Overcoming the significant regulatory, industry and clinical challenges of providing your health plan members comprehensive coverage begins with finding the right partners to walk alongside you in filling gaps and providing useful tools and information for your teams and your members. Finding the right partner starts with a strategic request for proposal (RFP).
An RFP is a formalized process of evaluating multiple vendors and selecting the ideal digital health partner for a health plan. RFPs open the bidding process for competing vendors and provides a health plan with a variety of options for solving current and anticipated challenges and working more efficiently. A strategically formulated RFP question-and-answer format gives the project review team a clear side-by-side comparison of what a vendor can offer and ensures the new potential partner checks off predetermined internal requirements.
Vendors embrace the opportunity to share new solutions with health plans interested in investing in healthcare innovation. Potential vendors should understand a health plan needs to deliver more than medical care to be successful and be able to meet those needs in changing regulatory environments.
New Regulations Require Innovation
Federal and state regulatory bodies leverage individual and aggregated data sources as a means of rating plans and pushing them toward innovation. For example, the Centers for Medicare and Medicaid Services (CMS) uses Star Ratings to hold Medicare Advantage plans accountable for performance and foster creativity in how they support member health. A digital health partner must be aligned with the measurement systems in place and able to position a plan to not only meet the requirements but also improve in the right measurement areas.
CMS has also placed health equity as a top priority. Health plans must ensure all members and communities receive the right services regardless of zip code or demographics to eliminate disparities in care. Upcoming requirements around race, ethnicity and language means health plans must rethink how they how they capture member demographics, primarily through self-attestation.
Many states are following CMS in the call for health equity and initiating state-specific regulations and strategic frameworks to address social determinants of health (SDOH). A strong partner should have the knowledge base to know and meet current and upcoming requirements and provide support in navigating regulation transition periods.
Identify the Right Boxes to Check
Streamlining vendor selection with an RFP allows a health plan to efficiently review the necessary vendor qualifications including:
- Capabilities. Efficiently gather member feedback and provide performance measurement.
- Services. Build personalized tools.
- Reliability. Capacity to support the health plan at every step in the process.
- Industry experience. History of working with health plans and solving challenges similar to yours.
- Company profile and leadership. How the organization is structured, vendor history and areas of thought leadership.
- Regulatory knowledge. Proficient in CMS requirements and practices, Protected Health Information (PHI), HIPPA and HITRUST certified.
- Reputation. Proven client retention.
- Pricing structure. Considerate of your established budget, is fair and projected as sustainable.
Recognizing RFP Challenges
While reviewing multiple vendors at once is beneficial, developing RFPs and conducting detailed assessments takes vital resources, time and staff away from ongoing quality improvement initiatives. Any roadblocks during the RFP process risks a team’s ability to meet deadlines and may delay time-sensitive member interventions. Extra attention in the early stages of the RFP process can ensure your team has the capacity to motivate members in meeting their health-focused goals.
Managing the RFP process requires a dedication to controlling timelines and guiding people. Be prepared to overcome a few of the common factors that delay RFP reviews:
- Unclear objectives. Develop the RFP with relevant questions that put the health plan goals at the foundation.
- Restrictive requirements. Define the RFP to meet the necessary infrastructure and security requirements.
- Shifting project milestones. Anticipate disruptions and identify realistic milestones.
- Fluctuations in budgets. Forecast budget changes that can require a complete RFP re-do.
- Lack of internal coordination. Create streamlined communication and define specific evaluation criteria.
- Leadership changes. Similar to budget fluctuations, understand leadership change and evaluate effect on scope of an RFP.
- Difficulties finding the right stakeholders and subject matter experts. It can be a challenge to find the people within the organization who have the expertise and bandwidth necessary for the ongoing project. Internal coordination is key to prevent the RFP from stalling.
Look for a Digital Health Partner with Relevant Experience
Your digital health partner should operate efficiently - as an extension of the organization. Your partner should understand your pain points and be able to eliminate manual work that hinders operational efficiency.
An efficient RFP selection process will evaluate a potential partner’s capabilities across key areas to ensure streamlined project development and implementation. In the coming weeks you can delve deeper into other important aspects of how to write an RFP to get the level of service your health plan deserves. We’ll share more information about the importance of finding a vendor ready to deliver in the following areas:
- Member-centric solutions. Equipped to help your plan address the complex needs of vulnerable and diverse populations. Experienced in designing flexible rewards programs that empower members to make healthy choices while acknowledging the challenges they face due to SDOH.
- Performance measurement and reporting. A tech savvy partner capable of simultaneously monitoring and managing every element of improvements. Skilled in measure computations, summary ratings, and Reward Factors while offering strategies to address long standing issues and collect new, more accurate data.
- Supportive account management. Able to relieve staff from manual processes so they can focus in their areas of expertise. Support that fosters improved operational efficiency for staff.
- Technical infrastructure and security. A digital-first mentality needs a strong base of data security practices and impeccable privacy protocols.
If you’re ready to get started now, download our comprehensive RFP guide and checklist to learn how to prepare a request for proposal. We’ll walk you through each main category of requirements for your new partner in member engagement, including specific questions to task during the RFP process and eliminate the guesswork. Refining the healthcare RFP process enables health plans to efficiently identify the right digital health partner to help them overcome critical regulatory and clinical challenges with member-centric solutions.
At Healthmine, our industry experts have experience working in government and commercial health plans and use that experience to support member-friendly digital solutions. We have a 100% client retention across multiple lines of business, including Medicare Advantage, Medicaid, Affordable Care Act, Commercial and the Federal Employee Program.
Download the RFP Guide and Checklist
- Supporting Your Dually Eligible Members During Redetermination
- Enhance Quality and Performance Reporting with the Right Partner
- Create a Request for Proposal to Find a Partner with Member-Centric Solutions
- How Quality Improvement Measures and the Hold Harmless Provision Affect Star Ratings
- Selecting a Digital Health Partner with a Request for Proposal