Expert Interview: Jolie Rollins & Monique Dever

What is an RFP?

Monique Dever: It’s a request for proposal, also known as a request for bid, request for quote, or request for information. So it basically has information that you need to find out about purchasing a new EHR. 

Jolie Rollins: RFIs, RFPs, RFQs, we’re going to use those terms interchangeably here today. RFIs are issued by either a procurement department or any agency, like a behavioral health agency, that may be looking to acquire software services. So for us specifically, we deal with a lot of government or local health department RFIs or RFPs, as well as our behavioral health agencies will also submit RFPs, either with or without a consultant. Part of that RFI process, though, is defining what you want. 

So Monique and I spend a lot of time doing the RFIs and the RFPs here at Patagonia Health. And one of the first things that we do is break the RFP apart in terms of: What is the statement of work? What are the functionality requirements? What are the terms and conditions, or T’s and C’s, as we call them around here. And what is the current state? Are they currently using something to solve this problem? Are they not using something to solve this problem? And what are their goals and aspirations?

Monique Dever: A lot of times a company will conduct an RFI, which is a request for information because they really don’t know what they need. So first, they may do an internal needs assessment. They may be coming off of paper, or they may be coming off a system that no longer meets their requirements. So in this case, they don’t know what is out in the market these days. Because technology, as we know, changes drastically. So they need to know what’s out there.

So they may conduct a request for information just to find out what comes in because they really don’t know where to start. So they may publish this on a public site somewhere and sometimes even publish it in the newspaper. I know that is a little archaic, considering the technology these days. So this is a great way for people to figure out kind of exactly what they need. 

Jolie Rollins: Now, in general, the process would be you release the RFI, if you’re going to have one, you understand what the market has out there since the last time you looked. And then you may use that to create your RFP, or request for proposal. In general, the way that we’ve seen it awards or the contract is not awarded via an RFI. So the RFI is just information gathering. Most of the time, they don’t even ask for pricing, or they just want budgeting numbers or things like that. But then when they get into the RFP, that’s where they get into the nooks and the crannies, if you will. And that would be functionality, contracting, and pricing. The whole point of the RFP process is to sanitize what they’re looking at. They want to compare apples to apples. Sometimes they need to work with a consultant so that they’re not asking the question in a way that doesn’t provide a sanitized answer.

Monique Dever: Now, not always isn’t required to do an RFP following an RFI, but it’s the best practice. But we have seen awards come through directly off an RFI. 

If you’re ready to do your RFP, how do you start? How do you build an RFP? How do you prepare for that process? 

Jolie Rollins: As the person who generally answers the functionality questions, I say work with your subject matter experts. We call it a needs assessment. So you need to understand – in the instance of public health – what does each program require? Are there similarities or cross-pollination between those even though the programs may work differently. Are there similar elements? In terms of the behavioral health market, which we also serve, they may not do programs, but they may offer different services. So you may have IOP, you may have substance use, you may be doing other types of peer review, assessments, and treatments like that. And so even though you’re all doing the same thing, you may have different areas that you need to focus on. And that’s where we’re getting to the subject matter experts, not just the leaders, but the actual do-ers, and getting what they need to have.

Monique Dever: Absolutely, I agree. They also have the option to use a consultant. And sometimes when they’re a larger entity, it really can take some of that workload off your staff. Bandwidth is not always high enough to be able to take on this type of a project, because they can be very labor intensive projects. So using a consultant in this case (these guys do it all the time), they can have all these meetings with your internal staff and figure out exactly what you need, and then build the RFP according to exactly what your needs are not what somebody else already did.

Jolie Rollins: I like the consultants, in that they do take some of that workload off of the the organization, whether it be a local health department or behavioral health agency, it does take that off of their plates. And when we talk about bandwidth, there’s a lot of data to crunch, there’s a lot of information to read. So if you think that your organization doesn’t have bandwidth today, then that would be the organization that needs to hire a consultant. And they can also slice and dice between what is a need, and what is a want. So what’s a nice-to-have versus a must-have.

Monique Dever: Now, the other thing to mention too is if you do have time, and you’re not urgently looking to change and purchase an EHR, you could actually conduct a few demos with some of your choice vendors that are out there, perhaps you’ve seen them or you were referred to them by one of the neighboring counties, that sort of thing. So it is kind of a good idea, because these demos can show you a few things in your area that maybe your agency is lacking, and you weren’t even really well aware of that. So seeing some demos of some of the new software that’s out there could help you make some decisions about what needs to be included. Where do you need to move forward?

Jolie Rollins: I agree, I like the pre-RFP demos, because as a vendor, that gives us a chance to say, here are the new things that we have that you may not have considered. Here are programs or other services that other agencies are offering that you may be interested in offering too.

How do I know if I even need to do an RFP? Can I just pick from a demo? Or should I even engage in the first place?

Jolie Rollins: So I love this question because one of the reasons that you may have to go through an RFP process is if you’re a government agency, and you are required at a certain threshold of expenditure that you have to go through this process. Now once you get into that process, know that you cannot engage with the vendors. You’re in what they call the cone of silence. You can’t call vendors, and you can’t take calls from vendors. In other times, like our behavioral health agencies, where you’ve got so many services, and people are using disparate products, and you know, this program bought this one, and this group bought this one. So you may have multiple products and services, and you’re gonna need that in order to make sure that everybody gets what they need to get at a minimum. 

Monique Dever: So whether it’s policy-driven or needs-driven, an RFP is always a good way to go. The policy can be kind of sidetracked a little bit if you have another county- let’s talk about public health departments for now- We’re doing an RFP, and you have another county in that same state, sometimes you can piggyback on their contract, and then bypass the whole RFP necessity based on what the policy is. And if you can do that, and you have similar services that the other county has, then it could be a good time saver for your department. 

Jolie Rollins: Right. We call that a sole source. So, if you are a public health agency right now and you’re wondering, do we have to do an RFP? I would check with your procurement department and also find out if there is sole source availability in your state and county. 

Monique Dever: So let’s talk about RFI versus RFP a little bit because the benefit of doing the request for information is that you can actually learn a lot about it in order to figure out what needs to go in the RFP as you’re creating it (if you need to do one), rather than doing all your own research. Talk about bandwidth… You don’t have to do all your own research and go down the rabbit hole 10 different times while you’re online. What about this EHR? What about that EHR? What do they have? Let them come to you. 

So an RFI includes high-level questions, can they do all this, and then the RFP gets to know the vendors. 

Jolie Rollins: And that also includes things like references, right? So I would always include references. And what you’re looking for in the references would be things of similar size, similar services, complexity, looking at your state your state requirements. If you’re doing billing, you want to know, are there other people doing similar billing that are successful in my state or my county?

What happens if you submit a poor RFP? Does it affect your practice at all?

Jolie Rollins: If you contract from that poor RFP, boy, can you have problems. There are going to be people in your organization, no matter how well your RFP is written, that are going to be resistant to change. These are the people that are going to immediately glom on to the “Well, this doesn’t work for me, you don’t know what I do, this vendor is trying to make me do these things. And it’s click intensive, and I don’t want to do it.” So they’re already in the mindset of not wanting to change, and you’ve just opened the door and given them a good excuse to not use it. And it’s a waste of time and money. I cannot emphasize how much time these things take. And that if you go down the path and you make that wrong decision, you may be back in this RFP process, or hiring a consultant or trying to live along, you know, through the contract terms of a poor EHR that you select.

Monique Dever: And you also may not get the solution you thought you were buying, and you end up within the first year, pulling your hair out trying to figure out how can we make this work. And if you can’t make it work, you end up jumping ship and then starting all over again and going with your second choice. Maybe you don’t have to do the RFP all over. But making the decision is really critical that you know that you’re that you’re picking the right one. And if you don’t publish a very adequate RFP, you’re not going to have enough evaluation information to pick the right vendor.

Jolie Rollins: Agreed. One of the things that I like that most RFPs do is that they have this question-and-answer period. So you can ask these clarifying questions in this certain period. Now all the questions and answers will go out to every vendor, usually a standard operating procedure. But that’s where I think a person who’s issuing the RFP can see where their deficiencies are. And so we see that a lot of times where they’re just not asking the right questions, they’re not asking the detailed questions. It’s just generic. So you may borrow one from someone who looks like you, and you don’t sanitize, you don’t put in your workflows and things like that you’re going to end up without the right solution.

Monique Dever: What we’re trying to get at is to do all your work upfront so that everything is laid out and you get exactly what you want. You’re going to have a very detailed, very well-organized RFP that as the vendors are responding, we know what we need to respond to, we know what your requirements are, we know what order they need to go in, we need to know all the different documents that you want us to submit. So make sure they’re in an order that makes sense to you. As you go through the RFP evaluation process. 

What should organizations ask in their RFP?

Monique Dever: An EHR RFP has to be very clearly defined. I would go as far as putting it exactly in the order that you want. And a lot of times we see RFPs that tell us what font size we need to use, what size margins, and they’re very, very specific. But if that’s what they require so that everything is consistent, they may be getting responses from 10 or 15 different vendors, they want to compare apples to apples. So again, like I said, if you do all the work upfront, you’re going to have a very easy evaluation process. So things such as, what are your goals? What do you want to improve in your agency? Do you need to have interoperability and reporting functionality improvements, all of that stuff? So a scope of work. That’s the best time to do the functionality requirements, Jolie you do the spreadsheet? They are much better when they’re either in a Q&A format or if they’re in a spreadsheet so it’s very easy to know, “Am I supposed to answer this?” Because sometimes we get a list of the scope of work. And we can’t really tell, are they asking us to respond? Because they don’t look like questions. So be very transparent with what you want. Do you want us to answer these questions? Format as a, “Please answer the following.” Sometimes we get these RFPS that are so vague that we really don’t know what to do with them. So I’m just here to tell you that when we have that type of format, I’m going to set it up because the best I can. And then we have to figure out what you’re looking for. And you’re gonna get very random responses from different vendors because we all interpret that differently.

Jolie Rollins: A spreadsheet makes it easy for me, because then I know that I need to respond to these questions. They’re usually organized by reg and sched, right? What are the security, interoperability, billing, specific program management, and billing scenarios? So it’s laid out. And then, how does it exist today? So you’re also understanding who else you’re partnering with in those questions when the responses are labeled that way.

Monique Dever: Some of the other key elements to have included in your RFP are qualifications. Do we have to have been in the business for at least five years? Do we have other customers that are already in that level of enterprise versus small customers? References. If you want to be able to call some of our existing customers, include that. The biggest key thing is your basic timeline, not just the published date, we already know that. But when are our questions due? And give us enough time to actually have time to review the RFP before the questions are due, because sometimes we may not get the actual RFP until like a week into it. So if that’s the case, then we’d like to have time to be able to really digest what’s in the RFP so that we can then list some of our questions and get them in on time.

Jolie Rollins: And I would say too in terms of time, allow yourself (meaning the person who’s publishing this) enough time. You may think that two weeks after you receive 15 RFPs, that you can digest those and get the criteria. I’m going to tell you, probably not. 

Monique Dever: If you’re having a pre-bid conference, it’s always a good thing to include their proposal, due date, and your anticipated award date. That would be really nice to have on our end. It also keeps you guys on track about when you need to have this project completed. Like Jolie said, we have seen RFPs get published three times before they actually select a vendor. We have seen RFPs get pushed out and pushed out and pushed out week after week because they were not prepared to process on their end because they had such an influx of responses. And it’s a lot of work. So those are the kinds of things you really need to think about. 

The biggest key thing that everybody bases pricing on is what? The number of users, concurrent users, or total number of logins or roles. So is it MD versus NP? And sometimes, it’s on encounter visits. So we need to know the information upfront about how we’re going to be able to price it. This is one of the most common questions that we ask because very rarely do people actually include that on their RFP. 

Jolie Rollins: One that we had not too long ago, it didn’t give the names, but it had the roles and the number of users. So when you were looking at that, it was a really good way to say where the majority of the staff are, so then you know where to put your emphasis on the most people that you’re going to be able to affect in a positive way. So I thought that was really good. And I think it’s also helpful for the vendors in terms of their time management, to know what is the evaluation criteria and or the scorecard. So is it 10% based on pricing, but 30% based on functionality and demo? That helps the vendor prepare and use their time wisely. If 10% of it is the price, well, then we’re not going to go in with a heavy discount, we’re going to wait until you come back and do a BFFO or a best-for-final offer. And then we can institute some discounting there.

Monique Dever: Very good point. Sometimes there are page limits on your response. And if you need to evaluate on our qualifications and experience, we might use you know, 10 out of the 12 pages on that and then simplify the process.

Jolie Rollins: As a product person, it’s always nice for me to have sample reports, sample forms, and any billing things that we may need to know about. We’re the type of vendor that if we cannot meet it, nor do we think it’s a reasonable expectation that we can develop it, we will respectfully not waste your time. We will decline an RFP probably more than we accept an RFP because we want to make sure that we’re a proper fit. We don’t want to be a square peg in a round hole.

Monique Dever: It is nice to have this information: What’s your current environment? Do you need interfaces? What is your current EHR? Or are you on paper? We need to know if the technical and the pricing need to be separate because sometimes people want to evaluate the product itself first, and then look at the pricing of their top choices. Because pricing, while it matters, shouldn’t be a deciding factor. 

The last thing to consider for us: Back in the day, there used to be hard copies for everybody. And now a lot of people are using electronic submissions, whether it’s an online portal or an email submission. And honestly, that saves a lot of time for the vendor because it buys us a few extra days as we’re not shipping across the states to get you your printed-out copies. Now, if you’re required to have paper copies, because of what your company or your your county decides to do, then we obviously would adhere to that. But electronic submission these days is more common than then otherwise. 

Jolie Rollins: I mean, even within five years, I would say right. Five years ago, everything was print print print, one that was like 26 prints. I’m like, is everybody getting a copy?

Monique Dever: The clearer you can be, as I said earlier, the clearer you can be in the RFP and really outline it and define it very well and make it not vague. Make sure that vendors know exactly what they are supposed to respond to. What are they supposed to submit if they missed something that disqualifies you? I mean, everybody’s had that. So you just need to make sure. One other common question that we have that could be answered in the RFP is: Do you use separate systems for billing or practice management? 

Jolie Rollins: I think that’s also a good one. What is your current budget? This will let vendors who may come in with a $56 million bid know that you have a $500,000 budget.

Do you dispense medications? Do you track medication inventory? Which labs do you need to connect to? If you need to connect to labs? Do you want to connect to your HIE or your immunization registry? Do you want a GL Code interface so that you can update your QuickBooks or whatever EPR you’re using? 

Monique Dever: This all adds to the complexity of what you need and what we are building. So, what are we pricing? And then how does implementation go? Because all of that goes into the big picture. 

Jolie Rollins: The final thing that we see too, and this has been common forever, is a requirement about where work can take place. So most, and I think there are some some legalities around this for the government agencies, where work needs to take place in the United States. They will make exceptions for maybe development arms and other areas, but maybe they don’t want to be in a conflict area where something could potentially have ransomware attached to it. That also goes into all of your security requirements as well. But know, if you are required to have all work done in the US, then you need to make that a requirement in your RFP or you could potentially select somebody who doesn’t.

What are some things that health organizations should consider when selecting a vendor?

Monique Dever: Well, hopefully, you define your RFP very well now that you have some evaluation criteria. Some of the key things to take away would be the people, the process, the product, and the price. When we say people: you’re going to be partnering with that vendor for at least five years, maybe 10. Sometimes shorter, but usually about five years of the contract these days. And so you want to make sure you’re partnering with somebody who fits your culture, your personalities, people who are going to care about what what kind of business you do and keeping up with the times for your needs. The people make a huge difference, somebody who can manage your support your ongoing support.

Jolie Rollins: And I’m gonna throw this in when we talk about people: There are going to be problems. When you install something new, I can guarantee you 100%, there’s going to be a problem. So when you select the right people to work with, do you trust them to have your similar urgency? Do you trust them to resolve the issue? Do you trust them to be transparent and honest with you, even when the message isn’t great? And when you select the right people, then I think those things fall in line naturally. There’s urgency at your end, there should be urgency at our end. And are we matching that?

Monique Dever: Yep. And that rolls into the process. Can they meet your timeline? Is the implementation and training process defined the way you need it? You have people on your end, the users, who are struggling to do this major change, and you need to know that the trainers (the people), they’ll give are going to be there to hold your hand and make sure things go smoothly, and that they care and sit one on one with you to really kind of help you through that struggle. Because not everybody is going to pick up computer related, you know, how-to’s.

Jolie Rollins: Just also in terms of the process: You’re going to need to have someone on your end, that acts as a project manager. If that person already has a full-time job, you may need to relieve them of some of those duties temporarily in this project management process, so that they can be the subject matter experts because that cuts down on time, but they can also have the freedom and the ability to to to be successful. If I’m doing my full-time, 45-hour-a-week job, and then you’re gonna put another 30 hours on me, I got no chance of being successful in any of it. 

Monique Dever: So the product is what everybody has in their foremind that they think, “This is what I need to figure out my vendor can do,” is to provide the product that meets my needs. Well, that’s obvious, but I think it’s not the only thing, people in the process make just as much of a difference. But yes, the security, the functionality, all those features, all the scope of work that you need to have done so that your workflows all make sense. So your reporting is there, the interoperability is there, and all that stuff really has to be in line with what your needs are. And the last thing was price. And this is, like I said, not usually a deciding factor. Sometimes it is. Sometimes you have a budget, sometimes you have funding that’s being provided. It doesn’t matter as much as some of the other things, but it does matter of course. Does it fit your budget? But also, are they nickel and diming you? Is it a flat rate? Is it an all-inclusive price? Do you know what you have to pay on a monthly basis? Are you going to get an invoice for every little step of the way that you take? 

Jolie Rollins: Every time I send a claim, I have to pay 25 cents. Do not pass go. Yeah, none of that.

Monique Dever: You have to make sure that when you compare pricing from your top vendors, you’re comparing apples to apples and not one over the other. You have to really dig down when it’s not a flat rate. You’ve got to see what they’re going to be charging me on a monthly basis. How does that end up comparing?

Jolie Rollins: Yes, what is first-year costs? What is second-year costs? 

Monique Dever: And if they are charging you per transaction, how many transactions does my agency have? So what does that equate to on a monthly basis? Add that into my monthly fee, and then compare the pricing. So really be aware of the fact that every vendor does price quite differently. 

Jolie Rollins: The importance that you place on these things can be seen by the vendor, and your criteria. So are you putting a 10% on references? Are you putting 25% on references, other people saying good things about you? That’s how you can let us know where your emphasis is.

In Summary

Jolie Rollins: You know, I would just kind of wrap it up and say: Do your needs assessment, understand what you need in terms of functionality company, etc. Understand your workflows and, you know, do you have a workflow that was created to fill a gap? So you don’t want to build a workflow on top of a workflow. Maybe step back and do a Lean Six Sigma and determine maybe this was a workaround? Do we want to have that workaround continue in the new system? Maybe we don’t. I think that expertise matters. 

Monique Dever: Not all vendors are specific to your needs and your market. Some are across the board and serve different markets. When you have a focused EHR, they’re going to know what you’re reporting. They’re going to know that the vendor understands your workflow and your limitations.

Jolie Rollins: You’re not calling up and saying, “Okay, let me explain to support once again, what a program is. What 340b is. What eMAR is. 

Monique Dever: And that actually kind of goes back into the company culture. So finding a match that understands you, that you know that you’re going to be good partners for the next five years.