Request for Qualifications Project Facilitator/Manager for Business Plan Development

Transcription

1 Request for Qualifications Project Facilitator/Manager for Business Plan Development INTRODUCTION The Mid-America Regional Council (MARC) is a public not-for-profit organization serving the Kansas City metropolitan region. Among its responsibilities, MARC serves as the Area Agency on Aging for five Missouri counties Cass, Clay, Jackson, Platte and Ray counties. MARC is seeking a consultant to support the development of a business plan for new regional asset, the Managed Services Network, to connect health care institutions such as hospitals and payers with community-based organizations through a new business model that enhances services to patients, reducing health care costs and improving health outcomes. BACKGROUND The nearly universal desire to remain independent in the community is challenged by the complexities of chronic conditions. Although superb clinical care provides a tremendous benefit to health and extended life, non-medical supports provided in the community are essential to safeguarding independence, preventing poor health and well-being outcomes, and addressing social determinants of health. Although research shows that community services help to reduce poor outcomes, including rehospitalization, there is often a lack of capacity to deliver targeted, systematic, and region-wide services and interventions. However, if this capacity could be established among community services organizations, then those organizations may be able to provide significant benefit to high-risk patients. Nationally, there is a growing movement for organizations to provide supportive services through formal networks, often established and managed by Area Agencies on Aging. One such network concept is a Managed Services Network (MSN), in which a central administrative organization helps to recruit high-quality network members, builds technical and billing capacity among these organizations, and provides a connection to populations of great need, such as recently discharged hospital patients. GOAL: The Mid-America Regional Council (MARC) aims to build an MSN to improve the capacity of community-based organizations (CBOs) to collaborate with health providers and other health care payers. The goal of improved coordination among CBOs and health providers and payers would be to treat the whole person including non-medical health-related needs to: Improve access of health provider or payer clients to community-based services; Create new reimbursement mechanisms for community-based services in the region; Leverage the new revenue streams to subsidize more community-based services, where necessary, for underserved populations;

2 Improve outcomes relative to transitions between levels of care (e.g., reduce hospital readmissions); and Improve rates of success living independently in the community (e.g., reduce nursing home admissions). MSNs exist in many regions across the country offering a variety of functions based largely upon the needs of the CBOs and health policy opportunities. Generally, a lead entity serves as a centralized administrative agent for a network of CBOs or local area agencies on aging. MSNs offer a variety of services that can include: Contract management, rate negotiation, or billing support between CBOs and health plans or health providers for the provision of community-based services. Evidence-based trainings for CBO staff, such as falls prevention, chronic care selfmanagement, or depression. Clinical oversight of intensive community-based assessment and care management for complex clients including Medicaid or dually-eligible Medicare and Medicaid clients. Planned and unplanned hospital-based care transition assistance including in-home or hospital-based assessment, referral to community-based services or follow up in the community. Most common home and community-based services offered through the network include: home delivered meals, adult day, transportation, personal emergency response systems, home modifications, medication management, and personal care. The above findings are the results of research MARC conducted on a variety of area agencies on aging that operate as a MSN for their region or are nationally recognized for their efforts to link community to health care. MANAGED SERVICES NETWORK MODEL CONCEPT: The concept leverages MARC s core strengths as a regional administrative, planning and support agent to offer a suite of services designed to meet the needs of the health payers and providers and CBOs, and the clients they serve. Envisioned Core MSN Functions. The MSN could perform a variety of functions tailored to meet the needs of the health provider and payers as well as the needs of the clients and CBOs. Based upon the preliminary research and an assessment of MARC s strengths, the functions could include: Access and Referral. Serve as a single point of entry to community-based services for health providers and payers to help them meet the needs of their clients, which includes accepting and distributing the referral for the service(s); Screening and Support. Assessment of client needs, as necessary, for both planned and unplanned hospitalizations and in the community, to assure connection to the

3 appropriate community-based services with follow-up in the community when needed; Technical Assistance. Provide capacity building technical assistance for CBOs, which may include trainings on evidence based practices (e.g., falls prevention, chronic care self-management); case conferencing and resource sharing; business acumen support; or assistance with data collection, data management and program evaluation; Administrative and Financial Support. Manage transactions (e.g., contracts with health providers and payers including Medicaid, rate negotiation, billing, reporting, information technology support) to cover the costs of services; Quality Assurance. Establish and promote accountability systems for the provision of community-based services (standards for delivery of services, certification, reporting, evaluation); or Community Needs Assessment. Periodic evaluation of the strengths and resources available in the community to meet the needs of the target population, which will inform ongoing strategic planning and performance goals for the MSN and its network. COMMUNITY-BASED SERVICES. The likely core package of community-based services would include: home-delivered meals; transportation; adult day care; medication management; home assessments and modifications; personal emergency response systems; evidence-based trainings; and personal care. FUNDING/SUSTAINABILITY: A variety of funding mechanisms can support a MSN model including health providers, Medicaid, Medicaid managed care organizations, Medicare, Medicare Advantage organizations, Programs of All-Inclusive Care for the Elderly (PACE) organizations, Accountable Care Organizations, or other commercial health plans. TARGET POPULATION(S): The MSN could serve older adults and individuals with disabilities of any age with an emphasis on underserved or high-need populations, such as dual eligible clients and people with multiple chronic conditions and functional limitations. PLANNING PROCESS: MARC will appoint a steering committee to enter into a 9-month planning process to develop the MSN model and initial pilot structure. The planning process will seek to collaboratively identify the MSN functions and goals; network partners; funding sources; information technology needs; staffing; and quality and evaluation processes. The planning process would include three phases: Research and Analysis. The first 3-months will include research and analysis to identify community and health provider/payer need, and community-based organization capacity. To conduct this research, MARC will systematically engage health providers,

4 health payers and community-based organizations through methods such as surveys, interviews, and workshops. Organizational Approach. MARC will then work with the steering committee over the following 3-months to design the MSN structure. This will include identifying, for the initial pilot, the MSN service options and target population; potential network partners; and CBO quality and performance standards. Implementation Plan. Over the final 3-months, MARC will work with the steering committee to develop an implementation plan for the initial pilot structure. The implementation plan will outline a timeline and budget for the initial pilot and will include, at a minimum: o Establishment of partnerships with the CBO network and health providers/payers through memorandums of understanding (MOUs); o Identification of staffing needs and information technology requirements; and o Development of an organizational management plan (e.g., bylaws, policies and procedures). PILOT. The 9-month planning process will culminate with a business plan and timeline for a defined initial MSN model and pilot including service options, target population, funding strategies, and identification of implementation and infrastructure needs. DESIRED SCOPE OF SERVICES 1. Research and Analysis to gain an in-depth understanding of health provider/payer needs and community-based organization capacity. The consultant will work with MARC staff in determining what research should be conducted and what information should be collected. Consultant may conduct individual stakeholder interviews, facilitate focus groups, arrange for surveys or help design workshops to gain an understanding of the needs of patients that health care providers see the need to serve. Individual interviews, focus groups, surveys or workshops may be used to obtain information about community-based organizations capacities to deliver certain services and how to help change their business model from charitable to fee-for-service. Consultant will help review the various business elements for a Managed Services Network. The analysis will include information on how such operations are organized, staffed, and financed and IT requirements. 2. Expert Advice. MARC has budgeted funds to solicit advice from national experts. The consultant will assist MARC staff in identifying the experts and arrange for their services, either by phone or in-person in Kansas City. 3. Meeting Facilitation of stakeholders and the steering committee by organizing agendas, presenting information, encouraging and facilitating discussion and advancing the work toward development of a business plan and pilot program launch.

5 4. Plan Preparation. The consultant will draft elements of the plan, including: (a) an analysis of services of greatest need among patients served by area health care organizations; (b) opportunities for reimbursement by public and private payers for various services in Kansas and Missouri; (c) the current capacities for community-based organizations and capacities needed to serve a greater demand for services; (d) key partnerships to establish the MSN; and (e) steps to design and create a Managed Services Network. 5. Design and Launch of Pilot Project. The consultant will assist in the design of a pilot project, the identification of steps required to launch the MSN in 2018, and identification of resources required and possible sources to enable the pilot to proceed. DESIRED QUALIFICATIONS Knowledge of the health delivery system and public and private payment mechanisms to reimburse health care and other organizations for various services. Project Management experience Strong communication and meeting facilitation skills. Experience in business plan development. Experience in pilot program design. PROJECT BUDGET MARC has budgeted $90,000 for this consultant engagement. RESPONSE CONTENTS Responses to this request should be directed to Marlene Nagel, by electronic mail at mnagel@marc.org or by mail to Mid-America Regional Council, 600 Broadway, Suite 200, Kansas City, Missouri 64105, by 4 p.m. CST on November 7, It is the responsibility of the respondent to confirm that the proposal is received by the deadline. The following items should be addressed in your response. Description of the Firm or Individual. Description of the firm offering to provide services to MARC, including type of business, date business was established, type of services provided, and description of client base. If an individual, provide background on experience, education and skills necessary to perform the required services. Briefly describe how your experience relates to the required scope of services and your approach to providing the desired services. References for Similar Projects. Provide three references of clients where services were similar to those requested by MARC. Description and Qualifications of Firm s Personnel. Description of qualifications of personnel who would be assigned to assist MARC. Provide resumes of the individuals who would be assigned to the MARC project, including information on their experience with work similar to that required by MARC. Indicate the degree to which identified personnel will be available to participate in the project.

6 Fee Schedule. Provide your hourly fee schedule and maximum hours per week that individual assigned to the project would be available. Indicate if the proposed scope of services could be accomplished within the project budget. ANTICIPATED CONSULTANT SELECTION SCHEDULE MARC expects to appoint a steering committee to oversee the project and an internal team to provide grant and project management. Several members of the steering committee will join MARC staff to review responses to this RFQ and determine if interviews with individuals and/or firms will be held. If interviews are scheduled, the tentative timeframe is the week of November 13, MARC expects to select a vendor and negotiate an agreement by November 30, PROJECT SCHEDULE It is anticipated that the work could begin as early as December 1, 2017, and be completed by August 31, AWARD OF CONTRACT This request for qualifications does not commit the Mid-America Regional Council to award a contract or to pay costs incurred in the preparation of a proposal in response to this request. MARC reserves the right to accept or reject any or all proposals received as a result of this request, or to cancel any or all of this Request for Qualifications, if it is considered in the best interest of MARC. MARC may require the proposer selected to participate in negotiations, and to submit to such price, technical or other information as may be needed to finalize a particular engagement for services. AFFIRMATIVE ACTION POLICY/DRUG-FREE WORKPLACE MARC hereby notifies all respondents that it will affirmatively ensure that minority and womenowned business enterprises will be afforded full opportunity to submit proposals in response to this request and will not be discriminated against on the grounds of race, color, national origin, sex, disability or veteran status in consideration of the contract award. It is an objective of MARC to use minority and women-owned businesses to the maximum extent feasible in carrying out its activities. Appendix A contains an "Affirmative Action Checklist" for firms employing 50 or more persons and an "Intent to Perform as a Disadvantaged Business Enterprise" form for use if applicable to firms submitting proposals. Consultant must agree to comply with the requirements of the Drug-Free Workplace Act of 1988, P.L , Sections 5151 through MARC CONTACT FOR FURTHER INFORMATION For further information about the project, contact Marlene Nagel at mnagel@marc.org by. The responses to all requests for information will be provided by to all vendors who contact the MARC contact referenced in this Section to indicate their interest in the RFQ.