Posted Date : September 13,2022
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : SW-61391
Government Authority located in Arkansas; USA based organization looking for expert vendor for patient centered medical home portal.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide patient centered medical home (PCMH) portal.
- Contracting for a service, off the shelf (not custom build) solution to host and operate the metrics tracking and analytic portal to support patient centered medical home (PCMH) portal. Portal shall perform as an analytic engine for configuring, implementing, and tracking a metric-based performance system (Patient Pathway), to track provider's performance in the (but not limited to) program.
- Portal shall allow DHS users to configure various metrics and metric groups, such as quality metrics, informational metrics, electronic clinical quality measures (eCQM), and care coordination metrics in a logical (no additional code needed after initial base configuration) manner and shall generate reports to keep DHS users as well as providers informed about their performance and the payments associated to such performance.
- Providers enrolled to participate in the PCMH program will regularly receive performance reports and will coordinate care teams to drive performance improvement. The metric performance-based payment model creates incentives aligned with quality in several ways relative to (but not limited to) the fee-for-service system, as it holds providers accountable for outcomes; and rewards providers who can reduce complications, error rates, and care that is not guideline-based.
- Data Exchange: Import of claims and structured non-claims data (e.g., quality metrics from the provider portal, admission-discharge-transfer (ADT) feeds, electronic health records (EHRs), etc.) into the Patient Pathway environment for processing.
- Metric execution: Running of the metrics and metric group algorithms for the relevant period to generate reports and calculate payment.
- Metric report generation and distribution: Creation of automated (batch-processed) standard reports (e.g., PDFs, .xlsx, CVS, etc.) that define performance and payment for providers and follow the DHS-defined format, and that can be filtered as needed to drill down information about the provider, the claim, and the payments.
- Payment calculation and reports management: Provider payment reports based on metric outcomes and performance shall be generated and transmitted to the enterprise-level MMIS systems to administer and process payments to providers.
- Allow configuration of rules to exclude claims and patients on a clinical or cost basis.
- Allow exclusion of claims from further processing based on claim, patient, and provider portal data.
- Allow for inclusion and exclusion flags to be set at the claim, Patient Pathway, patient, and PAP level. For example, all patient claims with a diagnosis code for diabetes can be flagged and excluded from a metric calculation (Patient Pathway).
- Calculate and adjust patient and provider costs according to patient risk and severity profile, comorbidities, and care site.
- Allow for manipulation of parameters for cost outliers, access limitations, paid and allowed costs, low case volumes, and regional pricing variation. For example, patient pathway cost should be able to be adjusted if conditional logic flags are set (e.g., patient is diabetic).
- Allow calculation of quality metrics based on data from multiple sources, including, but not limited to outpatient claims, pharmacy claims, EHR or HIS, HIE, immunization registries, or provider portal data.
- Allow for definition of summary statistics and statistical routines that operate on combinations of metrics, patient, and PAP-level data.
- Allow for definition and configuration of metric specific thresholds; and parameters to identify cost outliers.
- Allow configuration of metric-specific thresholds for average cost. The fields should be easily modified via parametric configuration.
(2) All the questions must be submitted no later than September 22, 2022
(3) The contract period will be for one year.
[C] Eligibility:
- Onshore (USA ONLY);
[D] Work Performance:
Performance of the work will be Offsite.
Budget :
Deadline to Submit Proposals: October 24,2022
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : SW-61391
Government Authority located in Arkansas; USA based organization looking for expert vendor for patient centered medical home portal.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide patient centered medical home (PCMH) portal.
- Contracting for a service, off the shelf (not custom build) solution to host and operate the metrics tracking and analytic portal to support patient centered medical home (PCMH) portal. Portal shall perform as an analytic engine for configuring, implementing, and tracking a metric-based performance system (Patient Pathway), to track provider's performance in the (but not limited to) program.
- Portal shall allow DHS users to configure various metrics and metric groups, such as quality metrics, informational metrics, electronic clinical quality measures (eCQM), and care coordination metrics in a logical (no additional code needed after initial base configuration) manner and shall generate reports to keep DHS users as well as providers informed about their performance and the payments associated to such performance.
- Providers enrolled to participate in the PCMH program will regularly receive performance reports and will coordinate care teams to drive performance improvement. The metric performance-based payment model creates incentives aligned with quality in several ways relative to (but not limited to) the fee-for-service system, as it holds providers accountable for outcomes; and rewards providers who can reduce complications, error rates, and care that is not guideline-based.
- Data Exchange: Import of claims and structured non-claims data (e.g., quality metrics from the provider portal, admission-discharge-transfer (ADT) feeds, electronic health records (EHRs), etc.) into the Patient Pathway environment for processing.
- Metric execution: Running of the metrics and metric group algorithms for the relevant period to generate reports and calculate payment.
- Metric report generation and distribution: Creation of automated (batch-processed) standard reports (e.g., PDFs, .xlsx, CVS, etc.) that define performance and payment for providers and follow the DHS-defined format, and that can be filtered as needed to drill down information about the provider, the claim, and the payments.
- Payment calculation and reports management: Provider payment reports based on metric outcomes and performance shall be generated and transmitted to the enterprise-level MMIS systems to administer and process payments to providers.
- Allow configuration of rules to exclude claims and patients on a clinical or cost basis.
- Allow exclusion of claims from further processing based on claim, patient, and provider portal data.
- Allow for inclusion and exclusion flags to be set at the claim, Patient Pathway, patient, and PAP level. For example, all patient claims with a diagnosis code for diabetes can be flagged and excluded from a metric calculation (Patient Pathway).
- Calculate and adjust patient and provider costs according to patient risk and severity profile, comorbidities, and care site.
- Allow for manipulation of parameters for cost outliers, access limitations, paid and allowed costs, low case volumes, and regional pricing variation. For example, patient pathway cost should be able to be adjusted if conditional logic flags are set (e.g., patient is diabetic).
- Allow calculation of quality metrics based on data from multiple sources, including, but not limited to outpatient claims, pharmacy claims, EHR or HIS, HIE, immunization registries, or provider portal data.
- Allow for definition of summary statistics and statistical routines that operate on combinations of metrics, patient, and PAP-level data.
- Allow for definition and configuration of metric specific thresholds; and parameters to identify cost outliers.
- Allow configuration of metric-specific thresholds for average cost. The fields should be easily modified via parametric configuration.
(2) All the questions must be submitted no later than September 22, 2022
(3) The contract period will be for one year.
[C] Eligibility:
- Onshore (USA ONLY);
[D] Work Performance:
Performance of the work will be Offsite.
Budget :
Deadline to Submit Proposals: October 24,2022
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$