coordination software platform. The platform is required to provide comprehensive care coordination functionality, reporting, analytical capabilities, and member engagement features. The workbook contains detailed requirements across multiple categories including care management, analytics and insights, and consumer engagement. Vendors must respond to the requirements, indicating whether the capabilities are automated, manual, or not supported, and provide additional details as requested.

The RFP is for the state of Oregon, specifically targeting the jurisdictions of Multnomah County and the City of Portland. The contract term and any renewal options are not specified. Pricing details, funding sources, and incumbent information are not provided in the document. The focus is on the technical and functional requirements of the care coordination platform that vendors must address in their proposals.

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Other files

File	Type	Posted
Exhibit E - References~2.xlsx	XLSX spreadsheet	Dec 8, 2022
RFP 2022-27 Care Coordination Software Platform Addendum 2.pdf	PDF	Dec 8, 2022
Exhibit A - Question Template.docx	DOCX document	Dec 8, 2022
Exhibit F - Proposal Certification.pdf	PDF	Dec 8, 2022
Tek84 Notice of Intent.docx	DOCX document	Dec 8, 2022
Exhibit D - Technical - NonFunctional Response Workbook.docx	DOCX document	Dec 8, 2022
RFP 2022-27 Care Coordination Software Platform.pdf	PDF	Dec 8, 2022
Exhibit B - Pricing Workbook.xlsx	XLSX spreadsheet	Dec 8, 2022
Exhibit G - Contracting Addendum.pdf	PDF	Dec 8, 2022
RFP 2022-27 Care Coordination Software Platform Addendum 1.pdf	PDF	Dec 8, 2022
RFP 2022-27 Response to Clarifying Questions - Publish Version.xlsx	XLSX spreadsheet	Dec 8, 2022
RFP 2022-27 Response to Clarifying Questions - Publish Version.pdf	PDF	Dec 8, 2022

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Instructions

Exhibit C Business Requirements Response Workbook

Introduction and Context:

CareOregon is currently seeking to replace its CareCoordination solution and seeks to understand vendors capabilities in the market.

This workbook contains the following tabs:

1. Care Management: detailed capabilities for care management including (but not limited to) case management, disease management and utilization management

2. Analytics, Insights, and Reporting: detailed capabilities for analytics, insights & reporting including (but not limited to) identification, stratification, segmentation, risk adjustment analytics, and cost and utilization analytics

3. Consumer Engagement: detailed capabilities for consumer engagement including (but not limited to) member/patient portals, provider portals, care alert reminders, member/patient experience, and omnichannel outreach and communication.

4. Pharmacy and Transportation

Response Instructions

- Vendors must utilize this template for their responses.

- While it is required that the vendor comply with this template, it is not required that vendor’s responses and proposals be contained solely within the columns and cells provided. Vendor is invited to attach additional documents to its proposal as it sees fit using appendices recognizing that CareOregon will be placing primary emphasis on the responses in the MS Excel. Responses in the MS Excel which consist only of cross-references to attached documents are not acceptable

		Please use the following definitions for your responses:
		Response Options
		Yes	Requirement will be met. This application requirement is met by proposed software that is installed and operational at other sites and can be demonstrated to CareOregon.
		No	Requirement will not be met.
		Customization I
(General)	The requirement doesn't exist in the proposed system's current functionality set but can be added as an enhancement through custom coding or extensive configuration and is included in the pricing proposal. If a functional requirement is answered 'Y', you may be asked to demonstrate that capability.

Note: In the Comments column next to this response, you must describe the estimated level of complexity to meet this requirement based on your estimated level of effort.

		Customization II
(Incurring Additional Costs)	Requirement will be met by customizing existing software for an additional cost to CareOregon.
		Supplied by Third Party	Requirement will be met by 3rd party software package and is included in this proposal.

Note: In the Comments column, indicate the name of the proposed 3rd party software package and indicate the interface/integration services being proposed.

Future / Under Development Requirement will be met by the solution that is currently under development, in Beta test, or not yet released.

Note: In the Comments column next to this response, indicate the date when requirement will be available for implementation.

&"Arial,Bold"Gartner Supply Chain Benchmarking Program for Retailers

1. Care Management Care Management

	#	Category	Sub Category	Requirement	-- Vendor Selection --
Must choose from defined options	-- Vendor Response --

Optional Detail As Needed or Requested by the Question

Care Management	General	Ability to toggle to another platform when a call comes in to gather information and then toggle back to prior platform to continue work
Care Management	General	Ability to include quick link buttons to allow users to quickly link to another platform
Care Management	General	Ability for more robust notes management for auditing purposes
Care Management	General	Ability to save a “draft” note
Care Management	General	Ability to build customized templates for more efficient note creation
Care Management	General	Ability to see notes for a calendar day
Care Management	General	Ability to track where a you have been within the platform to be able to return and continue where work was left off
Care Management	General	Ability for more robust queue management and audit trails
Care Management	General	Ability to track members by their given pronouns
Care Management	General	Ability for a talk to text feature
Care Management	General	Ability to email directly from the platform
Care Management	General	Ability to fax from the platform
Care Management	General	Ability to have call tracking capabilities within the platform and other platforms like QNXT
Care Management	General	Integration with QNXT, Healthwise, SharePoint

Care Management	Case Management (CM) & Disease Management (DM)	Ability to initiate cases based on broad segmentation by authorization requests, retrospective cost analysis, claims-based condition validation, and utilization (Admit, Discharge, Transfer) data
Care Management	Case Management (CM) & Disease Management (DM)	Ability for case managers to handle the majority of case work in workflow application, including all necessary integration to utilize claims, authorizations, and eligibility data from other enterprise applications
Care Management	Case Management (CM) & Disease Management (DM)	Ability to support a standard suite of assessments with ability to modify
Care Management	Case Management (CM) & Disease Management (DM)	Ability to support custom assessments and care plans to support different programs
Care Management	Case Management (CM) & Disease Management (DM)	Ability to load clinical guidelines into the tool
Care Management	Case Management (CM) & Disease Management (DM)	Ability for Evidence Based Medicine (EBM) information and other notes to display in assessment with applicable question, messages could be client specific
Care Management	Case Management (CM) & Disease Management (DM)	Ability to support different types of assessments and HRAs, one or more per member or participant
Care Management	Case Management (CM) & Disease Management (DM)	Ability to auto trigger care plans based on answers to assessments, and or by cases assigned, and allow user to accept and decline
Care Management	Case Management (CM) & Disease Management (DM)	Ability to auto trigger workflows based off organizational requirements (program enrollment, eligibility flag, case assignment)
Care Management	Case Management (CM) & Disease Management (DM)	Ability to manually create care plan and to manually update auto triggered care plan
Care Management	Case Management (CM) & Disease Management (DM)	Ability to support assessments to be updated manually or via data feed, data feed should be able to update existing assessment with new information, store and display answer history
Care Management	Case Management (CM) & Disease Management (DM)	Ability to include assessment information captured through OCR
Care Management	Case Management (CM) & Disease Management (DM)	Ability to support access to clinical practice guidelines and algorithms, including Regional Care Team Assignment and Population Segmentation
Care Management	Case Management (CM) & Disease Management (DM)	Ability to identify and triage highest risk cases and route to appropriate staff based on CareOregon Regional Care Team Assignment and Population Segmentation rules and risk related data, e.g., risk level; priorities can differ by line of business; system should recognize previous relationships to Care Manager and recognize any recent or completed Care Management activity
Care Management	Case Management (CM) & Disease Management (DM)	Ability to generate alerts from emergency department and A/D/T data feeds
Care Management	Case Management (CM) & Disease Management (DM)	Ability to capture and display case status
Care Management	Case Management (CM) & Disease Management (DM)	Ability to identify and report on a lead case manager with overall ownership of a case, but having associated tasks assigned to other staff. Also have the roles and responsibilities clearly displayed
Care Management	Case Management (CM) & Disease Management (DM)	Ability to manage, triage and close out cases, categorize (e.g., case type) and show status
Care Management	Case Management (CM) & Disease Management (DM)	Ability to capture and display contacts, assessments, feedback, care plans (develop and execute), results; must comply with NCQA and CMS reporting requirements
Care Management	Case Management (CM) & Disease Management (DM)	Ability to capture and display multiple conditions per member, manually and systematically
Care Management	Case Management (CM) & Disease Management (DM)	Ability to capture and display enrollment in CM and DM programs, multiple programs at one time per member, and ability to add new programs as an organization
Care Management	Case Management (CM) & Disease Management (DM)	Ability to capture and display current providers associated with a member, as well as maintain a history of provider relationships to the member.
Care Management	Case Management (CM) & Disease Management (DM)	Ability to capture and display medications, lab results, other services (eye exam, flu vaccine) and source, e.g., reported by member, by provider, by file
Care Management	Case Management (CM) & Disease Management (DM)	Ability to capture and display interventions (phone, email, letter, etc.) and referrals to internal and external programs
Care Management	Case Management (CM) & Disease Management (DM)	Ability to identify gaps-in-care consistent with both HEDIS, STARS and ACO Quality Performance Metrics based on claims data and to summarize and display to users and providers at the point of care.
Care Management	Case Management (CM) & Disease Management (DM)	Ability to customize and configure documentation needs, including but not limited to progress notes, encounters, care plans, goal planning, interventions, assessment.
Care Management	Case Management (CM) & Disease Management (DM)	Ability to capture, display and integrate all assessment data into the member record
Care Management	Case Management (CM) & Disease Management (DM)	Ability to create, store, and can modify the various assessments to support the care management program
Care Management	Case Management (CM) & Disease Management (DM)	Ability to conduct assessments on a tablet device and upload results into the care management application
Care Management	Case Management (CM) & Disease Management (DM)	Ability to have a member sign an assessment/care plan on a tablet device when a care coordinator is in a member's home
Care Management	Case Management (CM) & Disease Management (DM)	Ability to associate different custom assessments and care plans to support different programs
Care Management	Case Management (CM) & Disease Management (DM)	Ability to support coaching information and other notes that are displayed in assessment with applicable question.
Care Management	Case Management (CM) & Disease Management (DM)	Ability to track assessment results over time for assessments that have been taken more than once. Showing the different results by date
Care Management	Case Management (CM) & Disease Management (DM)	Ability for assessments to create evidence based medicine care plans based on answers to assessments. Further describe the automation functionalities as well as allowing the user to accept and decline the automated recommendations
Care Management	Case Management (CM) & Disease Management (DM)	Ability for care plan suggestions to be generated based on the member's clinical information
Care Management	Case Management (CM) & Disease Management (DM)	Ability to support Assessments that can be updated manually or via data feed. Data feed should be able to update existing assessment with new information, store and display answer history
Care Management	Case Management (CM) & Disease Management (DM)	Ability for users to build and store custom assessments
Care Management	Case Management (CM) & Disease Management (DM)	Ability to auto-populate letters by pulling data from Assessment and Care Plan into single document
Care Management	Case Management (CM) & Disease Management (DM)	Ability to link assessments, care plans, and interactions/encounters to Case Types (i.e. Transitional Care Case Type)
Care Management	Case Management (CM) & Disease Management (DM)	Ability to support multiple question types (drop downs; free text; yes/no)
Care Management	Case Management (CM) & Disease Management (DM)	Ability to support Branching logic
Care Management	Case Management (CM) & Disease Management (DM)	Ability to automatically change member status based on Assessment results
Care Management	Case Management (CM) & Disease Management (DM)	Ability to generate flags based on assessment response
Care Management	Case Management (CM) & Disease Management (DM)	Ability to view Member assessment history and prior work
Care Management	Case Management (CM) & Disease Management (DM)	Ability to support multi-language capabilities for assessments
Care Management	Case Management (CM) & Disease Management (DM)	Ability to distinguish between "Screening" and "Assessment" tools
Care Management	Case Management (CM) & Disease Management (DM)	Ability to look at Assessment and other areas within the Vendor system without closing the assessment.
Care Management	Case Management (CM) & Disease Management (DM)	Ability to generate Assessment reports (i.e. Turn-around time, Dates completed)
Care Management	Case Management (CM) & Disease Management (DM)	Ability to customize and configure Care Plans
Care Management	Case Management (CM) & Disease Management (DM)	Ability to link coaching script to assessment
Care Management	Case Management (CM) & Disease Management (DM)	Ability to build interactive care plans with Providers
Care Management	Case Management (CM) & Disease Management (DM)	Ability for the system to queue users to go deeper on specific questions and not skip questions
Care Management	Case Management (CM) & Disease Management (DM)	Ability to integrate with QNXT
Care Management	Case Management (CM) & Disease Management (DM)	Ability to integrate with Oregon's POLST registry
Care Management	Case Management (CM) & Disease Management (DM)	Ability to capture data points and narrative related to encounters and interactions with members
Care Management	Case Management (CM) & Disease Management (DM)	Ability to integrate with pharmacy authorization platform
Care Management	Case Management (CM) & Disease Management (DM)	Ability for users to create/configure a new workflow and program
Care Management	Case Management (CM) & Disease Management (DM)	Ability to create, use and/or update templated documentation standards throughout the application (i.e. dot phrases, templates)
Care Management	Case Management (CM) & Disease Management (DM)	Ability for multiple employees to collaborate in real time on a generated member outreach list

Care Management	HEDIS/Quality Improvement	Ability to Identify gaps in care consistent with both HEDIS, EBM, STARS and ACO Quality Performance Metrics based on claims data and to summarize and display to users and providers at the point of care
Care Management	HEDIS/Quality Improvement	Ability to view, query and measure HEDIS® data using customizable filters
Care Management	HEDIS/Quality Improvement	Able to identify gaps in care using Evidence Based Medicine (EBM), HEDIS or other standards
Care Management	HEDIS/Quality Improvement	Supports CMS, NCQA, HEDIS, and other regulatory and compliance reporting requirements, e.g., state DOI preventative reporting requirements
Care Management	HEDIS/Quality Improvement	Ability to support prospective support for HEDIS: Fully-integrated near real time population health analytics; comparative performance; and quality measures (HEDIS, STARS) (prospective)
Care Management	HEDIS/Quality Improvement	Ability to report on ACO metrics and identify gaps
Care Management	HEDIS/Quality Improvement	Ability to develop custom measures for your own clinical reporting initiatives
Care Management	HEDIS/Quality Improvement	Ability to identify how to close quality gaps

Care Management	Behavioral Health	Ability to use tools to support behavioral health including emotions, behaviors and biology relating to a person’s mental well-being, their ability to function in every day life and their concept of self.
Care Management	Behavioral Health	Ability to support fully-integrated workflows and behavioral health care considerations based on real time information available from care, claims, and finance sources
Care Management	Behavioral Health	Ability to identify barriers (psychological, social, financial, and environmental) that affect the patient's ability to adhere to treatments or maintain their health
Care Management	Behavioral Health	Ability to support Behavioral Health Utilization Management Capability
Care Management	Behavioral Health	Ability to support Behavioral Health Across all Lines of Business
Care Management	Behavioral Health	Ability to integrate with psychiatric consultation system
Care Management	Behavioral Health	Ability to integrate with coaching capabilities
Care Management	Behavioral Health	Ability to set parameters to show expiring, expired and current authorizations by care provider and by client.
Care Management	Behavioral Health	Ability to report real-time on completed visits and forms.
Care Management	Behavioral Health	Ability to support comparisons of weekly, monthly and year to date data are available to care providers and managers
Care Management	Behavioral Health	Ability to provide and control the listing of key links to other resources, including internal and external sites.
Care Management	Behavioral Health	Ability to provide, edit, and manage broadcast messages or targeted messages by team or program.
Care Management	Behavioral Health	Ability to easily view recent clinical notes or visits of clients.
Care Management	Behavioral Health	Easy access to full electronic record for each patient
Care Management	Behavioral Health	Ability for care managers to run and easily save a variety of customized saved reports.
Care Management	Behavioral Health	Ability to support a Notification System to display client, personal, and organization wide events on the homepage and calendar screen.
Care Management	Behavioral Health	Ability for users to choose to have event alerts sent to their email, supervisors, and others. Also, events can reoccur daily, monthly, yearly, etc.
Care Management	Behavioral Health	Ability to see in real-time whether Providers have capacity
Care Management	Behavioral Health	Ability to offer standard and on demand self-service custom reports
Care Management	Behavioral Health	Ability to flag substance abuse information

Care Management	Member Incentives	Ability to analyze incentives, establish best practices, identify both successes and failures, and present findings
Care Management	Member Incentives	Ability to compare actual behaviors to target state behaviors
Care Management	Member Incentives	Ability to create custom incentive programs and "out of the box" incentive programs/templates
Care Management	Member Incentives	Ability to integrate with wellness technology (mobile apps and monitors, for example)
Care Management	Member Incentives	Ability to integrate with service offerings (health coaching, for example)
Care Management	Member Incentives	Ability to track members / participants across employers throughout life of member
Care Management	Member Incentives	Ability to support incentive management and rewards tracking capabilities to feed other systems
Care Management	Member Incentives	Ability to pull in information from employers on a daily basis, that includes wellness and incentive programs
Care Management	Member Incentives	Ability to analyze incentives, establish best practices, identify both successes and failures, and present findings to clients.
Care Management	Member Incentives	Ability to distribute incentives via gift card (or other non-cash rewards)
Care Management	Member Incentives	Ability to support an active rules engine performs match-up of actual behavior to target behavior and feeds incentive fulfillment system
Care Management	Member Incentives	Ability to create incentive rewards reports (By member, by select population, by program)
Care Management	Member Incentives	Ability to integrate incentives program with core administrative system to allow incentives to be paid via deductible or premium
Care Management	Member Incentives	Ability to generate reporting that can be leveraged to highlight incentive strategies that work better for various population groups
Care Management	Member Incentives	Ability to enable members to select rewards online.
Care Management	Member Incentives	Ability to integrate incentive data with Population Health Management (PHM) platform
Care Management	Member Incentives	Ability to integrate with incentive card vendor
Care Management	Member Incentives	Ability to see all incentive opportunities on a per member basis

Care Management	Gaps-in-care prevention	Ability to use analytics to look for and close missed care protocols
Care Management	Gaps-in-care prevention	Ability to use predictive analytics for proactive intervention and to identify things like patients at risk of missing a clinical protocol or an appointment, or needing special services.
Care Management	Gaps-in-care prevention	Ability to support Integrated Health Economic Model that puts a dollar amount to gaps in care (and value to closing them)
Care Management	Gaps-in-care prevention	Ability to support customizable gaps in care reports with capabilities to push out to providers
Care Management	Gaps-in-care prevention	Ability to collect provider attestation of gap exclusion or clinical exception
Care Management	Gaps-in-care prevention	Ability to support customizable clinical alerts at point of care
Care Management	Gaps-in-care prevention	Care coordinator provided with access to a member's gaps in care
Care Management	Gaps-in-care prevention	Ability to engage members/patients to alert them of care gaps or recommended actions
Care Management	Gaps-in-care prevention	Ability to support the integration of claims, encounter data, clinical, and pharma data for gaps in care analysis

Care Management	Readmission Monitoring	Ability to identify and capture re-admissions with relevant information like time gap
Care Management	Readmission Monitoring	Ability to process re-admission information through BI rules to identify prospective patterns, causes, addressable issues
Care Management	Readmission Monitoring	Ability to support views, reports, and analyzes prospectively that activates at pre-discharge with next best action plan and communication to avoid the re-admit
Care Management	Readmission Monitoring	Ability to support real-time/predictive alerting to trigger actions to prevent readmissions
Care Management	Readmission Monitoring	Ability to assesses readmission risk based on utilization
Care Management	Readmission Monitoring	Ability to provide readmission rate reporting
Care Management	Readmission Monitoring	Ability to support sophisticated proactive and automated alerts for gaps in care and preventable readmissions, comprehensive clinical content with library of care plans
Care Management	Readmission Monitoring	Ability to integrate with Cotiviti

Care Management	Medication Adherence	Ability to identify and address medication adherence for specific members
Care Management	Medication Adherence	Ability to support the measurement of savings realized based on behavior changes
Care Management	Medication Adherence	Ability to deliver targeted messaging every time member picks up a prescription at a pharmacy, including medication adherence, cash monitoring, and immunization messaging. Messaging can be delivered through Pharmacist or direct patient messaging channels
Care Management	Medication Adherence	Ability to support retrospective medication adherence sources and calculations in near real time and generate member lists for taking action
Care Management	Medication Adherence	Ability to design a system with prospective look at medication adherence
Care Management	Medication Adherence	Ability to support the analysis and reporting of cost effective drug utilization through analysis of NDC based therapeutic interchanges (drug switches).
Care Management	Medication Adherence	Ability to integrate with PBM (currently OptumRx)

Care Management	Care path enablement, care coordination and documentation	Ability to create care paths within the clinical workflow, and enabling sharing of the care paths across providers and the care continuum
Care Management	Care path enablement, care coordination and documentation	Ability to create workflows that enable effective coordination and transitions of care across care coordinators, facilities and resources
Care Management	Care path enablement, care coordination and documentation	Ability to ensuring that documentation is effectively shared, integrated with the medical record systems and available to all providers within the network
Care Management	Care path enablement, care coordination and documentation	Ability to support customized care designs according to patient requirements, physician preferences, and special protocols, or guidelines for each diagnosis.
Care Management	Care path enablement, care coordination and documentation	Ability to support user-defined automated care plans and critical paths for variance charting and integrated order entry.
Care Management	Care path enablement, care coordination and documentation	Ability to provide multidisciplinary critical pathways and outcomes management.
Care Management	Care path enablement, care coordination and documentation	Ability to provide information on care plan status appraisal for care coordinators to monitor whether the care plan is on track
Care Management	Care path enablement, care coordination and documentation	Ability to support trending capability and capture of discrete clinical information are linked to case management, enabling the integration of standardized clinical guidelines and assessment of adherence to those standards.
Care Management	Care path enablement, care coordination and documentation	Ability to provide clinician access to an intuitive query tool for retrieval of information from the clinical database.
Care Management	Care path enablement, care coordination and documentation	Ability to provide user-defined labels for charting, identifying trends, and correlating consistent information for review and decision making.
Care Management	Care path enablement, care coordination and documentation	Ability to support an end-to-end fully-integrated behavior-driven system intelligently designing care pathways to optimize outcomes
Care Management	Care path enablement, care coordination and documentation	Ability to allow care coordinators to chart against and manage phases of care from one display screen, to access results, review order status, order variances, and review clinical outcomes.
Care Management	Care path enablement, care coordination and documentation	Ability to support point of care EBM tools that include a searchable data base of pathways.

Care Management	Telehealth	Ability to enable telehealth including e-visits, video conferencing, and audio consultations between a patient and a provider.
Care Management	Telehealth	Ability to support functionality to integrate telehealth, video visits, uploads data from wearable technology devices
Care Management	Telehealth	Ability to support the use of technology for remote primary care delivery (e-visits, virtual visits) via patient portal or other means
Care Management	Telehealth	Ability to enable use of devices to support telehealth visits (e.g. digital stethoscopes and digital cameras) and enable the remotely located physician to have access and control of tools
Care Management	Telehealth	Ability to support for real time, or synchronous, capability to transmit relevant information in a variety of media, such as text, audio, video or still images.
Care Management	Telehealth	Ability to integrate with mobile devices, such as smartphones, patient monitoring devices and other wireless technologies to create, store, retrieve and transmit data in real time between end users for the purpose of improving patient safety and quality of care.
Care Management	Telehealth	Ability to support for monitoring devices (via cellular, fixed broadband) for continuous remote monitoring of patients to receive alerts about real-time emergencies and to track lifestyle changes over time (e.g., personal emergency response systems to measure activity, inactivity and falls).

Care Management	Home Health Monitoring	Ability to identify and deploy home health monitoring to patients with high-cost conditions such as chronic heart failure, chronic obstructive pulmonary disease (COPD), diabetes, depression and post-traumatic stress disorder
Care Management	Home Health Monitoring	Ability to integrate home health monitoring with a program of chronic disease management and as a tool to help patients/consumers better manage their medical conditions
Care Management	Home Health Monitoring	Ability to support monitoring devices (via cellular, fixed broadband ) for continuous remote monitoring of patients to receive alerts about real-time emergencies and to track lifestyle changes over time (e.g., personal emergency response systems to measure activity, inactivity and falls).
Care Management	Home Health Monitoring	Ability to capture data from monitoring devices that capture physiological states, such as blood pressure, glucose level and weight.
Care Management	Home Health Monitoring	Ability to capture data from monitoring devices used communications with patients regarding their symptoms, cognitive state and behavior, and sending them information and advice.
Care Management	Home Health Monitoring	Ability to integrate with home health monitoring devices that are compatible with open standards for interoperability, connectivity and data integration with EHRs.
Care Management	Home Health Monitoring	Ability to support a daily data interface with external CM programs and other service partners
Care Management	Home Health Monitoring	Ability to identify barriers (psychological, social, financial, and environmental) that affect the patient's ability to adhere to treatments or maintain their health
Care Management	Home Health Monitoring	Ability to identify and deploy home health monitoring to patients with high-cost conditions such as chronic heart failure, chronic obstructive pulmonary disease (COPD), diabetes, depression and post-traumatic stress disorder
Care Management	Home Health Monitoring	Ability to integrate home health monitoring with a program of chronic disease management and as a tool to help patients/consumers better manage their medical conditions
Care Management	Home Health Monitoring	Ability to include incentives for clinicians to incorporate home health monitoring in cases where the adoption will improve care and reduce inconvenience to the patients

2. Analytics,Insights,Reporting Analytics, Insights, Reporting

	#	Category	Sub Category	Requirement	-- Vendor Selection --
Must choose from defined options	-- Vendor Response --

Optional Detail As Needed or Requested by the Question

Analytics, Insights, Reporting	General	Ability to see alerts that prompt or inform when Population Health Management (PHM) activities are shared across medical management functions
Analytics, Insights, Reporting	General	Ability for Population Health Management (PHM) staff to receive analytic insight in the context of their workflow application, or a coupled adjacent application
Analytics, Insights, Reporting	General	Ability to continuously improve and automate highly repetitive tasks using AI applications, including many elements of service authorization and clinical review
Analytics, Insights, Reporting	General	Ability to deploy AI capabilities broadly, crossing functional and enterprise boundaries
Analytics, Insights, Reporting	General	Ability to complete certified HEDIS reporting on a monthly or quarterly basis
Analytics, Insights, Reporting	General	Ability to perform online real-time interactive reporting or data exports to spreadsheets for further analysis
Analytics, Insights, Reporting	General	Ability to integrate PHM operational data, cost and health outcomes (including patient-reported) data to view PHM activities against KPIs
Analytics, Insights, Reporting	General	Ability for medical management staff to access outcome measures of cost, health and experience (individually and blended in indexes)
Analytics, Insights, Reporting	General	Deploy machine learning techniques on outcomes and attribution data to automate optimization of a small number of operational variables (like channel optimization)
Analytics, Insights, Reporting	General	Ability to perform event-driven analysis of the impact of PHM activities on member health value
Analytics, Insights, Reporting	General	Ability to create ad hoc reports to find patterns and areas of need with care managers (i.e. find providers they interact with the most, patients they treat the most, conditions most commonly treated, areas that are serviced the most often) at a team, department or organization level
Analytics, Insights, Reporting	General	Ability to disaggregate data based on race, ethnicity, language, and disability.
Analytics, Insights, Reporting	General	Ability to report out by Organizations preferred team and/or staff structure

Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to support stratification scoring algorithms integrated into a single platform
Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to proactively identify individuals within a population for specific care management programs or interventions
Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to support traditional segmentation of members/patient using claims and utilization data
Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to further define (stratify) cohorts within the population into levels based on assessments, clinical data, lab data, medications, or other data to match the member/patient to a specific program.
Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to support customizable stratification by selected condition, by employer group, affiliation, and LOB
Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to categorize (segment) members/patients into predefined groups based on cost parameters or other predetermined patterns or behaviors.
Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to support segmentation reporting that integrates lifestyle patterns into clinical performance to create new customer insights into their population
Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to leverage geographic information systems (GIS) to further segment patients
Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to support segmentation reporting that highlights populations that will best respond to a program or outreach
Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to segment reporting that identifies contact preferences and best delivery channel for population clusters
Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to support segmentation reporting that can be leveraged to highlight incentive strategies that work better for various population groups
Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to integrate with 3rd party risk stratification software, including: a. inpatient; b. outpatient; c. payer; d. population; e. preventable (i.e. potentially preventable readmissions, complications, emergency department visits)
Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to support encounter-driven stratification on the same platform: The ability to analyze a collection of events by encounter instead of cohort (User could create an encounter collection of all congestive heart failure admissions in a specific year)
Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to support risk stratification to accommodate multiple versions and are customizable by health model, e.g., Commercial, Medicare, Exchange, ACOs, PCMHs, Teams, Assigned Clinic, etc.
Analytics, Insights, Reporting	Identification, Stratification and Segmentation	Ability to support enterprise level "next best action" for a member during an interaction

Analytics, Insights, Reporting	Care Gap Analysis	Ability to identify members with gaps in care utilizing structured data fields, reporting, and analytics tools to track member/patient outcomes and gaps in care
Analytics, Insights, Reporting	Care Gap Analysis	Ability to identify gaps in care consistent with both HEDIS, STARS and ACO
Analytics, Insights, Reporting	Care Gap Analysis	Ability to integrate Clinical, Lab, Pharma, Care gaps, metrics and other data
Analytics, Insights, Reporting	Care Gap Analysis	Ability to support Integrated Health Economic Model that puts a dollar amount to gaps in care (and value to closing them)
Analytics, Insights, Reporting	Care Gap Analysis	Ability to track & monitor care gap performance on a daily basis
Analytics, Insights, Reporting	Care Gap Analysis	Ability to predict gaps in care and proactively prevent it.
Analytics, Insights, Reporting	Care Gap Analysis	Ability to engage members/patients to alert them of care gaps or recommended actions
Analytics, Insights, Reporting	Care Gap Analysis	Ability to support notifications to providers alerting them of patient gaps, including customizable clinical alerts at points of care
Analytics, Insights, Reporting	Care Gap Analysis	Ability to support gaps in care reporting at the member level is aggregated to the physician/group level for analysis
Analytics, Insights, Reporting	Care Gap Analysis	Ability to provide assessment of the value of closing gaps in quality and equity
Analytics, Insights, Reporting	Care Gap Analysis	Ability to collect provider attestation of gap exclusion or clinical exception
Analytics, Insights, Reporting	Care Gap Analysis	Ability to project the time required to bridge those gaps at the current pace of improvement
Analytics, Insights, Reporting	Care Gap Analysis	Ability to support letter generation allowing communication to members/physicians over appropriate use of services.
Analytics, Insights, Reporting	Care Gap Analysis	Ability to support integration/presentation of care gaps to providers within the provider EMR workflow

Analytics, Insights, Reporting	Risk Adjustment Analytics	Ability to support the use of prospective models to use data on a member from a previous year to estimate the member's future expenses and set health insurance premium rates for a given patient population
Analytics, Insights, Reporting	Risk Adjustment Analytics	Ability to perform risk assessment, which includes demographic characteristics and medical conditions
Analytics, Insights, Reporting	Risk Adjustment Analytics	Ability to support suspect Analysis: Identify members with suspect conditions and possibly undocumented conditions appropriate for retrospective targeting
Analytics, Insights, Reporting	Risk Adjustment Analytics	Ability to support identification of risk adjustment optimization opportunities including members who have previously been coded with chronic disease and comorbidities
Analytics, Insights, Reporting	Risk Adjustment Analytics	Ability to support identification of risk adjustment optimizations by high-risk providers (coding trends, etc.)
Analytics, Insights, Reporting	Risk Adjustment Analytics	Ability to support multiple risk models & populations, including Medicare, Medicaid, and Commercial
Analytics, Insights, Reporting	Risk Adjustment Analytics	Ability to support physician and staff education: Includes end-to-end risk-adjustment training and performance analysis of the participants; providing member-level actionable gaps; and educating with coding and documentation best practices to support risk adjustment
Analytics, Insights, Reporting	Risk Adjustment Analytics	Ability to support the use of Concurrent models, which draw on member data collected in the current year to explain expenses in the same period
Analytics, Insights, Reporting	Risk Adjustment Analytics	Ability to support a risk model that includes the following data sources: Demographics data, claims data, Prescription drug information, self-reported health status, lab and other clinical data, prior year expenditures,
Analytics, Insights, Reporting	Risk Adjustment Analytics	Ability to quantify opportunities by those with highest potential yield
Analytics, Insights, Reporting	Risk Adjustment Analytics	Ability to identify members with potential comorbidities not yet coded
Analytics, Insights, Reporting	Risk Adjustment Analytics	Ability to identify providers who have gaps in their coding practices
Analytics, Insights, Reporting	Risk Adjustment Analytics	Ability to support risk management capabilities includes provider profiling on an extensive mix of cost, utilization, quality, risk and efficiency metrics including; PCP and Specialty outpatient pharmacy utilization and detailing reports, Inpatient/Outpatient utilization with industry standard metrics for PMPM, days, LOS and other metrics.
Analytics, Insights, Reporting	Risk Adjustment Analytics	Ability to identify high risk populations and to segment populations

Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to identify cost of care categories and describe how they are derived
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to identify outliers and drivers of trend by Medical cost category and Provider
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to provide Disease Prevalence Reporting as part of medical cost of care trend analysis
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to provide medical cost of care trend analysis and utilization analysis by medical condition and Episode Groupings
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to measure service mix, provider mix, and severity mix impacts to medical costs
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to identify Retail Pharmacy cost drivers
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to support tools to assess the ROI for any internal or vendor program that may be implemented as a result of medical cost action planning
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to identify potential claim over/under-payments pre- and post-adjudication
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to analyze provider referral patterns
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to identify providers, members, or pharmacies committing acts of FWA
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to compare multiple cost drivers and key performance indicators using clinical (EHR) and Claims data
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to support high volume of key performance metrics in a single report for cost and utilization
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to analyze reasons driving claim adjustments (i.e. specific claim types, certain providers, certain CPT codes, etc.)
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to provide Medicare Advantage dashboard that gives insights into enrollment trends, demographics, and cost and utilization patterns
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to develop custom intervention cohorts that track cost, utilization, and quality indicators against a control group to assess cost savings attributable to intervention(s)
Analytics, Insights, Reporting	Cost & Utilization Analytics	Ability to perform trend comparisons utilizing various time periods (YTD, Calendar Year, Quarterly, etc.)

Analytics, Insights, Reporting	Automated Attribution	Ability to map members/patients/family groups to a provider through analysis of claims data, EHR data or other means automatically
Analytics, Insights, Reporting	Automated Attribution	Ability to map provider identities from multiple systems
Analytics, Insights, Reporting	Automated Attribution	Ability to use different attribution methodologies for different specialties
Analytics, Insights, Reporting	Automated Attribution	Ability to simultaneously hold multiple attribution models
Analytics, Insights, Reporting	Automated Attribution	Ability to choose attribution method: patient based vs. customer based; prospective attribution vs. retrospective attribution; "Single-Provider" or "Multiple-Provider" attribution model
Analytics, Insights, Reporting	Automated Attribution	Ability to disclose physician assignment to member/patient
Analytics, Insights, Reporting	Automated Attribution	Ability to support HMO and PPO attribution
Analytics, Insights, Reporting	Automated Attribution	Ability to support multiple attribution methodologies as market evolves (e.g. use of virtual and telephonic visits, etc.)
Analytics, Insights, Reporting	Automated Attribution	Ability to support retrospective and prospective attribution
Analytics, Insights, Reporting	Automated Attribution	Ability to view and manually attribute status
Analytics, Insights, Reporting	Automated Attribution	Ability to view proportion of high cost services captured by attribution method

Analytics, Insights, Reporting	Network & Profiling Analytics	Ability to manage and analyze network: including quality metrics, performance, compliance, and scenario planning
Analytics, Insights, Reporting	Network & Profiling Analytics	Ability to compare Networks: including maps, counts by provider type and detailed overlap statistics by provider type, specialty and geography.
Analytics, Insights, Reporting	Network & Profiling Analytics	Ability to perform Network Competitive Intelligence: See what providers have been added or dropped and also track which geographies and specialties of competitor networks
Analytics, Insights, Reporting	Network & Profiling Analytics	Ability to analyze member access and utilization requests to providers and support identification of which providers to recruit
Analytics, Insights, Reporting	Network & Profiling Analytics	Ability to support provider performance analysis/provider profiling: Provide efficiency index & quality index
Analytics, Insights, Reporting	Network & Profiling Analytics	Ability to profile and tier providers based on risk
Analytics, Insights, Reporting	Network & Profiling Analytics	Ability to gather Market Benchmark Information to make available for provider quality and efficiency
Analytics, Insights, Reporting	Network & Profiling Analytics	Ability to support “What-if” Scenario Planning for Networks
Analytics, Insights, Reporting	Network & Profiling Analytics	Ability to support network Quality Analysis (with Specialty Level Detail)
Analytics, Insights, Reporting	Network & Profiling Analytics	Ability to support Network Compliance Analysis
Analytics, Insights, Reporting	Network & Profiling Analytics	Ability to manage and analyze Provider Lists
Analytics, Insights, Reporting	Network & Profiling Analytics	Ability to support network utilization tracking (including "leakage", "steerage", and multiple-network tracking)
Analytics, Insights, Reporting	Network & Profiling Analytics	Ability to support Referral network tracking
Analytics, Insights, Reporting	Network & Profiling Analytics	Ability to support network optimization analysis/modeling

Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support real-time dashboard capability
Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support advanced visualization GUI
Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support visual interaction and exploration
Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support easy to understand dashboards that allow users to identify outliers, assess the effectiveness of initiatives and reduce variations in care
Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support advanced monitoring capabilities that allow refresh of the data as often as you like
Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support dynamic visuals and interactive BI reporting to change a query by clicking a section of a graph or chart
Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support drag and drop of multiple data sources
Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support built in connectors to join multiple data sources and formats including excel files, information from other applications, etc.
Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support dashboard widgets to pinpoint visualization for data to determine trends
Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support organizational, departmental, team, staff and provider-led dashboards
Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support advanced capabilities to filter and drill down along a variety of data visualization tools
Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support dashboard filters that can be added or removed in a click
Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support social sharing and mobile friendly
Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support visualization library/gallery
Analytics, Insights, Reporting	Dashboards and Visualization Tools	Ability to support cross-browser capability and cross-platform portability

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Apr 3, 2024.