REQUEST FOR COMPETITIVE BID Strengthening State Systems to Improve Diabetes Management and Outcomes I. Summary Information Purpose: ASTHO is requesting bids from states to participate in a demonstration project to partner across sectors including clinical, community, and public health partners to align state diabetes plans and address gaps to improve diabetes management and associated outcomes. Bid Deadline: The deadline for the 5 (max 8) page application is 3:00pm EDT/12:00pm PST, Thursday, December 1 st, 2016. Please send a short email to chronicdisease@astho.org with your intent to apply by November 11 th, 2016. Selection Announcement Date: The week of December 5 th, 2016. State Eligibility: States that are NOT 1422 funded and engaged with NACDD to develop a diabetes action plan: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Maine, Mississippi, Montana, Nevada, New Hampshire, North Dakota, Oregon, South Dakota, Tennessee, Vermont, West Virginia, Wisconsin, and Wyoming. Monetary Assistance Available to Awardees: Awards of $30,000-60,000 each will be provided for up to three state health agencies to participate in this project. States will be provided $30,000-60,000 for a planning project (phase I) which includes 1) statewide assessment of diabetes activities, 2) identifying challenges/gaps/needs, and 3) developing necessary partnerships and strategies for improving diabetes outcomes. Estimated Period of Performance and Final Report Date: The project period is December 12, 2016 through August 1, 2017. ASTHO Point of Contact: Elizabeth Walker Romero (eromero@astho.org). Applicants may also contact Alicia Smith, Director, Chronic Disease Prevention, with questions (asmith@astho.org). Elizabeth Walker Romero Senior Director for Health Improvement Association of State and Territorial Health Officials Phone: (571) 527-3170 Email: eromero@astho.org Alicia Smith Director, Chronic Disease Prevention Association of State and Territorial Health Officials Phone: (571) 318-5464 Email: asmith@astho.org 1
II. Description of Bid Purpose The purpose of this project is to support state health agencies and their partners with the development of a statewide plan that would focus on opportunities to align current efforts, address gaps, and leverage strategic partnerships to support diabetes management and improve diabetes outcomes. This grant will support strategic planning activities with clinical, community, and public health partners to collaboratively identify opportunities for secondary and tertiary prevention efforts to reduce the burden of diabetesassociated risk factors and complications. In phase I of the project, states will conduct a statewide assessment of diabetes activities in order to identify challenges/gaps/needs, and develop a plan outlining strategies to address the identified gaps. To support these activities, states will identify strategic opportunities to expand the scope of current partnerships with payer, clinical, and community partners. States will also identify relevant performance and evaluation measures (e.g. National Quality Forum measure 59 1 and others) to help guide implementation and evaluation of statewide efforts. This grant could also help states explore the feasibility of implementing strategies outlined in the statewide plan. Depending on readiness, states could elect to work with 1-2 clinical or community settings using a quality improvement approach to test strategies. State teams may use the Deming Plan, Do, Study, Act quality improvement model to try, assess, refine, and scale up a variety of strategies and approaches towards these ends. Background Diabetes is one of the leading causes of death and disability in the United States. More than 29 million people are estimated to have diagnosed or undiagnosed diabetes, and an additional 86 million US adults have prediabetes. i Through federal funding, all 50 states and the District of Columbia receive funds to support chronic disease prevention programs, including diabetes prevention and control programs. State chronic disease or diabetes plans identify priority areas for action around prevention, identification, and control of diabetes. ASTHO has demonstrated success with the Million Hearts State Learning Collaborative using a systems framework to support states annual objectives to improve hypertension control. Using a systems change approach, states can also strengthen their strategic plans to improve diabetes control through: data-driven action, multi-sector partnerships, standardizing practice, community-clinical linkages, financing, and policy. In phase I of the project, ASTHO aims to develop key systems change recommendations specific to diabetes and partner with up to two demonstration states to pilot the recommendations. ASTHO is partnering with the National Association of Chronic Disease Directors (NACDD) to support this project. NACDD has significant experience in working with state health departments and their partners to implement approaches for effective chronic disease programs, diabetes-specific public health actions, and coordination and integration of diabetes with other program strategies. The NACDD Diabetes Team is 1 The percentage of members 18-75 years of age with diabetes (type 1 and type 2) whose most recent HbA1c level during the measurement year was greater than 9.0% (poor control) or was missing a result, or if an HbA1c test was not done during the measurement year. 2
comprised of consultants who collectively have over 50 years of public health experience at the county, state, and/or national level working on diabetes and related chronic disease public health approaches. The NACDD Diabetes Team assisted CDC in launching the Diabetes Primary Prevention Planning Program (DP4) that funded state health departments to convene stakeholders to identify essential public health components for diabetes prevention and to develop state prevention plans. In addition, NACDD helped CDC coordinate the Diabetes Primary Prevention Initiative that funded five state health departments, and contractors to create a plan of action, pilot-tested surveillance, system dynamics modeling, and interventions, and, ultimately, produced recommendations for federal, state, and local public health implementation of diabetes prevention. NACDD has also supported the development of the BRFSS diabetes prevention module and collaborated with CDC to implement the State Diabetes Prevention Project (S-DPP). Project Activities ASTHO will support agencies in the development of an action plan to address current gaps in efforts to improve diabetes management and associated outcomes. Applicants will describe their proposed systems change approach and multi-sector partner engagement to support these efforts. Below is a general description of project activities: A. Statewide assessment of diabetes strategies and activities to identify challenges/gaps/needs. States may do this as part of diabetes action plan legislation mandate to publish or update a diabetes action plan. B. In-person and virtual learning sessions with key stakeholders to collaboratively develop a diabetes action plan. States will convene a wide variety of key stakeholders to review the statewide assessment and identify and prioritize policies, practices, and systems to implement and roles for stakeholders. C. Development of a diabetes action plan that clearly defines roles for key stakeholders. Systems Change: Applicants should describe how they will leverage ongoing public health and clinical initiatives to develop and/or implement strategies through existing and new statewide systems around data/health IT access and sharing, financing and reimbursement, and standardizing clinical and community practice and linkage protocols. Applicants should also describe what existing state-level initiatives are in place to support spreading and sustaining these systems. Examples include CMS State Innovation Model (SIM) initiatives, state health improvement plans, other CDC funding streams, other initiatives of partners, etc. State Team Members: Applicants should include a list of their proposed state team, as well as the proposed roles and responsibilities for each team member. The state health official will collaborate with state health agency staff to identify an agency staff member lead, and will engage several multi-sector leaders to participate as core planning team members. Additional team members will depend on the project design, available partners, and other state-specific factors. The core planning team capacity should include, at minimum: 1. State Health Agency Lead as identified by state health official, such as a Chronic Disease Director (This person will serve as ASTHO s primary contact and will be responsible for tasks such as coordinating in person sessions, reporting, participating in project lead calls, etc.) 2. A lead Deputy or Chief of Staff for the Agency (sometimes referred to as the Senior Deputy) 3
3. Public or private health plans 4. Regional partners (e.g. QIO, community health center network, health system, hospital service area or ACO) 5. Community Partners (e.g. YMCA State Alliance, Public Health Institute, etc) Expected Outcomes The goal of this project is to convene a wide variety of stakeholders to collaboratively identify systems change policies and practices to improve diabetes management and associated outcomes. Expected deliverables include: Date December 12, 2016 12:30-2:30pm ET December 2016 January/February 2017 TBD May 2017 TBD June 2017 TBD July 2017 TBD August 1, 2017 August 15, 2017 Monthly Deliverable Virtual kick-off call for state teams (must include multi-sector partners) Statewide assessment of diabetes strategies and activities to identify challenges/gaps/needs On-site in-person stakeholder meeting with ASTHO facilitator (TBD locations in each state) Virtual learning session Develop diabetes action plan to identify and prioritize policies, practices, and systems Virtual learning session End of project period; final invoice due to ASTHO Final reports due to ASTHO Invoices due to ASTHO Inclusion of Health Equity: ASTHO is committed to the promotion of health equity and the elimination of health inequities. Health inequities are reflected by disproportionately high rates of disease, premature death and a lower quality of life. Health inequities are avoidable and state, federal, and locally-funded activities play a key role in helping to solve this problem. Applicants are encouraged to address health inequities within the context of proposed activities. Technical Support ASTHO is available to provide information to the grantee at no additional cost to support grantees in meeting the expectations above by: Providing key recommendations to strengthen state systems for diabetes prevention and control. Providing on-site technical assistance through site visits, in-person meetings, and virtual technical assistance through online convenings, webinars, conference calls, etc. Providing connections to national partner organizations and individuals, as needed. Supporting the development, implementation, and evaluation of grantee s initiatives. 4
Funding Awards of $30,000-60,000 will be provided for up to three state health agencies to participate in phase I of this project. Bid Evaluation Bids will be evaluated by internal ASTHO staff. III. Requirements for Financial Award Allowable Expenses Funds may not be used for equipment purchases or continuing education. Per HHS requirements, funds awarded under this RFP are prohibited from being used to pay the direct salary of an individual at a rate in excess of the federal Executive Schedule Level II (currently $185,100). Required Grant Activities to be Covered by Award Travel for participants to attend the in-person learning sessions will be covered by the grant. Period of Performance The project period is December 12, 2016 through August 1, 2017. The general timeline is below. Starting week of December 5, 2016 December 12, 2016 December 12, 2016 12:30-2:30pm ET January/February 2017 TBD May 2017 TBD July 2017 TBD August 1, 2017 August 15, 2017 Monthly Applicants selected and contracts executed Project period begins Virtual Kick-Off Call On-site in-person stakeholder meeting with ASTHO facilitator (TBD locations in each state) Virtual learning session Virtual learning session End of project period; final invoice due to ASTHO Final reports due to ASTHO Invoices due to ASTHO Reporting Requirements In addition to participating in the meetings and calls highlighted above, grantee will be required to submit: 1. Progress report and invoices monthly. 2. Initial action plan. 3. Final diabetes strategic plan developed during project period. 4. Processes, best practices, tools, and resources developed through this project with team partners, leadership, ASTHO staff, and possibly the funder, national partners, and other stakeholders as appropriate. 5. Feedback and suggestions on project activities as requested via questionnaires and/or interviews 5
with ASTHO staff. 6. Final report after the end of the grant period. Additional Requirements N/A IV. Required Bid Content Applications should be approx. 4-5 pages and may not exceed 8 pages in length, excluding CVs and budget, and should be single-spaced in 11 point font. Required Sections: Cover Letter of SHO(s) (5 points), Support of Key Stakeholders (25 points), Proposed Approach (20 points), Prior Experience (5 points), Organization Capacity (10 points), Budget & Narrative (15 points), Response to Draft Contract (5 points), Proposed Multi-Sector Partnerships (5 points), Inclusion of Health Equity (5 points), and Evaluation Plan (2 points). Additional points will be awarded for participation in CMS Diabetes Affinity Group (3 points). A. Cover Letters a. Cover Letter from State Health Official: Include the name of the lead programmatic contact person (name, address, e-mail, telephone number, and agency s DUNS number or CAGE Code). b. Cover Letter from the Grantee Fiscal Agent: Include the name of the agency that will be the grantee fiscal agent specifying a contract (name, address, e-mail, telephone number). B. Support of Key Stakeholders: Please provide letters of support from at least two key stakeholders. The letters should clearly state the entities support; recognition of roles and responsibilities; resources and personnel; alignment with their current work and willingness to undertake the project in collaboration with the applicant. C. Proposed Approach: Provide a brief outline of the approach and strategy to accomplishing the requested project activities. Detail a work plan which includes activities, timeline, goals, and milestones to achieve the deliverables and meet the expectations noted above. D. Prior Experience and Performance: Describe experience and quality of performance on recent work completed with similar scope. Include information about familiarity with and understanding of the topic. Describe ability to represent ASTHO well in interactions with state and territorial health agency staff and other governmental, private sector, and/or non-profit stakeholders. E. Organization Capacity: Include information about the company and address ability and capacity to perform the services required within the specified timeframe. Describe staff qualifications and provide a CV for key personnel/staff lead. F. Budget & Budget Narrative: Provide a detailed cost-reimbursement budget, including detailed projected costs for the completion of the project. The cost reimbursement budget should include 6
salary, fringe benefits, other direct costs, and indirect costs, as appropriate. If indirect costs are included on your budget, please provide a copy of your approved Indirect Cost Rate Agreement. Maximum award is $60,000. Attachment A outlines the general format in which the budget should be presented. Applicants may use Attachment A as a template or simply as a guide to inform development of the project budget. A budget narrative must accompany the budget and indicate the costs associated with each proposed activity. G. Response to Draft Contract: ASTHO and selected applicant(s) will enter into a sub-grant agreement. A draft agreement between ASTHO and the selected applicant is available in Attachment B. Review the agreement s terms and conditions with your contracts officer and confirm that if selected, you will enter into this agreement, or identify and include any proposed changes with your proposal application. ASTHO reserves the right to accept or decline any proposed changes to the terms and conditions. Significant proposed changes, which could affect the agreement s timely execution, may impact your selection as a successful applicant. H. Proposed Multi-sector Partnerships: Please describe your partnerships and include a discussion of your partners, their potential roles and responsibilities in the project, and how they will support the goals of the project. Also provide a description of how partners represent a multi-disciplinary crosssection of entities and issues within your state, particularly related to your selected issues and target population. I. Inclusion of Health Equity: Throughout the proposal, incorporate the following: (1) describe the extent to which health disparities are evident within the health focus of the application, (2) identify specific group(s) which experience a disproportionate burden of the health condition, and (3) demonstrate how proposed activities address health inequities (this also includes identifying social and/or environmental conditions which are the root causes of health disparities). The root causes of health inequities are sometimes referred to as social determinants of health. All information regarding health inequities must be supported with data. J. Evaluation Plan: Please discuss capacity to develop performance measures and an evaluation plan; and collect, analyze and submit data at both the population health and individual patient level. Additional Selection Considerations Selection will also include consideration of diverse representation of state [and territorial, if applicable] health agencies such as agency structure (i.e., centralizes versus decentralized), geography, and organizational structure within government. V. Submission Information Application Procedure Applicants must respond to the request for bid by 3:00pm EDT/12:00pm PST, Thursday, December 1 st, 2016. Please send a short email to chronicdisease@astho.org with your intent to apply by November 11 th, 2016. Please submit an electronic copy of the application to ASTHO Staff at chronicdiease@astho.org. Incomplete applications or applications received after the deadline will not be considered. 7
Timeline October 27, 2016: Request for bid released December 1, 2016 at 3:00pm EDT: Deadline for submission of grant proposals Week of December 5, 2016: Contract award announced December 12, 2016: Contract period commences August 15, 2017: Final report due Applicant Questions and Guidance ASTHO will support interested applicants to offer guidance and address specific questions about the request for bid. Interested parties may contact ASTHO staff via e-mail at eromero@astho.org or asmith@astho.org. i CDC. 2014 Diabetes Report Card. Available at: http://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2014.pdf. Accessed 3/16/16. 8