Spreadsheet: 8e8a71e1-016b-49c8-a067-5617a4e80b64
Sheet: Attachment B4

STATE OF ARKANSAS
REQUEST FOR QUALIFICATION FOR PCMH CARE COORDINATION SUPPORT
RFQ NO: SP-13-0162
Attachment B4. Types of Documentation
Instructions
In the checklist below, respondents shall indicate which of the suggested types of documentation they are providing in Attachment B6: Portfolio of supporting documentation with table of contents.   The entirety of Attachment B will be scored based on the breakdown described in Section 4.1: Technical Proposal Requirements.
TYPES OF SUPPORTING DOCUMENTATION | INCLUDED IN THIS APPENDIX
 | Yes | No
Sample of deliverables
PCMH care coordination assessment tool | ⃝ | ⃝
Integrated care plan | ⃝ | ⃝
Care coordination documentation / prioritization tool / dashboard | ⃝ | ⃝
Care plan database | ⃝ | ⃝
Community resource database | ⃝ | ⃝
Care gap reporting tools | ⃝ | ⃝
Patient’s rights and responsibilities agreement | ⃝ | ⃝
Patient self-management tools (e.g., medication adherence) | ⃝ | ⃝
Sample tools and technologies for identifying or managing high-risk populations | ⃝ | ⃝
Sample tools and technologies for performance measurement and improvement | ⃝ | ⃝
Education or training materials
Basic training curricula and / or materials on care coordination for practice leaders | ⃝ | ⃝
Basic training curricula and / or materials on care coordination for practice staff | ⃝ | ⃝
Training curricula or materials related to teaching practices on specific care coordination topics, e.g., working within the medical neighborhood, team huddles | ⃝ | ⃝
Training curricula or materials related to teaching practices staff on specific care pathways / disease management, e.g., best practices in managing patients with diabetes | ⃝ | ⃝
Training curricula or materials related to teaching patients about disease management e.g., chronic disease management workshops and guides | ⃝ | ⃝
Evidence of business partnerships related to PCMH in Arkansas
Contracts with business partners (either in-state or out-of-state) related to future work in Arkansas related to PCMH | ⃝ | ⃝
Letters of intent with potential business partners (either in-state or out-of-state) related to future work in Arkansas related to PCMH | ⃝ | ⃝
Evidence of business partnerships related prior PCMH-related activities
Contracts with prior or existing partners, relating to work relevant to this procurement | ⃝ | ⃝
Letters of reference from prior or existing business partners, relating to work relevant to this procurement | ⃝ | ⃝
Details of operating plans
Process maps related to PCMH overall or to specific requirements or interventions | ⃝ | ⃝
Detailed protocols related to PCMH overall or to specific requirements or interventions | ⃝ | ⃝
Dialogue scripts for patient encounters | ⃝ | ⃝
Proposed budgets for PCMH implementation in Arkansas | ⃝ | ⃝
Map that illustrates proposed coverage of all regions in Arkansas | ⃝ | ⃝
Staffing
Job descriptions | ⃝ | ⃝
Organization charts related to PCMH overall or to specific requirements or interventions | ⃝ | ⃝
Rosters of existing or potential employees (in addition to Staffing Worksheet of Attachment B: Details on Specific Requirements) | ⃝ | ⃝
Evidence of impact
Reports or publications (respondent shall clearly annotate (a) the date of publication; (b) the time period from which the evidence was gathered; (c) whether the report or publication is public; (d) whether it was authored by anyone with a financial interest in the respondent; and (e) whether the report of publication was peer-reviewed | ⃝ | ⃝
List of clients in the past 3 years, including notation on whether there are new contracts and/or contract renewals | ⃝ | ⃝
Dun and Bradstreet credit scoring report | ⃝ | ⃝