The vendor is required to provide value based medical provider network services and pricing related to its partially self- insured medical plan.
- Provide high-quality, cost-effective care for employees, administrators, and taxpayers.
- The county's objectives focus on cost control, network adequacy, clinical and population health management, provider relationships, and technological integration.
- Cost control
• Negotiating favorable rates: engage in contracts that ensure competitive pricing for healthcare services.
• Fiduciary alignment: hold providers accountable for the total cost of care, promoting financial responsibility.
• Utilization management: implement tools to manage service usage effectively, such as site-of-care strategies for specific treatments.
• Alternative payment models: explore bundled payments, reference-based pricing, and cash-pay options to encourage transparency and efficiency of care delivery.
• Support for alternative payment models: adopt technologies that facilitate the implementation of various payment structures, such as bundled payments, cash pay, reference based contracting, etc.
- Network and network adequacy
• Broad provider access: ensure a diverse network of primary care physicians and specialists is available to members.
• Strong provider relationships: foster networks that facilitate easy access and collaboration among providers.
• Effective communication: ensure seamless collaboration between the provider network, third-party administrator (TPA) and prescription benefit administrator (PBM).
• Support for value-based models: encourage providers to participate in value-based and accountable care initiatives, focusing on quality outcomes.
• Accurate billing practices: ensure providers maintain efficient and precise billing and coding practices to reduce errors and administrative burdens.
• Inclusive services: incorporate access to durable medical equipment vendors, home infusion services, outpatient facilities, and diagnostic testing providers based on the overall cost of services.
- Clinical and population health management
• Robust analytics: utilize comprehensive reporting tools to analyze claims data, identify trends, and pinpoint areas for improvement.
• Identify gaps in care: utilize data sources to risk stratify and identify care gaps in the employee population.
• Prevention and wellness: ensure a commitment to fostering a culture of health and wellness, emphasizing preventive care, active engagement and holistic well-being.
• Member experience: provide dedicated navigation support for members and a variety of communication channels to engage members.
- Technology and data
• Member responsibility estimation: implement technology that accurately estimates patient financial responsibilities.
• Online portals: provide user-friendly online platforms for members to access health information and services.
• System integration: ensure provider networks can integrate with existing tpa technology platforms for streamlined operations.
• Care coordination: utilize technology to support active care coordination across the provider network, enhancing value-based care efforts.
• Support for alternative payment models: adopt technologies that facilitate the implementation of various payment structures.
- Contract Period/Term: 1 year
- Questions/Inquires Deadline: May 27, 2025