Specifications include, but are not limited to: 1. Support the goals of the GHIP Strategic Framework: a) Offer solutions that increase GHIP spend through advanced alternative payment models17. b) Offer solutions that reduce GHIP diabetic cost per-member-per-month (PMPM). c) Offer solutions that limit total cost of care inflation for GHIP participants at a level commensurate with the Health Care Spending Benchmark by focusing on specific components, which are inclusive of, but not limited to: o Outpatient facility costs, o Inpatient facility costs, and o Pharmaceutical costs. d) Offer point-of-enrollment and/or point-of-care engagement platform and/or consumerism tools along with solutions to increase GHIP member engagement in those tools. 2. Provide competitive financial terms for the requested scope of services: a) Offer competitive fee proposal compared to competitors. b) Guarantee performance of the requested scope of services (both financial and non-financial performance guarantees). c) Offer credits to offset the costs associated with implementation (if applicable). 3. Deliver on the core administrative functions of a medical TPA: a) Deliver all enrollment processing and claim administration functions of a typical third-party administrator. b) Possess qualified and experienced personnel to provide excellent customer service to GHIP participants. c) Provide experienced account management personnel who are responsive to the needs and requests of the Statewide Benefits Office. d) Support the communication of GHIP benefits (including any changes) to participants during Open Enrollment. e) Possess the ability to execute a comprehensive implementation project plan (communications, file transitions, testing, etc.) to ensure a smooth transition to new TPA or (for incumbent) to support implementation of new communications or benefits if awarded a new contract. 4. Support the GHIP’s programs and plan offerings: a) Administer a Medicare Supplement plan that duplicates the current Medicare Supplement plan without deviation. b) Integrate with other benefit programs and vendors supporting GHIP participants. c) Partner with other community health resources (e.g., in partnership with the Delaware Department of Health and Social Services, the Department of Public Health) to coordinate care for GHIP participants. 5. Possess extensive experience and qualifications to provide the requested Scope of Services: a) Able to follow through with operational commitments, such as protection demonstrated through performance guarantees offered to the State and has outstanding references that demonstrate the ability to meet the State's needs. b) Have at least five (5) years’ experience as an organization administering the requested scope of services with clients of similar size and complexity. c) Has existing customers of similar size (number of covered retiree lives), industry and experience administering the requested scope of services and offered best practice solutions for meeting the State's needs. d) Have outstanding references from both current and prior customers of comparable size and complexity to the State.
