The vendor is required to provide data aggregation services for population health analysis and management.
- Utilize the data files that are currently in place between the plan and the plan vendor, if the vendor does not already have a data sharing agreement in place with the plan’s vendors, to ensure the project is implemented on schedule.
- Provide a high-level implementation plan that includes the key milestones for the intake of plan data from each plan vendor and directly from the plan.
- Provide a high-level implementation plan for the go-live date of the vendor’s solution.
- Ensure accuracy of data files through matching output with standard reporting.
- Provide visibility and transparency at all stages of the implementation which includes providing a weekly status report that tracks to the implementation plans developed with each plan vendor as well as the overall status of the implementation.
- Provide subject matter experts, in addition to account management resources, to work directly with plan and plan vendor staff.
- Respond to plan inquiries regarding legal, financial, or operational matters within 48 hours. Of the request, unless extended by the plan.
- The response shall be received prior to 5:00 p.m. ET.
- Work with the plan and other plan vendors as needed to resolve issues.
- This includes providing the appropriate vendor resources with the expertise needed to address the specific issue(s), not just the account management team.
- Bring the appropriate subject matter experts and decision makers to the table to meet with the plan within one week of a new plan project or initiative request.
- Meeting topics could include, but would not be limited to, new data integration requests, pilots, and/or other plan partner initiatives.
- Software includes functionality to allow the review of individual and aggregated data to provide cost containing and outcome insights related to plan programs and services.
- System will integrate, at a minimum, plan member enrollment data, provider data and medical and pharmacy claims data.
- System can ingest other data such as health risk assessments, member surveys, social services programs, third party data, electronic health record data, and other data as requested by the plan.
- Ingest and integrate both fee-for-service claims data and capitated, bundled payment, or other risk-based claims data, as requested by the plan.
- Incorporates AI tools, where appropriate, to assist in data analysis.
- Analysis tools use aggregated data to identify opportunities to improve members’ outcomes while reducing healthcare spend by assessing population health, medical and pharmacy overspend, network performance, non-clinical social determinants, digital health programs, emerging risks, provider value, and holistic benefit approach.
- Provide data to identify potential solutions and cost savings through advanced cohort analyses.
- Upon request, vendor will contract with other vendors to obtain and integrate other data, tools or services that may enrich the plan’s ability to analyze and report plan metrics.
- Any such request will be memorialized via an amendment to the contract and the cost will be passed through to the plan.
- Group claims and people by disease state, risk score, surgical category, and other clinical buckets for plan population health initiatives.
- Able to group providers into systems or larger practice levels by tax identification number (tin) and national provider identifier (NPI).
- Provide a data dictionary that highlights methodology for all groupings (claims, disease, episode of care, etc.).
- Provide the plan with a consolidated flat file for each plan year incorporating all data elements.
- Upon request, vendor will provide data files and corresponding data mapping to the plan on an as needed basis.
- Upon request, vendor will prepare and transfer data to plan partners.
- Scheduled down-times are in the evening or weekends to minimize plan user disruption.
- Immediately report any data integrity or system issues to the plan and maintain service availability to greater than 99%.
- Contract Period/Term: 3 years
- Questions/Inquires Deadline: April 11, 2025