RFI_31865-00725_PCMH.pdf

11-20-13 RFI

STATE OF TENNESSEE

DEPARTMENT OF FINANCE AND ADMINISTRATION

DIVISION OF TENNCARE

REQUEST FOR INFORMATION

FOR

PATIENT CENTERED MEDICAL HOME (PCMH) RECOGNITION PROGRAM

RFI # 31865-00725

APRIL 11, 2025

1. STATEMENT OF PURPOSE:

The State of Tennessee, Department of Finance and Administration, Division of TennCare (“TennCare”) issues this Request for Information (“RFI”) for the purpose of obtaining insight f rom vendors on their approach to recognizing primary care organizations in a Patient Centered Home Model. We appreciate your input and participation in this process.

2. BACKGROUND:

TennCare has a rich history with value-based programs aimed at transforming the healthcare delivery system. In 2013, Tennessee launched the Tennessee Health Care Innovation Initiative, with State Innovation Model grant funding awarded by the CMS Innovation Center. With this funding, TennCare formulated strategies to change the way health care is paid for in Tennessee, moving from paying for volume to paying for value. One of the programs developed is the Patient Centered Medical Home (PCMH) Program, which aims to improve cost, quality and delivery of primary care to TennCare members. The PCMH Program currently has eighty-one (81) organizations, four hundred and ninety-two (492) sites, and around six hundred and fifty thousand (650k) attributed members. Approximately forty-f ive percent (45%) of TennCare members are attributed to a PCMH program participant. For additional information about the PCMH Program, please see the following: Patient-Centered Medical Homes (PCMH).

The foundation of the PCMH Program is PCMH recognition, which assesses and approves primary care participants who follow a patient-centered, coordinated, and team-based approach to care. The current recognition contains six distinct domains: Team Based Care/Practice Organization, Knowing and Managing Your Patients, Patient-Centered Access and Continuity, Care Management and Support, Care Coordination and Care Transitions, and Performance Measurement and Quality Improvement. Current Contract:

https://www.tn.gov/content/dam/tn/tenncare/documents2/Nationalcommitteeforqualityassurance8 1881.pdf. The PCMH recognition is designed to improve healthcare quality, enhance patient experience, and reduce costs by emphasizing comprehensive, accessible, and proactive care.

TennCare is seeking to identify vendors with subject matter expertise in assessing and recognizing primary care organizations in (PCMH) recognition. Specif ically, TennCare’s objectives are to:

https://www.tn.gov/tenncare/health-care-innovation/primary-care-transformation/patient-centered-medical-homes-pcmh.html https://www.tn.gov/content/dam/tn/tenncare/documents2/Nationalcommitteeforqualityassurance81881.pdf https://www.tn.gov/content/dam/tn/tenncare/documents2/Nationalcommitteeforqualityassurance81881.pdf

(1) Identify vendors in the marketplace that provide PCMH recognition;

(2) Gain insight into respondent’s scale and scope of the recognition operations, and

(3) Develop a deep understanding of each respondent’s requirements for PCMH recognition.

3. COMMUNICATIONS:

3.1. Please submit your response to this RFI to:

Donovan Morgan, Assistant Director of Contracts Division of TennCare 310 Great Circle Road, Nashville, TN 37243

(615) 741-0041 Donovan.Morgan2@tn.gov

3.2. Please feel free to contact the Division of TennCare with any questions regarding this RFI.

The main point of contact will be:

Donovan Morgan, Assistant Director of Contracts Division of TennCare 310 Great Circle Road, Nashville, TN 37243

(615) 741-0041 Donovan.Morgan2@tn.gov

3.3. Please reference RFI #31865-00725 with all communications to this RFI.

4. RFI SCHEDULE OF EVENTS:

EVENT TIME

(Central Time

Zone)

DATE

(all dates are State business days)

1. RFI Issued April 11, 2025

2. RFI Response Deadline May 1, 2025

5. GENERAL INFORMATION:

5.1. Please note that responding to this RFI is not a prerequisite for responding to any future solicitations related to this project and a response to this RFI will not create any contract rights. Responses to this RFI will become property of the State.

5.2. The information gathered during this RFI is part of an ongoing procurement. In order to prevent an unfair advantage among potential respondents, the RFI responses will not be available until af ter the completion of evaluation of any responses, proposals, or bids resulting from a Request for Qualifications, Request for Proposals, Invitation to Bid or other procurement method. In the event that the state chooses not to go further in the procurement process and responses are never evaluated, the responses to the procurement including the responses to the RFI, will be considered conf idential by the State.

5.3. The State will not pay for any costs associated with responding to this RFI.

mailto:Donovan.Morgan2@tn.gov mailto:Donovan.Morgan2@tn.gov

6. INFORMATIONAL FORMS:

The State is requesting the following information f rom all interested parties. Please f ill out the following forms:

RFI #31865-00725

TECHNICAL INFORMATIONAL FORM

1. RESPONDENT LEGAL ENTITY NAME:

2. RESPONDENT CONTACT PERSON:

Name, Title:

Address:

Phone Number:

Email:

3. Describe in detail the number of customers you have served with your PCMH recognition program. Please provide the number of organizations and sites recognized. If available, provide the number of members/patients served at the organizations.

4. Outline the process of how an organization achieves PCMH recognition including timeline, touchpoints and criteria to meet the standards.

5. Please share information about the role of the reviewer/recognizer from your organization. Share their standard background and credentials, if any are required.

6. Has your organization worked with other Medicaid Plans or State agencies? If so, please share the states and brief ly share the scope of work.

7. Does your organization have a certified content expert program for PCMH recognition? If so, provide the requirements to achieve. Please provide the level of continuing education for the content experts and the mediums you use to share the education.

8. Describe how you track and inform stakeholders or customers on the progress of each organization in the recognition lifecycle.

9. Please share the domains that your organization assesses for PCMH Program recognition. Under each domain, please share the requirements to meet or achieve the domain.

10. Please share if your organization recognizes PCMH organizations at the Tax Identif ication/organization level or at the site level. Share your reasoning behind the response.

11. Please share any data your organization has collected regarding the efficacy or outcomes of your PCMH recognition.

12. Please share the requirements for a provider organization to maintain PCMH recognition and the f requency required for that renewal.

13. Do you have certif ied health claims based validated measures that include benchmarks applicable to the Medicaid population in primary care, utilization, behavioral health, and chronic care management?

14. Can your workforce support accreditation for at least (82) organizations and f ive-hundred (500) sites?

15. Can your organization provide technical assistance on nationally validated quality measures?

16. How many years’ experience does your organization have doing this?

COST INFORMATIONAL FORM

1. Describe what pricing units you typically utilize for similar services or goods (e.g., per hour, each, etc.:

2. Describe the typical price range for similar services or goods

ADDITIONAL CONSIDERATIONS

1. Please provide input on alternative approaches or additional things to consider that might benef it the State: