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6198-3 Employee Health Clinic mgmt Scope of Work EX3 8-18-16 SECTION I General Information and Instructions The scope of work shall be finalized upon the selection of the Firm. The respondent’s submission shall have accurately described your understanding of the objectives and scope of the requested products and services and provided an outline of your process to implement the requirements of the Scope of Work and Services. It is anticipated that the scope of work will include, at a minimum, the following: The City of Denton (City) is seeking qualified vendors to provide Clinic Operation and Management Services at its existing near-site Employee Health Center (Clinic), for the City’s employees, retirees, and dependents that are enrolled in the City’s self-funded health plans. The Clinic provides all medical services typically associated with a family-practice doctor’s office. These medical services include, but are not limited to: primary care, minor emergency care, health risk assessments, call support, immunizations and injections, prescriptions, wellness education, disease management, and primary case management for all members 24 months of age and older. The City currently pays a monthly management fee to existing clinic Management Company on Per Employee per Month (PEPM) based on the number of employees enrolled in the City’s self-funded health plan. All other operational costs for the clinic, including but not limited to, lab services, medical supplies, medical equipment, office equipment, office supplies, furniture, and staff salaries are passed through to the City, at straight cost, with no additional fees or markup added to them. The Health Risk Assessments (HRA) conducted at the clinic are a critical component of the City’s overall wellness program. The HRA consists of a comprehensive blood draw at the Clinic and follow-up with a Clinic provider. Additional services may eventually include new hire physicals, initial workers’ compensation triage, workers’ compensation return-to-work, and pre-employment/random/post-accident/reasonable suspicion drug specimen collection. SECTION II BACKGROUND AND PHILOSOPHY BACKGROUND The City of Denton (City) is requesting your proposal to provide Clinic Operations and Management Services for the employees, retirees, and dependents enrolled in the City’s self-funded dual option medical plan. The City offers medical benefits to all full-time employees (employees working 30 or more hours) and their eligible dependents. Additionally, the City extends medical benefits to our retirees, and their eligible dependents, if the retiree elects to maintain coverage at the time of separation. The City has operated the Clinic since December of 2011, through a third-party operations and management company. The City is conducting this Request for Proposal (RFP) process because our current contract with that company expires December 31, 2016. The Clinic is located in the professional building at Denton Regional Medical Center, 3537 S. I35E, Denton, Texas 76210. The Clinic has 2,832 square feet, with four exam rooms, two laboratory areas, two provider offices, a conference room, waiting area, and front desk area. The Clinic is staffed by a part-time Physician, a full-time Nurse Practitioner, a part-time Nurse Practitioner, and three Medical Assistants. The medical staff performs lab draws in-house, but the majority of tests are run at an outside laboratory (currently LabCorp). The City of Denton has an estimated population of 131,000 residents and was incorporated in 1866. Denton is located approximately 40 miles north of Dallas and Fort Worth. It sits at the apex of a triangle that encompasses the Dallas-Fort Worth metropolitan area. Although it benefits from the overall growth and expansion of the largest Consolidated Metropolitan Statistical Area in the state, Denton and its economy stand proudly independent. In general, Denton is a full-service city that provides law enforcement, fire safety, paramedics/rescue, refuse collection, sanitary landfill, electric distribution and transmission, water, wastewater, storm sewer, animal control, parks/recreation, library and airport services. Two major universities—University of North Texas and Texas Woman’s University—along with a fully accredited public school system, allow local citizens every educational advantage possible and a rich blend of cultures. The City of Denton has a work force of approximately 1,500 employees. The City has had an effective safety and risk management program since 1970, an active Wellness Program since 1990, an insured employee assistance program (EAP) since 1998, and became self-funded for the employee health plan in 2008. Additionally, the City has an Employee Insurance Committee (EIC) representing all departments, providing education and feedback as well as recommendations to City Management and City Council. The City has an active Wellness Committee and has developed a wellness incentive program that began in 2011. The City’s health plan enrollment is: 1,338 employees 3,501 total lives (including 56 retirees + 27 dependents of retirees) Each year the Clinic has increased both the number of available appointments and the number of filled appointments. In 2014, there were 7,640 available appointments with a 92% utilization rate. In 2015, there were 7,870 available appointments with a 90% utilization rate. For 2016 we expect to top 8,000 available appointment with an 85% utilization rate. The City’s benefit plan year is January 1 through December 31. PHILOSOPHY The City wants to provide high quality, cost effective medical care with a focus on wellness and prevention to our eligible employees, retirees, and dependents (“members”) that participate in the City’s self-funded health plan. We want to help our members establish a “medical home” at our clinic and help them develop a personal relationship with our medical team. We want to provide our members with free access to primary care medical services so that cost is never a barrier to seeking medical care. We want to link the wellness programs and resources available through the City and our health plan third-party administrator (TPA) to the point where our members access care. We seek a caring and committed partner to help the City engage our members in a manner that will motivate them to take an active role and have personal accountability for their overall health and wellbeing. We seek to be a change agent for our members by helping to improve their overall quality of life. We understand that in accomplishing these things, the City will realize savings on our health plan costs in the long term. We seek a partner that has experience in managing clinical operations for employers; has experience taking over an existing clinic (if applicable) and continuing effective operations; has a robust and easy to access wellness platform; and, has an integrated Electronic Medical Records (EMR) system with electronic prescribing features. CURRENT STAFFING MODEL The City currently xxxxxxxx SECTION III City Provided Goods and Services City shall provide the following goods and services to the awarded contractor: Clinic location Denton Regional Medical Center Professional Building, 3537 S.I35, Suite 317, Denton, TX, 76210 – See Supplement F for a floor plan and layout of the existing clinic space All necessary medical equipment and furniture Reasonable and necessary medical supplies All needed phones, computers, printers, fax, and peripherals Fully furnished waiting area, office and conference room furniture Reasonable and necessary office supplies Phone, cable, and internet services through Charter Communications SECTION IV Proposal Guidelines for Onsite/Near-Site Medical Clinic Operations and Management Services The following good and services shall be supplied by the awarded contractor: Outline of Expected Services Onsite/Near-Site Medical Services Provide the highest quality primary care and minor emergency medical services for non-occupational illnesses and injuries for a nine (9) consecutive hour time period, Monday through Friday (observing all City holidays) to members age 24 months and older. The exact hours of operation will be determined after the contract is awarded; Provide appropriate medical professionals to staff the clinic during the prescribed hours. The City’s preference is to maintain the existing structure and existing employees. However, the City is willing to entertain other staffing models to deliver the requested medical services; Provide sufficient “relief” medical professionals to staff the clinic in cases of illness, vacation, training, or to temporarily fill-in when vacancies occur; Provide inoculations and immunizations including, but not limited to, flu and tetanus shots as desired or promoted by the City; Conduct pre-employment physicals as requested; Plan, develop and support wellness initiatives in conjunction with the City’s wellness program, including but not limited to: Health screenings such as blood pressure checks, HDL/LDL cholesterol, blood glucose, total BMI and other screenings as requested during the year Provide employee follow-up and education Chronic disease management, monitoring, and employee education Coordination with the City’s wellness program to support wellness related activities Assist the City in developing wellness initiatives that have a direct impact on potentially reducing identified health risks in the City Provide support for the City’s Healthy Incentives Program (see Attachment) Provide education, support and assistance to patients in the form of live/telephonic/online health coaching, nutritionists, etc. If services are expanded in the future, serve as a collection site for pre-employment, random, reasonable suspicion, post-accident and follow-up drug testing in accordance with DOT and the City’s testing requirements and procedures: Provide for proper chain of custody and all necessary forms Provide for collection supplies Provide for or make arrangements for transportation of specimens to laboratories If services are expanded in the future, provide triage of workers’ compensation injuries as well as: Job specific return-to-work evaluations Job specific pre-employment and fit-for-duty physicals Maintain the current clinic model of each patient having a full 20 minute appointment with the medical provider (i.e., in an hour time period only 3 appointments are available per provider) Clinical Management During the clinic transition phase, provide assistance and expertise to ensure a successful and efficient transfer that allows operations to continue; Provide resources and expertise to ensure optimal and positive positioning of the clinic throughout the term of any contract, through employee communication and promotion; Provide staffing of medical, technical, and support staff that demonstrate strong interpersonal skills, exceptional service delivery philosophy and passion for the holistic treatment, care, wellness, and recovery of patients; Provide supply and inventory management; Provide medical administration of patient care including patient management and patient referral management; Maintain patient records in a secured environment, in electronic medical record (EMR) format, in compliance with HIPAA regulations. EMR should have electronic prescribing capabilities; Provide for the active management of the City’s employee health by deploying target wellness and chronic disease management initiatives; Maintain open dialogue with the City’s health and workers’ compensation third-party administrators (if applicable), and with City staff responsible for those functions, to balance both recovery and City return-to-work programs; Assist with and actively engage in cost savings management initiatives; Provide regular scheduled reports to the City (as outlined in Section IV- Reporting) that sufficiently describe the program impact, cost impact, employee satisfaction, and other performance parameters as agreed upon with the City; Maintain communications with City staff regarding patient status within HIPAA, FMLA, and ADA guidelines; Maintain ongoing communication with City staff regarding program opportunities and enhancements. This includes regular face-to-face meetings with City staff as well as attendance at various meetings such as the Employee Benefits and Wellness Fair and other health fairs, and meetings with other City staff including management, the City’s Employee Insurance Committee, and the City’s Wellness Committee, as needed. Medical Personnel minimum requirements Doctors Shall be a medical doctor, fully licensed with the State of Texas Medical Board Nurses Shall be a fully licensed, LVN, RN ???, with the Texas Board of Nursing Technology Provide for a “paperless” medical office by having state of the art electronic medical records software and hardware; Provide state of the art technology to support scheduling requirements for patients and online check-in; Ability to send multiple appointment reminders via email, phone, and/or text; Provide online access to patient status updates and test results; Capture relevant procedure code data to enable the City to perform comparisons between the services rendered in the clinic with the cost of performing those services outside of the clinic setting; Provide the capability to interface the health TPA’s computer system: Ability to file “zero dollar” claims with the City’s health TPA Ability to capture a reasonable “fee schedule” for those claims Provide an application solution for iOS, Android, and other smartphones; Provide a web-based consumer education portal; Ability to export clinical/lab data to medical carriers; Information Technology support services for clinic operations. Reporting Provide City specific management reports on a weekly/monthly basis to include but not be limited to: Clinic census data (patients seen/day; duration of visit, etc.) Number of available appointments, number of filled appointments, and utilization percentage on a weekly basis No show report by provider and lab draws Number of lab procedures Financial performance data Employee satisfaction data Referral data Cost savings data Wellness initiatives and efforts Wait time data Aggregate reports summarizing the types of disease states, conditions, illnesses, and injuries of patients accessing the clinic Monthly reports of those employees who have had the HRA blood work performed and completed the required follow-up visit with the provider Provide the appropriate medical records in the appropriate format to the City’s health third-party administrator in order to allow the data to be integrated with the third-party administrator’s disease management and wellness programs. NOTE: By responding to this RFP, the Contractor agrees to comply with the above Scope of Services. If you are unable to provide/perform any service, please list that service and provide and explanation in Attachment B.