AI-Powered Predictive Analytics and Clinical Decision Support Platform

The Vendor is required to provide to design, implement, and support an AI-Powered Predictive Analytics & Clinical Decision Support (CDS) Platform (the "AI Solution") that can support the reduction of avoidable Department utilization and preventable inpatient admissions and readmissions across its:
• Medical Access Program (MAP)
• MAP Basic
• Sendero Health Plans
• Affiliated safety-net populations
- Solutions addressing one or both domains, and may focus on specific components of the overall problem (e.g., predictive modeling, clinical decision support, workflow enablement, or data integration), provided they clearly articulate how their solution contributes to measurable outcomes.
- Goals and Desired Outcomes
1. Predictive & Risk Stratification Goals
• Accurately predict avoidable agency utilization and preventable admissions/readmissions using multi-source data
• Segment populations into actionable cohorts for targeted interventions
• Maintain performance in environments with incomplete or delayed data availability
2. Clinical Decision Support & Intervention Goals
• Deliver actionable, prescriptive insights to multidisciplinary care teams
• Support transitions of care, medication management, and follow-up adherence
• Enable workflows that connect predictions to real-world interventions
• User-friendly interface with streamlined administration, reducing reliance on manual processes that enables non-technical staff to manage, configure, and act on outputs without significant IT dependency
3. Outcome & Impact Goals
• Reduce avoidable agency utilization and preventable admissions/readmissions
• Improve care coordination, patient outcomes, and health equity
• Support measurable ROI and operational performance improvement
4. Governance & Compliance Goals
• Align with applicable regulatory and ethical standards
• Ensure transparency, fairness, and accountability in AI-supported decision-making
- Capabilities that may include, but are not limited to:
1. Predictive Analytics
• Risk prediction using multi-source data (e.g., clinical, claims, ADT, pharmacy, behavioral health, and Non-Medical Drivers of Health)
• Identification of rising-risk individuals, avoidable agency utilization, and preventable admission drivers
• Model performance monitoring, including discrimination, calibration, and stability over time
2. Prescriptive / Clinical Decision Support
• Delivery of real-time or near-real-time recommendations and next best actions
• Support for multidisciplinary care teams (e.g., physicians, APPs, CHWs, case managers, social workers, care coordinators, behavioral health, and pharmacists)
• Clinical pathways addressing complex and comorbid conditions
3. Closed-Loop Care Enablement
• Integration of predictions into care workflows
• Ability to track interventions and measure downstream outcomes
• Continuous learning and model refinement based on real-world performance
4. Data Integration & Interoperability
• Integration across diverse data sources, including systems that may lack consistent unique identifiers
• Support for interoperability standards (e.g., FHIR, HL7, C-CDA, and EDI X 12)
• Ability to function effectively in environments with incomplete or delayed data
- Functional Requirements
1. Predictive Capabilities
• Multi-source predictive modeling
• Identification of high-risk cohorts and utilization drivers
• Transparent outputs with explainability and fairness indicators
2. Clinical Decision Support
• Actionable recommendations aligned to clinical workflows
• Support for care transitions and community-based care models
• Multidisciplinary care team enablement
3. Reporting & Monitoring
• Dashboards for utilization, risk, model fidelity, and outcomes tracking
• Performance metrics (e.g., AUC/ROC, precision-recall, calibration)
• Reporting to support ROI, program evaluation, and operational decision-making
4. Administration and Usability
• Intuitive user interface accessible to clinical and operational staff without significant technical expertise
• Streamlined administrative workflows that minimize manual configuration, maintenance, and intervention
• Role-based access, self-service configuration, and operational management capabilities that reduce IT dependency