Executive Summary Response Questionnaire for Proposers
Please submit the following responses as “Attachment A1 to Executive Summary Questionnaire:
Organization Overview.” PLEASE NOTE: MAXIMUM OF FOUR PAGES OF
1. Full legal name of firm, and any assumed business name (d/b/a):
2. Licensed or registered to do business in ________________ (home or domestic state) as
________ (type of company) and license or registry number _____________.
3. If not located within Oregon, are you authorized to do business in Oregon? If yes, state
license or registry number.
4. Are you licensed as an insurance company, health care service contractor, or third party
administrator in Oregon? Does your proposal require such licensure? If you answered “no”
to the first and “yes” to the second, please explain your plans.
5. Are you able to provide the required insurances noted in Exhibit G of the Appendix?
6. Number of years your organization has been in business?
7. How long has your firm been performing the proposed services?
8. Describe your corporate or organizational philosophy and culture.
9. Explain how your corporate philosophy and culture would support PEBB’s 2007 strategic
10. PEBB is seeking comprehensive fully integrated proposals that address all of the critical
elements outlined in the 2007 strategic Vision. Please provide a brief description of your
organization’s approach to achieving PEBB’s 2007 strategic Vision including the following
a. Description of proposing organization including overview of providers, partnerships,
b. High level summary of your organization’s proposed implementation plan using the 2007
strategic Vision RFP elements
1 PEBB RFP 01/10/2005
c. Brief explanation of how your organization can serve the entire PEBB populations within
the counties you are proposing on.
d. For medical service proposers, a brief explanation of your proposed wellness services as
part of fully integrated services for the PEBB population (for background detail see
FACCT Report Parts 1 and 2 (quality and technical sections related to wellness, HRAs,
chronic disease, etc.) and see overview of PEBB’s current Wellness Program in Exhibit F
of the Appendix.
e. Listing of senior level account executive(s) who would be responsible for working with
PEBB Board and Administration.
f. Listing of key clinical contacts that would represent your organization on the PEBB
Council of Innovators. (This group would be comprised of a variety of PEBB-designated
technical and administrative resources. The group would meet on a regular basis to
monitor PEBB’s progress towards 2007 strategic Vision and recommend additional or
revised strategies as needed. See PEBB’s Guiding Principles attached to Cover Letter.)
g. Describe your organization’s experience and success in implementing large-scale change
in the health care delivery system.
h. Describe any key suggestions or potential internal or external barriers your organization
has identified in achieving PEBB’s 2007 strategic Vision.
i. PEBB is seeking fully integrated and comprehensive strategies including reimbursement
methodologies that support PEBB’s Mission and Vision. Describe your organization’s
proposed reimbursement methodology and rationale (fully insured, ASO with stop loss
arrangements, fully capitated, etc.)
11. Please attach as “Attachment A2 to Executive Summary Questionnaire: Organization Chart”
an organizational chart depicting the organizational structure and where your company is
located within that structure.
12. Are you responding to the medical questionnaire? The pharmacy benefits questionnaire?
13. Please review the legal terms and conditions in Exhibit B of the Appendix. Submit as
“Attachment A3 to Executive Summary Questionnaire: Terms and Conditions” any terms or
conditions you wish to vary, specifying the desired variance. You will be deemed to have
accepted all terms and conditions not mentioned in your Attachment A3. PEBB will
negotiate the terms and conditions but may reject a proposer whose requested variances are
unacceptable to PEBB.
2 PEBB RFP 01/10/2005