The vendor is required to provide that health and welfare benefits consulting service medical, dental, vision, pharmacy and wellness programs.
-The design, maintenance, communication, and improvement of the aforementioned benefit programs.
-The advisor must be able to demonstrate experience in the strategic development, oversight, and direct contracting negotiations with health provider organizations.
-It is also expected that the advisor has experience with risk sharing arrangements within accountable care organization contracting.
-The consultant must be able to provide or have access to, as part of their services, actuarial, underwriting and data analytic service resources.
-The successful bidder(s) must provide support and high-level results in the following areas:
•Providing attendance at regular meetings and negotiations throughout state;
•Maintaining established relationships with state-based healthcare networks and associated health data management organizations;
•Complying with state and federal laws/legislation;
•Providing expertise, advice and support for development and support of health and wellness initiatives, population health management and value-based insurance design
•Advising and participating in the design of cutting-edge contracting solutions with state primary and acute care healthcare systems. this will involve participation in on-site and telephonic meetings with the department, health systems, and their consultants to redesign;
•Advising on and providing assistance with negotiations on accountable care organization/risk sharing agreements and other creative contracting solutions;
•Assisting the department and state employee health commission in matters pertaining to competitive bidding and/or negotiations with vendors including health and dental insurances, managed care and prescription drug vendors;
•Benchmarking of health & welfare plan with other state government and industry standards;
•Advising in the negotiation of third-party administration contracts and associated performance guarantees;
•Underwriting analysis for self/fully insured health, dental, pharmacy and vision plans (employee and retiree group plans) including premium/cobra rate development;
•Providing plan design and evaluation/modeling;
•Assisting in the development of competitive bidding, associated with employee benefits administration and in the analysis of bidders’ responses;
•Reporting on cost, utilization and other key plan drivers for the health, dental and vision programs;
•Consulting on other ongoing vendor management issues such as eligibility administration, claims processing, appeals with insurers and third-party administrator;
•Assisting with the content and development of communication/education materials;
•Reviewing plan documentation including, plan documents, and benefit administrator contracts; and
•Performing other benefit consulting duties as initiated by the department or state employee health commission.
-Specific responsibilities may include, but are not limited to:
•Attending any operational meetings and contract negotiations;
•Assisting the department in compliance with laws and regulations related to employee benefits;
•Researching, alerting and advising of any new developments in state and federal law and employee benefit programs on an ongoing basis;
•Working with the department on strategic planning with regard to all health and welfare coverage;
•Advise and assist in controlling and reducing plan costs and developing strategic initiatives based on subscriber outcomes;
•Supporting the department’s vendors in developing unique contracting solutions with state healthcare system;
•Assisting in the development of summaries used in competitive bidding for health and dental plans in accordance with state practices. support for competitive bidding may include drafting specification and scope of work, as well as assisting with the evaluation process in varying capacities.
•Assisting the department with provider negotiations on all contractual issues including premiums rates, benefit levels, and plan design.
•Providing expertise and advice in support of the wellness programing, services, and strategies.
•Assisting with benefits communications strategy including the drafting and review of documents and recommendation of non-traditional communication methods;
•Providing useful data, data analysis and reporting for use in subsequent benefit solution strategies, and the use of eligibility and claims data warehouse in generating these reports:
oUtilization and cost trends
oClaims experience, and claim administration metrics
oPerformance measurement and service guarantees
•Attending state employee health commission, department meetings, and periodic vendor meetings.
-Contract Period/Term: 3 years