MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM
ADDENDUM #1 TO THE REQUEST FOR PROPOSALS FOR DSRIP STRATEGY AND TECHNICAL ADVISORY SERVICES 90-17-028-RFP COVER SHEET BY SIGNING AND RETURNING THIS COVER SHEET, I CERTIFY RECEIPT OF ADDENDUM #1 TO THE DSRIP STRATEGY AND TECHNICAL ADVISORY SERVICES RFP.
Printed Name of Authorized Individual
Name of Submitting Organization
Signature of Authorized Individual
Date
THE SIGNATURE PAGE OF THIS ADDENDUM ONE MUST BE SIGNED AND RETURNED WITH YOUR PROPOSAL/RESPONSE/QUOTATION. CONTRACTS MANAGEMENT DEPARTMENT 2611 E PIERCE STREET, PHOENIX, AZ 85008-6092 602-344-1497 ● 602-344-1813 (FAX)
DSRIP STRATEGY AND TECHNICAL ADVISORY SERVICES 90-17-028-RFP ADDENDUM #1 The Maricopa County Special Health Care District (“District”) d.b.a. Maricopa Integrated Health System (MIHS) is hereby issuing Addendum #1 to the Request for Proposals which requested sealed proposals from qualified Proposers to provide DSRIP Strategy and Technical Advisory Services. Pursuant to the Procurement Code Clause HS-305, Addenda to Solicitations, Paragraph A (3), this Addendum One will furnish to other Respondents information given to one Respondent to assist the other Respondents in submitting their responses. 1.
Question: For Attachment B item #9, are individual professional biographies sufficient or are actual resume copies required?
Answer: Individual biographies are acceptable Question: Is MIHS able to provide an estimated date when CMS might approve the Arizona waiver? Answer: The last update from AHCCCS is that they were hopeful of a waiver decision no later than October 31, 2016 2.
Question: Will the design and activation of a DSRIP governance and operational entity or corporation require legal counsel services provided by the successful bidder? Answer: At this time it is not anticipated that the successful bidder would be required to provide legal counsel services. 3.
4.
Question: Will MIHS’ DSRIP activity include participating in counties other than Maricopa?
Answer: MIHS may choose to provide services outside of Maricopa County but is unable to answer this at this time as not enough information is available to do so. Question: Will MIHS pursue Designated Entity status for a defined geographical area within Maricopa County that does not include all of Maricopa County such as specific zip codes or other 5. geographically defined service areas? Answer: The ability to pursue Designated Entity status for its own defined geographic scope may not be an option depending upon the final approved program. Question: What governance and/or operational role does the District Medical Group have in the DSRIP model design? Answer: DMG is the sole source provider group for MIHS –representing all the major medical, surgical, and subspecialties. DMG should be viewed as a collaborative partner providing input and decision making in support of DSRIP initiatives that involve providing services at MIHS. DMG is a not-for-profit practice plan owned and operated by physicians and functions as a separate entity with a separate Board of Directors. 6.
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DSRIP STRATEGY AND TECHNICAL ADVISORY SERVICES 90-17-028-RFP ADDENDUM #1 Question: What governance and/or operational role does the Maricopa Health Centers Governing Council have in the DSRIP model design? Answer: Maricopa Health Centers Governing Council operates as the governing body for all FQHC-Look Alike sites based on HRSA requirements. Sites include our Family Health Centers and CHC that are currently providing primary and specialty care services.
7.
Question: If MIHS does not pursue Designated Entity status and instead chooses to be a Performing Provider, will MIHS be open to working with more than one Designated Entity? Answer: MIHS would be open to working with more than one Designated Entity as a Performing Provider. 8.
9.
Question: What is the expected budget for completing the support described in the RFP?
Answer: A final budget has not yet been finalized. This is part of the RFP response based on the SOW and your respective firm’s experience. Question: What is the expected timing of completion for the 3 phases of work described in the RFP (the contract is for two years with a potential maximum of 5 years, so is the expectation to complete the 3 phases over 5 years)? Answer: Successful bidder is recommended to establish timelines for phases based on past experience with DSRIP initiatives. The expectation is that the 3 phases would be completed over the 5 year DSRIP cycle. 10.
11.
Question: Will MIHS allow the bidder to propose alternate timelines in their proposal response?
Answer: We are open for the most efficient program implementation and as such would be open for alternative timelines with clear explanations for the deviations. Question: Can you confirm that AHCCCS has already submitted the 1115 Waiver to CMS for approval and has received initial CMS feedback on the waiver application? Answer: AHCCCS has submitted the 1115 Waiver to CMS. At this time MIHS is unaware if feedback has been received or not. 12.
13.
Question: If the 1115 Waiver has been submitted and CMS has provided feedback, which elements of Phase 1 does MIHS believe are relevant for the currently submitted 1115 Waiver?
Answer: See #12 14.
Question: Does Phase 1 reference planning for a future Waiver renewal or the current submission?
Answer: Current submission
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DSRIP STRATEGY AND TECHNICAL ADVISORY SERVICES 90-17-028-RFP ADDENDUM #1 15.
Question: If Phase 1 references a future Waiver renewal, will MIHS review the requirements and consider removing certain elements from the current scope of Phase 1?
Answer: See #14 Question: Is determination of successful completion of the project dependent on MIHS selection as a provider partner? Answer: MIHS is committed to be an active participant in the AZ DSRIP program. Preference is to be a lead entity and MIHS will work to achieve that designation but would not preclude MIHS from being a participating provider. 16.
17.
Question: Attachment E requires that Contractors provide pricing methodologies for indirect costs, such as fringe and overhead. However, contractors proposing Commercial Pricing not based on an indirect cost build-up will not have such information to provide. Can Commercial Contractors instead provide a detailed description of what is contained in their all-inclusive pricing?
Answer: It is not necessary to provide the price breakdowns as stated in the RFP.
18.
Question: Attachment E requires that Contractors provide “hourly rates” for additional work. Many state and local agencies have found that weekly or daily rates provide better alignment between the agency and the vendor, and an enhanced ability to accurately predict costs. Can Contractors who do not work on an hourly basis, and who do not have hourly rates available instead propose alternative pricing such as weekly or daily rates in line with their commercial practices?
Answer: Yes Question: For the “Compliance with RFP Requirements and Contract Provisions” Evaluation Factor described on Page 12, will MIHS consider awarding points (out of the 30 possible for that 19. factor) proportional to the number and extent of the RFP and contract provisions exceptions taken? The criterion as written is unfair to Bidders who may propose only a minor number of exceptions. Answer: This criterion is not an all or nothing and incorrectly states that any exceptions will not receive any points. The correct application of the points for this criterion will indeed be proportional to the degree of exceptions taken by a proposer.
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20.
Question: Will MIHS provide a Word version of Attachment A-G to bidders or allow Bidders to recreate the proposal response in Bidder’s preferred format when Attachments require additional information/pages?
Answer: For those pages in A-G that require a signature, MIHS requires those pages be returned with the appropriate signature. Other pages not requiring a signature may have additional information provided as supplemental documentation. Question: Will MIHS consider allowing bidders to submit a copy of their completed proposal with proposed redactions for those items wished to be kept confidential in accordance with 21. Attachment H, at a later date and time after the proposal deadline, for example 3-5 business days after proposal submission? Answer: No. MIHS requires all proposals meet the format and content requirements on the date and time proposals are due. 22.
Question: Is there a published definition of a lead entity versus a participating provider?
Answer: Successful bidder should utilize past DSRIP experience of lead entity versus participating provider definitions. This definition has not yet been communicated at the State level. 23.
Question: Does AHCCCS envision creating an incentive pool of funds that are allocated regionally to the lead entity and then left to the lead provider to allocate to participating providers in that region?
Answer: Determination of allocation of funds from AHCCCs has not been communicated.
24.
Question: Is it correct to interpret the AHCCCS proposal to say that each “strategic focus” or target population can have a lead entity such that one organization is not required to take on all target areas to qualify for DSRIP funding? If yes, has AHCCCS described how the incentive pool would be allocated to the lead entities?
Answer: This has not yet been defined by AHCCCS. Question: Has AHCCCS released any information related to the sustainability plans associated with DSRIP funds allocation? Answer: Not to our knowledge. The engaged consultants would have the opportunity to help MIHS as a lead entity, partner with AHCCCS in developing this and other DSRIP related strategies. 25.
26.
Question: Has AHCCCS released any measures sets or incentive scoring related to DSRIP funds allocation?
Answer: Not to our knowledge.
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DSRIP STRATEGY AND TECHNICAL ADVISORY SERVICES 90-17-028-RFP ADDENDUM #1 Question: What patient surveys are currently fielded by MIHS overall and for the specific populations targeted in the AHCCCS DSRIP proposal? What surveys are produced by the State? Answer: MIHS utilizes patient surveys, however, the surveys are not specific to the populations targeted in the AHCCCS DSRIP proposal. State based reports may be found on the AHCCCS website at: https://www.azahcccs.gov/
27.
28.
Question: How is the MIHS revenue cycle managed, are the hospitals and clinics combined or are these separate revenue streams?
Answer: MIHS operates under one NPI and Tax ID Question: Does MIHS have existing agreements with providers outside its network but frequently accessed by its likely attributed population? Please describe. Answer: Currently DMG provides all provider services for primary care and specialty and sub-specialty services. Services with external providers when needed are through existing agreements and independent contracts arranged directly through DMG. 29.
30.
Question: Have primary care practices in the MIHS engaged in any NCQA patient centered medical home assessments or scoring activities?
Answer: Yes FHCs are designated NCQA PCMH sites. Question: What is the anticipated interaction between Mercy Maricopa Integrated Care and the DSRIP project contemplated in this RFP? Answer: High level of interaction with MMIC as a collaborative partner. Evolution of this relationship will depend on how lead entities and participating providers are established by AHCCCS under this program. 31.
Question: Is the contractor providing technical assistance to AHCCCS regarding DSRIP work precluding from bidding on this RFP? Answer: MIHS will evaluate the merits of each bidder and as a good partner with AHCCCS, MIHS would likely contact AHCCCS to ensure there are no conflict of interest issues. It would also be prudent for the bidder with a related working relationship with AHCCCS to secure similar assurances. 32.
33.
Question: Does Maricopa Integrated health System (MIHS) intend on partnering with other health systems to accomplish its DSRIP program goals?
Answer: Health systems and necessary providers and community agencies as needed.
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DSRIP STRATEGY AND TECHNICAL ADVISORY SERVICES 90-17-028-RFP ADDENDUM #1 34.
Question: Does MIHS currently have clinical and/or business relationships with other healthcare providers in its service area?
Answer: Collaboratives and participation in clinically integrated networks and other alignments are constantly evolving. MIHS participates in those arrangements that facilitate our mission. 35.
Question: In addition to the Statewide HIE, does MIHS participate in any regional HIEs?
Answer: MIHS receives inbound data from Surescripts that is reconciled into the chart. MIHS is in the process of implementing Care Everywhere which will bring in data from other EPIC sites. No other formal regional HIEs exist in Maricopa County to our knowledge. 36.
Question: Are there other private or public HIE systems that provide clinical data to MIHS?
Answer: MIHS will be participating as an EPIC site in the national Carequality Initiative. 37.
Question: How many EHRs are spread across the enterprise?
Answer: All MIHS centers are on EpicCare 38.
Question: What Care Management platform is in use at the present time?
Answer: EpicCare v2014 (MIHS is looking to implement the formal EpicCare Management module), post-acute facilities can connect to us via EpicCare Link. 39.
Question: What platforms/software do you currently use to analyze population data?
Answer: EPIC, with several visualization tools (McKesson Spotfire, Microsoft Cubes, Epic SlicerDicer) 40.
Question: Is there a Data Warehouse platform in use presently?
Answer: MIHS is implementing the Epic Cogito suite, including the Caboodle data warehouse
41.
Question: What is the extent of Medicaid data that you currently have access to for clinical, claims, financial, socio-demographic types of patient data?
Answer: Clinical and financial data, with future import of external data into data warehouse
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42.
Question: Do you currently perform risk stratification analysis for your Medicaid population?
Answer: No. This is not a self-performed analysis. Currently MIHS Medicaid health plan partners are providing risk stratification analysis for our assigned member populations. 43.
Question: Do you currently have a PMO structure in place?
Answer: Yes 44.
Question: Who is currently responsible for data quality within the organization?
Answer: Quality Department (with respect to external reporting-Hospital Compare, Leapfrog)
45.
Question: Does MIHS currently provide Population Health Management services to the communities it serves?
Answer: No. Coming in the near future.
46.
Question: Does MIHS currently have contracts with MCOs and other health plans that have some or all of its payments based on some measure of quality or outcomes (Value Based, or Alternative Payment Arrangements)?
Answer: Yes. Some payments are based on quality or outcomes. 47.
Question: What percentage of admitting physicians are employed?
Answer: None. All admitting physicians are employed by DMG. DMG is a not-for-profit practice plan owned and operated by physicians and functions as a separate entity with a separate Board of Directors. 48.
Question: Will MIHS consider extending the due date based on questions submitted?
Answer: Any extensions granted will be in the best interest of MIHS and communicated by an Addendum on the Procurement website. 49.
Question: Question 8 asks “Is your agency acting as the administrative agent for any other agency or organization?” Please clarify what would constitute an “administrative agent”.
Answer: An organization that works on behalf or in the best interests of another organization 8
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50.
Question: On page 15 (Section 5.2), the RFP stated the bidder should submit “One (1) soft copy of a scanned copy of the completed and signed original Proposal in Adobe PDF format on CD or flash drive with one original and five (5) hard copies of the Proposal and one (1) soft copy on CD or flash drive.” On pages 4 and 17, the RFP indicates only one soft copy is required. Please clarify if you would like two soft copies or one. If two, if the first copy is a scanned copy of the original, what should the second copy be?
Answer: Only one soft (scanned) copy is required. The scanned copy should be consistent with the format followed in the hard copies. Question: The start date for the project is December 1 of this year, but Arizona has not received CMS approval of its waiver application nor DSRIP program and may not receive that until most of 51. the way through 2017. What is the likelihood MIHS will move forward with this project on December 1 given those timeframes? Answer: MIHS won’t move forward on the project until there is more certainty that the waiver will be approved. However, we may seek technical assistance to educate us on what we should be thinking about internally on how to respond to possible DSRIP funding. Question: Please briefly describe MIHS’s role and position with the State in advocating for waiver approval. Answer: MIHS has received no other role than what has been extended to other stakeholders in the State. 52.
Question: How many FTEs does MIHS have or does it intend to have assigned to support DSRIP activities? Answer: Resource allocation will depend upon funded DSRIP activities. It is expected that the successful bidder will propose core and structural staff recommendations based on past DSRIP experiences. 53.
Question: What are MIHS’s expectations regarding the proportion of time the project team is onsite? Answer: Expectations are based on need and timing and understands the variability in project planning and effectuation. MIHS expects the bidder to be available if not on-site on a near-real time basis. 54.
55.
Question: Does MIHS have a Medicaid ACO or Clinically Integrated Network, or is it in the process of developing one? If so, how will this relate to MIHS’s DSRIP program?
Answer: MIHS does not have a Medicaid ACO, however, we are in the process of developing a CIN. 56.
Question: What budget has been allocated for this engagement?
Answer: See #9 9
DSRIP STRATEGY AND TECHNICAL ADVISORY SERVICES 90-17-028-RFP ADDENDUM #1
57.
Question: Please clarify whether the three bullets under RFP Attachment E (1. Fees by phase including hourly rates, 2. An “at risk” approach, and 3. Requirements for out of pocket expenses) apply only to “additional proposed services not described in the Scope of Work” or for all services described in the Scope of Work.
Answer: Both
58.
Question: If the three bullets listed under RFP Attachment E are only for services not described in the Scope of Work, is there a preferred format for pricing those services described in the Scope of Work?
Answer: See #57 59.
Question: Please define “out of pocket expenses,” as used in Attachment E: Pricing.
Answer: These will generally be travel and travel related expenses. Question: The RFP references that “full text of the MIHS Procurement Code may be found at the following link: http://mihs.org/uploads/sites/19/District_Procurement_Code_60. _Revised_Eff_04-23-2014.pdf.” We were unable to locate this document. Please provide as an attachment. Answer: This link will provide access to the Procurement Code: http://www.mihs.org/uploads/District_Procurement_Code_-_Revised_01-29-2014.pdf 61.
Question: Please confirm that this is a 2-year engagement and that the responses to the work statement and the proposal cost should relate only to this initial 2-year term.
Answer: The initial term is 2-years with 3-one year available extensions Question: Can you clarify how the phases as detailed in the RFP correspond to a time line? How 62. long is Phase 1 expected to last and does it overlap with Phase 2 in the planned first year of the contract term? Answer: MIHS is seeking a firm to help guide and effectuate our participation in the DSRIP program and flex timing of each respective phase based on internal and external partner preparedness along with recommendations from the consulting firm(s) selected to support this endeavor.
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63.
Question: Should activities relating to Phase 3 be part of the bidder’s proposal and project cost? If so, should the bidder consider only those activities that would occur during year 2 of the contract term or activities that occur throughout the 5-year program?
Answer: Yes. Successful bidder is recommended to establish timelines for phases based on past exposure to DSRIP initiatives. The expectation is that the 3 phases would be completed over the 5 year DSRIP cycle. Question: Is MHIS currently receiving funding under the DSRIP program to support the activities of the awardee? Does MHIS expect to receive funding going forward to cover the cost of the work performed by the consultant in each of the phases of the work plan? Answer: MIHS is not currently receiving funding under the DSRIP program. MIHS anticipates receiving funding going forward to cover the cost of the work performed by the consultant in each of the phases of the work plan. 64.
65.
Question: When will lead entities be selected for the DSRIP program?
Answer: The AHCCCS 1115 Waiver is still pending CMS approval. Once this is completed, MIHS anticipates discussions with prospective lead entities would ensue quickly. 66.
Question: What criteria are considered when a lead entity is selected? Does AHCCCS perform the selection? Is there a printed resource available that provides more information about the process?
Answer: Specific selection criteria have yet to be defined by AHCCCS.
67.
Question: Aside from general areas of focus for the AZ DSRIP project, are there specific initiatives to drive improvement in these focus areas that are under consideration by the state?
Answer: Known AZ DSRIP focus areas and specific initiatives are listed in the materials provided on the AHCCCS website from past presentations and can be found at https://www.azahcccs.gov/ 68.
Question: Is MIHS currently working with AHCCCS on any projects or planning activities related to the DSRIP program? If so, are you willing to provide an overview or current or planned activities?.
Answer: Not at this time.
69.
Question: Is there a budget in mind for this project or a “not to exceed” price the bidders should be aware of?
Answer: Price or proposed costs should be based on the SOW requirements and the respective bidder’s past experience in developing similar DSRIP structures. 11
DSRIP STRATEGY AND TECHNICAL ADVISORY SERVICES 90-17-028-RFP ADDENDUM #1
70.
Question: To what extent will the bidder be involved in the actual preparation of the submission of the application for the DSRIP program of the 1115 Waiver to AHCCCS?
Answer: MIHS will rely on the respective bidder’s past experience in developing a response to AHCCCS. 71.
Question: Is there a page limit for the proposal?
Answer: MIHS has set no page limit for the proposal, however, it would be in the best interests of the Proposers to present a concise and appropriate length submittal to ensure that the salient aspects of the offering are presented in a manner that the evaluation team can readily identify and assess. Supplemental marketing information and other non-essential documentation can only serve to obscure the important elements of the Proposers offering. 72.
Question: What percent of time on-site does MIHS envision the contractor being onsite for each year of the contract?
Answer: See #54
73.
Question: Was this RFP and the criteria contained herein developed internally or did another firm that would be a potential bidder contribute?
Answer: MIHS is responsible for the RFP
74.
Question: We do not typically provide pricing breakdowns as requested in Attachment E (direct, indirect, fringe, overhead, etc.) due to confidentiality reasons. Is it required that we provide that breakdown to be considered a responsive bidder?
Answer: See #17 75.
Question: Will any subcontractors also be required to provide the breakdown as requested in Attachment E?
Answer: See #17
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