PCG_Employee_Benefits_Concierge_&_Health_Navigation_RFP.xlsx
XLSX spreadsheet 612 KB Posted
- Solicitation number
- 26-0251-REQ
- Issued by
- Pinellas County, Florida
About this file
Summary of RFP 26-0251 for Employee Benefits Concierge & Health Navigation Services
This is a Request for Proposal (RFP) evaluation document issued by Pinellas County, Florida, on behalf of the Board of County Commissioners' Human Resources Employee Benefits department, seeking employee benefits concierge and health navigation services for approximately 3,250 benefits-eligible County employees and their families. The services requested include benefits advocacy, health navigation, care coordination, clinical support, and utilization management to complement existing health benefits administered through United Medical Resources (medical), Express Scripts (pharmacy), Cigna (dental), and EyeMed (vision). The RFP evaluation criteria encompasses five categories: Qualifications (300 points/30%), Approach (300 points/30%), Statement of Work (250 points/25%), Compensation (100 points/10%), and No Exceptions to RFP (50 points/5%), with all proposals limited to 50 pages. Questions must be submitted by February 19, 2026, at 10:00 a.m., and proposals are due March 5, 2026, at 3:00 p.m. via the OpenGov procurement portal. No site visits or bidders' conferences are scheduled. The initial contract term is five years effective August 1, 2026, with options to extend for two additional twelve-month renewal periods subject to mutual agreement.
Pricing must be submitted using a specific Excel format with per-employee-per-month (PEPM) unit costs for two service lines: General Concierge Services and Health and Employee Benefits Navigation Services. Five vendors have been invited to submit proposals: Alight Health, Included Health, Quantum Health, Transcarent/Accolade, and Healthjoy. Qualified contractors must demonstrate a minimum of three years of experience delivering health advocacy services to large public or corporate clients and must possess HITRUST and SOC2 certifications, maintain Cyber Risk Liability insurance with $5,000,000 per occurrence limits, and carry Professional Liability coverage of $1,000,000. Contractors must also execute a HIPAA Business Associate Agreement, comply with mandatory attestations including the Foreign Countries of Concern Affidavit and Human Trafficking Affidavit, register with the Florida Division of Corporations, meet E-Verify requirements, and provide certificates of insurance prior to award. The RFP does not specify an explicit budget or award value, though expenditures will be capped at an amount to be determined following award, and the County reserves the right to unilaterally add or delete locations or services at any time during the contract term. No set-asides for disadvantaged enterprises or restrictions limiting organizational types from responding are indicated in the available documentation.
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Text version
Company Overview
| Evaluation Criterion: | Employee Benefits Concierge & Health Navigation Services RFP |
| Requested by: | |
| True Kelly-Martin, Director of Benefits on behalf of Pinellas County Board of County Commissioners (PCBOCC) | |
| Attachments Requested | |
| Company Overview | |
| opportunity analysis data fields/ example version | |
| white PNG or SVG logo | |
| implementation timeline | |
| standard agreement | |
| Program | |
| visual of full suite of services | |
| member experience visuals | |
| Outcomes and Quality | |
| clinical studies or evidence that support clinical outcomes | |
| physician network criteria | |
| Reporting | |
| example of client real time reporting | |
| key metrics in standard reporting | |
| outcomes reporting | |
| data required from client | |
| Communication and Engagement | |
| engagement report sample | |
| communication report sample | |
| outreach ICD10 codes | |
| Financial & Security | |
| performance guarantees | |
| ROI validation | |
| Security/Compliance | |
| Company Overview | |
| 1 | Primary Contact Name |
| 2 | Primary Contact Email |
| 3 | Primary Contact phone number |
| 4 | Please provide a concise description of your services. |
| 5 | Confirm you perform an opportunity analysis for a client. If so, please attach the data and fields required to do so and an example version. |
| 6 | Describe your company's financial solvency state, including recent investors, acquisitions and debt. |
| 7 | Describe the company's recent impactful initiatives and future roadmap enhancements. |
| 8 | Please highlight your company's main differentiators from your competitors. |
| 9 | Years in Business. |
| 10 | Provide a list of your top five industries based on client benefit population numbers. |
| 11 | What is your client retention rate for more 3 or more years within the last 3 years. Express as a percentage (retained for three years/ total clients in past 3 years). |
| 12 | Confirm how many clients do you serve in total. |
| 14 | Confirm the minimum size company you will work with based on the number of lives, per service. |
| 15 | Confirm if there is a minimum annual contract amount. |
| 16 | List any U.S. states where services are not applicable. |
| 17 | Confirm you provide services on a global scale. If yes, confirm which countries are you currently providing services. |
| 18 | If yes to above, if there are any services within the product offerings only offered in the U.S. and not globally. If applicable, identify those services. |
| 19 | Describe your language capabilities in regards to apps, clinicians and customer service support. |
| 20 | Net Promoter Score 2022 (from members) |
| 21 | Net Promoter Score 2022 (from client account management) |
| 22 | Net Promoter Score 2023 (from members) |
| 23 | Net Promoter Score 2023 (from client account management) |
| 24 | Please provide an ideal implementation plan, including client responsibilities and timelines. |
| 25 | Please include a sample copy of your standard agreement. |
| 26 | Please list all partnerships and channel/re-seller partners. |
| 27 | For internal marketing and external client consultative discussions, include your logo. Please attach white PNG or SVG logo. |
| 28 | Please list the names of any current Gallagher clients and their account team for internal reference. |
| Program: | |
| 29 | Please provide a visual attachment of the full suite of services, resources and tools. |
| 30 | Please provide a visual of the member experience. |
| 31 | Please provide recommended eligibility and qualifying criteria. |
| What is the diversity of your advocate team? | |
| 32 | Confirm the hub results/recommendations prioritize and select third party carve out solutions (COEs (surgical or fertility) currently utilized by a client within navigation. |
| 33 | Confirm if AI is currently being used within your product. If so, please specify how AI is used (outreach, messaging, etc.). |
| 34 | Confirm if AI will be incorporated in future plans and if so, please describe. |
| For categories below, briefly summarize the abilities within that category. If additional services are offered, note those below. | |
| transparency, navigation, concierge | |
| transparency, navigation, advocacy, hub, wellbeing | |
| 35 | Transparency, navigation, advocacy, hub, utilization management |
| transparency, navigation, advocacy, hub, utilization management, expert medical opinion, virtual primary care, behavioral health (if virtual primary care is offered, you will be receiving another RFI related) | |
| 36 | Additional services not mentioned above (financial, absence, etc.) |
| Please confirm if you offer the categories below and provide a brief description of the clinical support offered, if applicable. | |
| 37 | Nurse support with the ability to answer basic clinical questions (explain diagnoses, explain treatment, identify gaps in care and triage, 24 hr. nurse line, Care Coordination Management, explain biometric results, drug interactions) |
| 38 | Surgical oversight- internal specialist support with the ability to answer surgery, rare or complex health issues |
| 39 | Virtual primary care-ability for the same physician to manage the same member with chronic conditions and primary care needs |
| 40 | Expert medical opinion- network of contracted physicians with the ability to review medical records, diagnose and create treatment plans |
| 41 | Additional clinical support |
| Advocacy: please confirm you offer these services and provide a brief description of the support if offered. | |
| 42 | Manage all benefit plan type inquiries; medical, pharmacy, dental, vision, disability, Life & ADD, Supplemental Life AD&D, Voluntary Accident/Cancer, Identity Theft, Perks |
| 43 | Educate members about new or changing benefit plans |
| 44 | Explain HSA and FSA accounts (customize to clients) and how they can be used (based on the member’s plan design) |
| 45 | Assist in locating a pharmacy or transferring a prescription to home delivery, or renewal |
| 46 | Help members understand the processing for obtaining coverage for medical equipment, devices and supplies |
| 47 | Claims/ Billing |
| 48 | Medical review and appeals |
| 49 | Resolve incorrect plan procedure interpretations (i.e. hospital procedures denied for lack of pre-certification) |
| 50 | Resolve questions of denial of benefits deemed to be non-covered, not medically necessary or ineligible |
| 51 | Resolve errors in the application of deductible and/or co-payments |
| 52 | Negotiate fees with healthcare providers to possibly lower the member’s out-of-pocket costs before or after the service. |
| 53 | Engage with health plan and hospital to ensure optimal care coordination, home care and discharge planning |
| 54 | Troubleshoot pharmacy issues involving tiered pharmacy benefits, mail order, formularies or point-of-sale eligibility problems at the pharmacy |
| 55 | Interface directly with the PBM on behalf of a member |
| 56 | Coordinate benefits with spouse’s plan or between health and ancillary health vendors |
| 57 | Educate and coordinate use of telemedicine |
| 58 | Explain how to understand an Explanation of Benefits (EOB) |
| 59 | Assess family unit needs as a result of the patient’s condition and provide resources and referrals |
| 60 | Assess barriers to treatment and make recommendations on how to remove barriers |
| 61 | Locate homemaker, adult day care and rehabilitation services not covered by the member’s health plan |
| 62 | Locate inpatient private duty nursing or home health aids |
| 63 | Help members complete qualification applications for individual coverage options, including Medicaid and Medicare |
| 64 | Arrange hospice and other services for terminally ill patients |
| Employee Navigation | |
| 65 | Assist in finding a PCP, Specialist or in-network facility or lab |
| 66 | Locate physicians, hospitals, Centers of Excellence (medical, surgical and mental health) |
| 67 | Obtain referrals for required services such as specialist, EAP or Behavioral Health referrals |
| 68 | Assist members in locating in-network providers and outreach to members if referred to an out-of-network provider |
| Care Coordination | |
| 69 | Help to identify and coordinate a range of services such as preventive screenings and other covered services |
| 70 | Coordinate home-care needs and services to facilitate hospital discharge |
| Clinical Care (Confirm if below services are offered. If included in core PEPM confirm. If ad hoc confirm). | |
| 71 | Transparency |
| 72 | Lifestyle management coaching (nutrition, weight) |
| 73 | Wellbeing |
| 74 | Benefits Integration |
| 75 | Utilization Management |
| 76 | Case Management |
| 77 | Medication Therapy Management |
| 78 | Consumerism/decision support programs & resources |
| 79 | Hub Capabilities |
| Utilization Management (pre certs, inpatient hospital reviews) | |
| 80 | Describe your organization's ability to take on utilization management. Confirm the number of members you serve today with the UM function. |
| 81 | Provide number of years you have offered UM |
| 82 | Confirm if company uses outside sources to administer UM, if so, who |
| 83 | Please report on provider satisfaction |
| 84 | Describe how you measure success within the provider services/UM function |
| 85 | Other services not listed above: please specify |
| Outcomes and Quality | |
| 86 | Please provide book of business reporting on the following outcomes and describe how those are tracked and measured, if applicable: |
| Outcomes | |
| 87 | % improvement in A1c, specific to Chronic Condition Management services |
| 88 | % of cases that lead to an alternate diagnoses, specific to Expert Medical Opinion (EMO) |
| 89 | % of cases that result in a change of medication regime |
| 90 | turn around time related to EOBs/ SPD related questions |
| 91 | turn around time related to claim appeal processes |
| 92 | turn around time related to navigation related questions |
| 93 | Provide the response time to connect with human advocate |
| 94 | Provide call abandonment rate |
| 95 | Please provide any additional valuable outcomes measured |
| Quality | |
| 96 | Describe what makes your company's concierge and advocacy experience unique |
| 97 | Confirm if the member has a personal care coordinator. Confirm if member works with the same support member for every interaction. |
| 98 | Confirm if there is a dedicated app associated with the platform.? Specify how it is "best in class" for an improved member experience. |
| 99 | Describe how your product tools and technology are "best in class" and different from competitor’s offerings, specifically in regards to navigating to quality providers and determining accurate, affordable pricing. |
| 100 | Data: provide detail regarding the data you use to create internal algorithms to measure quality in physicians and facilities. Describe if this data was acquired, when and quantifiably what is included. |
| 101 | Confirm if your company plans on acquiring more data in the near future to better refine your quality metrics |
| 102 | Specify which features make up quality algorithms (cost, clinical quality, etc.) |
| 103 | Provide biggest challenges in obtaining provider data |
| 104 | Provide clinical studies or evidence that support the efficacy of your solution. Please attach case studies, etc. that support these outcomes. |
| 105 | Describe your processes for medical oversight (e.g., medical director, physician advisory board) |
| 106 | Provide examples of how your solutions have helped in preventing later stage cancers, complications, ER visits and readmissions health issues among participants |
| 107 | Explain how your company proactively steers members towards low- cost and high quality providers |
| 108 | If clinical care/oversigh is included in the product, confirm the qualifications of the nurses |
| 109 | Provide qualifications of the advocates/ care support teams |
| Reporting | |
| 110 | Provide key metrics, outcomes and performance indicators included in your standard reports (e.g., engagement rates, health improvement metrics, cost savings). Please attach an example and frequency associated. |
| 111 | Confirm how your company reports cost savings achieved through your solution |
| 112 | Confirm if reports include benchmarking data to compare the client's outcomes with industry standards or similar organizations |
| 113 | Confirm how you analyze and report on trends over time to articulate the long-term impact of your solutions |
| 114 | Provide any additional reporting examples. |
| 115 | Confirm your ability to provide transparent reporting in terms of the numerator and the denominator when reporting percentages (%s) |
| 116 | Confirm if ad hoc and/or custom reporting is available. If not confirm pricing for any ad hoc reporting outside of standard reporting package. |
| Integration | |
| 117 | Confirm if you match Member ID from the health plan carrier and Rx for internal Gallagher (County benefits consultant) analyses |
| 118 | Describe how the product coordinates benefits or shares data with the employer’s health plan |
| 119 | Describe how the solution coordinates care with a member's providers including PCP and Specialist |
| 120 | If integrated with Electronic Medical Records exists, please identify platform(s) utilized |
| 121 | Confirm if you hold contracted agreements with carriers and the ability to integrate/ exchange data? If so, confirm which carrier(s), at what frequency and data latency. |
| 122 | Data integration - please list the PBMs you currently have the ability to integrate /exchange data and the frequency of the data exchanges, and data latency |
| 123 | Confirm if your direct program varies from program delivered through a carrier. If so, identify differences. |
| 124 | Assuming the proper data agreements are in place - confirm if you are willing and able to provide data extracts to Gallagher (County benefits consultant) to enable performance oversight |
| 125 | Confirm what data is required from the client. Attach data extract file if relevant. |
| Communication & Engagement: | |
| 126 | Describe how you define and measure engagement. Specify when engagement can and cannot incur fees if fees are based on engaged participants. |
| 127 | The County has a dedicated on staff communications team that produces internal/external communication in print/intranet etc. Confirm you are willing to work with our communications team to cobrand communications. |
| 128 | Confirm on average, what percent of eligible members that start your program continue to be active at 6 months and 12 months. |
| 129 | Provide the average eligible population and engagement each as a percentage across the BOB for your product, specific to key services. |
| 130 | List various methods you employ to engage participants through marketing (such as mail, flyers, mobile apps, and push notifications) |
| 131 | Confirm resources or onboarding support do you provide to help employees understand and engage with the service |
| 132 | Please provide an overview of the elements that are open to customization for clients, as well as any limitations on customization |
| 133 | Please include customization elements that would incur an additional fee |
| 134 | Confirm if you allow for cobranding of materials with the client/employer logo |
| 135 | Describe KPIs and metrics you track to measure engagement and communication effectiveness. Please provide an engagement report sample. |
| 136 | Confirm if you use behavioral science to encourage participation and continued engagement |
| 137 | If applicable, describe your proactive outreach strategies to re-engage employees who are less responsive |
| 138 | Describe how you gather and respond to employee feedback on communication and engagement |
| 139 | Based on your BOB, provide the most used services (advocacy, clinical, navigation, care coordination, etc.) and include metrics |
| Outreach | |
| 140 | If applicable, explain how outbound member engagement is performed, including how you identify members for outreach, when follow-ups are necessary and when a case or issue is considered resolved. Please attach the list of codes/claims or internal responses that identify a trigger and the timing associated with claims look back review. |
| 141 | Describe how is outreach communicated (push notification, call, email) |
| 142 | Across your book of business, provide the percent response specifically to outreach notifications |
| 143 | Confirm if you provide below methods of communication (available to our employee population) to an advocate: |
| 144 | phone conversation |
| 145 | text or messaging |
| 146 | video with live camera |
| 147 | |
| 148 | chat (person) |
| 149 | chat (AI) |
| 150 | digital app |
| 151 | other, please describe |
| Financial / Security | |
| 152 | Confirm what is included in your core services |
| 153 | Describe the pricing model for the core solution. Specify fee structure options. |
| 154 | Provide pricing for any add on solutions. |
| 155 | Confirm ability to run the cost of the program through the medical plan as a claim |
| 156 | Describe the billing process |
| 157 | Confirm proposed fees for your program for a group over 3200 lives |
| 158 | Confirm if there is a fee impact with population fluctuations |
| 159 | Confirm frequency fees are billed |
| 160 | Confirm the minimum length of contract required. County typically likes a 3-5 year term. |
| 161 | Describe any additional fees charged to the client for implementation |
| 162 | List any fees you would charge for integration with the existing PBM, Medical carrier, TPA, or other source |
| 163 | List any fees you would be willing to waive as courtesy |
| 164 | Please describe any other fees not included in the above |
| ROI and PGs | |
| 165 | Describe a client with the most success (and why) with your product including ROI. Confirm if County may reach out to this client. |
| 166 | Describe a client with the least success (and why) with your product including ROI (or lack of). Confirm if County may reach out to this client. |
| 167 | Provide your best recommendation for the highest ROI |
| 168 | Confirm how you measure ROI. Include details of your ROI methodology. |
| 169 | Confirm if guarantees are tied to ROI or if you put fees at-risk based on measurable outcomes. If so, confirm length of term. |
| 170 | Please attach any associated ROI validation studies on the program |
| 171 | Confirm if ROI/savings calculations are reviewed by an outside actuarial resource. (If yes, please attach) |
| 172 | Confirm if ROI is age-adjusted for the client population |
| 173 | Confirm if willing to offer customizable performance guarantees to Gallagher (County benefits consultant) clients |
| 174 | Confirm if program requires the employer provide an incentive. If so, please provide details. |
| 175 | Please describe or attach a copy of your standard performance guarantees including the description and requirements |
| 176 | Describe your reconciliation methodology |
| 177 | Confirm when ROI is measured. If ROI not achieved confirm how $$'s are returned to County. |
| Security and Compliance | |
| 178 | Confirm your company is Hitrust certified |
| 179 | Confirm your company is SOC2 certified |
| 180 | Identify any other certifications related to data security your company holds |
| 181 | Describe ownership and management of technology |
| 182 | Confirm data is encrypted at rest |
| 183 | Confirm the data is encrypted during transmission |
| 184 | Provide security measures currently in place to protect sensitive data and prevent unauthorized access |
| 185 | Describe how data is ensured compliant with relevant industry regulations and standards (e.g., GINA, HIPAA, ERISA) |
| 186 | Describe how company ensures the integrity and authenticity of data during transmission and storage |
| 187 | Describe measures in place to monitor and detect potential security breaches or unauthorized activities |
| 188 | Describe data sharing capabilities with client's consultant/ broker. Include member-level data capabilities |
| 189 | Please describe how company avoids and manages technology service interruptions |
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