West Virginia’s Department of Health and Human Resources within their Bureau for Medical Services (BMS) in February issued an RFP “v10.0-DW/DSS (MED11015)”. The RFP seeks proposers to help design, develop, implement, operate, a “WV Medicaid Data Warehouse/Decision Support System (DW/DSS).”
Systems enhancements are needed so that BMS can meet their data analysis and reporting needs. According to the RFP, BMS is responsible for the overall strategic direction and priorities for the state Medicaid Program. The Bureau wants to streamline the administration to better tailor services to meet the needs of enrolled populations and to better coordinate care especially with individuals with chronic conditions. BMS would like a robust DW/DSS in place as soon as possible.
The Medicaid program provides healthcare benefits to 411,000 people across 55 counties using a network of 24,000 active providers. The MMIS processes about 17.7 million claims per year, 9.5 million medical/dental claims, and 8.2 million pharmacy claims. About 93 percent of claims are received electronically of which 53 percent are pharmacy claims. About 165,000 Medicaid recipients consisting of families with dependent children, low-income children, and pregnant women are enrolled in three Managed Care Organizations (MCOs).
So far, the Medicaid program has paid for certain services for MCO recipients specifically for pharmacy, children’s dental services, and behavioral health services. The Medicaid program also manages a Primary Care Case Management program. The Physician Assured Access System processes claims for two waiver programs and several state funded eligibility programs and functions as their party administrator for other state agencies.
The WV Office of Technology Enterprise Project Management Office (EPMO) manages information technology projects, provides oversight for state agency information technology projects, and will provide oversight for the DW/DSS procurement project BMS plans to reduce redundancy in services and payments by integrating with other entities, plans to automate reporting capabilities, and integrate claims data with clinical data. The Bureau plans to use technology tools and provide training for data analysis to enhance decision and policy making capabilities.
The vendor proposal opening date is May 17, 2011. To view the Request for Proposal, go to www.wvdhhr.org/pdfs/purchase/MED11015%20DW%20DSS%20Final%20to%20Vendor.pdf.