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New York County moves to privatize its public safety systems: Is this the start of a new trend?

Monroe County New York is in the final stages of an agreement with Navitech to completely manage its public safety and security systems. The contract would be for twenty years and cost $11.2 million annually. As this contract moves closer to fruition, one may wonder if this is a good thing for the County or something disturbing that may become more common in the public safety sector.

One of the major facets of state and local public safety projects, from Computer Aided Dispatch to County-wide radio systems, is the need for constant competition. Long term contracts may be common place in some of these areas, but locking up long term deals of twenty years might actually have a detrimental effect on the cities and counties themselves.

Locking up these deals prevents the City from reevaluating the system and the vendors themselves, every few years, really is doing them a disservice. Being able to determine that the software or hardware is not a good fit enables a city or county to re-bid and allow for a new competitive bid process.

Overall, projects like that in Monroe County will be disadvantageous to cities, counties and vendors alike. While these types of deals may give the locality the option to upgrade systems or equipment on a regular basis, it is essential that state and local governments continue to allow continuous competitive bids for services in the public safety sector.

CMS Seeks Industry's Help with Assessing the National Health IT Infrastructure

If you're tracking the federal and state and local (S&L) health IT markets like GovWin, you know that our work is never done. As if by design, the Centers for Medicare and Medicaid Services (CMS) released an RFI for an assessment of the nation's health IT infrastructure on the same day GovWin's Industry Analysis team published its latest reports," Health IT Transformation: FY2009-FY2014 Federal Market Forecast" and " Health IT Transformation: FY2009-FY2014 State and Local Market Forecast."

In both reports, we discuss the fact that, regardless of the makeup of the final health care reform legislation, health IT will be a major investment area IF there is major progress in standards and interoperability. Without it, the information exchange that makes electronic health records such a cost saving factor will be impossible.

Although work has been done in this area with Health Information Exchanges (HIEs) and the National Health Information Network (NHIN), CMS wants to take a step back and perform a "national scan of the electronic infrastructure available among all entities sharing a role in the reporting of measures...to potentially support meaningful EHR use in the near term and the broader exchange of health information expected with health care reform." Similiar to stimulus money given to the National Telecommunications Information Agency (NTIA) to perform a national broadband inventory, CMS wants ideas for how to gain a baseline inventory for current health IT infrastructure as well as for developing a national strategic framework for the future national health information infrastructure. It's the first step in an uphill battle to first determine the level of infrastructure that already exists and then determine the best approach for filling the gaps.

Using funding provided as part of the stimulus package, CMS' National Gap Analysis and Readiness Assessment for the Health Information Technology Infrastructure to Enable the Electronic Exchange of Quality Measures as Part of EHR RFI - that's a mouthful - asks for industry's help in determining the options, tasks, level of effort, deliverables and timelines required to:

  • Generate an initial infrastructure framework (to include a summary of existing work products produced by various organizations currently involved in health IT, such as the Federal Health Architecture (FHA), Medicare/Medicaid/CHIP programs, Healthcare Information Technology Standards Panel (HITSP), Certification Commission for Healthcare Information Technology (CCHIT), Nationwide Health Information Network (NHIN), and various public testimony and white papers).
  • Convene a team of health IT experts from the public and private sectors to validate approaches.
  • Describe how the infrastructure would accommodate the service variables within an EHR that would be of interest to payers of health plans; information that should be required within EHRs; data flow between providers, plans and payers; and transaction standards for data exchanges.

    Implications

    Contractors have until October 1 to respond to this RFI, which is the first step in what amounts to one of the most important element of health care cost savings: broad exchange of health data. Contractors have the opportunity to help shape the roadmap for national health IT implementation - from processes and policies to applications and technology. Contractors should be prepared to address standards, privacy/security, capacity planning, and how the government can leverage its existing health IT infrastructure and service-oriented architecture investments in this initiative.

    Contractors that have been active in previous NHIN trials and health IT workgroups have a leg up. Although NHIN is still a work in progress, it can offer direction in what to do and what not to do moving forward.

  • CMS Divulges Medicaid Health IT Plans at the 2009 MMIS Conference

    This year the Medicaid Management Information System (MMIS) Conference was held in the windy city and provided a forum for rich dialogue amongst industry stakeholders. The Conference buzzed with interest over funding allocated for Medicaid health information technology (IT) in the Health Information Technology Environmental and Clinical Health Act (HITECH) under the American Recovery and Reinvestment Act of 2009 (ARRA).

    On day four, Denise Bazemore, a Project Officer at the Centers for Medicare and Medicaid Services (CMS), provided insights and details on the upcoming state Medicaid directors' letter addressing how to proceed with HITECH. During the presentation, states were advised to seek prior approval from CMS on planning activities, develop a state Medicaid health IT plan (SMHP) as a chapter in the larger statewide plan, start to think about a Medicaid health IT advanced planning document (APD) which will be required, flesh out roles and responsibilities and finally consider the 90% administrative Medicaid health IT federal match when engaging in administration, oversight or encouraging adoption. Going forward, CMS is going to try to differentiate and distinguish between the MMIS APD and the Medicaid Health IT APD as they are two separate pools of money. The agency anticipated requiring separate tracking tools for funding and spending of MMIS dollars and recovery dollars. CMS has already begun to develop funding codes for this initiative, including, 19B Health IT Administration; 19B1 Health IT Planning: Cost of in-house activities; and 19B2 Health IT Planning: Cost of private contractors.

    The state Medicaid directors' letter is currently under review with the Office of Management and Budget (OMB) and there may be some editing before the letter is released. Once the letter is released it will be followed by a state call whereby states can ask question and discuss next steps.

    Now that CMS has outlined their intended guidelines and requirements for HITECH funding states will jump to action which will enable contractors to better understand where they can play. Some states will utilize contract vehicles to solicit consultant to help develop strategic plans that must illustrate Medicaid's role in the broader statewide health IT plans and incorporate Medicaid Information Technology Architecture (MITA) principles. Contractors will also be called upon to provide assistance with developing APDs which will likely have a similar template to MMIS APDs. Accountability and transparency will be vital as the federal government is expecting Medicaid agencies to track recovery funding spending.

    Follow the LEADER: Intent to Award Posted

    A procurement process that began in July 2004 is nearing an end. The Los Angeles County Department of Public Social Services (DPSS) issued an Intent to Award the Los Angeles Eligibility Automated Determination Evaluation and Reporting (LEADER) Replacement System to Accenture LLP. The LEADER System automates administration of welfare programs in LA County (CalWORKs, Food Stamps, Medi-Cal, CAPI, and General Relief), including eligibility determination, benefit calculation, case maintenance, and management/fiscal reports and controls. Proposals had been under evaluation since May 2008 with the threat of a two-year award delay due to the California budget crises. Contract negotiations will begin in September 2009. For more information, visit GovWin Opportunity ID 15968.

    State & local health IT is heating up

    As you might recall from GovWin's coverage of federal stimulus for health IT, the legislation left it to the Secretary of Health and Human Services to fill in the blanks defining how state and local governments will contribute to the national effort.

    Recent events are bringing new insights into exactly what that contribution will be.

    First, earlier this week HHS Secretary Kathleen Sebelius formally delegated authority to the Office of the National Coordinator (ONC) for Health IT to oversee section 3013 of the legislation relating to the awarding of state grants to promote health IT. A Beltway outsider, Blumenthal brings a state-based perspective to his wide-ranging role, having been director of the Institute for Health Policy at Massachusetts General Hospital.

    Today, Vice President Joe Biden announced that $1.2 billion in funds will be awarded by ONC under its new authorities. $598 million will go toward competitive grants establishing 70 Health IT regional Extension Centers, as part of the Health IT Extension Program (GovWin S&L Grant Opportunities profile), which will "offer technical assistance, guidance and information on best practices to support and accelerate health care providers' efforts to become meaningful users of Electronic Health Records (EHRs)."

    Key excerpts from the program "Facts-At-A-Glance":

    • Grants under the Extension Program will be awarded on a rolling basis to U.S.-based, nonprofit institutions or organizations with an expected 20 grants awarded in the first quarter of FY2010, another 25 in the third quarter and the remaining awards in the fourth quarter of FY2010. The initial funding includes approximately $598 million to ensure that comprehensive support is available to providers under the Extension Program beginning early in FY2010, with an additional $45 million available for years 3 and 4 of the program. Federal support continues for four years, after which the program is expected to be self-sustaining. Of the total federal investment in this program, about $50 million is dedicated to establishing the national HITRC, and $643 million is devoted to the Regional Centers.

    Another $564 million will go directly to states for integration with regional health information exchanges (HIEs) as part of the State Health Information Exchange Cooperative Agreement Program.

    Key excerpts from the program "Facts-At-A-Glance":

    • Over the next several months, cooperative agreements will be awarded through the State Health Information Exchange Cooperative Agreement Program (GovWin S&L Grant Opportunities profile) to states and qualified State Designated Entities (SDEs) to develop and advance mechanisms for information sharing across the health care system. States may choose to enter into multi-state arrangements. A cooperative agreement is a partnership between the grant recipient and the Federal government. States and SDEs will be required to match grant awards beginning in 2011.
    • Under these State cooperative agreements $564 million will be awarded to support efforts to achieve widespread and sustainable health information exchange (HIE) within and among states through the meaningful use of certified Electronic Health Records (EHRs). The goal of meaningful use of EHRs is for health care providers to use this technology to improve the quality and efficiency of care. State programs to promote HIE will help to realize the full potential of EHRs to improve the coordination, efficiency and quality of care.
    • The Centers for Medicare & Medicaid Services (CMS) will issue proposed criteria for meaningful use by the end of 2009. This process began in June.

    GovWin's Take:

    • Vendors should be enthusiastic about these developments as they will certainly accelerate interest and adoption of health IT. Remember, in past years the entire ONC effort has only been funded at slightly more than $100 million annually.
    • First, be mindful of the fact that the non-governmental extension offices will have a limited need for programmatic technology, but they should not be overlooked by vendors with experience with non-profit health care entities. These extension offices are likely to be adjunct to regional HIEs, which are often adjunct to consortia of major regional health care providers and insurers.
    • Second, the HIE program will significantly boost state HIE involvement where it has been very limited in the past. It is not clear how this engagement will play out. The criteria for meaningful use to be issued later this year will be critical to shaping that engagement. CMS's involvement in defining the criteria confirms GovWin's long-standing contention that state Medicaid systems are the nation's oldest HIEs and will be integral to--if not the foundation for--a system of national exchanges. Vendors with experience in Medicaid Management Information Systems (MMIS) will be well positioned in this area.
    WISCOM and SEPTA Fare Collection System total $120 million in contracting opportunities

    Yesterday, August 18th was a big day for the State of Wisconsin- Department of Transportation, Division of State Police and the Southeastern Pennsylvania Transportation Authority (SEPTA) as both agencies had large projects with proposals due. Both projects, a Statewide Radio Communication System and a Smart Card Fare Collection System, combine to total an estimated $120 million.

    The State of Wisconsin released a Request for Proposals on July 8th for a statewide P25 high-band trunked digital radio system. The state contracted with L. Robert Kimball & Associates to help conduct studies and assist in the development of requirements for this project, which is part of the Statewide Communications Interoperability Plan (SCIP). Kimball & Associates have estimated that a 71 site system would cost $17.1 million, while an 80 site system would cost $18.8 million. A pre-proposal conference was held July 20th. Vendors who attended the conference include Harris Corporation, Raytheon, Tait Communications, EADS, Motorola, EF Johnson, and Alcatel Lucent. Please monitor this opportunity for more information as the selection process continues.

    SEPTA released a Request for Proposals on November 7, 2008 for a Smart Card Fare Collection System. The project originated in March 2008, when the authority released a Request for Information on the different options for new payment technologies. SEPTA has estimated that the implementation of a new fare collection system will cost around $100 million. Companies who have expressed interest in this project include: Accenture, Computer Sciences Corporation, IBM, Northrop Grumman, SAIC, and Unisys. A variety of banking and financial institutions have also expressed their interest in this project. Please monitor this opportunity for more information as the selection process continues.

    Early Release of Prisoners in California and the Implications for Technology Vendors

    One of the most politically divisive issues in the ongoing struggle to find a solution to California's budget crisis has been the proposal to drastically reduce the population of California's state prison system. For the purposes of this blog I will leave the politics to the politicians, and approach the issue from the perspective of an observer of the corrections technology industry.

    The most obvious direct impact of the conditional release of tens of thousands of prisoners is increased usage of electronic monitoring (ankle bracelet) contracts to keep tabs on the former inmates. Additionally, if the short term strategy of avoiding prison time for non-violent offenders becomes a long term policy, the value of these contracts could drastically increase, assuming conviction rates remain constant. GovWin is currently tracking 14 offender electronic monitoring contracts at all levels of government in the State of California. For example GovWin Opp ID 54693 in Trinity County.

    Another factor that is often times overlooked when focusing on short term cost savings is the recidivism rate of the state's prisoners. The state reports a recidivism rate of roughly 70%. Combine this figure with high unemployment in the state, further reducing the availability of legal means of making money, and it is likely that quite a few of these individuals will find themselves occupying the cells they once vacated. While this is a negative statistic for society in general and California in particular, it does benefit those technology vendors who are concerned about the California Department of Corrections and Rehabilitation (CDCR) having a continued need for their products and services.

    A large movement of prisoners out of the CDCR's jurisdiction and into local jails and probation systems could serve to expose inadequacies in overwhelmed jail management and case management systems. Although budgets may be too tight for complete upgrades and overhauls, this influx of activity has potential to raise the priority level of such projects. GovWin will be keeping a close eye on local level strategic planning in order to monitor this trend.

    The coming weeks will determine how many prisoners are released from California's prisons, if any. One thing that is always certain is that any product or service that can produce significant cost savings or risk avoidance (particularly in terms of violence against guards) will gain the attention of corrections purchasing officials.

    Missouri & Kansas Award Contracts Valued at Over $127 Million

    Recently, two projects of unequivocal price from Kansas and Missouri were awarded at a value of $40 million and $87 million respectfully. These projects are outlined below:

    Project 2010 Replacement of VIPS KDLS and KVIS in the Kansas State Department was awarded to 3M at the value of $40 Million dollars. This project was contracted to replace the Vehicle Information Processing System (VIPS), the Kansas Drivers License System (KDLS) and the Kansas Vehicle Inventory System (KVIS). The primary requirement for this project was Enterprise Application Integration (EAI). To implement this project, a feasibility Study was first solicited in September of 2006, and awarded to Webelan Inc., who completed the study November of 2007 for a value of $196,000. The Solicitation for this project was released the following October 20, 2008, once funding was allotted. A conference was held, and 5 addenda were released (including a list of pre-proposal attendees, additional information regarding Real ID compliant changes and a workflow prototype diagram, and 3 Q&A documents) before proposals were due January 7, 2009. Project 2010 Replacement was finally awarded August 1, 2009. In order to fund such a large project, the State had to wait for funding from the state legislature, which met in January of 2008. They passed House Bill No. 2542 which created the Division of Vehicles Modernization Fund that provided support in the creation, finding, and maintenance of the project. To generate funding for the project, the legislation passed a surcharge on vehicle registration to generate the (estimated at the time) $40 million they would need to complete the project. Go to this Opportunity for more information.

    The Design and Build State VHF Trunked Radio System in the Missouri State Department was awarded to Motorola at the value of $87 million dollars, for duration of 36 months (base). This project was part of the State Capitol Improvement Plan ($111 million over 10 years), and was contracted to design and build a statewide hybrid VHF trunked radio system, replacing the previous 50-year-old system. To implement this project, the State used consulting services twice before releasing an RFP. In 2004 the State contracted the Titan Corporation to conduct an Emergency Communications Interoperability Study.This revealed that many of the radios used by other agencies are more than 20 years old and have passed their life expectancy. Then in 2007 L.R. Kimball and Associates provided the assistance required to determine the needs of the State, and then assisted in the development of the formal solicitation for this communications system. The Solicitation was released July 8, 2008 and 5 addendum were released (including an extension of the proposal due date, pre-bid attendee list, clarifications, modifications, and a Q&A document) before proposals were due on October 7, 2009. The Budget Committee approved the $111 million for the State Capitol Improvement Plan on May 5, 2009 and finally, the contract was then awarded June 27, 2009. Go to this Opportunity for more information.

    NY five-county consortium to spend over $100 million on radio systems

    It looks like the five-county consortium of Onondaga, Oswego, Madison, Cortland, and Cayuga counties of New York will be moving one step closer to interoperable communications. Cayuga County is set to release a solicitation in the upcoming week for a UHF Radio Communications System (GovWin Opportunity #50000). The system, originally estimated at $23.3 million, will include 1,837 radios and 1,172 pagers. Cayuga County will be the third of the five-county consortium to move in the direction of interoperable communications purchasing. Onondaga County signed a $35 million contract with Motorola and is set to go live in the fall. Madison County also signed a $20 million contract with Motorola. Cortland County is in the process of working with Federal Engineering to design a new narrow-band interoperable communications system estimated at $20 million, which may go out to bid in the next year (GovWin Opportunity #57896). Oswego County is also in the process of working with Langone & Associates and Charles Gabriel to develop a new radio communications system, estimated at $21.6 million, which may go out to bid before year's end (GovWin Opportunity #42248). More information on the latest news surrounding each of these projects can be found through the links attached.

    CA DGS Holds Webcast for IT Procurement Reform

    The California Department of General Services (DGS) held a webcast on August 11th to go over their plan for IT procurement reform. The meeting was held as a way for DGS to explain changes going forward with IT procurement as a result of Governor Schwarzenegger signing a budget deal the week of July 21st. The main two topics of the meeting were to address timeliness and the procurement process in general.

    As it relates to timeliness, the goal of both California as a whole and DGS is to speed the procurement cycle up. In recent years, mutli-million dollar procurements within the State have taken as long as 3-5 years to procure. Going forward, it is a goal of the DGS to cut that time down to 22-26 months. Likewise, procurements for "complex IT systems" have taken on average 29.7 months in the past. However, it is now a goal of the DGS to cut that time down to 9.3 months.

    As far as announcements on the procurement process in general go, the news is that looking ahead, there will be quite a few more RFIs. The Governor's proposal will require that an RFI stage is included in all potential procurements, before any attempt to release a formal solicitation is made. The reason for this is simple: CA wants to verify that vendors are capable of providing solutions before they spend the time and money to create an RFP.

    Both of these concepts seemed to go over very well with those in attendance either in person or through the webcast. Only time will tell how successful CA is with shortening the procurement process, but if they can pull it off, it will surely be beneficial to both the State and the vendor community as well.

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