SOURCES SOUGHT
R -- Request for Information Concerning Military Health System Medical Quality Monitoring Services - Military Health System Medical Quality Monitoring Contract RFI
- Notice Date
- 10/23/2013
- Notice Type
- Sources Sought
- NAICS
- 541611
— Administrative Management and General Management Consulting Services
- Contracting Office
- Other Defense Agencies, Defense Health Agency, Contract Operations Division - Aurora, 16401 E. CenterTech Pkwy., Aurora, Colorado, 80011, United States
- ZIP Code
- 80011
- Solicitation Number
- DHA-RFI-14-CQMP
- Point of Contact
- Margaret Zancanella, Phone: 3036763451
- E-Mail Address
-
margaret.zancanella@dha.mil
(margaret.zancanella@dha.mil)
- Small Business Set-Aside
- N/A
- Description
- Military Health System Medical Quality Monitoring Contract RFI The Department of Defense (DOD) Defense Health Agency (DHA), formerly TRICARE Management Activity (TMA), seeks information about the methods DHA may use to perform quality improvement activities for healthcare it provides both in its own medical treatment facilities (MTFs) and that it purchases in the private sector. To accomplish its goal of ensuring the provision of the highest quality healthcare possible for all Military Health System (MHS) beneficiaries, DHA intends to restructure how it administers its quality oversight program to obtain maximum impact and value to taxpayers. In particular, DHA seeks comments regarding which approaches it should consider to assess various aspects of clinical quality. DHA will consider approaches that the public identifies would best achieve the goals of the MHS's Clinical Quality Program. This RFI seeks comment from members of the public about how DHA can best assess clinical quality across both the Direct and Purchased Care Sectors. DHA will use the information received in response to this RFI for market research to develop its acquisition strategy and to achieve its program objectives for upcoming requirements for quality oversight functions. Specific program requirements and additional detailed information about the Program are below: TRICARE manuals are available at http://manuals.tricare.osd.mil/. BACKGROUND : TRICARE is a DOD healthcare program which serves active duty and retired military personnel, other uniformed service personnel, and their dependents. DHA is accountable for the management and operation of the TRICARE program, which provides care to over 9.6 million beneficiaries worldwide in DOD MTFs and is augmented with private sector services obtained through Managed Care Support Contracts (MCSCs). The MHS maintains active and effective organizational structures and program activities to ensure quality in healthcare throughout the MHS. Clinical quality management activities include clinical performance measurement and improvement, credentials and clinical privileging, risk management, adverse actions, and patient safety. DHA currently has two contracts in place to assist in performing oversight of the clinical quality of healthcare provided to beneficiaries in accordance with Title 32 Code of Federal Regulations Part 199.15 (32 CFR 199.15). The MHS Clinical Quality Management (CQM) Contract provides oversight of the clinical quality of care provided within the Direct Care System's MTFs; and the TRICARE Quality Monitoring Contract (TQMC) provides quality oversight of care provided in the Purchased Care System. DHA is considering consolidating these two contracts into a single contract, which would provide oversight of the clinical quality provided to beneficiaries in both the Direct and Purchased Care Systems. The contract will perform the following services: •Healthcare Effectiveness Data and Information Set (HEDIS) Compliance Audits; •Joint Commission ORYX National Hospital Quality Measures Reporting, •External Reviews of Military Treatment Facility (MTF) Standard of Care (SOC) Cases. •Medical Necessity (Reconsideration) Reviews (Second Level Appeals), •Internal/External Case Reviews for Appeals and Hearings, and provide Clinical/Expert Witnesses for medical appeal administrative hearings and proceedings, •Assessment of Evolving Practices, Devices, Medicines, Treatments and Procedures, •Provide initial application/certification as a TRICARE- authorized RTC, PHP, and SUDRF proceeding and review for recertification, and •Focused Studies. The MHS CQM Contractor for the Direct Care System: The MHS CQM Contractor for the Direct Care System conducts studies (collect, measure, synthesize, analyze, report findings and formulate recommendations based on prevailing healthcare standard and evidence based practice) focused on evaluating and improving health care and reducing variation in the MHS. The work performed is comparable to the quality of studies presented in professional medical research literature. The MHS CQM Contractor proposes at least eight studies for consideration based on a thorough review and analysis of information gathered from DHA leadership, including the Services and the MCSCs; current trends in the healthcare industry with reference to the application to the MHS; and the findings of past MHS studies/outcome measures. The MHS CQM Contractor collects, displays, and reports clinical performance data on the MHS aligned with the strategic direction of the system and in support of the strategic plan. The clinical performance data utilized by the MHS are consistent with current national measures. Joint Commission ORYX® Core Measures (Collection): The MHS CQM Contractor collects, displays and reports data on applicable approved Joint Commission ORYX® core measures for all 55 DOD inpatient MTFs. Patient identification for data collection for each core measure continues for six months following end of the month discharges. The MHS CQM Contractor reviews and reports on newly developed Joint Commission National Hospital Measure Sets to determine applicability to DOD MTFs, the volume of patient records meeting the specifications for the past year, and the proposed data collection process. In Fiscal Year 2012, 80,000 records were abstracted, of which 60,000 were performed to collect Joint Commission core measure data. Both paper copy and electronic health records were utilized. MTF-specific patient level data created from these measures is available to authorized users and Service Quality Leaders. The secure web-based access includes drill down capability to the patient level and data analysis with display (i.e. statistical process control charts, bar graphs, line charts) on each participating MTF. The data are provided with national comparative benchmarks and MTF trends, and opportunities for improvement are identified. Best practices are noted and shared across the MHS. For measures in which any MTF is significantly below the national benchmark as identified in quarterly reports, the MHS CQM Contractor reviews the literature to identify best practices and provide the information to the Clinical Support Division (CSD), Service representatives, and the MTF(s). On a quarterly basis, the MHS CQM Contractor downloads, analyzes, displays and reports, as posted on the Hospital Compare website, National Hospital Quality Measure data from DOD, network, and Designated Provider (DP) network hospitals. The data includes comparable national benchmarks for average and top performing hospitals, along with trends noted and opportunities for improvement. Facility-level data created from these measures are provided to DHA users and Service Quality Leaders. The MHS CQM Contractor posts the National Hospital Quality Measures work products on a secure web portal. This includes data analysis with display (i.e. statistical process control charts, bar graphs, line charts) stratified by Service, Contract Region, DP and MHS levels. Reports, presentations and a user's guide to support new users of the site are also included. The MHS CQM Contractor supports the MHS in maintaining compliance with the Joint Commission ORYX® accreditation requirement. The MHS CQM Contractor has a certified Joint Commission ORYX® vendor for Inpatient Joint Commission ORYX® and is certified for DOD Information Technology Security Certification and Accreditation Process (DIACAP). Part of Joint Commission ORYX® costs include submission of the previous quarter's data to ensure the data set is complete. The MHS CQM Contractor also has approved Non-Core Joint Commission ORYX® measures in their measurement system for disease management of diabetes, asthma care and hypertension aligned with the measures historically used by the DOD. Administrative data and electronic data sources are used as much as possible and supplemented by medical record abstraction and/or survey data as required. The MHS CQM Contractor facilitates the MHS's transition to new core measure sets as appropriate. The MHS CQM Contractor plans and conducts a non-core measure pilot and submits the developed measure set to Joint Commission for approval. At the completion of the contract, all MTF data collected to meet the Joint Commission ORYX® requirements will be transitioned per CSD's direction. The Contractor assumes responsibility for all tasks in the Performance Work Statement at the end of the 6-month transition-in period. This includes the Data Use Agreements (DUA), Authorization to Operate (ATO), and personnel clearances to access DOD data systems. The Contractor must obtain an ATO prior to accessing Government data systems and patient information. TQMC in the Purchased Care System : The TQMC provides DHA with an independent, impartial evaluation of the care provided to MHS beneficiaries in the Purchased Care System. As a part of TRICARE's Quality and Utilization Peer Review Organization Program, in accordance with 32 CFR 199.15, TQMC reviews care provided under the MCSCs and the Uniformed Services Family Health Plan (USFHP) DPs. The USFHP consists of six DP programs that care for about 111,000 beneficiaries. The six DP programs are Johns Hopkins, St Vincent, Martin's Point, Brighton Marine, Christus Health and Pacific Medical Centers. The TQMC also reviews records from other TRICARE contractors such as the TRICARE Dual-Eligible Fiscal Intermediary Contract (TDEFIC), TRICARE Overseas Contract, and the TRICARE Pharmacy Contract (TPharm) on a limited basis. The TQMC measures and reports on the quality of health care services and provides tools for making informed decisions; insight for targeting quality improvement activities; information that allows for external comparisons of health care services against civilian benchmarks, between regions and DP service areas, and against the Direct Care System; and information that promotes medical care that is consistent with clinical guidelines. It measures, evaluates, and identifies superior quality health care services and recommends means to transfer successes throughout the MHS. It performs mental health facility certifications, peer reviews for the DHA, reconsideration reviews, and Standard of Care determinations for Military Treatment Facility (MTF) malpractice cases. The TQMC reviews medical, surgical, and mental health cases to determine the medical necessity and appropriateness of care of the services provided and to ensure the MCSCs and DPs are performing pre-authorizations and retrospective and prepayment reviews. The TQMC also identifies cases of inappropriate medical care, preventable admissions, care that is not a TRICARE benefit, and potential cases of fraud and abuse. The TQMC applies appropriate quality screens and medical judgment to identify quality issues. These quality reviews utilize both process and outcome measures that focus on deficiencies in the delivery of health care that result in an adverse effect on the patient and also identify superior healthcare services. Any quality issues that are identified are confirmed by a board certified, licensed physician, who is actively practicing in the clinical area being reviewed. The TQMC analyzes patterns, trends and variations among the Health Service Regions to include an assessment of "best value health care," identification and recommendation of superior quality health care transfer, a means for decreasing medically unnecessary utilization of health care services, a means for reducing preventable admissions, and recommendations for focused studies and quality improvement projects from a health plan perspective. The TQMC conducts focused studies that allow DHA to understand critical risks quickly and design and test specific interventions to improve the quality of care. The studies selected are those with a potential to significantly impact beneficiary health, functional status, satisfaction, and utilization. The TQMC conducts external reviews of paid malpractice claim cases in which the Military Service's preliminary determination is that the malpractice payment was not caused by failure of any practitioner to meet the standard of care. The TQMC also reviews selected cases involving injury to active duty soldiers, including those resulting in a payment of a disability and/or death benefit. When the case involves a physician, the case is reviewed by a licensed physician who is board-certified in the same clinical specialty as the physician who provided the care. Additionally, the physician reviewer has an active clinical practice in the same clinical area being reviewed. If the case involves a provider other than a physician, a reviewer who is similarly qualified conducts the review. When a case involves more than one specialty, a separate report is issued for each specialty. For all cases, the TQMC (1) summarizes the facts of the case, (2) discusses the allegations, (3) determines whether the standard of care at the time the care was provided was met for each involved provider, (4) provides the rationale for that finding (standard text, practice guidelines, any evidence-based medical citations from the literature relevant at the time of the incident, etc.), and (5) determines whether the care provided caused the patient's injury. In addition, if the case was identified as a system problem, the TQMC includes rationale for agreeing or disagreeing with the identified system issue. The TQMC provides clinical/expert witnesses as needed for medical appeal administrative/trial attendance, discovery, and DHA appeal subject manner conference calls in support to the DHA Office of General Council (OGC), Appeals and Hearings. The TQMC is responsible for determining whether Residential Treatment Centers (RTCs), Substance Use Disorder Rehabilitation Facilities (SUDRFs), and Psychiatric Partial Hospital Programs (PHPs) meet TRICARE requirements for authorized provider status in accordance with the provisions of 32 CFR 199.6 and the TRICARE Policy Manual, and certifies facilities or recommends decertification of facilities to the DHA. The TQMC reviews the hierarchy of reliable evidence, as defined in 32 CFR 199.2, and recommends to the DHA devices, medical treatments, or procedures which the TQMC believes have moved from unproven to proven. The TQMC performs health care technology assessments, which include full in-depth assessments and short assessments on specific focused health care topics. Short assessments are those which require less time to complete due to the lower availability of literature to review. The assessments use published, refereed scientific literature and assess individual health care technologies, to include the full range of medical or surgical devices, services or procedures; behavioral health devices, services or procedures; dental health devices, services or procedures; or the use of pharmaceuticals for purposes other than that approved by the U.S. Food and Drug Administration. DHA furnishes the data contained in the MHS population health portal to the TQMC to validate through a Healthcare Effectiveness Data and Information Set (HEDIS) certified vendor. The TQMC reviews National Coverage Determinations from Centers for Medicare and Medicaid (CMS) to determine their applicability as potential benefits in the TRICARE program. RFI RESPONSE FORMAT : DHA requests RFI responses in the form of a white paper in Microsoft Word (Times New Roman, 12-point font). Please submit responses in the following format: Section I. Company name, mailing address; and the name, phone number, fax number, and email of the designated point of contact. Section II. The name and contact information for the business or other organization whose views are represented in the paper if that contact information is different from that provided in Section I. Section III (NO MORE THAN 15 PAGES). Please provide responses to each of the questions listed below. QUESTIONS: Respondents should review the Background information above prior to answering the questions. Respondents are asked to draw their responses from objective, empirical, and actionable evidence and to cite this evidence within their responses. DHA is particularly interested in the findings of research in the areas of health services delivery, citizen services, public policy and/or the administration of complex policy programs, innovation diffusion, change management, community organization/mobilization, industrial engineering or manufacturing, operations research, and other disciplines that can inform the quality improvement of services delivered in health care systems or the promotion of health through community-based organizations. While some of the goals of the clinical quality oversight program are directed by statute, the overall goal of the program is to ensure the MHS delivers the highest quality care possible to its eligible beneficiaries. DHA may use responses in designing the future direction of the MHS Clinical Quality Program. DHA asks that each respondent address each of the following questions as it pertains to utilizing a single contractor to provide program support for all quality oversight functions throughout the MHS: 1. Given the background information provided, what do you believe is the best approach to assessing the quality of care rendered in both the inpatient and outpatient settings for Direct and Purchased Care that would deliver maximum program value to beneficiaries? (Respondents are reminded that all requirements listed in 32 CFR 199.15 must be met.) 2. What advantages would the program expect to realize by adopting the approach you articulated in your response to Question 1? 3. How would utilization of the approach articulated in your response to Question 1 allow DHA to ensure it delivers the most impact to patients' safety and well-being? 4. What are some important factors for DHA to consider if it were to adopt your recommended approach (including any alternative approaches you suggest in your response) in organizing its quality oversight program in this way? What else should DHA think about as it makes its decision? The following questions are related to factors affecting acquisition planning and competition: Based on the Background information above: 5. DHA is considering combining the services described above into a single requirement. a. Are there any reasons the services should not be combined? b. What economies of scale and other cost savings can DHA expect to achieve by consolidating? c. What are some added costs that may result from combining the contracts? d. If the two requirements are not consolidated, what are some other ways to organize these services that would save money? 6. Based on the DOD Implementation Directive for Better Buying Power, Obtaining Greater Efficiency and Productivity in Defense Spending, knowledge-based contracts should be limited to a total of 3 years to increase competition. a. Based on your company's experience, what is the typical length (years) of this type of contract? b. How would a 3-year limit on the length of the contract affect competition? What factors would promote competition for this type of service? 7.a. Considering solicitation characteristics such as contract type, options, multiple vs single award, performance incentives, what specific solicitation characteristics would encourage your organization to submit a bid proposal in response to a solicitation for these services? Why? b. What solicitation characteristics would discourage or prevent your organization from submitting a bid proposal? 8. a. What solicitation characteristics would attract small business participation? b. What solicitation characteristics would discourage/prevent small business participation? 9. a. Would your organization provide most services in-house? If yes, which services would be performed in-house? b. What services would your company be most likely to outsource? Why? 10. a. How are these services typically priced? For example, which services are typically fixed price, which are typically cost reimbursed? For fixed price what is the unit of measure? For example hourly labor rates? Price per study? b. For cost-reimbursed contracts what are the major cost drivers? 11. What are the major risk factors associated with these services? 12. What are the biggest challenges and frustrations facing your industry? What is the cost impact of these challenges? 13. What incentives are typical for these services? 14. Are there benchmarks/standards or industry "best practices" that your company uses to assess the quality of the services provided? If yes, please describe them. 15. DHA is considering the NAICS codes below for this requirement. Which does your company recommend and why? Is there a NAICS code not listed that is more suitable? Why? a. 541611, Administrative Management and General Management Consulting Services (Medical office management consulting services or consultants) b. 813920, Professional Organizations (Peer review boards, professional standards review boards, professional standards review committees) c. Other: THIS IS AN RFI ONLY. This RFI is issued solely for market research. It does not constitute a Request for Proposal. Interested firms shall not send proposals in response to this Notice nor shall they contact any other individuals about this Notice or the requirement. Any information provided to DHA is strictly voluntary and given with no expectation of compensation and is clearly provided at no cost to the Government. A solicitation will not be issued at this time, and this Notice shall not be construed as a commitment by the Government to issue a solicitation nor does it restrict the Government to a particular acquisition approach. The Government may issue a formal solicitation on the Federal Business Opportunities (fbo.gov) website at a future date. If the Government issues a solicitation, the Government will conduct any source selection in accordance with the Federal Acquisition Regulation (FAR), as supplemented. Any future information on this acquisition (statement of work, specifications, solicitation, etc.) will be posted on www.fbo.gov. It is the responsibility of the prospective offeror to review this site regularly for updates and/or changes. DHA will not respond to questions about the policy issues raised in this RFI. Please email white papers to the primary point of contact listed in this notice. Please state "DHA-RFI-14-CQMS Response" in the email subject line. DUE DATE : Friday, November 8, 2013.
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/notices/920099eb8da4392b972958389377c633)
- Place of Performance
- Address: To be determined, United States
- Record
- SN03221128-W 20131025/131023234517-920099eb8da4392b972958389377c633 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
(may not be valid after Archive Date)
| FSG Index | This Issue's Index | Today's FBO Daily Index Page |