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December 9, 2010 3130 Fairview Park Drive, Suite 800 | Falls Church, VA 22042 | phone: (703) 269-5500 | fax: (703) 269-5501 | www.lewin.com December 9, 2010 West Virginia Department of Health and Human Resources Office of Purchasing ATTN: Donna Smith One Davis Square, Suite 100 Charleston, WV 25301 Re: RFP MED 11010 Dear Ms. Smith: The Lewin Group is pleased to submit our technical proposal to provide administrative and operational services for the West Virginia Bureau for Medical Services’ Medicaid managed care program. Lewin offers an exceptionally qualified team that has worked closely with the Bureau for Medical Services since 1995. We welcome the opportunity afforded by this RFP to offer our technical and analytic expertise in continued support of the West Virginia Bureau for Medical Services. The Lewin Group will provide expertise in Medicaid managed care operations, capitation rate development, and program evaluation and improvement strategies, alongside our in-depth understanding of the current federal regulatory environment. Our project team reflects these capabilities, providing high-level policy and program experience, operational expertise, broad national exposure, and West Virginia knowledge. The Lewin Group accepts all RFP terms, and certifies that our bid price was arrived at without any conflicts of interest. I am authorized to bind The Lewin Group to the terms set forth in the enclosed proposal to the West Virginia Department of Health and Human Resources. My contact information is: Lisa Chimento, Chief Executive Officer The Lewin Group 3130 Fairview Park Drive, Suite 800 Falls Church, VA 22042 Phone: (703) 269-5556 Email: [email protected] Thank you for your consideration of our proposal. We look forward to the opportunity to address any questions you have. Sincerely, Lisa Chimento Chief Executive Officer RFP #MED11010 Managed Care Administration Table of Contents EXECUTIVE SUMMARY (4.1.4) ............................................................................................................ 1 VENDOR’S ORGANIZATION (4.1.5).................................................................................................. 4 Business name and address: ............................................................................................................. 4 Subcontractor detail:.......................................................................................................................... 4 Financial information: ....................................................................................................................... 4 Additional RFP Requirements: ........................................................................................................ 7 LOCATION (4.1.6) .................................................................................................................................... 8 VENDOR CAPACITY, QUALIFICATIONS AND RELEVANT EXPERIENCE (4.1.7) ............... 9 The Lewin Group Organizational Structure .................................................................................. 9 Experience and Capabilities ........................................................................................................... 10 PROJECT APPROACH AND SOLUTION (4.1.8) ............................................................................ 30 Statement of Understanding........................................................................................................... 30 Scope of Work: Yearly Operations Plan (3.2.1) ............................................................................ 33 Scope of Work: Program Management and Improvement (3.2.2)............................................. 55 Scope of Work: Program Evaluation and Improvements (3.2.3)............................................... 76 Scope of Work: Federal Regulatory Compliance (3.2.4) ............................................................. 87 Scope of Work: Additional Services (3.2.5)................................................................................... 95 VENDOR STAFFING (4.1.9)............................................................................................................... 110 Key Project Personnel.................................................................................................................... 110 Project Staff Organization ............................................................................................................. 111 SUBCONTRACTING (4.1.10)............................................................................................................. 132 SPECIAL TERMS AND CONDITIONS (4.1.11)............................................................................. 133 SIGNED FORMS (4.1.12)..................................................................................................................... 134 RFP REQUIREMENTS CHECKLIST (4.1.13) .................................................................................. 135 APPENDIX A: ADDITIONAL CORPORATE QUALIFICATIONS ........................................... 146 APPENDIX B: STAFF RESUMES ...................................................................................................... 166 i 523964 RFP #MED11010 Managed Care Administration Executive Summary (4.1.4) In a successful effort to constrain the growth of Medicaid expenditures while improving the quality of health care services provided to Medicaid beneficiaries, the Department of Health and Human Resources – Bureau for Medical Services (BMS or the Bureau) implemented full- risk managed care contracting in 1996. The State’s primary care case management program, the Physician Assured Access System (PAAS), was joined with the full-risk capitated program under one combined 1915(b) waiver in 2004. The programs are now collectively known as Mountain Health Trust (MHT) and together serve over 180,000 West Virginia beneficiaries. Today, West Virginia is moving closer to the goal of having a statewide, comprehensive managed care program. Over the next six years the Mountain Health Trust program has more to do, both to build on past successes and to manage emerging challenges to positively affect the program in the future. Opportunities and challenges now facing the State include: Ensuring that the State is purchasing the best value service for the best price; Successfully completing the implementation of major program changes and effectively monitoring the expanded program; Preparing for federal health reform; and Continuing to operate the program and serve beneficiaries currently enrolled. As the incumbent contractor and a nationally-recognized Medicaid policy firm with best-in- class capabilities, The Lewin Group is ideally and uniquely equipped to assist the Bureau for Medical Services in responding to all of these challenges and opportunities. We have supported the Bureau with the development, implementation, and operation of the program since its inception, and over the past 15 years, Lewin has gained deep experience with West Virginia, as well as with other Medicaid programs across the country. Our team is personally committed to the success of the program: Lisa Chimento, Lewin’s chief executive, has supported MHT since its inception, and several additional project members have assisted MHT for more than a decade. Our partnership has resulted in significant successes for the West Virginia Medicaid program: Expansion of the MCO model statewide, with at least two MCOs offering members a choice in 42 of the State’s 55 counties; Increased use of appropriate preventive health services and corresponding decreases in emergency room visits, hospitalizations, and other unfavorable health outcomes; High levels of member satisfaction, with 92 percent of MCO parents rating their children’s personal doctors at 7 or above (10 being the highest possible), higher than the national Medicaid average, and 83 percent of adult beneficiaries reporting high satisfaction with their personal doctor or nurse; Performance above the national average for Medicaid programs in the areas of cervical cancer screenings, controlling high blood pressure, comprehensive diabetes care, adult access to preventive and ambulatory care, and timeliness of prenatal and postpartum care; and 1 #523964 RFP #MED11010 Managed Care Administration Over $25 million in cost savings since the inception of the Medicaid MCO program by slowing the growth in the use and cost of medical services and administrative efficiencies. We are proud of our long term relationship with West Virginia and the growth of the program over the last several years. We understand the needs of the Bureau and are prepared to meet these needs. Bureau for Medical Services Needs The Lewin Group Capabilities A consulting team with detailed and long term As the incumbent contractor, we have a knowledge of the West Virginia Medicaid strong working relationship with the Bureau program, that can begin work immediately and deep knowledge of the program as well as upon contract award effective working relationships with other entities that regulate and operate the program, including CMS, the MCOs, and other MHT vendors Skilled actuaries and a rate-setting team to Our team’s rate-setting expertise in West ensure that West Virginia Medicaid funding is Virginia and experience in over 30 other states spent efficiently and MCOs are paid accurately provides the basis for designing and securing approval of more sophisticated payment arrangements, including risk adjustment and pay-for-performance
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