ODMR 2425-0006 EQRO Attachment B - Tech. Prop. Form.pdf

Attachment B

ODMR 2425-0006

ATTACHMENT B

ODMR 2425-0006

Technical Proposal Score Sheet

PHASE I: Initial Qualifying Criteria

The Proposal must meet all the following Phase I proposal acceptance criteria in order to be considered for further evaluation. Any Proposal receiving a “No” response to any of the following qualifying criteria shall be disqualified from consideration.

ITEM # PROPOSAL ACCEPTANCE CRITERIA

RFP

Section Reference

YES NO

1. The Proposal was received by the deadline as specified in the RFP. 2.1, 3.1, 6.5

2. The Offeror submitted a Proposal comprised of a Technical Proposal and, in a separate, appropriately labeled, sealed envelope, a Cost Proposal.

3.1, 6.1, 6.2, 6.3

3. The Offeror’s Proposal includes a fully completed Attachment A, including all required signatures, affirmative statements, and certifications, as specified in Section 6.2.1.

3.1, 6.1, 6.2.1

4. The Offeror is not prohibited from entering into a contract with ODM due to restrictions related to the federal debarment list, unfair labor findings, or as established in ORC Section 9.24.

3.1, 9.8

5.

The Offeror provided an attestation that the Offeror has at least 5-years’ experience in the following areas: Medicaid beneficiaries, policies, data systems and processes; managed care delivery systems, organizations, and financing; quality assessment and performance improvement methods; quality improvement science methods; research design, methods and statistical analysis; effective population health management strategies; and value-based payment strategies.

3.1.E

6.

The Offeror provided an attestation that the Offeror has assigned, or proposed staff who are employed with, or have a subcontract with, a qualified organization that is designated as a National Committee for Quality Assurance (NCQA) – certified Healthcare Effectiveness Data and Information Set (HEDIS) Compliance Auditor. The attestation includes a copy of their NCQA Recognition Certificate that provides the name of the certified supplier/subcontractor/individual, an effective date, and an expiration date of the certification.

3.1.F

7.

The Offeror provided an attestation that the Offeror has an IT system with the capacity capable of receiving, storing, transferring, protecting, organizing, managing, manipulating, and analyzing large data sets that cover a population of approximately 3.0 million individuals.

3.1.G

8. The Offeror provided an attestation that Offeror’s Technical Proposal demonstrates the required knowledge of X-12 standards and experience with electronic data interchange

(EDI).

3.1.H

9.

The Offeror provided an attestation that the Offeror’s Technical Proposal contains demonstrated experience with cloud-based Software-as-a-Service (SaaS) database management tools (e.g., Alteryx) and advanced analytic capabilities using programming language (e.g. R, Python, SAS).

3.1.I

10. The Offeror provided an attestation that the Offeror’s Technical Proposal contains demonstrated experience with data visualization tools (e.g., Tableau) and dashboard server management.

3.1.J

11. The Offeror provided an attestation that the Offeror’s Technical Proposal contains demonstrated information security and privacy compliance including implementation of

3.1.K

Based upon this Phase I evaluation, does the Offeror’s proposal proceed to Phase II scoring below?

Yes _________ No__________

ITEM # PROPOSAL ACCEPTANCE CRITERIA

RFP

Section Reference

YES NO

the Health Insurance Portability and Accountability Act 0f 1996 (HIPAA) compliant administrative, technical, and physical safeguards.

12.

The Offeror provided an attestation that the Offeror’s Technical Proposal demonstrated independence from the state Medicaid agency, MCEs, and providers (e.g., Medicaid-contracted hospitals and providers enrolled in the Comprehensive Primary Care Program) under review as part of this Contract and as required by 42 CFR 438.354(c). If a conflict does exist between the Offeror and providers under evaluation, the Offeror must be able to mitigate this conflict in a manner approved by ODM.

3.1.L

13. The Offeror completed and returned all requirements and forms in Attachment A upon submission of Proposal. 3.1.M

14.

The Offeror provided a proposal of a selected Ohio certified Minority Business Enterprise (MBE) subcontractor assigned, at a minimum, job duties that will equate to a minimum of 15 percent of the total dollar amount of the contract per state fiscal year (SFY). This requirement is further described in MBE (EDGE) SUBCONTRACTING REQUIREMENTS.

3.1.N

15. The Offeror’s Proposal meets the requirements and prohibitions related to personal confidential information as provided in Section 3.6 and trade secret/proprietary information as described in Section 9.2.

3.1.O, 3.6, 9.2

16. The Offeror has attested that it understands, accepts, and will comply with ODM’s payments structure based upon SOW sets of key milestones and services credits described in 4.2.A.

3.1.P, 4.2.A, Appendix A

17. The Offeror has attested that it understands, accepts, and will comply with ODM’s right under 4.2.B to impose corrective and/or remedial actions as provided in the RFP, including Appendix A.

3.1.Q, 4.2.B, Appendix A

18. Offeror has agreed that, pursuant to 4.2.C, Contract performance specifications may be added or adjusted by mutual agreement during the term of an awarded Contract to align with ODM business needs, organizational objectives, and technological changes.

3.1.R, 4.2.C

19. The Offeror has attested that it, pursuant to 4.3, commits to assisting ODM with transitioning services from its current EQR vendor to the Offeror if selected for a Contract. 3.1.S, 4.3

20. The Offeror has fully disclosed breaches of contract, CAPs, and/or non-CAP service credits, liquidated damages, penalties, or sanctions as required, or attested that it does not have any such disclosures.

3.1.T, 9.9.A- C

21. The Offeror’s disclosures required by sections 3.1.T and 9.9A-C do not result in disqualification in the discretion of ODM in accordance with Section 9.9D. 3.1.T, 9.9.D

22. The Offeror’s Proposal well-organized and complied with the formatting instructions in 4.1, 6.1, 6.2, and 6.4.

3.1, 4.1, 6.1, 6.2, 6.4

PHASE II: Criteria for Scoring of Technical Proposal

Qualifying Technical Proposals will be collectively scored by a Proposal Review Team (PRT) appointed by ODM. The PRT will collectively judge the merit of each RFP requirement and assign a rating as follows:

DOES NOT MEET (0 pts.): Response does not comply substantially with requirements or is not provided.

WEAK (1 pt.): Response was poor related to meeting the objectives or expectations.

WEAK TO MEETS (2 pts.): Response indicates the objectives or expectations will not be completely met or at a level that will be below average.

MEETS (3 pts.): Response generally meets the objectives or expectations.

MEETS TO STRONG (4 pts.): Response indicates the objectives or expectations will be exceeded.

STRONG (5 pts.): Response significantly exceeds objectives or expectations in ways that provide tangible benefits or meets objectives or expectations and contains at least one enhancing feature that provides significant benefits.

A Technical Proposal’s total PHASE II score will be the sum of the point value for all the RFP requirements, which shall be assigned after all qualifying Proposals are reviewed and assigned the appropriate rating. Technical Proposals that do not meet or exceed a total score of at least 63,750 points (a “passing” score determined by calculating 60% of the total technical points available, which represents that the Offeror has the capability to successfully perform the project/program services) out of a maximum score of 106,250 points will be disqualified from further consideration. If disqualified for not passing this minimum threshold, the Cost Proposal will neither be opened nor considered. Only those Offerors whose Technical Proposals meet or exceed the minimum required technical points (63,750) will advance to PHASE III of scoring.

Proposal Evaluation: The PRT will rank the Proposals by multiplying the score received in each category by its assigned weight and adding all categories together for the Offeror's total technical score. The scoring values, 0 through 5, are available ratings for each category. The number value assigned will be based on the PRT’s evaluation.

The Offeror with the highest point total from all phases of the evaluation (Technical Points + Cost Points) shall be recommended for selection. If the PRT finds that one or more Proposals requires further consideration, the PRT may select one or more of the highest scoring Proposals to advance to the next phase.

ITEM

# RFP REQUIREMENTS

RFP

SECTION

REFERENCE

WEIGHT RATING TOTAL

ORGANIZATIONAL EXPERIENCE AND CAPABILITIES

1.

The Proposal demonstrates experience relevant to completing the work identified in the Scope of Work (SOW) Sections of this RFP. The Proposal includes information on the background of the Offeror, including any subcontractors who would perform work under any Contract resulting from this RFP.

3.2(A) 212.5

2.

The Proposal includes samples (excerpts and/or Executive Summaries acceptable) of at least two, but no more than four similar sized projects completed or begun in the past five (5) years that demonstrate expertise and experience in providing expert assistance in the strategies and objectives listed in section 1.3.

1.3, 1.4, 3.2(B) 106.25

3.

The Proposal includes demonstrated knowledge of and experience in Medicaid and the practical application of the laws and regulations impacting its operations.

The Proposal includes Ohio-specific knowledge and experience.

3.2(C) 212.5

RFP

SECTION

REFERENCE

WEIGHT RATING TOTAL

4.

The Proposal includes names and contact information for at least three entities for which the Offeror has performed similar large-scale projects in the past five

(5) years.

3.2(D) 106.25

5.

The Proposal demonstrates commitment to ongoing engagement with ODM including but not limited to staying current on ODM’s policies and programs, and any relevant changes; participating in executive leadership meetings with ODM’s Director, Medical Director, and other key ODM personnel; attending meetings on-site as requested by ODM; collaborating with ODM’s contracted Offerors as requested by ODM; and following ODM’s guidance as evidenced by the supplier’s willingness to cooperate, be flexible, and timely respond to ODM feedback’s regarding performance concerns.

3.2(E) 425

6.

The Proposal demonstrates commitment with dedicated, adequate resources to adopt and implement a comprehensive, integrated, and customized approach for all SOWs outlined in Section 4.1 that ensures: 1) project work plans, project management tools including timelines, report templates, methodologies, analysis plans, etc.; 2) coordination with ODM on activities with project dependencies, overlapping goals, etc.; 3) cross pollination across the different SOWs (i.e., to share best practices and insights from one area of work with another); 4) regular meetings for the core team of key staff including project leads, as specified in Section 3.3 and led by the Project Director; 5) the Project Director will take an active role in overseeing all aspects of the SOWs and deliverables; and 6) that at-risk activities will be escalated as soon as possible to ODM’s Agreement Manager.

3.2(F), 3.3, 4.1

7.

The Proposal includes a description of the supplier’s method(s) for ensuring sufficient staffing capacity for providing the services and deliverables under the SOWs.

3.2(G) 212.5

8.

The Proposal includes a description of a robust training plan that ensures staff will be sufficiently trained in Ohio Medicaid’s programs, policies, and requirements and all relevant federal requirements pertaining to the SOWs described in Section 4.1.

3.2(H), 4.1 106.25

9. The Proposal includes a description of the Offeror’s robust quality assurance process for all deliverables. 3.2(I) 212.5

10. The Proposal includes a description of the Offeror’s process to ensure data integrity. 3.2(J) 106.25

KEY PERSONNEL AND ADDITIONAL STAFF EXPERIENCE AND CAPABILITIES

11.

The Offeror provided a resume or curriculum vitae with sufficient experience for the Project Director who has:

1. Not less than a master’s degree (e.g., Business Administration, Public Administration, Health Services Administration). Commensurate experience may be considered with approval by ODM.

2. Five years of health care related project/contract management experience with demonstrated successful implementation of multiple large-scale projects; and

3. Demonstrated knowledge and experience of working with Medicaid Managed Care Programs and federal managed care and external quality review regulations.

4. A Project Management Professional (PMP) Certification (preferred not

3.3(A) 425

RFP

SECTION

REFERENCE

WEIGHT RATING TOTAL

required);

5. The Offeror also provided evidence that the position will be an FTE for the

Ohio Contract and will be fully dedicated, available to, and accountable for Ohio Medicaid’s External Quality Review Contract. The Project Director may not be a subcontractor.

12.

The Offeror provided a resume or curriculum vitae with sufficient experience for the Medical Director/Chief Medical Officer who has:

1. Be a physician with a current, unencumbered license through the State Medical Board, preferably in Ohio or the supplier’s primary business location; and

2. Demonstrate at least 5 years of experience with the following: Medicaid populations, direct clinical experience seeing patients and interacting with payors (contracting, utilization management, submitting claims, etc.), leading major clinical quality improvement initiatives (including relevant data analytics & use of rapid cycle quality improvement approaches and tools), health equity efforts, implementing meaningful population health management activities, and leading/guiding practice transformation efforts.

3. The Offeror also provided evidence that the position will be an FTE for the Ohio Contract and will be fully dedicated and available to the Ohio Medicaid’s External Quality Review contract. The Medical Director/Chief Medical Officer may not be a subcontractor.

3.3(B) 425

13.

The Offeror provided a resume or curriculum vitae with sufficient experience for the Statistician who has:

1. No less than a master’s degree in a related field (e.g., Statistics, Mathematics, Bio-Statistics), commensurate experience may be considered with approval by ODM;

2. Five years of health care related experience; and

3. Five years of experience with complex statistical analysis, statistical programming, sampling methodologies, etc.

4. The Offeror provided evidence that the position will be an FTE of the

Offeror and will not be a subcontractor.

3.3(C) 212.5

14.

the Information Technology Director who has:

1. No less than a master's degree in a related field (e.g., Computer Science, Computer Programming), commensurate experience may be considered with approval by ODM; and

2. Five years of experience with the following:

a. Managing a health care data warehouse for a large data set covering a population of 3,000,000 or more individuals;

b. Providing role-based access to multiple users for the receipt and exchange of data, ensuring system security and performance consistent with industry standards;

c. Performing information systems reviews;

d. Providing technical assistance to users;

e. Designing, building, and maintaining complex business intelligence solutions (e.g., databases, scorecards, dashboards);

f. Electronic health record-derived measures and related application programming interfaces (APIs), health information exchanges, data validation, data quality and accuracy checks; and

3.3(D) 212.5

RFP

SECTION

REFERENCE

WEIGHT RATING TOTAL

g. The ability to provide privacy and protection of data provided by ODM.

3. The Offeror provided evidence that the position will be an FTE of the

Offeror and will not be a subcontractor.

15.

The Offeror provided a resume or curriculum vitae with sufficient experience for the Healthcare Data Analyst who has:

1. No less than a master’s degree in a related field (e.g., Health Services Administration, Public Health, Public Administration, or Business Administration), commensurate experience may be considered with approval by ODM; and

2. Five years of experience working with large data sets (enrollment and eligibility files, claims and encounter data), survey methods, HEDIS quality measures (or equivalent national measurement sets), and explaining performance variation, comparisons with performance benchmarks, and trends in metrics.

3. The Offeror provided evidence that the position will be an FTE of the

3.3(E) 212.5

16.

the Technical Writer who has:

1. No less than a bachelor’s degree in a related field (e.g., Communications, Technical Writing, Business);

2. Three years of experience in writing external quality review reports; and

3. Demonstrated experience with synthesizing information with critical thinking related to key insights derived from the data.

4. Offeror has provided evidence that the position will be an FTE of the

3.3(F) 212.5

17.

the Project Lead: The supplier must assign a Project Lead for each scope of work (SOW) in Section 4.1. The Project Lead will interact directly with ODM’s assigned Project Lead and can be a lead for multiple SOWs. The Project Lead cannot be filled by the individual serving as the Project Director. Each individual serving in a Project Lead role must have:

1. A bachelor’s degree in a related field (e.g., Health Services Administration, Health Policy, Public Health or Business Administration);

2. At least one year of experience performing external quality review related activities;

3. Demonstrated knowledge of federal managed care and external quality review regulations; and

4. Demonstrated experience with successful implementation of one large scale project.

3.3(G), 4.1 425

ADMIN. STRUCTURES-PROPOSED WORK PLAN

18. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW A1A: Performance Measure Validation.

4.1(A)(1)(A) 850

19. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW A1B: HEDIS Performance Measure Calculation and Reporting.

4.1(A)(1)(B) 212.5

RFP

SECTION

REFERENCE

WEIGHT RATING TOTAL

20.

The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW A2: Non-HEDIS and Ohio-specific Performance Measures Development, Calculation, and Reporting.

4.1(A)(2) 425

21. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW A3: Electronic Health Record (EHR) and Electronic Clinical Data Base Measures.

4.1(A)(3) 212.5

22.

The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW A4: Technical Assistance for Health Plan Performance Measures: HEDIS, CAHPS, HOS, Non- HEDIS, and Ohio-specific Measures.

4.1(A)(4) 212.5

23. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW B1: Comprehensive Administrative Reviews.

4.1(B)(1) 850

24. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW B2: Targeted Reviews for MyCare.

4.1(B)(2) 212.5

25. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW B3: Targeted Review for MCOs, OhioRISE, or SPBM.

4.1(B)(3) 212.5

26. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW B4: Deeming Crosswalk. 4.1(B)(4) 212.5

27. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW C1A: Medicaid Addenda Audits.

4.1(C)(1)(A) 425

28. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW C1B: Medicaid Provider Directory Audits.

4.1(C)(1)(B) 425

29. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW C2: Appointment Availability and Access Surveys.

4.1(C)(2) 425

30. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW C3: Validation of Network Adequacy Standards.

4.1(C)(3) 850

31. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW D: VALIDATION OF

PERFORMANCE IMPROVEMENT PROJECTS.

4.1(D) 850

32. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW E1A: Consumer Satisfaction Survey for Ohio Medicaid Managed Care Program.

4.1(E)(1)(A) 425

33. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW E1B: Consumer Satisfaction Survey for MyCare Ohio Program.

4.1(E)(1)(B) 425

34. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW E1C: Consumer Satisfaction Survey - OhioRISE Program.

4.1(E)(1)(C) 425

35. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW E2: Case Management Surveys.

4.1(E)(2) 425

RFP

SECTION

REFERENCE

WEIGHT RATING TOTAL

36. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW E3: MCO, MyCare Ohio, and OhioRISE Provider Satisfaction Surveys.

4.1(E)(3) 425

37. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW F1: Encounter Data Collection and Validation.

4.1(F)(1)(A) 425

38. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW F2: Encounter Data Technical Assistance.

4.1(F)(2) 212.5

39. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW F3: Encounter Data Volume Assessments.

4.1(F)(3) 425

40. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW F4: Encounter Data Submission Completeness Assessments.

4.1(F)(4) 425

41. The Offeror has provided work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW G: RATING OF MANAGED CARE

ENTITIES.

4.1(G) 850

42. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW H: Information System Review.

4.1(H) 425

43. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW I: EXTERNAL QUALITY

REVIEW TECHNICAL REPORT.

4.1(I) 425

44. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW J: MEDICAID MANAGED

CARE QUALITY STRATEGY EVALUATION

4.1(J) 425

45. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW K: CARE INNOVATION

AND COMMUNITY IMPROVEMENT PROGRAM (CICIP) EVALUATION.

4.1(K) 425

46. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW L: STATE DIRECTED

PAYMENT EVALUATIONS

4.1(L) 425

47. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW M. INDEPENDENT ASSESSMENT OF 1915(b) WAIVER PROGRAMS.

4.1(M) 425

48. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW N1: Health Risk Assessment Data.

4.1(N)(1) 425

49. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW N2: Population Health Management Data Project.

4.1(N)(2) 425

50. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW N3: OhioRISE Enrollment Data Transmission.

4.1(N)(3) 425

51. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW O: Care Coordination Program Evaluation.

4.1(O) 425

RFP

SECTION

REFERENCE

WEIGHT RATING TOTAL

52. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW P1: Ohio CPC Evaluations.

4.1(P)(1) 425

53. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW P2: Ohio CMC Evaluations.

4.1(P)(2) 425

54. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW Q: CPC AND CPC FOR

KIDS ACTIVITY MONITORING.

4.1(Q) 425

55. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW R: CMC ACTIVITY

MONITORING.

4.1(R) 425

56. The Offeror has provided a detailed work plan that demonstrates how they will successfully perform the Tasks and Deliverables for SOW S: GENERAL TECHNICAL

ASSISTANCE.

4.1(S) 212.5

Total Technical Score _______________

Based upon the Total Technical Score earned, does the Offeror’s Proposal proceed to the Phase III evaluation of its Cost Proposal?

(Offeror’s Total Technical Score must be at least 63,750 points.)

Yes ________ No ________

(If “No,” Offeror’s Cost Proposal will not be opened.)