SOLICITATION NOTICE
Q -- TRICARE OVERSEA'S PROGRAM 08
- Notice Date
- 8/18/2006
- Notice Type
- Solicitation Notice
- NAICS
- 524114
— Direct Health and Medical Insurance Carriers
- Contracting Office
- Other Defense Agencies, Office of the Secretary of Defense, TRICARE Management Activity, 16401 East Centretech Parkway, Aurora, CO, 80011
- ZIP Code
- 80011
- Solicitation Number
- Reference-Number-RFITOP08
- Response Due
- 9/18/2006
- Archive Date
- 3/31/2007
- Description
- TRICARE OVERSEA?S PROGRAM 08 REQUEST FOR INFORMATION REQUEST FOR INFORMATION The TRICARE Management Activity invites potential sources to provide an industry perspective to the TRICARE Overseas Program in order that the structure of the second generation of TRICARE Overseas Managed Care Support (MCS) contract may be developed to reflect best practices and innovative solutions to the many military health care challenges. Input and information may be provided in writing or through one-on-one meetings with the TRICARE Management Activity. One-on-one meetings are intended to allow full disclosure in an environment that protects any information shared. The one-on-one meetings will be held face-to-face at TRICARE Management Activity Offices in Aurora, Colorado; and will occur between September 18, and September 29, 2006. If you are interested in providing input into the future of the military health care system through the services provided under contracts for Managed Care Support, please contact Mr. Martin A. Martinez, Contracting Officer, via e-mail at martin.martinez@tma.osd.mil no later than 8 September, 2006, to make arrangements for a one-on-one meeting. If a face-to-face meeting is not possible, conference calls, or submission of written information will be considered. Overview: The Defense Health Program (DPH) consists of direct care provided by DoD personnel through Military Treatment Facilities (MTF), Dental Treatment Facilities (DTFs) and clinics located both in the continental United States and purchased care provided through Managed Care Support Contractors. In the overseas arena, direct care is provided to active duty service members and their family members at the MTFs, DTFs, and through contract support for remote and designated locations, to include Puerto Rico. This overview is to describe the overseas purchased care portion of the DHP. Additional information is available on the TRICARE Management Activity World Wide Web site at www.tricare.osd.mil. In order to fulfill the purchased care needs of the DHP, sources/contractors must provide all services necessary to fully support DoD?s primary wartime readiness mission while supplementing the services provided through DoD owned and/or operated health care facilities. Information from sources/contractors should address providing clinical and administrative services that are comparable to the best offered in the host nation civilian community, Puerto Rico, and/or U.S. standards and fulfilling the objectives complying with the scope and structure of TRICARE Program; i.e., benefits and beneficiary liabilities, including technical requirements specified under the TRICARE uniform health care benefit. Information must address the expertise of managed care organizations and health benefit administrators in incorporating and operating the best business model and practices of the private sector in support of DoD healthcare delivery. Any contractor selected for contract award will have to provide the DoD with clinical and administrative services that are comparable to the best offered in the host nation civilian community, Puerto Rico, and/or U.S. practices. Information is sought to assure that the services will be delivered in a manner that achieves a fully integrated health care delivery and financing system for the Active Duty (AD) and Active Duty Family Members (ADFMs) permanently stationed in remote overseas locations. Current Status of the Defense Health Program (DHP): The medical mission of the Department of Defense is to maintain readiness through health and medical services provided to the armed forces during military operations, and to provide health and medical services/support to the members of the armed forces, their family members and other entitled to DoD health care. The MHS must be prepared not only to provide a high quality, cost-effective health care benefit to its eligible members during peacetime, but also must be prepared to support the armed forces during exercises, contingencies, operations other than war, and in wartime. In support of its readiness mission, the MHS maintains a system of MTFs and clinics worldwide, that provide direct care to active duty personnel and to others who are eligible for military health benefits if space is available. Although the number and size of direct care facilities has declined in recent years and will continue to do so under the transformation of the military, it remains important that MTFs are optimized where possible in order to maintain the clinical skills of military clinical staff to support medical readiness. Currently, the direct care system cannot fully support the total demand for health care services; therefore, TRICARE uses the direct care system as the main delivery system, and through the awarding of MCS contracts overseas, augments the direct care system through a host nation civilian network of providers and facilities serving its eligible active duty service members and their families. MCS services apply to approximately 378,000 AD and ADFMs of the Uniformed Services overseas: the U.S. Army, the U.S. Navy, the U.S. Air Force, the U.S. Marines Corps, the U.S. Coast Guard, the Commissioned Corps of the Public Health Service and the Commissioned Corps of the National Oceanic and Atmospheric Administration, their spouses and children. Currently, TRICARE provides two health care options for beneficiaries overseas: Prime and Standard. TRICARE Prime is similar to an Health Maintenance Organization with a Point of Service option and requires beneficiary enrollment. All AD personnel are TRICARE Prime enrollees, although they are required to receive all of their care either in the MTF or under special rules that apply to Active Duty healthcare. ADFMs who are command sponsored may elect to enroll into TRICARE Prime and are not required to pay an annual enrollment fee or co-pays for care delivered in the Host Nation network or the direct care system. TRICARE Standard is a fee-for-service option in which the beneficiary is free to use any authorized provider. TRICARE Standard is utilized by ADFMs who choose not to enroll in TRICARE Prime or are not command sponsored and by retirees who choose to live overseas and utilize their TRICARE benefit for health care. TRICARE Extra is not offered overseas. The two options of TRICARE are described fully in 32 CFR Part 199.17 and 199.18 which may be accessed on the TRICARE Management Activity World Wide Web site at www.tricare.osd.mil. Currently, TRICARE Prime enrollees receive all primary care from a Primary Care Manager (PCM), who may be located at the MTF or may be a civilian provider in the MCS provider network. The MCS contractor is responsible for providing eligible beneficiaries with other services such as network referrals, assistance in locating host nation providers for care, medical management, and beneficiary education. The MHS is organized into three TRICARE Regions overseas: TRICARE Area Office - Pacific (TAO-P); TRICARE Area Office - Latin America and Canada (TAO-LAC), and TRICARE Area Office - Europe (TAO-E). Currently, at a minimum, a MCS contractor is required to establish a TRICARE Prime network in designated remote overseas locations. The Department of Defense (DoD) requires delivery of a uniform health care benefit in the form of uniform healthcare quality, structure and patient cost-sharing. However, DoD is also interested in taking advantage of the expertise of the civilian sector and incorporate the best practices for the overseas environment. Proposed Contract Performance Objectives: A world-class health system that supports the military mission by fostering, protecting, sustaining and restoring health is our vision for fulfilling the MHS mission. To enhance DoD and our Nation?s security by providing health support for the full range of military operations and sustaining the health of all those entrusted to our care. As noted above, this is accomplished through an integrated health care delivery system consisting of our military hospitals and clinics, as well as services purchased in the civilian sector. The TRICARE Program is accomplishing this mission today through Managed Care Support Contracts (MCSC) that contains the following Contract Objectives. These Objectives are not listed by order of importance. Objective 1: In partnership with the Military Health System (MHS), optimize the delivery of health care services in the direct care system for all MHS beneficiaries. Objective 2: Beneficiary satisfaction at the highest level possible throughout the period of performance, through the delivery of world-class health care as well as customer friendly program services. Beneficiary must be highly satisfied with each and every service provided by the contractor during each and every contact. Objective 3: Attain best value health care services in support of the MHS mission utilizing commercial practices when practical. Objective 4: Fully operational services and systems at the start of health care delivery. Minimal disruption to beneficiaries. Objective 5: Ready access to contractor maintained data to support the Department of Defenses (DoD) financial planning, health systems planning, medical resource management, clinical management, clinical research, and contract administration activities. These Objectives are not unchangeable. Potential sources may have more contemporary information on the proper objectives for achieving our vision and mission while clearly focusing on measurable, high quality clinical and administrative services achieved in the most cost efficient manner for the American taxpayer. We are also very interested in the industry?s thoughts concerning performance requirements. Requirements in this setting represent performance that must occur at or exceed specified performance standards and that achieves outcome based objectives identified in a contract. Examples of the performance standards may be found in the TRICARE Operations Manual at www.tricare.mil. TMA is very interested in the industry?s assessment of the existing performance standards and suggestions for new, revised, and or completely changed performance standards. Performance standards information is desired for the following areas of interest that are being included in the contract. 1. Networks: Access to Host Nation medical and dental network providers, and location of networks. Offerors are allowed to propose networks where cost-effective. What does industry suggest in relation to networks? Should the contract include a requirement for the contractor to develop a pharmacy network or just provide pharmaceutical services to include facilitation of processing and paying pharmacy claims only? 2. Referral Management: Beneficiaries enrolled to the TRICARE Global Remote Overseas Contract and the Puerto Rico Contract Overseas currently can self refer for primary care as they reside in locations distant from an MTF and are not assigned a Host Nation provider as a PCM at present. How would the the contractor review and schedule routine specialty care appointments? 3. MTF Coordination: Currently, a pilot program is in Europe to establish and maintain inpatient healthcare networks around selected MTFs and provide inpatient case management to MTF enrollees admitted to host nation facilities, and to implement a process to review and standardize the outpatient network host nation provider credentials. Close coordination between those selected MTFs in Europe and the MCS is critical to provide seamless continuity of health care services as networks and referral management must continuously adjust to support the changes in MTF capability and capacity that occur daily as the result of war, contingency operations, national disasters, deployments, training, transfers, etc. TMA is interested in discussing the impact MTF operations have on contracts and the extent to which this impact affects costs, and network management. 4. Medical Management: We define medical management as contemporary practices in areas such as network management, utilization management, case management, care coordination, disease management, assessment of clinical quality and various additional terms and models for managing the clinical and social needs of the beneficiary to achieve the short and long term cost-effectiveness of the MHS while achieving the highest level of satisfaction among MHS beneficiaries. What is the value of each of the named approaches and are there other opportunities to enhance the quality of care while ensuring the appropriate expenditure of tax dollars. 5. Claims Processing: TRICARE currently processes 680,000 overseas claims a year. How can TRICARE achieve efficiencies while complying with federal laws regarding the expenditure of Government dollars? What practices are recommended to screen and put processes in place to prevent fraudulent billing? 6. Customer Service: TRICARE provides customer services via telephone, e-mail, web based materials, on-site service centers at MTFs. Currently, enrollment of beneficiaries into the current contract is performed by contractor staff at each TRICARE Area Office vs. the contractor. Should the contractor perform a full range of customer services to include enrollment functions and on-site service centers? How would a commercial concern approach customer service? Discuss telephone service availability to assist overseas members when back in the continental United States. 7. Automated Data Processing: TRICARE has a number of unique data processing requirements including Department of Defense mandated security procedures and certifications, interfaces with DEERS to determine eligibility on-line, processing enrollments through Government systems, and submitting payment records in support of claims processing activities. Many of these requirements are not negotiable: however, we are interested in the impact of these requirements on cost and the level of interest in proposing on future contracts. 8. Management Services: This is a broad category that includes staffing, quality management/quality improvement, reporting, responsiveness to change, provider education, and managing contractor operations to fulfill the Governments performance standards while achieving the Governments outcomes. What should the Government require in terms of management services, how should they be measured, and how should the Government monitor performance? 9. Incentives: What positive and negative incentives are used in the industry, if any, and how do they impact your operations and proposals? What incentives should be created that would help achieve the goals of TRICARE? 10. IT Services: Anything to consider with regards to HIPAA, DITSCAP network security and electronic communication overseas? The Government is interested in any information potential sources would like to address in support of achieving high quality, cost effective delivery of health care services. Please remember there are legislative limitations and recommendations conflicting with statutes may not be able to be implemented. However, any of the administrative requirement changes which support a more efficient TRICARE Program may be acceptable for information presentation. The Regulations, TRICARE Operations Manual, TRICARE Policy Manual, TRICARE Systems Manual, and TRICARE Reimbursement Manual are all requirements of the TRICARE Program and uniform benefit. These are available for review at www.tricare.mil and may provide insight to potential sources. Any questions shall be directed to either Martin A. Martinez, Contracting Officer, Phone 303-676-3903, Fax 303-676-3987, Email Martin.Martinez@tma.osd.mil; or Howard D. Redden, Contract Administrator, Phone 303-676-3919, Fax 303-676-3987, Email Howard.Redden.ctr@tma.osd.mil.
- Place of Performance
- Address: Not Applicable
- Zip Code: 00000
- Country: UNITED STATES
- Zip Code: 00000
- Record
- SN01120015-W 20060820/060818222242 (fbodaily.com)
- Source
-
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