By OPEN MINDS Circle
On May 9, the California Department of Health Care Services (DHCS) released an Invitation for Proposal (IFP) for a population health management (PHM) service vendor to support state’s Medicaid initiative, California Advancing and Innovating Medi-Cal (CalAIM). DHCS released an invitation for proposal (IFP 21-10375) for the services on May 9, 2022. Questions were due on May 18, 2022 and responses are due on June 6, 2022.
The PHM service will provide health plans, provider organizations, Medi-Cal members, and other users with access to timely, accurate, and comprehensive data on members’ health history and needs, to help improve care, and avoid duplicative processes. The service will support risk stratification and segmentation and risk tiering functions. A key goal is improving DHCS’ ability to understand population health trends and support oversight. Additionally, the PHM service will make it easier for members to update their information. It will provide members with access to health education, their rights and applicable benefits, and information on how their data are being used. The selected contractor will provide at least the following services to CalAIM stakeholders:
- Support access to medical, behavioral, and social service data
- Provide authorized entities access to necessary administrative and clinical data with respect to Medi-Cal beneficiaries across Medi-Cal and other applicable public programs
- Provide data at the individual member level
- Support bulk downloads for the purpose of population health analytics and clinical management by authorized entities in support of population management activities
DHCS intends to award a single contract on July 15, 2022, and the proposed start date for the contract is August 1, 2022. The initial term will run through June, 2025, followed by up to three optional one-year extensions.
Additionally, the PHM contractor will support DHCS with all certification activities required by the Centers for Medicare & Medicaid Services (CMS). The following milestones are identified for the initial contract term:
- Initial PHM service implementation period: August 1, 2022 through December 31, 2022
- PHM service launch for multi-county/user testing starting January 1, 2023
- PHM service service statewide launch/scaling starting July 1, 2023
- PHM service operations: January 1, 2023 through June 30, 2025
- Turnover to DHCS: January 1, 2025 through June 30, 2025
The CalAIM PHM services are being implemented in response to California Assembly Bill 133 (AB 133) of 2021. The ultimate objective of the PHM service is to offer a whole-system, person-centered service delivery to Medi-Cal members that supports the quadruple aim of enhanced consumer experience (including mitigating racial and other inequities), improved population health, reduced costs, and improved work life of health care professionals. The PHM service is anticipated to reduce administrative silos and foster coordination among managed care plans, local health jurisdictions, other social service agencies, delivery systems and provider networks, Medi-Cal programs, other partners, and beneficiaries.
DHCS intends to use a multiple stage evaluation process to review and/or score the proposals. DHCS will reject any proposal that is found to be non-responsive at any stage of evaluation. Proposals will be evaluated for 15 different rating categories. Each rating category will receive both a pass/fail evaluation, and all “pass” evaluations will be rated from 0 (inadequate) to 4 (excellent or outstanding). This initial evaluation will be followed by an interview and technical demonstration, cost proposal evaluation, site visit demonstration, adjustments to score calculations for bidding preferences/incentives, and a final score calculation.
For more information about the IFP, contact: Contract Services Branch, California Department of Health Care Services, 1501 Capitol Avenue, Post Office Box 997413, Sacramento, California 95899-7413; 916-552-8006; Email: CDRFP8@dhcs.ca.gov; Website: https://www.dhcs.ca.gov/CalAIM/Pages/PopulationHealthManagement.asp
For more information about the CalAIM Population Health Management Initiative, contact: California Department of Health Care Services, 1501 Capitol Avenue, MS 0000, Post Office Box 997413, Sacramento, California 95899; Email: CalAIM@dhcs.ca.gov; Website: https://www.dhcs.ca.gov/CalAIM/Pages/PopulationHealthManagement.aspx