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Catalyst for a National Initiative:

Project Management and Implementation Support for the U.S. Marshals Service’s 

New Managed Healthcare System

A HealthCare Resolution Services, Inc. Case Study

Client

The U.S. Marshals Service (USMS) is the nation’s oldest and most versatile federal law enforcement agency. Serving the country since 1789,the agency’s many responsibilities include protecting federal judicial officials, conducting fugitive investigations, carrying out special missions, ensuring the safety of witnesses, and housing federal detainees.

The Marshals Service assumes custody of individuals arrested by all federal agencies and is responsible for housing and transporting prisoners from the time they are brought into federal custody until they are either acquitted or sentenced. Each day, some 54,000 federal detainees are housed by the Marshals Service. Just over two-thirds of these prisoners are in custody in 1,300 state, local and private jails. The rest are detained in Federal Bureau of Prisons (BOP) facilities.

The Marshals Service relies on state and local jails, as well as BOP detention facilities, to provide in-house medical care. However, the service is responsible for paying for care when a prisoner must go to medical facilities in the local community. USMS spends about $52 million annually on medical services and $9 million on prescription drugs.

Business Challenge

USMS offices in different regions held individually negotiated contracts with local physician networks and community hospitals for this care. USMS recognized the need to centralize healthcare contract management, with an ultimate goal of standardizing healthcare and realizing economies of scale.

For the first time in its 200-year history, the USMS set out to establish a national managed healthcare plan for detainees, with the goal of saving $28 million per year by consolidating contracts for healthcare.

Beginning in 2003, a diverse committee representing the agency began the monumental task of creating an RFP that would cost-effectively address prisoner medical needs and generate significant vendor interest. It soon became evident the agency’s geographic disparity compounded the task as 94 Marshals Service district offices and 212 sub-offices operate within the U.S. Department of Justice.

In 2005, USMS sought a contractor to manage the final acquisition process and oversee the implementation of a national managed healthcare system to substantially reduce costs associated with providing this volume and level of medical care.

USMS chose Healthcare Resolution Services, Inc. (HCRS), a healthcare consulting firm, to serve as the Program Management team to assist the USMS in finalizing the RFP and ultimately identifying the “best value” healthcare management partner to serve as the Managed Care Organization.

Solution:

In the initial 20 months of the contract, HCRS provided consulting services in the area of acquisition management. The firm helped USMS define what it needed, taking into account 14 constituencies that included law enforcement, clinicians, public health officials, and the like in 94 USMS District Offices.

An Advisory Committee was developed, with five leaders, to communicate information to their respective districts and sub-districts.

Stakeholders were interviewed to identify core work processes. When appropriate, these processes were redesigned based on healthcare industry best practices.

USMS’s needs were translated into a well-defined RFP that generated significant vendor interest and ultimately expanded the number of qualified bidders from two (on a previous attempt) to five.

After a winning vendor was selected among competitive proposals, HCRS assisted the USMS in facilitating a kickoff meeting in October 2007 to establish roles, responsibilities, a timeline and accountability.

Five regions are piloting the new managed healthcare plan. HCRS is now responsible for Quality Assurance, monitoring implementation and streamlining processes.

At the recommendation of HCRS, an intranet site is being developed for joint collaboration online. With this tool, instant, real-time project updates will be possible.

In healthcare—a highly regulated industry—HCRS brought its signature expertise to the project, ensuring that national healthcare standards are met in both the bidding and implementation phases.

Results

Beginning its third year on this contract, HCRS continues to accumulate results. Among the top ones to date:

HCRS helped make the project a reality, by meeting all deadlines, from inception to RFP release and contract award date and distribution in October 2007.
HCRS brought together a vast audience, creating the framework for a unilateral decision about a new managed care system.
Extensive market research of commercial and private plans in the managed healthcare business identified 22 potential vendors.
By significantly refining the user requirements, eliciting creative responses and inspiring renewed interest from the industry, HCRS generated eight comments to a Request for Information and draft statement of work and five qualified proposals to the final RFP. (This compares to two proposals from the original RFP in 2003.)
HCRS helped USMS acquire funding for four additional staff who are dedicated exclusively to the project.

Performance measures in the statement of work have been identified to produce the desired $28 million annual savings.

“In our capacity as consultants, we helped the Marshals Service articulate where they were, determine where they needed to go, and now we’re helping them get the job done so they can get there,” explains Brenda Doles, RN, President, HCRS.

About HCRS

Career-Capping Success

In my 30-year career, seeing this project through to a successful completion is the proudest accomplishment of my office.
— (Name)
(Formerly – title – ), now retired

A Supportive Team

HCRS’ work to date has been outstanding. One of HCRS’ many strengths is their team of skilled professionals who are both goal- and task-oriented.

— LCDR Michael Tingen, RN
Nurse Consultant
U.S. Marshals Service Headquarters
Washington, DC.

Three Steps Key to Success

First, all assigned tasks are reviewed carefully by HCRS until an appropriate solution is revealed. Second, their ability to gain knowledge and skills quickly has been very important to our project. HCRS has a keen understanding of what we need, and makes suggestions on meeting our goals. Third is their time commitment. HCRS has been willing and able to respond to each call for assistance.

— LCDR Michael Tingen, RN
Nurse Consultant
U.S. Marshals Service Headquarters
Washington, DC.

A Value-Added Approach

HCRS is having a positive impact on our project. They’ve provided the expertise to see a project of this magnitude awarded successfully, and now they’re instrumental in the critical implementation phase. HCRS’ involvement has added value to the overall approach and delivery of this project.

— LCDR Michael Tingen, RN
Nurse Consultant
U.S. Marshals Service Headquarters
Washington, DC.