Commercial Payer Consultant

The Oregon Health Authority (OHA) is issuing a Request for Proposals (RFP) for a Commercial Payer Consultant to support the Family Connects Oregon (FCO) program, specifically targeting negotiation of reimbursement rates between home visiting service providers and commercial health benefit plan providers. The project seeks a qualified professional to help align the actual cost of home visiting services with appropriate commercial health insurance reimbursement rates. The FCO program aims to support newborns and families through nurse home visiting services, community resource alignment, and data monitoring and evaluation. The consultant will work with seven home visiting service provider communities to develop strategic reimbursement strategies. Key deliverables include comprehensive rate negotiation support, cost alignment analysis, and potential commercial payer engagement strategies. The RFP was posted on January 28, 2022, with proposals due by February 25, 2022, and the OHA anticipating contract award on or around March 4, 2022. Potential respondents should demonstrate expertise in healthcare reimbursement, negotiation skills, and understanding of home visiting service models.

The solicitation does not explicitly mention specific set-aside designations or restrictions on respondent types. The contract is structured as a one-year agreement with an optional one-year extension, providing potential flexibility for the selected consultant. The estimated contract value is $150,000 for the initial one-year term, representing a moderate-sized professional services engagement. No incumbent vendors are specifically identified in the available documentation. The consultant will need to integrate with existing FCO program infrastructure and work collaboratively with seven home visiting service provider communities across Oregon. Successful respondents will likely need to demonstrate substantial experience in healthcare reimbursement negotiations, particularly in pediatric and maternal health service contexts. The procurement appears open to qualified individual consultants or consulting firms with appropriate healthcare financial expertise.