RFQ 2022-06 Organizational Benchmark.pdf

RFQ 2022-06 Organizational Benchmark Consulting Services Page 1

REQUEST FOR QUOTES (RFQ) #2022-06

Issue Date: April 12, 2022

Project Name: Organizational Benchmark Consulting Services Quote Due Date/Time: May 5, 2022, 2:00 PM PST Procurement Representative: Kim Randall Phone: 503-416-4760 Email: randallk@careoregon.org

SUBMIT QUOTES VIA EMAIL TO PROCUREMENT@CAREOREGON.ORG

PLEASE NOTE: EMAIL SUBMISSIONS SHOULD HAVE

“RFQ 2022-06” IN THE SUBJECT LINE

1. ANNOUNCEMENT AND SPECIAL INFORMATION

Quoters are required to read, understand, and comply with all information contained within this Request for Quotes (“RFQ”). All quotes are binding upon Quoter for sixty (60) days from the Quote Due Date/Time.

Quotes received after the Quote Due Date/Time may not be considered. If authorized in the RFQ and resulting contract, travel and other expense reimbursement will only be reimbursed in accordance with the CareOregon Travel Reimbursement Allowance in effect at the time the expense is incurred. The Policy may be found at https://www.careoregon.org/contact-us/vendor-resources.

RFQ Documents can be downloaded from OregonBuys at the following address:

https://oregonbuys.gov/bso/. Prospective Quoters will need to sign in to download the information and that information will be accumulated for a Plan Holder's List. Prospective Quoters are responsible for obtaining any addenda or clarifying questions from OregonBuys.

Complete Quotes must be or emailed to Procurement@careoregon.org. The subject line of the email must identify the RFQ title. Quoters are encouraged to contact Procurement to confirm receipt of the Quote.

All questions regarding this RFQ are to be directed to the Procurement Representative named above.

Quoters may not communicate with CareOregon employees or representatives about the RFQ during the procurement process until the Procurement Department has notified Quoters of the selected Quoter.

Communication in violation of this restriction may result in rejection of a Quoter.

2. SCOPE

The purpose of this RFQ is to contract with a consultant that can assist in creating and interpreting Organizational Benchmark Comparisons.

Background:

CareOregon is a non-profit, community-oriented organization operating out of Portland, OR that generates about $2 billion of annual revenue and has roughly 1,000 FTEs. Our business model is primarily centered around the administration of managed Medicaid and Medicare health plans. We are seeking the services of an external organization to provide local and national benchmarks for both of our health plans and to help us determine how we are performing compared to those benchmarks. Comparisons should be presented in a way that make them easily actionable.

We are looking for benchmarks related to the administration of health plans and would like metrics grouped by similarity into categories. Medical expense benchmarks would be welcomed, but we are aware that adding medical expense benchmarks could expand the project significantly, and we are open to focusing

CareOregon, Inc.

Procurement Department

315 SW 5th Ave.

Portland, OR 97204

(503) 416-7646 (Office) mailto:Procurement@careoregon.org https://www.careoregon.org/contact-us/vendor-resources https://oregonbuys.gov/bso/ mailto:Procurement@careoregon.org

RFQ 2022-06 Organizational Benchmark Consulting Services Page 2 only on administrative metrics at this time. Ideally, we would like to be able to select from a list of available administrative benchmarks and have the option of focusing on those we feel are most critical to our success. We expect to pull and submit our own data but would need some guidance to make sure it was being pulled in a way to allow for a fair comparison to the benchmarks.

We would like benchmarks to come from a universe of organizations like ours in terms of size, plan design and business model. It will be important that we be able to drill into the results of the study to compare ourselves to other companies based on similar membership mix, lines of business and benefits, and that we be able to compare Medicaid separate from Medicare.

Scope of Work:

Consultant to provide detailed instructions to CareOregon regarding how to submit data, including mapping and data scrubbing instructions if necessary. CareOregon would submit its own data in the right format and structure so that the Consultant can easily fit the data into its benchmarking framework. Benchmarks should come from organizations similar to CareOregon. Consultant should help interpret comparisons and results and suggest areas of improvement. Consultant should provide support as needed during the data submission process and interpretation of results. Comparisons could be in the following categories (this is meant to be an example of potential categories, and not a complete list):

• Financial

• Care management

• Claims processing

• Product mix

• Operational efficiency

• Utilization and cost

• Information system platforms

• Staffing levels and compensation

Examples of potential benchmarks could include:

1. Operational Benchmarks

a. Average speed of answer for provider service inquiries,

b. Average member enrollment processing speed,

c. Percent of customer service inquiries by reason for inquiry,

d. Annual number of suspended claims processed per representative,

e. Broker commissions per broker member,

f. Facilities square feet per FTE (since we are generally remote, is this a relevant question?)

g. Product mix (under operational metric, what product mix are you discussing?)

h. Source of member growth (historical vs anticipated?)

i. Admin costs: sales & marketing costs, member acquisition costs

2. Staffing/Compensation Benchmarks

a. Staffing ratios for each major function of each product

b. Inferred FTEs for outsourced services

c. Average compensation by FTE in each function:

i. Staffing Costs per FTE,

ii. Composition of Compensation,

iii. Compensation Costs per FTE, and

iv. Staffing Costs Per Member Per Month

d. Propensity to outsource each function:

i. Outsourced Costs as a Percent of Total Costs,

ii. Outsourced Staffing Costs as a percent of Total Staffing Costs,

iii. Outsourced Staffing Costs as a Percent of Total Costs, and

iv. Outsourced FTEs as a Percent of Total FTEs

RFQ 2022-06 Organizational Benchmark Consulting Services Page 3

3. Labor Intensity:

a. Staffing Costs as a Percent of Comprehensive Total Costs,

b. Non-Labor Costs per FTE, and

c. Total Costs per FTE

Benchmarks and resulting comparisons provided by the Consultant will be used to help CareOregon identify efficiencies and cost saving opportunities. We expect that the Consultant will work offsite and CareOregon will provide them with our prepared data. A series of weekly or biweekly meetings may be set up for the duration of the project to support CareOregon during the project duration. We expect at least annual comparisons of CareOregon data to the benchmarks in order to identify areas of opportunity. We would need reports for metrics we have chosen to be made available in detail and summary format.

Estimated Project Schedule:

• Kickoff and introduction to the organization; Discuss support and training options for submitting data to the benchmark survey; Understand the data structure and submission requirements; Discuss options for Consultant to interpret survey results and make the findings actionable [0-1 month]

• Extract and submit data; Refine data submission if needed [1-2 months]

• Creation and interpretation of results; Provide summary for leadership [1-2 months]

Project Timeline and deliverables:

CareOregon will expect regularly scheduled progress reports and meeting to make sure the project is on track. The resulting Contract is expected to be one-year and a budget of approximately $150,000.

3. SAMPLE CONTRACT

Submission of a Quote in response to this RFQ indicates Quoter’s willingness to enter into a contract containing substantially the same terms of the below referenced contract, which can be found at:

https://careoregon.org/contact-us/vendor-resources, with the requirements indicated below. No action or response to the sample contract is required under this RFQ. The applicable sample contract is the:

Personal Services Contract (unless checked, item does not apply)

The following paragraphs of the Professional Services Contract will be applicable:

Article I, Paragraph 5 – Travel and Other Expense is Authorized Article II, Paragraph 29 – Protection of Patient Privacy and Security Article II, Paragraph 30 – Criminal Background Check Requirements Article II, Paragraph 31 – Key Persons Article II, Paragraph 32 – On-Call Contract Basis Article II, Paragraph 33 – CareOregon Data Security Requirements

The following insurance requirements will be applicable:

Commercial General Liability: combined single limit, or the equivalent, of not less than $1,000,000 per occurrence, with an annual aggregate limit of $2,000,000 for Bodily Injury and Property Damage.

Professional Liability: combined single limit, or the equivalent, of not less than $1,000,000 per occurrence, with an annual aggregate limit of $2,000,000 for damages caused by error, omission, or negligent acts.

Automobile Liability: combined single limit, or the equivalent, of not less than $500,000 per occurrence for Bodily Injury and Property Damage.

Cyber Liability: combined single limit, or the equivalent, of not less than $1,000,000 per occurrence for network security (including data breach), privacy, interruption of business, media liability, and errors and omissions.

4. QUOTE

Quotes should be short and concise with answers to the following information (limit 30 pages):

https://careoregon.org/contact-us/vendor-resources

RFQ 2022-06 Organizational Benchmark Consulting Services Page 4

A. Quoters General Background and Qualifications:

a. Description of the firm

b. Credentials/experience of key individuals that would be assigned to this project

c. Description of providing similar services to non-profit entities of similar size within the past five (5) years.

d. Description of the firm’s typical customer profile, such as size and service provided. What are your customer retention rates?

B. Scope of Work:

a. Have you done this type of work with other non-profit health plans?

b. What other health plan organizations are included in your benchmark studies?

c. What specific support and training will your firm offer the survey participants to compile the data before submission to the benchmark survey?

d. How is the benchmark data structured? Please provide data definitions.

e. What are the data elements and mapping requirements?

f. What other support would your firm need from CareOregon?

g. What specific support and training will your firm offer to help survey participants interpret their results and make the findings actionable?

h. To help us understand what to expect during this project, please provide a high-level overview about your work with other health plans on benchmarking:

i. How did the process flow?

ii. How long did the process/project take to get data, compare to benchmarks, and share insights?

iii. Did you meet with those health plans on a regular basis during the project?

iv. What were some of the main challenges? And how should we proactively plan for overcoming them?

v. What considerations do you have for us as we look to engage in this effort?

vi. How many FTS’s were required to complete the project and over what period of time?

vii. What did the final product look like and who was it shared with?

C. Please describe your firm’s equity, diversity and inclusion values, policies, efforts, and successes.

D. Fees should be on a time and material basis with a not-to-exceed amount. Fees should be sufficiently descriptive to facilitate acceptance of your firms quote/proposal. Fees and fee schedules should outline ALL estimated expenses including hourly rates for all assigned individuals, anticipated travel (if applicable) and any other reimbursable expenses.

E. References – please provide three (3) references.

F. Completed Quote Certification Form (next page); and G. Any additional information that CareOregon should take into consideration for the project or qualifications.

5. EVALUATION

Quotes will be evaluated based on subjective factors including, but not limited to: Firm experience, Scope of Work, the firms EDI efforts, price/fees, references, and proposal to complete the project (including timeline).

RFQ 2022-06 Organizational Benchmark Consulting Services Page 5

QUOTE CERTIFICATION FORM

RFQ #2022-06

Submitted by:

(Must be entity’s full legal name, and State of Formation)

Each Proposer must read, complete, and submit a copy of this Proposal Certification with their Proposal. Failure to do so may result in rejection of the Proposal. By signature on this Proposal Certification, the undersigned certifies that they are authorized to act on behalf of the Proposer and that under penalty of perjury, the undersigned will comply with the following:

SECTION I. NON-DISCRIMINATION: That the Proposer has not and will not discriminate in its employment practices with regard to race, color, creed, age, religious affiliation, sex, marital status, disability, sexual orientation, gender identity, national origin, veteran status, or any other protected class. Nor has Proposer or will Proposer discriminate against a subcontractor in the awarding of a subcontract because the subcontractor is a disadvantaged business enterprise, a minority-owned business, a woman-owned business, a business that a service-disabled veteran owns or an emerging small business that is certified under ORS 200.055.

SECTION II. CONFLICT OF INTEREST: The undersigned hereby certifies that no officer, agent or employee of CareOregon is personally interested, directly or indirectly, in any resulting contract from this RFP, or the compensation to be paid under such contract, and that no representation, statements (oral or in writing), of the CareOregon, its officers, agents, or employees had induced Proposer to submit this Proposal. In addition, the undersigned hereby certifies that this proposal is made without connection with any person, firm, or corporation submitting a proposal for the same material, and is in all respects fair and without collusion or fraud.

SECTION III. COMPLIANCE WITH SOLICITATION: The undersigned further agrees and certifies that they:

1. Have read, understand, and agree to be bound by and comply with all requirements, instructions, specifications, terms, and conditions of the RFP (including any attachments); and

2. Are an authorized representative of the Proposer, that the information provided is true and accurate, and that providing incorrect or incomplete information may be cause for rejection of the Proposal or contract termination; and

3. Will furnish the designated item(s) and/or service(s) in accordance with the RFP and Proposal.

Name:_________________________________________ Date:__________________________________________

Signature:______________________________________ Title:__________________________________________

Email:_________________________________________ Phone:_________________________________________

Oregon Business Registry Number:__________________ OR CCB # (if applicable):____________________________

Business Designation (check one):

Corporation Partnership Sole Proprietorship Non-Profit Limited Liability Company

Minority (MBE), Women (WBE), Service-Disabled Veteran (SDV), and Emerging Small Business (ESB):

Certified by the State of Oregon (provide certification number as applicable):

MBE WBE SDV ESB

Self-identified (check as applicable):

MBE WBE SDV ESB

RFQ 2022-06 Organizational Benchmark Consulting Services Page 6

CAREOREGON, INC.

INSTRUCTIONS TO QUOTERS

1. QUOTE FORMAT: Quotes must be submitted as indicated in the RFQ.

2. CONFORMANCE TO RFQ REQUIREMENTS: Quotes must conform to the requirements of the RFQ. Unless otherwise specified, all items quoted are to be new, unused, and not remanufactured in any way. Any requested attachments must be submitted with the quote and in the required format. Quote prices must be for the unit indicated on the quote. Failure to comply with all requirements may result in quote rejection.

3. ADDENDA: Only documents issued as addenda by CareOregon serve to change the RFQ in any way. No other directions received by the Quoter, written or verbal, serve to change the RFQ document. NOTE: IF YOU HAVE RECEIVED A COPY OF THE RFQ, YOU SHOULD CONSULT OREGONBUYS (https://oregonbuys.gov/bso/) TO

ENSURE THAT YOU HAVE NOT MISSED ANY ADDENDA OR ANNOUNCEMENTS. QUOTERS ARE NOT

REQUIRED TO RETURN ADDENDUMS WITH THEIR QUOTE. HOWEVER, QUOTERS ARE RESPONSIBLE

TO MAKE THEMSELVES AWARE OF, OBTAIN AND INCORPORATE ANY CHANGES MADE IN ANY

ADDENDA ISSUED INTO THEIR FINAL QUOTE. FAILURE TO DO SO MAY, IN EFFECT, MAKE THE

QUOTER'S QUOTE NON-RESPONSIVE, WHICH MAY CAUSE THE QUOTE TO BE REJECTED.

4. USE of BRAND or TRADE NAMES: Any brand or trade names used by CareOregon in the specifications are for the purpose of describing and establishing the standard of quality, performance, and characteristics desired and are not intended to limit or restrict competition. Quoters may submit quotes for substantially equivalent products to those designated unless the RFQ provides that a specific brand is necessary because of compatibility requirements, etc. All such brand substitutions shall be subject to approval by CareOregon.

5. PRODUCT IDENTIFICATION: Quoters must clearly identify all products quoted. Brand name and model or number must be shown. CareOregon reserves the right to reject any quote when the product information submitted with the quote is incomplete.

6. FOB DESTINATION: Unless specifically allowed in the RFQ, QUOTE PRICE MUST BE F.O.B. DESTINATION with all transportation and handling charges included in the Quote.

7. DELIVERY: Delivery time must be shown in number of calendar days after receipt of purchase order.

8. EXCEPTIONS: Any deviation from quote specifications, or the form of sample contract referenced in this RFQ, may result in quote rejection at CareOregon’s sole discretion.

9. SIGNATURE ON QUOTE: Quotes must be signed by an authorized representative of the Quoter. Signature on a quote certifies that the quote is made without connection with any person, firm or corporation making a quote for the same goods and/or services and is in all respects fair and without collusion or fraud. Signature on a quote also certifies that the Quoter has read and fully understands all quote specifications, and the sample contract referenced in this RFQ (including insurance requirements). No consideration will be given to any claim resulting from quoting without comprehending all requirements of the RFQ.

10. QUOTE MODIFICATION OR WITHDRAWL: Quotes, once submitted, may be modified in writing or withdrawn before the time and date set for quote closing. Quoters may not modify quotes after Quote Due Date/Time.

11. QUOTE SUBMISSION: Quotes may be submitted by returning to CareOregon by email at the email address provided in the introduction of the RFQ. The email subject line should contain the RFQ Number and RFQ Title.

12. PRIOR ACCEPTANCE OF DEFECTIVE PROPOSALS: Due to limited resources, CareOregon generally will not completely review or analyze quotes which fail to comply with the requirements of the RFQ or which clearly are not the best quotes, nor will CareOregon generally investigate the references or qualifications of those who submit such quotes. Therefore, neither the return of a quote, nor acknowledgment that the selection is complete shall operate as a representation by CareOregon that an unsuccessful quote was complete, sufficient, or lawful in any respect.

13. DELIVERY: Significant delays in delivery may be considered in determining award if early delivery is required.

14. CASH DISCOUNTS: Cash discounts will be considered if included in the Quote.

15. PAYMENT: Quotes which require payment in less than 30 days after receipt of invoice or delivery of goods, whichever is later, may be rejected.

16. INVESTIGATION OF REFERENCES: CareOregon reserves the right to investigate references and or the past performance of any Quoter with respect to its successful performance of similar services, compliance with specifications and contractual obligations, and its lawful payment of suppliers, sub-contractors, and workers.

CareOregon may postpone the award or execution of the contract after the announcement of the apparent successful Quoter in order to complete its investigation. CareOregon reserves the right to reject any quote or to reject all quotes at any time prior to CareOregon's execution of a contract if it is determined to be in the best interest of CareOregon to do so.

17. METHOD OF AWARD: CareOregon reserves the right to make the award by item, groups of items or entire quote, whichever is in the best interest of CareOregon.

18. QUOTE REJECTION: CareOregon reserves the right to reject any and all quotes.

19. QUOTE CONFIDENTIALITY AND RESULTS: Quoters who submit a quote will be notified of the RFQ results.

Quotes submitted will be considered confidential and will only be shared internally with applicable staff for this project.

https://oregonbuys.gov/bso/