REQUEST FOR INFORMATION(RFI)

Commonwealth of Massachusetts – Request for InformationIssued by

The Executive Office for Health and Human ServicesOn behalf ofMassHealth

MassHealth Enhanced Data Environment and Business Intelligence ToolsISSUED: September 18, 2015

RFI DOCUMENT #: 16EHSMHANALYTICSRFI

Note: The Massachusetts Executive Office of Health and Human Services is issuing this RFI in order to expand its knowledge base for purposes of a possible future procurement of an advanced analytics IT system, as described below.

Respondents to this Request for Information (RFI) are invited to respond to any or all of the questions in this document. Responses to this RFI shall serve solely to assist the Commonwealth in understanding the current state of the marketplace with regard to the solicited information or to inform the development of a possible solicitation for a Request for Responses (RFR) or Request for Quotes (RFQ) in the future. This RFI does not in any way obligate the Commonwealth to issue or amend a solicitation or to include any of the RFI provisions or responses in any solicitation. Responding to this RFI is entirely voluntary, and will in no way affect the Commonwealth’s consideration of any proposal submitted in response to any subsequent solicitation, nor will it serve as an advantage or disadvantage to the respondent in the course of any RFR or RFQ that may be subsequently issued or amended.

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Table of Contents1. INTRODUCTION.................................................................................................................32. AGENCY................................................................................................................................33. MASSHEALTH’S DATA SYSTEMS..................................................................................3

A. Background......................................................................................................................3B. Issues in Current Operations.........................................................................................3

4. BACKGROUND FOR INFORMATION SOLICITED.....................................................5A. Further Detail on MassHealth’s Proposed Data Mart................................................5B. Anticipated Work Phases...............................................................................................6C. Details on Functionality..................................................................................................7D. Timeframe........................................................................................................................9

5. RFI QUESTIONS................................................................................................................10A. Timeframe and Work Scope........................................................................................10B. Design Decisions............................................................................................................12C. Skill Sets.........................................................................................................................12D. Other Considerations..............................................................................................12E. Alternatives.................................................................................................................12

6. GENERAL INSTRUCTIONS............................................................................................137. OTHER RFI INFORMATION..........................................................................................14

A. Costs...............................................................................................................................14B. Review Rights................................................................................................................14C. Public Record................................................................................................................14

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1. INTRODUCTIONThe Executive Office of Health and Human Services (EOHHS) is issuing this Request For Information (RFI) to acquire information regarding the proposed development of a MassHealth Data Mart and accompanying Business Intelligence tools. Such a Data Mart and accompanying tools would enhance MassHealth’s storage and retrieval capabilities to support population-based payment models and enhanced analytics. Interested parties are invited to provide EOHHS with information, feedback, and comments regarding the topics and questions discussed below.

2. AGENCYPursuant to Executive Order 549, EOHHS is the Secretariat responsible for managing the consolidated information technology resources of its constituent agencies, including the Office of MassHealth.

Additionally, pursuant to M.G.L. c. 6A § 16, EOHHS is also the single state agency for the administration of Medicaid programs. Such administration occurs through the Office of MassHealth. One of EOHHS’ and MassHealth’s key missions is to improve the health outcomes of its diverse Members, their families and their communities, by providing access to integrated health care services that sustainably promote health, well-being, independence, and quality of life. The advanced analytics program is designed to accomplish this goal by providing an easy and efficient mechanism to audit MassHealth claims and accurately ensure that adequate care is provided to Members throughout the Commonwealth.

3. MASSHEALTH’S DATA SYSTEMS

A. Background

Currently, MassHealth employs an enterprise data warehouse (“Data Warehouse” or “DW”) in an Oracle environment that integrates Medicaid Management Information System (MMIS) enrollment and claims data; encounter data from MassHealth’s managed care entities (MCEs); long-term care assessment data; provider data; federal reporting requirements; and other relevant information from multiple sources in relational tables. The Data Warehouse is used for report generation for scheduled (i.e., weekly, monthly, and annual) reports, as well as a wide variety of ad hoc queries to meet distinct needs. MassHealth analysts use SAS, SQL, and IBM’s Cognos Business Intelligence (BI) to retrieve data, generate reports, and conduct ad hoc queries. See Attachment A for a graphic map of the existing Data Warehouse Data Flow and other documentation.

B. Issues in Current Operations

MassHealth has identified several areas for improvement in the Data Warehouse, to support enhanced analytics and the administration and evaluation of population-based payment models.

1. MassHealth has identified the following underlying causes of data issues:

Data is not standardized: Members have the option of enrolling directly with MassHealth with a Primary Care Clinicians (PCCs), who provide fee-for-service

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care, or with a MassHealth contracted Managed Care Organizations (MCOs). Data is fed separately to the DW from MMIS and MCO encounter data in dissimilar formats, and differing payment structures:

Tables are not organized for analytics or reporting: The Data Warehouse is currently organized as a series of relational tables, some with indexing, As the organization has grown and reporting needs have changed, additional structures and tables have been added. The data is not optimally organized in a manner that readily allows analytical reporting, from different perspectives, i.e. member, provider, or service.

Tables are not optimized for analytic querying performance: The Data Warehouse provides a complete history of claims, encounter, eligibility, and enrollment information that is optimized for “point-in-time” transaction reporting and not for aggregate and\or analytical reporting. Member and claims tables have increasingly become unwieldy with increases in Member caseload and claim volume.

Data Warehouse includes few pre-generated, standardized reports: MassHealth would like to have standard reports on topics such as outcome comparisons by provider or grouper results (e.g., DRG, DxCG) results by patient type.

2. MassHealth has identified the following consequences to the above-stated issues:

MassHealth cannot easily analyze data across programs: Because PCC and FFS claims and MCO encounter data are not fully compatible, utilization cannot be cleanly analyzed across PCC and MCO lives for a given provider. For example, PCC inpatient and outpatient hospital claims identify the distinct inpatient and outpatient providers who have treated a Member, while MCO encounter data submissions list the hospital as the single provider of service

Ad hoc DW queries take a long time: Analytical requests often require multiple queries to the Data Warehouse due to the way the data is structured. For example, a total cost of care calculation for a member or panel may require joins across several claims and encounter tables, hindering performance of basic analyses.

MassHealth Leadership does not have easy access to important real-time summary data: MassHealth would like to obtain a wide range of advanced reports that are important for policy and program decision-making, as well as for provider and payer quality improvement initiatives.

The analytics necessary to implement alternative payment methods are difficult to obtain: Uniform requirements, outcome measurement, and payment triggers are necessary for alternative payment methodologies to succeed. Due to the lack of standardized data and the structure of the existing DW, it is difficult for MassHealth to produce the reports with the level of confidence required for its initiatives. The current structure also makes it difficult to take an iterative approach to policy development given the time required to re-query the warehouse for additional information.

Common reporting needs are not incorporated into the Warehouse: There are many common reporting procedures that are handled in an ad-hoc fashion, requiring analysts to re-create the wheel for each ad-hoc analyses. These include

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common flags or algorithms that could be accomplished by internal flags or tables that would identify common measures such as “Substance Abuse”, “ED visits”, or “Cost of Care”.

C. Summary of Proposed Solution

MassHealth is currently undertaking a major initiative to enhance its internal data and analytic capabilities to address the systemic issues described in Section 3.B above. There are three major components of this initiative:

1) Improving the quality of data input into the Data Warehouse, through closer collaboration with data contributors. This work is currently ongoing and will be largely led by MassHealth;

2) The proposed creation of a Data Mart that will overlay the Data Warehouse. Such a Data Mart would provide a user-friendly data environment for enhanced analytics, particularly those necessary to support the administration and evaluation of population-based payment models. The Data Mart would transform current DW data and standardize it a star schema with a central fact table and supporting dimensional tables that enable rapid, interactive data analysis. The Data Mart would be accompanied by enhancements to the Business Intelligence tool, such as reports, cubes, and dashboards. This work has not yet begun. The purpose of this RFI is to gather information to guide MassHealth’s approach to this work.

3) Developing, producing, and distributing provider-facing data reports. This work is the responsibility of an external vendor and has been procured through a separate RFR. This vendor will be expected to extract, transform and load (ETL) data from the DW and create reports that will inform providers about the characteristics of their attributed MassHealth members. These reports will include quality and cost performance measures from MassHealth’s in-development Alternative Payment Models (APMs), including population-based payment models. This vendor may be expected to develop claims extracts for providers as part of this effort.

Through this RFI, MassHealth seeks feedback on this approach, and particularly on the Data Mart and Business Intelligence solution described in Section 3.C.2 above.

4. BACKGROUND FOR INFORMATION SOLICITED

A. Further Detail on MassHealth’s Proposed Data Mart

Currently, MassHealth envisions the creation of a Data Mart that will overlay the Data Warehouse to create a dimensional, user-friendly, and efficient data environment. The Data Mart will be accompanied by new Business Intelligence tools (i.e., new standardized reporting and analytics) built within the existing Cognos framework.

Table 1 below shows how this solution addresses the four issues described in Section 3.B above.

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Table 1 – Summary of anticipated impact of Data Mart on systemic data issuesCauses of issues Work Details Benefits of solutionData is not standardized

--Standardize PCC and MCO data

--Patient services across sites and claims will now be synthesized

Tables are not organized for analytics or reporting

--Create star schema--Create views/data cubes that organize the cleaned-up data

--Staff time will be reduced--Data will be accurate and appropriate--Synthesized data can be viewed by claim, payer, patient, provider, DRG, etc., for analytic purposes, including meta-analyses--Distinct views or dashboards will be available to various user groups with appropriate levels of protected health information (PHI)

Tables are not optimized for analytic querying performance

--Create star schema --Reports can be run quickly with accurate data

Data Warehouse includes few pre-generated, standardized reports

--Create flags for topics such as inpatient stays and outpatient encounters--Create variables or reports with clear definitions for topics such as total cost of care (TCOC)

--Data will be viewed at multiple drill-down levels--Reports will be consistent--Data can be analyzed and publicly reported to support reform initiatives, such as alternative payment methods

B. Anticipated Work Phases

MassHealth envisions achieving its proposed Data Mart and Business Intelligence tools through the following four main phases of work, as described:

1. Create Data Mart

Design an analytics database (“Data Mart” or “DM”) from EOHHS’ existing Oracle tables in Data Warehouse, that include encounter and claims data and provides multiple dimensional views and star schema, such as by provider, member, service, claim, and ACO;

Create flags for inpatient stays and outpatient encounters, as well as other key measures;

Store industry-standard groupers, risk-adjusters, etc., such as DRG, APG, DxCG, and ETG, as provided by EOHHS;

Ensure interoperability with Cognos, MassHealth’s existing Business Intelligence tool.

Work with EOHHS to determine details on creation of flexible structure that can adapt to change;

Ensure EOHHS staff have direct access to Data Mart tables; and Develop the DM so it is hosted internally at EOHHS

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2. Produce Provider-Facing Data Reports

Note that the development and detailed design of these reports is the work of a vendor separately procured for by EOHHS. The Data Mart/Business Intelligence vendor will be responsible for ensuring the successful production of data reports from the Data Mart based on detailed specifications provided by EOHHS, including:

o Implementing all key measures and algorithms as identified by EOHHS in the Data Mart, enabling one-step reporting on those measures and algorithms without need for manual calculation by MassHealth analysts;

o Testing and validating report results in Data Mart;o Inputting into Data Mart the algorithms and business requirements for

provider claims extracts created by existing vendor ; ando Testing and validating extract results in Data Mart.

3. Build New Business Intelligence Tools (reports/cubes/dashboards/etc.) Gather requirements for BI tools based on discussions with a wide range of

MassHealth staff, including BI tools for both internal users (MassHealth) and external users (legislature, governor’s office, advocates, MCOs, PCCs, providers, members/general public, etc.);

Identify measures to be flagged in the Data Mart, such as emergency department visits, chronic diseases, DRGs for inpatient stays, and costs that should be included in total cost of care;

Prioritize BI tools based on MassHealth need and feasibility/time and review priority list with MassHealth for sign-off;

Determine appropriate level of drill-down/PHI for each BI tool user, such as through a role-based system;

Create Business Intelligence analytics, including cubes, reports, and views with drill down capabilities, using clean data from the Data Mart; and

Train MassHealth staff to create additional reports using the Data Mart.

C. Details on Functionality

The Data Mart must support reports and functions such as, but not limited to, the following:

1. Core Functions of Data Mart

Standardize and unify data across MCO Encounter and PCC FFS claim payments. Create cubes/views that aggregate and combine claims, encounter, and supporting

data in pre-defined ways, including by claim, by encounter, by client, by service provider, by service provider group, by ACO, by payer, as well as by claims and eligibility level.

Calculate and store multiple provider enrollments for all MassHealth members. Note, EOHHS will need to determine provider membership on the basis of Plan (MCO) submitted enrollments, our own PCC enrollments, and retrospective utilization algorithms. The DM should facilitate the reporting across all of these approaches.

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Produce provider reports using algorithms created by existing MassHealth vendor.

2. Calculation and Analysis Functions

Create eligibility and claims flags, such as for ED visit claims, members with pass through payments, and members assigned to specific provider systems such as an ACO.

Calculate key measures such as total cost of care, pharmacy rebates, or key quality measures so they do not need to be independently calculated for each report.o Accurately calculate and store total cost of care (TCOC) for all MassHealth

members, combining services from both FFS claims and MCO encounter data. o Analyze costs and utilization metrics in a standardized way for all members

regardless of plan enrollment. Metrics could include, but are not limited to, average lengths of stay, spend breakdown by location of service, Emergency Department visits by reason, treatment patterns and member churn patterns.

o Calculate key required quality metrics from administrative data, such as HEDIS and NQF administrative measures.

o Calculate utilization and costs associated with various conditions and events, including by groupings such as DRG, EAPG, and ETG.

Provide longitudinal views of client and provider services. Calculate Provider performance on standard measures used in provider-facing

reports created by existing MassHealth vendor. Give providers extracts of their claims, as developed by existing MassHealth

vendor, at regular intervals.

3. Business Intelligence

Include dashboards that will provide views and reports with various drill-down capabilities, to various staff and stakeholders, based on their role and level of access to data. MassHealth staff will have access to PHI as appropriate, while MCOs, ACOs, and providers will also have access to details of care about only their patients. These reports will allow drill-downs so analysts can identify trend drivers and outliers. Other reports will be public-facing and will contain aggregate data only, such as regional summaries of service levels, patient diagnoses, and cost of care. Some examples of public reports can be found at New York State’s Medicaid website: http://dsripdashboards.health.ny.gov/

Incorporate industry standard information and algorithms to tables to be used in reporting and analysis, such as consistent DRGs across inpatient stays in fee for service claims and Encounters and patient level risk scores such as DxCG. These industry standards will be developed and deployed in consultation with EOHHS and relevant stakeholders.

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Incorporate non-claims based payments into the environment in order to capture all system spending, such as Delivery System Transformation Initiative (DSTI) payments, Disproportionate Share (DSH) payments, Pay for Performance payments, and other payments not related to a direct medical claim.

Create reports from standardized data so that MassHealth can accurately calculate alternative payments, such as by outcome rather than by discrete service, with case mix adjustment to account for differences in patient populations, for varied levels of provider and payer risk and shared savings. These reports need to provide evaluation along the spectrum of stakeholders, including providers, provider groups, ACOs, and MCOs.

D. Timeframe

Per Table 2 below, MassHealth plans to use the following timeline and deliverables for implementation of the Data Mart:

Table 2 – Timeline of DeliverablesDeliverable Description/Purpose Timeline

1. Create Data MartSummary of existing environment

After reviewing EOHHS documentation and conferring with key staff, the vendor will summarize the existing Data Warehouse environment, data issues, and challenges to resolving those issues as they relate to the Data Mart

In Month 1

Functional Requirements

Developed in conjunction with EOHHS, a concrete set of functional requirements will be created to guide technical design work

In Month 1

Detailed Technical Design Draft

A document describing, in detail, a MassHealth enterprise analytics environment and Data Mart for review by EOHHS, including integrating and harmonizing reports and processes from MassHealth’s existing vendor who received ETLs and created provider reports.

By Month 2

Final Detailed Technical Design

Revised technical design document that incorporates comments from EOHHS

Approximately Month 3

Begin Development Based on the Final Detailed Technical Design, begin coding of the Data Mart

Approximately Month 3

Testing Plan A document describing, in detail, the testing plan to be used to validate the functionality and outputs of the analytics environment and Data Mart

Approximately Month 3

Launch of BETA Data Mart

Successful launch of BETA version Approximately Month 4

Validation of Data Mart

Implementation of testing plan and resolution of any issues raised during implementation

Approximately Month 5

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Launch of Data Mart environment

Fully validated Data Mart environment for use in Provider Reporting and advanced analytics

Approximately Month 5

2. Produce Provider-Facing ReportsIncorporation of Business Rules for Provider Reporting into Data Mart

Using algorithms from EOHHS’ provider reporting vendor, implement the provider reports and claims extracts into the Data Mart

Approximately month 5

3. Build New Business Intelligence ToolsRequirements gathering

Meet with multiple MassHealth staff and other stakeholders as necessary to determine what reports, cubes, and/or dashboards are needed; prioritize needs by speed and complexity of creation

Months 2-5

Plan and design BI tools, review with MassHealth

Submit plan to MassHealth regarding proposed list of BI products to be created; refine products and list through discussions with MassHealth; design BI products in collaboration with MassHealth staff regarding fields, criteria, formulas, etc.

Months 6-7

Build BI tools Build BI tools Month 8Test BI tools Review tools with MassHealth staff; refine as

necessaryMonth 9

5. RFI QUESTIONSWhen responding to the questions below, please limit the number of pages to 15. Attachments or examples do not count towards this page limit.

A. Timeframe and Work Scope

1. Are the time frames above reasonable? Please comment on any or all steps involved in the work involved. You can use Table A below or summarize your thoughts in text format or in another manner.

If the time frame for a task is dependent on certain issues, conditions, etc., please provide those details (e.g., “If it’s X, it will take __ months; if it includes Y, then it will take ___ months; if EOHHS provides us with Z, then it will take ___ months”).

MassHealth understands that all time estimates provided in this RFI are estimates only and do not represent any commitment from any respondent for future work.

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Table A – Timeframe and work scope commentsDeliverable EOHHS

Target Timeline

Respondent comments on reasonability of timeline / time respondent thinks is necessary for work involved

1. Create Data MartSummary of existing environment

Month 1

Functional Requirements

Month 1

Detailed Technical Design Draft

By Month 2

Final Detailed Technical Design

Month 3

Testing Plan Month 3Launch of BETA Data Mart

Month 4

Validation of Data Mart

Month 5

Launch of Data Mart environment

Month 5

2. Produce Provider-Facing ReportsIncorporation of Business Rules for Provider Reporting and Claims Extracts into Data Mart

Month 5

3. Build New Business Intelligence ToolsRequirements gathering

Months 2-5

Plan and design BI tools, review with MassHealth

Months 6-7

Build BI tools Month 8Test BI tools Month 9

2. To meet the deadlines, would the Data Mart solution need to be an off-the-shelf product, or could it be a custom developed/custom designed product?

3. Are there any issues that would affect your likelihood to bid? Please list those issues and explain why. (e.g., EOHHS wanting to host the Data Mart; EOHHS wanting a custom-developed product; EOHHS wanting dashboards)

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B. Design Decisions

1. Is there a cost difference for frequency of data transfers from the Data Warehouse to the Data Mart? If yes, what is the cost difference between weekly, monthly, and quarterly transfers? Your answer can be in multiple format--for example, if quarterly transfers would cost $X, then how much more would monthly and weekly transfers cost? (e.g., 2X; 5X)

2. What constraints or limits would you want to put on the Business Intelligence component of the project, such as limiting the number or scope of the reports, in order to meet EOHHS’ deadlines?

C. Skill Sets

1. If we require the BI component be done in Cognos, our current BI tool, do you have internal capability to do the work?  Would you hire subcontractors?  Or would you not bid on such work?

2. Do companies with experience in building Data Marts typically have experience deploying BI tools and extracting claims and vice versa?

3. The work described above involves three distinct skill sets: 1) creation of the Data Mart; 2) development of BI tools (reports, dashboards, cubes, etc.); and 3) development of claims extracts for providers. Do you recommend that EOHHS release a single RFR that includes all three skill-set projects together? If not, how do you recommend EOHHS breaks out the work? (e.g., Data Mart and BI tools on a single RFR, but not claims extract; or bid each component separately; etc.)

4. Have you ever bid on work that gave bidders the option of doing either some or all of the work? For example, an RFR where bidders could bid on both Parts A and B, or only Part A or only Part B. If the either-or option was a factor in your decision to not apply, please explain.

D. Other Considerations1. Are there other design considerations or issues we should be considering if we

proceed with a Data Mart?

2. Are there inherent limitations to the Data Mart approach in enhancing MassHealth’s analytic capacity that we may not be considering?

E. Alternatives1. Are there other solutions, other than a Data Mart, that will meet MassHealth’s needs?

Please explain/specify details about the solution itself as well as details about how it will resolve the issue described above and provide us with the capabilities we need.

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2. Is there any other information we need to know about or think about when reviewing our options? This is a section for other comments not covered by the above questions.

6. GENERAL INSTRUCTIONS

Please note that this RFI is issued solely for the purpose of obtaining information. Nothing in this RFI shall be interpreted as a commitment on the part of the Executive Office of Health and Human Services to enter into a contract with any respondent or to make any procurement.

A. This RFI has been posted on September 18, 2015.B. Respondent Questions. Potential respondents who have questions regarding this RFI

may e-mail them to the contact listed in Section 6.F. below by September 25, 2015. Respondents may only make inquiries and request clarification concerning this RFI by written questions via e-mail. Responses to inquiries and clarification questions will be provided electronically to all interested parties via a posting on COMMBUYS.

C. Response Submission.

All responses to this RFI are due no later than 5:00 PM on October 2, 2015. However, MassHealth will begin reviewing RFI responses as they are received.

Respondents should submit one (1) electronic copy via e-mail to the contact listed in Section 6.F below. All responses must include on the first page the official name (if any) of the firm or entity submitting the response. Please consecutively number all pages of the response.

D. Information Requested

1. Company Name (please list parent company as well);2. Company Address;3. Company Website;4. Contact name and information (e-mail address required);5. Provide a description of your company and the basis of your expertise in response to

this RFI.

E. Response Format. EOHHS requests that all responses are typewritten and include a timeline of the vendor’s estimate to completion. Font must be Times New Roman or similar font, size 10 point or larger. Marketing material should not be included.

F. EOHHS Contact Information. Please direct the RFI responses to the following contact person:

Melissa Morrison, Procurement CoordinatorExecutive Office of Health and Human Services, Legal UnitOne Ashburton Place, 11th floor Boston, MA 02108Email: Melissa.Morrison@state.ma.us

Respondents are prohibited from communicating directly with any employee of EOHHS or any of its constituent agencies with regard to the subject matter of this RFI except as specified above. No other individual Commonwealth employee or representative is authorized to provide any information or respond to any question or inquiry concerning this

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RFI. Respondents may contact the contact person for this RFI in the event the respondent is having trouble obtaining any documents or attachments electronically through COMMBUYS.

G. Additional Information. EOHHS retains the right to request additional information from respondents. EOHHS may, at its sole discretion, elect to request formal presentations from certain vendors and/or create an RFR or RFQ which will include the detailed requirements and key success criteria for the procurement and be based, at least in part, on the responses received from this RFI. EOHHS may request further explanation or clarification from any and all respondents during the review process.

7. OTHER RFI INFORMATION

A. Costs

By submitting a response, respondents agree that any cost incurred in responding to this RFI, or in support of activities associated with this RFI, shall be the sole responsibility of respondent. EOHHS shall not be held responsible for any costs incurred by respondents in preparing their respective responses to this RFI.

B. Review Rights

Responses to this RFI may be reviewed and evaluated by any person(s) at the discretion of EOHHS, including independent consultants retained by EOHHS now or in the future.

C. Public Record

All responses to this RFI are subject to the Commonwealth’s Public Records Law, Mass. Gen. L. Ch. 66 s. 10, regardless of confidentiality notices set forth on such writings to the contrary. EOHHS will maintain the confidentiality of information submitted in a response to this RFI to the extent it is able and subject to EOHHS’ requirements to disclose information pursuant to the public records law.

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Attachment A

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