SOW_EnhancingPrivateSectorReadiness.pdf

STATEMENT OF WORK

U.S. Department of Health and Human Services (HHS)

Office of the Assistant Secretary for Preparedness and Response (ASPR)

Emergency Management & Medical Operations

And

The National Academies of Sciences, Engineering, and Medicine (NASEM)

Project Title

Enhancing Private Sector Readiness for 21st Century Health Threats

Background

The mission of the Office of the Assistant Secretary for Preparedness and Response

(ASPR) is to save lives and protect Americans from 21st century health security threats.

To do this, ASPR focuses on four priorities: providing strong leadership, building a regional disaster health response system, sustaining robust and reliable public health security capabilities, and advancing an innovative medical countermeasures enterprise.

ASPR collaborates with its stakeholders, including other HHS programs; other Federal agencies; State, local, Tribal, and territorial officials; and the private sector to accomplish its mission. This initiative is in direct response to and support of the overall ASPR mission.

A robust response to 21st century health threats will require seamless integration between public and private sector response activities. While efforts led by ASPR provide public sector resources for emergency preparedness, these measures cannot succeed without complementary investments by the private sector. Because the private sector is the primary health care delivery system for civilians both day-to-day and during disasters and other emergencies, it is critical to engage this sector in building the necessary readiness and response capabilities to protect the nation’s health security. Although ASPR supports a grant program to improve readiness by creating local coordination between healthcare stakeholders, it controls no direct levers to influence the healthcare delivery system. Events that require an emergency response from the healthcare system, whether large or small, are influenced by a number of regulatory and payment incentives controlled by both public and private sector entities. Substantial work has demonstrated that existing incentives prioritize scheduled, high-margin care over emergency care or readiness efforts. Sufficient incentives do not currently exist to motivate private sector health care facilities to invest in services and systems that increase capacity to respond to threats that do not have an immediate return on investment. The 21st century health security environment is increasingly complex and dangerous, the American population is aging, more medically complicated, and often managed in outpatient settings.

Responding to health threats will require alignment of incentives and engagement of the private sector in order to save lives during disasters and public health emergencies.

In support of this integration, the National Academies of Sciences, Engineering, and

Medicine (NASEM) sponsored three workshops focused on readiness within the past 18 months. The first workshop focused on aligning incentives so that private sector healthcare systems are more engaged in ensuring there is capacity to meet the needs of the American public during times of crisis. A second workshop explored medical and public health preparedness for a nuclear incident, including an exploration of the challenges, opportunities, and implications for building capabilities within the healthcare system to respond and recover. The final workshop, in response to the shortage of intravenous saline solution that was exacerbated during the 2017 hurricane season, was convened to better understand the gaps that led to cascading effects in patient care throughout the U.S. health care system.

A central theme emerging from these workshops is that the U.S. health care system is not prepared to respond to 21 century health threats, including disasters and intentional acts of mass violence that may generate thousands or more ill or injured citizens, or to absorb chronically ill patients that are displaced by weather related events. Prior workshops additionally highlighted that a robust response to health threats will require public sector coordination efforts as well as the definitive medical care that is delivered in the private sector, making private sector engagement in capacity building critical for true readiness for 21st century health threats.

Despite the critical role of the healthcare system in responding to 21st century health threats, acute conditions and acute exacerbations of chronic conditions, such as those that occur during a disaster or public health emergency, comprise just a small fraction of a civilian hospital finances. Recent health care system innovations – including changes to payment policy – have focused on improving quality and safety outcomes for high-margin and high-frequency services (e.g. chronic care and elective operations).While emergency departments deliver acute unscheduled care daily, more work could be done to improve readiness across the entirety of the health care system and to encourage collaboration across systems to optimize regional outcomes. Incentives do not currently exist to motivate health care facilities to invest in services and systems that increase capacity to respond to threats that do not have an immediate return on investment. As the largest purchaser of healthcare in the U.S., the USG has the ability to create and align incentives that create a business case for the private sector to invest in services and systems that increase capacity or capability to respond to threats to the public’s health.

Scope

To address this need, ASPR proposes to engage the NASEM to complete two tasks. The first task is mandatory and the second task is optional. The first task (1) is to convene a one day expert panel meeting of hospital and health care system c-suite executives to discuss ways to enhance private sector health care readiness for 21st century health threats; and an optional task (2) to subsequently convene a workshop to expand upon the discussion of the expert panel meeting in a larger, public venue of hospital and health care system c-suite executives and other experts.

Specifically, the objectives of the expert panel meeting are to:

Task 1 –Convene an expert panel meeting to discuss high-level strategic approaches to:

Identify, assess, and prioritize potential incentives – including financial and policy

– that can be used to incentivize the health care sector to improve readiness for

21st century health threats. Potential analysis may include:

o Why increased private sector health care system investment in services and systems that increase capacity and capabilities to respond to 21st century health threats is needed;

o Case studies/examples that illustrate how proactive health care system investment in services and systems that increase capacity and capabilities supported improved patient care and outcomes following a past disaster or public health emergency and whether similar approaches may or may not be feasible for improving readiness for larger, more catastrophic 21st century health threats.

Similarly, provide case studies/examples that illustrate how lack of investment in readiness activities exacerbated patient care and outcomes following a past disaster or public health emergency, and how lack of investment in readiness may further complicate response to the larger, more catastrophic events included in the 21st century health threat landscape.

o Levers that could incentivize private health care sector participation in readiness activities through direct payments or indirect payment.

o Ways to increase statewide and regional medical surge capacity.

o Provide guidance about how to integrate military (DOD and VA) and civilian response assets.

o Ways to identify, develop, and maintain the highly specialized clinical capabilities critical to unusual hazards (chemical, emerging infectious disease) or catastrophic events (radiation/nuclear).

o Ways to increase healthcare coalition participation to ensure that states and multi-state regions maintain accessible and response-ready clinical capabilities that are essential in disaster and public health emergencies;

o Ways to integrate the National Disaster Medical System for engagement of private sector health care facilities in readiness.

Identify actionable approaches for implementing identified incentives.

Discuss the need for identifying private sector champions to motivate key health system leadership to invest in the enhancement of private sector readiness for 21st century health threats.

Optional Task 2 -Workshop: Convene a workshop to expand upon the discussion of the expert panel meeting in a larger, public venue of hospital and health care system c-suite executives and other experts to discuss potential actionable approaches to:

To incentivize the health care sector to improve readiness for 21st century health threats.

Outline actionable approaches for implementing identified incentives.

Identify private sector champions (when appropriate) to motivate key health system leadership to invest in the enhancement of private sector readiness for 21st century health threats.

Specific Tasks

NASEM (hereafter referred to as the contractor) shall perform the following tasks:

TASK 1: Convene a one day expert panel meeting of hospital and health care system c-suite executives to discuss ways to enhance private sector health care readiness for 21st century health threats. Membership in the expert panel shall include private sector hospital and health system c-suite executives (e.g. Chief Executive Officers, Chief

Operating Officer, Chief Financial Officer, etc.). Including systems that invest in preparedness and have had recent disaster response experience. Subtasks to be provided are:

1.1. The contractor shall request recommendations from ASPR (exact people will be identified after award) for an expert panel comprising hospital and health system executives to serve as subject matter experts. For the purposes of this SOW, a hospital or health system executive is defined as a health care organization senior executives with institutional decision-making authority. Titles of health care executives may include but are not limited to, President, Chief Executive Officer, Chief Operating Officer, Chief

Medical Officer, Chief Financial Officer, Chief Nursing Officer, and Medical Director.

1.2. The contractor shall establish an expert panel with between 12- 20 members.

This panel should take into account input from the list of recommendations from ASPR ( which will be provided after award) as well as leverage NASEM membership and connections. The expert panel should include health care executives from a diversity of systems (e.g. for-profit, not-for-profit, academic medicine, etc., as well as include representatives from large health systems).

1.3. The contractor shall coordinate with relevant ASPR staff (who will be identified after award) to determine preferred dates for the expert panel convening and to review project timeline and goals.

1.4. The contractor shall plan, schedule, and convene a one day closed door meeting of the expert panel and provide a neutral venue for structured, facilitated discussions of various topics consistent with the Scope.

1.5. The contractor shall provide detailed summary notes of the meeting highlighting key discussions and recommendations. Notes shall include a sufficient description of topics discussed to include a statement of the problem(s), potential enabling factors or barriers to problem resolution, and recommended next steps necessary as needed to inform the workshop planning committee and the development of the public workshop.

TASK 2: (Optional at the discretion of the government): Convene a workshop to expand upon the discussion of the expert panel meeting in a larger, public venue of hospital and health care system c-suite executives and other experts within five (5) months of the completion of Task 1. Membership in the planning committee shall include private sector health care executives, including at least 2 representatives from the expert panel meeting to ensure the workshop builds upon the discussions of the expert panel meeting.

Subtasks to be provided are:

2.1 .The contractor shall establish a planning committee with a minimum of 5 and a maximum of 10 individuals comprised of hospital and health system c-suite executives to guide the workshop. The planning committee must include at least

2 representatives from the expert panel meeting to ensure the workshop builds upon the discussions of the expert panel meeting. The planning committee will convene during the workshop planning phase virtually via teleconference.

2.2. The contractor shall request recommendations for proposed planning committee members from ASPR (exact people in ASPR will be identified once this optional task is exercised) and shall share the list of appointed planning committee members via a public website for the established workshop.

2.3. Leveraging the planning committee, the contractor shall identify key stakeholders to invite to the 1.5 day public workshop. In addition to C-suite executives, payers to include Centers for Medicare & Medicaid Services (CMS), as well as finance and Internal Revenue Service (IRS) representatives shall be considered as potential invitees to workshop. The contractors shall request and consider recommendations for proposed invitees from ASPR.

2.4. The contractor shall coordinate with relevant ASPR staff to determine preferred dates for the workshop and to review project timeline, goals, and supporting materials but this dates will be within the period of performance of the contract.

2.6 The contractor shall plan, schedule, and convene a 1.5 day public workshop that provides a neutral venue for structured, facilitated discussions consistent within Scope.

2.7. Based on discussions during the workshop, the Contractor shall publish a

Proceedings in Brief and submit to the contracting officer’s representative prior to publication.

Deliverables

The contractor shall (1) establish an expert panel; (2) convene a one day expert panel meeting and provide a detailed notes with the summary of the meeting OPTIONAL:(3) establish a planning committee; OPTIONAL(4) invite key stakeholders and publicly market the workshop; OPTIONAL(5) convene a 1.5 day workshop; OPTIONAL(6) publish a Proceedings in Brief summarizing the discussions during the workshop; (7) submit monthly progress reports and reports of potential problems to the Project Officer;

(8) participate in quarterly performance reviews.

Place of Performance

The place of performance shall be the NASEM complex buildings. NASEM shall provide facilities and equipment required for the proposed project.

Period of Performance

The period of performance under this contract is from award (projected 2/15/2019) to

October 30, 2019.

Type of Contract

This is a cost-reimbursable contract.

Hours of Operation

Normal duty hours will range from 8:00 AM to 5:00 PM, Monday through Friday, excluding Government holidays, unless otherwise required by the Project Officer.

Travel

Travel cost associated with attendance at the expert panel meeting or workshop is included in the overall cost of this contract as some personnel may be required to travel.

Reimbursement for travel will be in accordance with government travel regulations.

Government Furnished Facilities and Equipment

No government-furnished facilities and equipment will be required.

Status Meeting

The Project Manager and other members of the contractor’s staff shall meet to discuss status of events, projects, issues, and problem areas related to the project. The meetings shall be with the Project Officer (PO) (ASPR employee) and other members of government project team. Results of meetings shall be documented and summarized in monthly reports and submitted to the Project Officer. The schedule for the meetings shall be identified by the Project Officer.

In addition to the monthly reports, the contractor shall immediately bring problems or potential problems affecting performance to the attention of the Project Officer. Verbal reports shall be followed by written reports when requested by the Project Officer.

Confidentiality of Data

Duplication or disclosure of the data and other information to which he/she will have access to as a result of this contract is prohibited. It is understood that throughout performance of this contract, the person selected will have access to confidential data, which either is the sole property of HHS or is the sole property of other than the contracting parties. The Contractor and his subcontractor(s) (if any) agree to maintain the confidentiality of all data to which access may be gained throughout contract performance, whether title thereto vests in HHS or otherwise. The Contractor and his

Subcontractor(s) (if any) agree to not disclose said data, any interpretations and/or translations thereof, or data derivative there from, to unauthorized parties in contravention of these provisions, without the prior written approval of the Contracting

Officer or the party in which title thereto is wholly vested. Subcontractors are subject to the same stipulations and may be held responsible for any violations of confidentiality.

Security Requirements

The contract employee must obtain and maintain appropriate security clearances as determined by ASPR to effectively perform his/her duties under this task order. If a prospective employee is found to be ineligible for access to Government facilities or information, the Project Officer shall advise the Contractor that the employee shall not continue to work or to be assigned to work under this task order.

Standards of Conduct

In performing this contract, selected personnel may be required to interact with high-level government and non-government officials. The Contractor shall ensure that all its personnel conduct their work in a professional and responsible manner. All Contractor personnel working on the Government’s site shall abide by the rules and regulations as set forth by HHS.

Government Liability

The government shall not be liable for any injury to the Contractor’s personnel or damage to the Contractor’s property unless such injury or damage is due to negligence on the part of the government and is recoverable under the Federal Torts Claims Act, or pursuant to other Federal statutory authority.

Inspection and Acceptance

The Contractor’s performance and the quality of services provided hereunder shall be subject to final inspection and acceptance by the Contracting Officer in conjunction with the Project Officer.

Periodic Inspections

The PO shall periodically conduct on-the-job inspections to determine overall quality of contract performance, the job knowledge or individual employees, the effectiveness of training, and to observe and determine the conduct and appearance of uniformed personnel.

Contractor Performance

At the Project Officer’s discretion, he/she and the contractor’s Program Manager shall meet quarterly to evaluate the manner in which the contractor performed in accordance with the contract requirements and standards such as: good workmanship, the contractor’s record of forecasting and controlling cost; the contractor’s adherence to contract schedule, contractor’s history of reasonable and cooperative behavior and commitment to customer satisfaction, and generally the contractor’s business-like concern for the interest of the customer. The Contracting Officer may attend these meetings.

508 Compliance

The awarded contract will be subject to Section 508 compliance. Section 508 of the

Rehabilitation Act of 1973 (29 U.S.C. 794d) requires Federal agencies to purchase electronic and information technologies (EIT) that meet specific accessibility standards.

This law helps to ensure that federal employees with disabilities have access to, and use of, the information and data they need to do their jobs. Furthermore, this law ensures that members of the public with disabilities have the ability to access government information and services.

There are three regulations addressing the requirements detailed in Section 508. The

Section 508 technical and functional standards are codified at 36 CFR Part 1194 and may be accessed through the Access Board’s Web site at http://www.access-board.gov. The second regulation issued to implement Section 508 is the Federal Acquisition Regulation

(FAR). FAR Part 39.2 requires that agency acquisitions of Electronic and Information

Technology (EIT) comply with the Access Board’s standards. The entire FAR is found at Chapter 1 of the Code of Federal Register (CFR) Title 48, located at http://www.acquisition.gov. The FAR rule implementing Section 508 can be found at http://www.section508.gov. The third applicable regulation is the HHS Acquisition

Regulation (HHSAR).

Regardless of format, all Web content or communications materials produced for publication on or delivery via HHS Web sites - including text, audio or video - must conform to applicable Section 508 standards to allow federal employees and members of the public with disabilities to access information that is comparable to information provided to persons without disabilities. All contractors (including subcontractors 1) or consultants responsible for preparing or posting content intended for use on an HHS-funded or HHS-managed Web site must comply with applicable Section 508 accessibility standards, and where applicable, those set forth in the referenced policy or standards documents below. Remediation of any materials that do not comply with the applicable provisions of 36 CFR Part 1194 as set forth in the SOW or PWS, shall be the responsibility of the contractor or consultant retained to produce the Web-suitable content or communications material.

Prime contractors may enter into subcontracts in the performance of a Federal contract, but the prime remains obligated to deliver what is called for under the contract.

References:

HHS Policy for Section 508 Electronic and Information Technology (E&IT) (January

2005):

http://www.acquisition.gov/ http://www.section508.gov/ http://www.hhs.gov/od/Final_Section_508_Policy.html

HHS Section 508 Web site: http://508.hhs.gov/

HHS ASPAWeb Communications Division Web site:

http://www.hhs.gov/web/policies/index.html

US General Services Administration (GSA) Section 508 Web site:

http://www.section508.gov/index.cfm