Decision Support System

The Vendor is required to provide decision support system (DSS) capable of integrating multiple data sources into a single, analytically robust environment.
- DSS must enable university to evaluate plan performance, understand utilization and cost trends, benchmark against industry norms, and support strategic benefit decision making.
- Objectives
• Centralized integration of medical, pharmacy, dental, vision, disability, encounter, and eligibility data.
• Enhanced um ability to measure cost, utilization, quality, and member access across its population of 50,000 members.
• Streamlined analytics to inform plan design, trend evaluation, and program impact measurement.
• Improved operational efficiency in producing reports, dashboards, risk scores, and forecasting.
• Secure storage of a rolling five-year historical data repository with archiving capabilities.
- Demonstrate experience accepting data from the following plan types:
• Medical
• Pharmacy benefit manager (PBM)
• Dental
• Vision
• Disability plans (long and short term)
- DSS as a turnkey service, such that the university has no responsibility for the database, decision support software, hosting, or technical infrastructure.
- The system must be:
• Web accessible.
• Secure.
• HIPAA-compliant for the life of the contract and any period in which the bidder maintains the university data.
- Online consumer plan selection tool with the following capabilities:
• Enable members to view historical claims cost and utilization data for themselves and their dependents.
• Allow members to incorporate historical claims information to compare available health plan options and support informed decision-making during open enrollment.
• Support newly enrolled members, including those without historical claims experience, by estimating future healthcare costs to facilitate plan comparisons.
• Be available during annual open enrollment as well as for members added throughout the year.
• Be accessible via single sign-on (SSO) through the university website.
- Provide VDSA reporting services, which include:
• Entering into a voluntary data sharing agreement (VDSA) with the centers for Medicare and Medicaid services (CMS).
• Conducting monthly data matching to determine Medicare eligibility.
• Transmitting the Medicare eligibility matching results to the university on a monthly basis.