There are many reasons that a health plan will decide to go through the process of selecting a new care management vendor. It could be due to a change in its line of business, the need for improved operational efficiencies, a merger, or sunsetting of the vendor’s platform, to name just a few.
One of HighPoint’s recent opportunities occurred when a health plan learned that its existing care management system was being sunsetted. The health plan decided to take the opportunity to look for a new vendor for its care management system needs.
Selecting a care management vendor
Some health plans use an RFP process to begin the care management selection process. With the recent opportunity, the health plan decided to use a different method. HighPoint was selected to assist the health plan in selecting a new care management vendor through a Proof of Concept (PoC) process.
The health plan began its vendor selection process to investigate the tools used in the care management market, and asked HighPoint — because of our industry knowledge and expertise — to support them in the vendor selection process. The health plan wanted to partner with someone who knew the care management vendor marketplace, and asked for assistance in reviewing several potential vendors through a PoC process. After developing a Statement of Work (SoW), the vendor selection process began in earnest. The SoW was used to determine potential vendors and match them with the health plan’s needs. The health plan was looking for three qualities when selecting the new care management vendor: Price, Product and Partnership.
The health plan’s staff actively engaged with HighPoint’s clinical experts, and were open to the suggested changes necessary for selecting a new vendor. With HighPoint’s assistance, the health plan performed a vendor assessment and determined which vendors they wanted to participate in the PoC.
The health plan defined its business and technical requirements. HighPoint also assisted the health plan in developing the PoC, which included background information on the vendors, the health plan’s goals and objectives, and business and technical requirements associated with a Population Health Management platform that would support its concept. The health plan discussed its pain points during the requirement gathering process. Lack of automation in the application presented a significant challenge with the existing care management system. The health plan wanted a new care management platform that would eliminate workarounds and manual processes. They also needed a care management platform that would allow them to expand into government business.
The PoC identified several potential vendors for a unique exercise. This was different than other vendor selections in that the health plan wanted the vendors to perform an exercise, which would show more than just a theory, but an actual concept. The health plan wanted the two vendors to show their hands-on experience working in their care management system. The care management vendors were given various scenarios that demonstrated the business and technical requirements that were required to perform the care management workflows.
A HighPoint Business Associate led the development of the business requirements for the vendor selection process. This included such things as observing the vendor demos, and assessing/scoring the vendor’s processes.
Best practices for selecting a vendor
HighPoint followed these objectives in the assessment and vendor selection process:
- Led the health plan in defining its business and technical requirements
- Led the vendor review sessions and facilitated workgroups with the health plan to finalize the clinical system business and technical requirements
- Assisted with developing the PoC. This included background, goal and objective setting, and business and technical requirements
- Provided a template within a Population Health Management platform that supported the PoC
- Assisted the health plan with determining which vendors would be invited to participate in the PoC exercise
- Identified the vendors for PoC exercise
- Coordinated vendor on-site meetings and PoC exercise
- Coordinated interactions between the health plan and vendors
- Developed a comprehensive scoring mechanism
- Completed response scoring
- Presented vendor selection results to the health plan stakeholders
- Review finalist vendor proposal
Care management experience
The health plan relied on HighPoint’s support for its rich knowledge of the care management vendor market. HighPoint will continue to work with the health plan during the implementation phase.
The health plan selected a vendor that was an excellent fit for their organization. This success was due to HighPoint’s industry knowledge and expertise.
HighPoint helps get payers in line with efficient workflows and technology that spur the transition to value-base care. Through assessments of existing systems for optimization, then recommending and implementing what’s needed, HighPoint finds the most efficient solution available, creating a foundation of trustworthy data to drive a clients’ population health strategies.