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A Look at the Health and Social Services Market for the Month of December

The Health and Human Services Department started off the month of December strong by creating a new grant program to distribute $235 million to communities that can serve as models for the use of electronic health records (EHRs). Through the Beacon Communities Program, 15 communities who have demonstrated high levels of digital health record usage will be awarded $220 million, with $15 million going to technical assistance and independent evaluation services. Applications will be available in the near future, and vendors should stay aware as the grants will pay for building and strengthening health IT infrastructures and health information exchange, including privacy and security measures.

Not to be outdone, President Obama announced on December 8 the allocation of $88 million to boost electronic health record adoption as part of nearly $600 million in funding targeted at community health centers. This is part of the $787 billion federal economic stimulus package funding. These EHR funds will go to help health care organizations digitize their medical records and upgrade their technology systems. And if vendors did not already have enough money to keep track of, on December 10 the Centers for Medicare and Medicaid Services (CMS) awarded $16 million in matching funds among six states and the US Virgin Islands to help them plan their systems and processes for the upcoming task of managing electronic health record incentive payments. This funding involves a separate American Recovery and Reinvestment Act (ARRA) funding stream, which provides a 90 percent federal match for state planning activities. States receiving funds include

Even though the holidays filled most people's minds towards the end of December, even the last day of the month can be one of the most important. Today CMS and the Office of the National Coordinator released its 700-page plan for "meaningful use" to improve healthcare value and quality by accelerating the use of health IT by doctors and hospitals. The plan calls for tens of thousands of dollars in financial incentives for doctors and hospitals meeting three stages of progressively more demanding goals for implementing health IT in their practices. The price tag for the incentives may be lower than originally estimated, surprisingly, falling from $34 billion to as low as $14.1 billion. Stage 1 will be the evolution of meaningful use, focusing on data collection, information sharing, and reporting measures. The end of 2011 will focus on structure information exchange and continuous quality improvement while Stage 3 will focus on support for "national high priority conditions" and population health.

Even though health care seems to be the hottest vertical in the United States right now, social services does have its share of movers and shakers. The Louisiana Department of Social Services in the midst of releasing five RFPs between January and September 2010 in support of their One DSS Modernization project. GovWin previously wrote a blog earlier in the month describing the project's direction and the RFPs that will be released: Statewide Automated Child Welfare Information System (SACWIS); Customer Service Center; Document Imaging; Common Access Front End (CAFÉ); and Quality Assurance. One DSS focuses on the need to improve service delivery to external customers, clients and providers, and largely to improve work processes and tools for staff.

California's Department of Child Support Services is hoping to release a RFP in January 2010 for the maintenance and operations (M&O) services for their Child Support Enforcement (CSE) System. The CSE application was implemented in 2005, collecting and disbursing more than $2.3 billion annually in child support payments. The anticipated term of the CSE M&O Services contract is planned to be a minimum of three years with a maximum cost of $24 million per contract year.

Hawaii is looking to centralize their Women, Infant, and Children (WIC) Databases in 2011. The Department of Health released a RFP for a Project Planning Contractor to come in and conduct a feasibility study in support of an Implementation Advanced Planning Document (IAPD) for a new system. Proposals are due by January 15, 2010.

Child development will be the major focus of Vermont's Department for Children and Families through 2011. DCF released a RFP for Business Analysis surrounding their Children's Integrated Services (CIS) data management system. Proposals are due by January 20, 2010. The winning vendor will develop a RFP for the implementation of the recommended solution. GovWin estimates a release date in early 2011.

Below are some notable contract awards that occurred in December:

Michigan- The Department of Community health has contracted with First Health Services Corporation in the amount of $20.5 million for Pharmacy Benefit Management (PBM) Services for the Medicaid Program.

West Virginia- The Department of Health and Human Services awarded a contract for an Imaging System for the Bureau for Child Support Enforcement to Northwoods Consulting Partners. Stimulus dollars will be utilized in this project.

Idaho- In the planning and replacement of the Pension Administration System (PAS), the Public Employee Retirement System (PERS) awarded the Project Oversight contract to Provaliant Inc. The RFP for the system replacement is expected to be released in July 2010 when funding is approved.

Utah- The Department of Administration awarded their Office of Recovery Services (ORS) Document Generation System to Cincom Systems Inc. ORS helps to ensure child support payments and services.

North Carolina- The Department of Health and Human Services has contracted with Health Management Systems in the amount of $3.3 million for Third Party Liability (TPL) Recoveries, Cost Avoidance, and Credit Balance Reviews.

Montana- Deloitte has been chosen as the contractor who will provide fiscal services and enterprise architecture for the Department of Public Health and Human Services' Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) Eligibility System.

December brings not only the end of the year 2009, but the end of a decade. Although States faced the biggest deficits seen since the Great Depression, as evidence in this blog, enormous amounts of funding continue to flow into the health IT arena. Want to get ahead of the game? Check out GovWin's recent report "Statewide Health Information Exchanges: A $910 MM Market by 2014" or register for our upcoming webinar in January, Statewide Health Information Exchanges: ARRA Brings Transformative Opportunities to the States.

Alameda County Interested in Obtaining a Learning Management System

Alameda County released a Request for Interest for a Learning Management System (LMS) on December 22, 2009. The intent of the RFI is to search for qualified vendors who are interested in providing a LMS as required by the Alameda County Conference Center. The County intends to release a Request for Proposals and award a three year contract, with option to renew, to the bidder selected as the most responsible bidder whose response conforms to the RFP and meets the County's requirements.

The County seeks to enter into a contract with a qualified vendor to provide, install and configure a LMS. The system shall be used by County personnel to register via the County intranet for classroom and online training sessions. The LMS will provide a registration approval process, automate reporting on critical information such as compliance and costs, and will track individual employee training progress including required curriculums dependent on job code. The installation of the LMS system will include the integration/migration of current data and must interface with the County's current PeopleSoft human resources management system.

The RFI will remain open until the RFP is released. At this time, the RFP is anticipated to be released on January 29, 2010.

Democrats lay Groundwork for 2010 Stimulus (maybe)

Wrangling over health reform has eclipsed some recent events that point toward the likely avenues Congressional Democrats will take for economic stimulus when both houses reconvene after the New Year. However, health care negotiations could linger in conference through January, delaying discussion of new stimulus until February. This would allow President Obama to lay out his goals for a new jobs-oriented stimulus in his State of the Union address in late January or early February.

In a December 8th speech at the Brookings Institution, Obama provided early insights into his goals for this stimulus, including eliminating capital gains taxes for small businesses, non-specific infrastructure spending, residential "green" retrofitting, and a variety of emergency relief to seniors and the unemployed.

12/16: The House passed a $154 billion "Jobs for Main Street Act" (H.R. 2847) that is intended to redeploy unused funds from bank bailouts to keep a lid on unemployment, which increased at a rate not anticipated by the initial $787 billion stimulus package. This bill truly piggy-backs on the earlier stimulus program, inserting additional funds into highways, an "Education Jobs Fund," school renovations, public housing and various benefits extensions.

12/24: The Senate passed a $290 billion increase in the nation's debt limit to $12.4 trillion. (The House passed similar legislation the week prior.) This will allow the federal government to borrow money through February. Congressional Democrats had originally sought an increase that would cover borrowing for all of 2010.

GovWin's Take

  • I'll declare the debate over health care refom legislation to be over when the President signs a bill and not one second before. We won't know until next week (at the earliest) how much trouble Speaker Pelosi will encounter in trying to line up enough of the pro-public-option members in her chamber to support the Senate's public-option-free version of reform. It's not inconceivable that this could take weeks and maybe even scuttle reform altogether.
  • So far, the Democrats--Obama included--are not proposing any radical new visions as part of their jobs stimulus. They are simply proposing a supplement to the American Recovery & Reinvestment Act of 2009. (Call it "Stimulus, Jr.") However, if Congressional Republicans have been willing to mount an endless rear-guard action on health care reform, it will come as no surprise if they do the same on additional stimulus spending. (And we haven't even begun the debate on climate change legislation!) Exhaustion could easily result in a Congressional stalemate on additional stimulus.
  • As it now stands, government IT vendors should make plans for 2010 that depend in any way on the timing or amount of any jobs stimulus finding its way into federal or state and local agency coffers.

New Wave of Broadband Grant Awards Announced

Vice President Joseph Biden announced the first wave of broadband stimulus awards on December 17, 2009. As part of the American Recovery and Reinvestment Act, approximately $183 million of the $7.2 billion program through the Department of Commerce's National Telecommunications and Information Administration (NTIA) and the Department of Agriculture's Rural Utilities Service (RUS) will be allocated to broadband projects in 17 states. Four different kinds of awards were made last week: Middle Mile Awards, which are used to build and improve connections in communities lacking sufficient broadband access; Last Mile Awards, which are used to connect end users such as homes, schools, hospitals, etc. to a broadband infrastructure; Public Computing Awards, which are used to expand computer center services for public use in locations such as public libraries and community colleges; Sustainable Adoption Awards, which are used to promote broadband accessibility to populations where the service has been historically underutilized.

Middle Mile Awards were made in Georgia, Maine, New York and South Dakota. Public Computing Awards were made in Arizona, Massachusetts, Minnesota, and Washington. Sustainable Adoption Awards were made in New Mexico and Washington. Last Mile and Middle Mile awards were made in Alaska, Colorado, Hawaii, Michigan, Nebraska, New Hampshire, New York, Ohio, and Oklahoma. To see how funding was appropriated to state programs, please see the White House press release.

On December 22, 2009, NTIA announced awards for broadband mapping and planning activities in 15 states: Arizona, Florida, Georgia, Illinois, Michigan, Minnesota, Nevada, North Dakota, Ohio, Oregon, Puerto Rico, Rhode Island, South Carolina, South Dakota, and Tennessee. Funding from these awards will be utilized by the states to collect data and perform broadband planning in order to better increase broadband access and adoption.

On the state and local level, vendors will begin to see broadband projects start to roll out in the early months of 2010. Funding from the awards announced last week will begin to be disbursed within the next 75 days for their designated projects and states will need to act quickly to maintain all deadlines associated with grant funds are met. It would behoove vendors to prepare all hands on deck, to not only assist states that have already received awards, but to be able to act swiftly with the remaining awards, which are sure to come out within the next few months. Whether it be for mapping and planning purposes, or implementation purposes, states will call upon vendors in the upcoming months to assist them in leveraging grant awards so that they may provide quality broadband services to as much of the US population as possible.

White House Names Cybersecurity Coordinator

Just when many in the federal technology community had effectively closed the book on major tech news for 2009 the White House announced today the appointment of Howard Schmidt as the federal government's cyber coordinator, more than six-months after President Obama released his national Cyberspace Policy Review in May, designating plans to create the position. Schmidt is a former cybersecurity chief under President Bush.

In the announcement, John Brennan, Assistant to the President for Homeland Security and Counterterrorism, reaffirmed cybersecurity as a major priority for the Obama Administration on par with economic recovery and health care reform. Schmidt will be charged with "orchestrating the many important cybersecurity activities across the government" and have "regular access to the President." The statement goes on to say that Schmidt will serve on the National Security Staff and work closely with the President's economic team. Both elements were introduced in the cyber review, but there was broad speculation as to where the position would primarily reside. Now we see that it is on the security side.

The announcement confirms another aspect of the position that GovWin saw early on when we assessed the May review, as well as what we have been hearing around town – that the job would have broad responsibility without the sufficient authority to drive action. The Washington Post confirms that many declined the position due to that very concern.

What is noteworthy about the selection of Schmidt is that his broad background in this area, both in and outside of government, means that he likely understands the minefield that he is stepping into – both from the practical cybersecurity perspective as well as the leadership perspective. Time will tell.

Louisiana Gears Up for Social Services Modernization

The Louisiana Department of Social Services (DSS) has established a modernization project focused on the need to improve service delivery to external customers, clients and providers, and largely to improve work processes and tools for staff. The state is anticipating federal approval after submitted planning documents. Together DSS and the Department of Health and Hospitals (DHH) analyzed services and identified opportunities for both agencies to reduce duplication of services and to increase awareness of programs. Each agency is responsible for development of its internal systems, but plans to develop systems with service integration capabilities. As part of the planning process state representatives have visited other states to gain insights on modernization efforts that have been deployed and understand the impact to operations and systems. States visited include Utah, Florida, Texas, and Oklahoma.

The technology thrust of the project includes the establishment of a bridge from the back end systems using a common access to the front end which will provide web interface and largely result in new business processes. Additionally, agency plans include a move away from paper process and will institute document imaging and which will allow for centralized document files that can be attached electronically to case records. The establishment of web portal interface will support staff, clients and providers. Changes will result in considerable staff reorganization which will significantly restructure the physical footprint of the agency. More staff will be mobile in the field, and some offices will be closed. Through community partners, such as the Council on Aging and nonprofit groups for disabled, more citizens in need of services will have greater awareness and access to services.

GovWin has been advised that current plans are likely to yield a similar process that Florida has instituted whereby community partners are engaged to support client's access to services. In addition, specialized methods are in place in Florida to manage clients' intake via web and call centers. Greater efficiency will be created and the new call center will provide a more cost effective solution for addressing supporting clients as well as providing web enablement to those who have internet access.

The agency has engaged First Data Solutions to provide project management and to leverage their expertise of Federal programs such as SNAP. The state will continue to engage the vendor community and anticipates release of multiple solicitations. The timelines for release of RFP's are anticipated to span between January, 2010 and September 2010.

GovWin has established an Umbrella program and multiple opportunities for the solicitations:

  • DSS Modernization Umbrella GovWin Opportunity #54758,

  • Customer Service Center GovWin Opportunity# 60243,

  • Document Imaging GovWin Opportunity #60239,

  • Common Access Front End (CAFÉ) GovWin Opportunity #60326,

  • Statewide Automated Child Welfare System (SACWIS) GovWin Opportunity #60238,

  • Quality Assurance GovWin Opportunity #56100

GovWin Report: $910 MM Health Information Exchange Market

GovWin's newly released report, Statewide Health Information Exchanges: a $910 MM Market by 2014, examines the Health Information Exchange (HIE) marketplace, HIE Cooperative Agreement Program (CAP) grant details, and forecasts the State & Local HIE spend from 2009-2014. Highlights include:

  • Medicaid's role in advancing HIEs and the recession's impact on health information technology (HIT)
  • GovWin's top ten HIE business opportunities offering a snapshot of state HIE planning projects, system requirements, and procurements
  • Recommendations to vendors on how to approach the market and where to find business

The American Recovery and Reinvestment Act of 2009 (ARRA) allocated an unprecedented amount of HIT funding, providing momentum to assemble stakeholders and mobilize states. The Health Information Technology for Economic and Clinical Health Act (HITECH) section of the stimulus package set-aside $564 million in HIE CAP grants for states to develop a core infrastructure. States are spearheading HIE initiatives, charged with convening, coordinating, and managing activities. With aggressive timelines, federal drive, and a significant amount of funding state are going to move quickly and seek technical assistance from consultants, systems integrators, IT equipment providers, and software and services providers along the way. These efforts provide a down payment on the Administration's health care reform agenda.

Coinciding with the release of the HIE report, GovWin will be hosting a webinar on the topic on Tuesday, January 26th, 2010. Please contact your member advisor if you are not able to obtain the report.

VITA Holds Broadband Teleconference

The Virginia Information Technologies Agency (VITA) held a non-mandatory pre-proposal teleconference this morning for their statewide Broadband Internet Service project. VITA is looking to establish a firm fixed price contract with multiple vendors to increase access to broadband services in underserved areas, making broadband services affordable for all citizens and businesses, and improving digital literacy throughout the Commonwealth.

In addition to carefully reviewing the Invitation to Bid and all associated documents, VITA stressed that the resulting awarded contracts will be the first of their kind for the Commonwealth. VITA is hoping to secure multiple contracts accessible to all public bodies for a variety of broadband technologies. The Agency has divided the Commonwealth by zip code and has set up the resulting contract so that vendors may bid specific technologies for specific areas. When a question arose regarding the expected value of the resulting contracts, VITA responded that due to the nature of the bid and the current state environment, the Commonwealth is looking for the lowest-cost options available. VITA assured vendors, however, that this is a service that has been long-requested by users.

During the conference, discussion was raised concerning the current broadband service "tiers" as defined in the Invitation to Bid. A decision was made by conference participants and the Agency for VITA to revisit their definitions so that potential vendors may present the best offers possible while maintaining VITA's ability to conduct an equitable selection process. VITA stated that any and all changes will be posted publicly on eVA, the Commonwealth's procurement website. Bids for this opportunity are due no later than 3:00 PM EST on January 11, 2010.

Indiana Reveals Hybrid System Details

In a follow-up to GovWin's previous blog, Indiana's Family and Social Services Administration (FSSA) has released details surrounding the new "hybrid system" that will determine eligibility for Medicaid, Food Stamps (SNAP), and Temporary Assistance for Needy Family (TANF) programs, replacing the failed IBM system. Even in these times of increased automation, the plan's main focus will be face-to-face contact between clients and caseworkers/contract staff. Although this may seem to be backwards thinking in a climate of privatization, States may start to find that with increasing applications for benefits and higher rates of lost information, failed delivery of services, and fraud, social service systems may require a more personalized, hands-on application than other program areas.

FSSA plans to increase county office staff to serve in teams with contractors to deliver services to clients within their own county (as opposed to IBM's system with workers communicating to clients across the entire state). The hybrid system will be two-tiered, with one employee approving benefits and another processing the case, adding increased accountability. Clients will now be transferred to their local office for assistance rather than waiting for a response at a centralized call center. With IBM's system, FSSA contracted outreach and problem resolution through the vendor. With its more localized approach, FSSA will communicate directly on a regional basis with providers and advocates. Rather than contracting with one large entity, FSSA is in the process of establishing individual contracts with vendors, allowing FSSA more direct control and management of their contracts to improve responsiveness and accountability. As of today there is no time-line in place for the new system's implementation, but FSSA plans to roll out a pilot in the Vanderburgh Region in January 2010.

There are still questions to be addressed in regards to the new system, including the difficulties of operating three platforms at the same time: some counties will be on the hybrid system, some on the modernized system, and some remain on the legacy system. Another is funding. Governor Mitch Daniels has already called for emergency budget cuts as the state's revenue continues to fall short of projections. Indiana is negotiating lower contract rates with vendors, but FSSA confirmed that this does not include Affiliated Computer Services and other vendors involved with the hybrid system. FSSA believes the new system will save money over the old IBM system, and states that all the changes will be made within the agency's current budget.

CMS Awards Medicaid Health IT Planning Grants

On December 9, 2009 the Centers for Medicare and Medicaid Services (CMS) awarded $16 million in federal economic stimulus grant funding to six states and the U.S. Virgin Island for Medicaid health information technology (IT) planning and implementation efforts in preparation for the release of provider electronic health record (EHR) incentive payments. These states join the Iowa Medicaid program which was the first to receive an award in the amount of $1.16 million in November. Other states are expected to receive awards in the future. Reportedly, state Medicaid Offices, not CMS, will be tasked with managing up to $63,750 over six years in incentive payments to providers who demonstrate meaningful use. Grant provisions include a 90% federal match for state health IT planning activities. The following states received federal matching funds:

  • California- $2.48 million
  • Georgia- $3.17 million
  • Idaho- $142,000
  • Montana- $239,000
  • New York- $5.91 million
  • Texas- $3.86 million
  • U.S. Virgin Islands- $232,000
States will utilize the funding to study existing EHR adoption barriers, provider eligibility and requirements for incentive payments, conduct a comprehensive analysis of state HIT activities and determine the needs for consumer-controlled personal health records (PHR). In addition, states will develop a State Medicaid Health IT Plan as part of the statewide HIT roadmap.

GovWin's Take:

Medicaid agencies are tasked with conducting environmental scans and developing strategic plans which may entail assistance from technology consultants. State Medicaid Offices will leverage existing resources and continue to work collaboratively with state designated Health Information Exchange (HIE) entities which are currently detailing strategic and operational plans, as well as, revisiting state health IT roadmaps. It will be vital for Medicaid Management Information Systems (MMIS) to align with state health IT goals and federal requirements. Further, contractors may be called upon to assist states with managing incentive funding through tracking tools and technologies.

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