The Pennsylvania Department of Public Welfare (DPW) released a request for proposals (RFP) on June 22, 2010 for Information Technology (IT) Support and Services for DPW. A pre-proposal conference will be held on July 12, 2010. Questions are due by July 16, 2010. Proposals are due by August 23, 2010.

Background: DPW has wide-ranging responsibilities, including eligibility determination, child welfare, child support enforcement, and benefits delivery. The department's function in recent years has shifted towards client management where technology plays a crucial role in adhering to ever-changing business requirements and policies. In order to provide more comprehensive, holistic support services, the department is moving away from siloed systems to a more integrated platform.

Requirements: The department is requesting services for seven separate lots divided into three service types: IT consulting services (lots 1-5), systems architecture services (lot 6), and technical support services (lot 7). Vendors may propose on multiple lots, but no vendor will be awarded both the IT consulting services and technical support services lots. The seven lots are as follows:

• Lot 1 - Eligibility Systems IT Consulting Services
• Lot 2 - Provider Management IT Consulting Services
• Lot 3 - Case Management IT Consulting Services
• Lot 4 - Child Welfare IT Consulting Services
• Lot 5 - Child Support Enforcement IT Consulting Services
• Lot 6 - Systems Architecture Services
• Lot 7 - Technical Support Services

Funding/Contract Value: INPUT estimates the value of this opportunity to be approximately $15 million to $30 million based on projects similar in size and scope.

For further details on the IT Support and Services project, please see INPUT Opportunity #54988.

INPUT's Take:

The procurement model, whereby the state will award the lots separately or in some combination, will enable the state to select a best-of-breed cohort of vendors to assist with the varied services requested. The strategy provides an opportunity for smaller players to get a piece of the pie. This also promotes teaming and networking to develop valuable partnerships that could span into future collaborations.

The Centers for Medicare and Medicaid Services (CMS) is currently accepting applications from states through August 3, 2010 for Multi-payer Advanced Primary Care Practice Demonstrations (MAPCP), also known as patient-centered medical homes (PCMH). Demonstrations are aimed at improving care coordination and quality outcomes, in addition to developing and implementing multi-payer reform initiatives. These projects have been touted as a model for addressing flaws in the health care delivery system, such as quantity versus quality. Efforts align with President Obama's health care reform overhaul and will be spearheaded by state Medicaid agencies and/or health departments. Other stakeholders include private health plans, self-insured employer-sponsored health plans, and eventually Medicare.

Some states and localities have already been working on home health pilot projects and have the opportunity to submit an application to participate and expand their current efforts. For example, Vermont's Blueprint Integrated Pilot Program, which has been in place for several years, is aimed at chronic care management and prevention. In May 2010, Harvard Medical School evaluated 26 existing demonstration projects and found many had adopted a three-part payment model: Fee-for-service payments, a fixed, monthly case management fee, and potential bonuses based on clinical performance. Other findings included substantial diversity in the pilots' design and a lack of evaluation plans in several projects. The CMS MAPCP program requires an evaluation plan to monitor performance and gather feedback from participating groups to understand the impact on utilization, expenditures, access to care, and the quality of care.

INPUT's Take:

The demonstration projects will provide an opportunity to initiate advanced health care reform at the state level. Vendors will serve as valuable partners in evaluating and monitoring programs. In addition, health IT systems will play a crucial role in facilitating care coordination, timeliness, and improved patient-provider communication. Vendors providing health IT solutions should work closely with stakeholders to understand end-goals and objectives to ensure system flexibility.

This is the third blog in a series of recaps on the recent Government Health IT Conference. Of the several sessions I attended, I particularly enjoyed the lively and thought-provoking session delivered by Dr. Harry Greenspun, chief medical officer of the Dell Services health care group. I felt like I was at a standup comedy show listening to his musings on health reform. He began the session by asking the rhetorical question, "Ultimately, what are we trying to accomplish?" He then went on to illustrate possible answers.

Greenspun provided interesting examples of the type of care that's only available to wealthy and powerful people. He described how the late Senator Ted Kennedy got sick and left Massachusetts, despite its prominent medical care, and flew past New York, Philadelphia, Baltimore, and right on down to Duke. What did he know that we didn't? Would the average person diagnosed with brain cancer know where to find the best doctors with reputations for operating on hard to reach tumors? The same goes with former president Bill Clinton; he knew exactly where to have his heart surgery – at a hospital known for dealing with complications. Low and behold, he ended up having complications with his surgery. Why is this life-saving information only known to select people, or why is publically available information not being utilized in making health care decisions for the everyday citizen?

Generally, there was laughter and nods of agreement through Greenspun's session of clever remarks and quick-witted banter on complicated matters. After the session, I even heard someone comment that most of us have no idea what the health care reform bill is really going to do for us. However, when Dr. Greenspun said he couldn't believe the government thinks it will get major savings out of reining in fraud, waste and abuse, the nodding stopped and furrowed brows washed over the crowd. He said it was an unrealistic belief that much of the fraud fighting and program integrity initiatives in the plans for health care reform can actually take a good chunk out of the trillion dollar reform price tag. Hands shot up and people spoke up, saying there is a mind-blowing amount of fraud taking place in this market, but the savings can be realized if done correctly.

Greenspun said health care reform should actually be known as health insurance reform. The good news about health reform is that primary care does get more money, but on the flipside, there will be $500 billion in Medicare cuts. So, we'll have more people covered, but the coverage will be poor. In regards to keeping health care prices down, Greenspun said everyone should have insurance, but we just don't want them to actually use it. The nation still remains divided on the legislation that restructures the nation's health care system. The only thing saving the reform from a full-on attack by opposition is the oil spill.

In closing, Greenspun shared his love of his Chipotle iPhone application, giving his endorsement that it is the best application out there for burrito fans. He said he can be out on the street at any time and find the closest Chipotle and place his order for pickup from the comfort of his phone. However, if he were hit by a bus, do you think he could just as quickly find the closest surgeon, and one that actually took his insurance? Perhaps he just answered his opening question.

Look for a complete analyst recap, summarizing additional conference sessions, available on INPUT's site shortly.

One of the best sessions I attended at the Government Health IT Conference was Jeff Blair's presentation on New Mexico's state health information exchange (HIE) program. I wanted to provide a recap of New Mexico's experiences since it is the first state to meet all of the Office of the National Coordinator for Health Information Technology's (ONC) HIE requirements for state HIE cooperative grant funding.

Blair is the Director of Health Informatics at Lovelace Clinic Foundation and he has lead responsibility for the New Mexico Health Information Collaborative (NMHIC) which is the name of the HIE and community collaborative that supports the network. Blair began the session describing the state's early experiences with ONC. Strikingly different was the federal and state governments' perspective on the grant funding. He said the federal perspective was one of "let's help accelerate the development of state HIE networks to support meaningful use of Health IT." New Mexico's perspective was "we're in trouble with our financial sustainability and we need money, or we are going to have to cut staff or do something even more drastic, which would cause the HIE to lose the momentum it has built."

NMHIC was created in 2004 and was funded by a grant from The Agency for Healthcare Research and Quality (AHRQ). The NMHIC was also awarded a Nationwide Health Information Network (NHIN) trial contract in 2007, and in May 2009 the governor selected it as the state designated entity (SDE) to provide HIE network services. He said the state offered support in designating it the SDE and was a participant in the HIE governance, planning and functions strategies. The HIE has been coordinating with Medicaid and is designated as the agent for e-reporting to the public health entity.

The HIE is currently connected to 13 out of 58 hospitals in the state, two major medical groups and two major clinical laboratories. Its Community Master Patient Index contains more than 1.1 million unique people, with the total population for the state at two million. The types of services provided by NMHIC include maintaining patient records, public health and quality reporting, and laboratory studies.

Blair described the cooperative grant process and said the NMHIC had seven weeks to respond with a complete plan. He said it met all of ONC's requirements, but did not have time to review the plan with local stakeholders. ONC responded with 17 more questions and so they went through another few weeks of planning to include those local stakeholders and to include priorities from the NMHIC business plan. The NMHIC had a second version of the plan in April. Blair praised ONC, saying it was very collaborative throughout the process. The approach for developing a successful plan was to convene stakeholders, agree on common goals, and rely on good project management experience. The NMHIC used the detailed instructions provided by ONC and answered every question, not relying on any 'not applicable' responses.

Blair joked that the strategy for funding was to spend it as fast as possible. In all seriousness, the $7 million will be split between HIE communication over the NHIN and HIE expansion within the state. Blair said he expects it will actually take a $15 million budget, half of which was received with the grant, to get it right.

As far as New Mexico's plans for HIE expansion for the rest of 2010, the state will connect with specialty medical groups and go back to NHIN connections to work with the Social Security Administration in the summer, Indian Health Services in the fall, and the Veterans Affairs in the winter.

What worked well for New Mexico is that it was able to build upon a reservoir of trust and confidence among community stakeholders, not to mention the state's strong project management experience. What doesn't work so well is that the size of the state HIE plan discourages people from actually reading it. Blair said the NMHIC is still struggling with sustainability plans and reluctant providers who just don't want to share their data. 

So, the moral of the story is that for a successful state HIE plan, you need support from potential clinician users and providers, support from payers and employers, and a willingness to share the data. States also need successful coordination to take place among state agencies, such as Medicaid and public health departments.

Look for a complete analyst recap, summarizing additional conference sessions, available on INPUT's site shortly.

This month, a few of INPUT's health and social services analysts, myself included, headed downtown to the Healthcare Information and Management Systems Society's (HIMSS) 2010 Government Health IT Conference in Washington, DC. We joined the likes of industry, nonprofit, government, hospital and academia professionals also in attendance.

The atmosphere at this event compared to previous years was immediately apparent. In the past, it seemed everyone was very positive, hyped and hopeful about the prospect of health IT and stimulus funds launching adoption rates. At this year's conference, however, I felt morale was sluggish now that the boots are actually on the ground. Many folks voiced concerns about timelines and seemed cynical about how this is all going to come together. Hot topic discussions centered on meaningful use and certification criteria. Government expects the final meaningful use rule to be released before the end of the month. Here are some other talking points:

 
• The main vector and guiding light of health change is meaningful use, and this whole health transformation is about what the providers do with the vendor's solutions
• Although we've all heard the statement, "It's not about the technology, it's about what you can do with the technology," multiple times during the past few years, I lost count of just how many times it was repeated throughout this conference
• If you're going to talk the talk, do not pronounce the Regional Extension Center's acronym, REC, as 'wrecks.' Say it like you are spelling it out ("R-E-Cs")
• Government is hoping new vendors will come to play in the market with new offerings. It was suggested that smaller vendors don't have to provide the whole nine yards, but can still add an important component to the big picture, as long as they continue doing what they do well
• The Office of the National Coordinator (ONC) is hoping to increase competition in the certification field as they look for multiple certifying bodies. All of the pieces will be in place by August 2010, with testing and certifying by late summer/early fall
• We are leaving the 'doctor knows best' era and entering the 'I looked it up on the web' era. We have to be prepared to move from the traditional hospital and doctor's visits to trips to the minute-clinics. I heard this mentioned multiple times. The new generation is weaned on computers and they are self-declared experts on their own health and how to manage it
• While moving forward with the expansion of the Nationwide Health Information Network (NHIN), they are trying to respect established regional health information organizations and health information exchanges since many of them have already created technology and standards to support clinical data exchange
• It was said NHIN exchange participants will likely triple over the next nine months
• In his closing remarks, Acting Director of the Office for Interoperability and Standards Doug Fridsma reminded the audience it is not just a sprint to 2011 for stage 1 meaningful use, but a marathon to 2015. No matter what you want to call it, people are still running

Next, I will post recap blogs on two of my favorite sessions from the conference:  Jeff Blair's presentation on New Mexico's state HIE program, and the entertaining session with Harry Greenspun on health care reform.

If you attended and have some other insights to add, please make a comment below!

Also, look for a complete analyst recap report on INPUT's site shortly.

After almost two years of planning and project development, the city of Indianapolis recently awarded its long-awaited enterprise resource planning (ERP) system contracts. This project is a success considering the many failed attempts state and local governments have had with trying to implement similar projects. City officials believe they can buck that trend by keeping the project's focus on business process improvements instead of technological issues that doomed previous attempts.

Many city officials feel the new ERP system is long overdue. It will replace an antiquated and increasingly inadequate 30-year-old mainframe-based IT environment. Although the city government and surrounding Marion County government have functioned as a consolidated entity for 40 years, both have maintained separate planning and development systems. With the new plan, these systems will merge into one large ERP system that will manage accounting, procurement, human resources, and payroll. The new system is designed to save money while streamlining business processes and providing greater data availability and long-term technology. Full implementation of the system is expected within three years.

Two awards were made for the project: The first, for implementation and integration of the technology, was awarded to New York-based Zannet, Inc. The actual mainframe planning system was awarded to Oracle Corporation. Both opportunities and announcements are being tracked by INPUT. (ERP System-Oracle, Implementation-Zannet, Inc.)

I have long said one of the best forms of intelligence for the state and local IT marketplace is local newspapers. They help you understand the commonality of problems faced by state and local governments, public schools and universities. Newspapers also expose you to unique, non-IT-oriented insights not found in the government IT trade press.

For example, a USDA deputy secretary is visiting a farmer's market that has found a unique way to help its sellers do business with those who are using electronic benefit transfer (EBT) food stamps. Normally, only grocers with credit card capabilities can serve this customer base. Farmers' markets are generally cash only.

If you read INPUT's report on waste, fraud and abuse, you know we recommend increased use of electronic transaction mechanisms to verify incidents of services, pre-empt fraud, and provide real-time transactional data for performance management using business intelligence (BI) tools.

If you read INPUT's report on the governors' state of the state addresses, you know governors are keen to capture as much revenue for local businesses as possible. The use of EBT is a good example of how to capture federally collected dollars for a purely local economic interest. It's a niche-y example, for sure, but one that can open our eyes to the secondary economic development potential of EBT. In times like these, no possible business justification is too small to consider.

The General Services Administration released numbers on state and local government's use of GSA Schedule 70 (what GSA calls its Cooperative Purchasing Program) for Q2 of federal FY 2010. As INPUT forecasted in the recent S&L GSA Schedule Use through Q1 FY 2010 Industry Insight, orders have tempered slightly in Q2 compared to Q1. This reflects the continued scrutiny of spending at the state and local level during revenue shortfalls and budget crunches in nearly every state.

Despite negative growth quarter-to-quarter, S&L Schedule 70 orders remain up 10% year-over-year.

For more information on which hardware, software, and services companies are selling to states and locals through Schedule 70, and what the future holds for cooperative purchasing in the state and local market, check out the recent Industry Insight report.

On Monday, June 21, 2010, INPUT launched its newest offering within the social services vertical solution: The Women, Infants and Children (WIC) program. WIC is a federal assistance program administered by the United States Department of Agriculture (USDA), Food and Nutrition Services (FNS). WIC provides health care and nutrition for low-income pregnant women, breastfeeding women, and infants and children under the age of five. The program has grown steadily since its inception. In 1974, total participation in the program was 88,000, compared to an estimated 9.1 million in 2009.

Two hot technologies within the WIC program that INPUT is tracking are the WIC management information systems (WIC MIS) and WIC electronic benefit transfer (WIC EBT) systems. Right now, there are 14 states planning or transferring WIC MIS, and 16 states planning EBT systems. This increased amount of opportunities is due to the American Recovery and Reinvestment Act (ARRA) of 2009. The WIC program received $500 million in stimulus funding, with $400 million going directly into benefits. The remaining $100 million went to establish, improve, or administer WIC MIS to include changes necessary to meet new legislative or regulatory requirements.

Funding was released in three waves, with the first totaling $34 million for existing EBT/WIC MIS projects. The second included $8.5 million for new EBT planning and WIC MIS transfer projects. The final wave covered any remaining technology projects, which included planning for new clinic systems, upgrading to Web-based systems, system enhancements to incorporate new program requirements, modernizing for future EBT implementation, equipment upgrades/replacements, etc. In total, 53 technology projects were funded under the ARRA, with 41 states receiving funding.

Talk to your member advisor today to find out more about INPUT's vertical solutions and the new WIC program offering. Recently, INPUT released a report examining the WIC program and the contracting opportunities available to venders. The report, The Special Supplemental Nutrition Program for Women, Infants and Children (WIC), is available here. In concert with the report and product launch, INPUT will host a webinar on WIC on Tuesday, July 27, 2010, at 2:00 p.m. EDT.

The California County of Solano Department of Mental Health plans to release a Request for Proposals (RFP) for the implementation of an electronic health record (EHR) system. The department submitted a funding request for $2.1 million as part of the Mental Health Services Act (MHSA) technology project in April 2010. The release of the RFP is expected sometime in July 2010. A tentative date for the project's award is set for November/December 2010. Complete implementation of the system is expected by fall 2012.

The Solana County Mental Health Division's mission is to provide mental health services and support that is person-centered, safe, effective, efficient, timely and equitable. In addition to promoting wellness and recovery, the division strives to fully incorporate shared decision making between consumers, family members and providers.

EHR systems are expected to assist health professionals with multiple daily tasks, including scheduling and management of appointments, documenting client interactions, and helping with the standardization of policies and procedures. Solano County's EHR system plans to include applications for scheduling and tracking appointments, templates for electronic assessments, e-prescribing capabilities, and management of billing processes. INPUT is currently tracking the project here.