Q) Please provide the reinsurance terms you would like quoted, i.e. specific deductible, contract type, commission, etc.
A) Section 12.3 and 12.4 include all contract basis and requested specific deductible levels.
Q) Also, I did not find Cobra indicated on the census. Please let me know if there are individuals enrolled in Cobra.
A) There are approximately 8 COBRA employees that were not included in the census. The information we have on the COBRA enrollees is as follows:
4 PPO Single
2 PPO Family
2 Regular HMO Single
Q) Please provide current and/or renewal rates.
A) Current rates will not be released. Renewal rates for a 1/1/19 effective date are not available.
Q) Are you willing to sign and execute a Non-Disclosure Agreement (NDA) for us to release provider-level discount data as requested in the RFP (Attachment G)? Can you confirm that the full discount data will be accessed by both Lake County and Segal?
A) Discount data at the provider level will be analyzed by Segal. Lake County evaluation committee members will only have access to high-level, overall discount information. One component of the discount analysis will be to use the Uniform Data Submission (UDS) evaluation system, to which Segal and you have already agreed to a separate NDA. Lake County has signed the UDS agreement that pertains to plan sponsors.
Q) The RFP states that BCBSIL currently provides "a voluntary, self-directed wellness program" that "includes access to health experts for stress management programs and physical activity programs." Does Lake County want vendors to quote telephonic and/or digital wellness coaching services?
A) No, this program being referenced was not to be duplicated.
Q) Please describe your current Case Management offering in greater detail.
a. What is your Case Management reach/engagement rate?
b. Please provide engagement statistics by modality (i.e. telephonically, digitally, in person).
c. Please provide your definition of engagement.
d. Please provide the current ROI attained as well as a list of clinical care and utilization improvement statistics.
e. Please provide additional insight into what is working well and what you would like to see improved.
A) This information is not available
Q) Please describe your current Disease Management offering in greater detail.
a. What is the prevalence rate by disease state?
b. Please provide the current ROI attained as well as a list of clinical care and utilization improvement statistics.
c. Please provide additional insight into what is working well and what you would like to see improved.
d. What percent of members with a chronic illness are identified as high risk, moderate risk and low risk? Of those, what percent are engaged by modality (i.e. telephonically, digitally, in person)?
e. Please provide your definition of engagement.
f. What is the average length of time individuals are engaged in your current Disease Management programs by modality (i.e. telephonically, digitally, in person)?
A) This information is not available
Q) Please describe your current behavioral health offering in greater detail.
a. What is your behavioral health utilization?
b. What are your high-cost behavioral health drivers?
c. Please provide further information on your network access and out-of-network utilization.
o What is your in-network versus out-of-network utilization?
o Where is out out-of-network utilization concentrated (location, facility, etc.)?
o Do you have significant out of network usage consolidated with a few providers?
o What is driving your out-of-network utilization? For example, do you need more of a specialty provider, more general providers in a specific area, or are individuals travelling for substance abuse treatment?
o Are there specific challenges with outpatient treatment access?
d. Please provide your last three years of behavioral health utilization reports.
e. Please provide a more detailed description of your substance abuse issue.
o Are you experiencing significant out of network utilization related to substance abuse treatment? If so where is the utilization by region and specific facilities?
o What substances are driving your substance abuse utilization (opioids, alcohol, other)?
o What age groups are driving the utilization?
o What cost impact has substance abuse treatment had over the last three years?
f. What is your current readmission rate?
g. What is your current recidivism rate?
h. Who is your EAP provider?
o Would you like vendors to supply an EAP quote?
i. What is your level of satisfaction with your current medical/behavioral integration? Do you feel there is room for improvement? If so, what are the current challenges?
A) This information is not available.