RFP: Legal Consultant for Pay for Success Projects with Value-based Health Care

The Green & Healthy Homes Initiative (GHHI) is working with a growing cohort of asthma programs around the country to help them secure Medicaid reimbursement for two types of traditionally non-reimbursable services: 1) home visiting to reinforce self-management of asthma and 2) home modifications to remove the underlying asthma triggers. Many of these projects will utilize value-based contracting with managed care organizations (MCOs) to reimburse for these services on the back end. Through the value-based contract, MCOs will pay providers from savings produced by the asthma services as verified by actuarial evaluation. Under this agreement, providers would have flexibility to deliver the services (including non-covered services) they deem necessary to achieve those savings. As needed, Pay for Success (PFS) financing will be employed to secure working capital for providers on the front end. In PFS financing models, third-party funders provide upfront funding for services under an agreement to be repaid only if predetermined outcomes are met. In this innovative model GHHI is pioneering, providers will repay the PFS funders through the value-based payments received from the MCOs. See appendix for illustrative diagram.
GHHI is actively working with MCOs and providers to construct value-based contracts for asthma projects. GHHI seeks an experienced legal consultant to build a model PFS financing agreement that could be customized by third-party funders, service providers, and MCOs according to the needs of a foundational value-based contract. While GHHI is currently working on behalf of asthma programs, the goal is for this contract template to be applicable to other issue areas related to the social determinants of health.

Email completed proposals and qualifications (single-spaced, 12pt font) to Michael McKnight
(mmcknight@ghhi.org) by February 4, 2019. Prior to submission, interested parties may have a 30-minute call with GHHI to discuss and ask for more background information. If interested, these calls must be requested by January 25, 2019.

GHHI will review all submitted proposals and select finalists by February 11, 2019. For finalists, GHHI may send clarification and/or follow-up questions to finalists via email and discussed via phone call prior to selection. Following this second round, GHHI will award a contract to the selected Legal Consultant by February 18, 2019.

You may download the RFP here.