36C10F23Q0008.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. UEI: EFT:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

36C10F23Q0008 12-30-2022

Kevin Armillotti 202-894-0999 01-17-2022

10:00AM EST

Department of Veterans Affairs Office of Construction and Facilities Management (00CFM3B) 425 I Street, NW Washington DC 20001

X

Y

541611

$21.5 Million

N/A

X

003C4A

Department of Veteran Affairs Office Of Construction and Facilities Management 425 I Street, NW Washington DC 20001

003C4A

Department of Veterans Affairs Office of Construction and Facilities Management (00CFM3B1)

Washington DC 20001

Department of Veterans Affairs

FMS-VA-2(101)

Financial Services Center www.Tungston-Network.com

See CONTINUATION Page

Draft Request for Quote (RFQ) Veteran Facility Transformation & Healthcare Enhancement (VFTHE) Blanket Purchase Agreement (BPA) The eventual solicitation will be for GSA MAS 541611 Schedule holders only.

The dates in sections 6 and 8 of the 1449 are anticipated dates for the actual solicitation.

The purpose of this draft solicitation is to seek industry feedback and answer questions.

Questions to this draft solicitation are due no later than Thursday, December 15, 2022, at 10:00AM EDT.

Feedback for this draft solicitation is due no later than than Monday, December 19, 2022.

The Government will be conducting a virtual pre-solicitation conference on Wednesday, December 14, 2022. Specific information regarding the conference will be posted to SAM.

and GSA.

The Government anticipates a single award BPA as a result of the eventual solicitation.

See CONTINUATION Page

(Will be provided at the BPA Call level) x x

Tiffany Rivers

36C10F23Q0008

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 BLANKET PURCHASE AGREEMENT (BPA) ADMINISTRATION DATA

B.2 STATEMENT OF WORK

SECTION C - CONTRACT CLAUSES

C.1 FSS RFQ INTRODUCTORY LANGUAGE

C.2 52.204-14 SERVICE CONTRACT REPORTING REQUIREMENTS (OCT 2016) . 43

C.3 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.4 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) ... 44

C.5 52.219-9 SMALL BUSINESS SUBCONTRACTING PLAN (OCT 2022)

C.6 52.223-99 ENSURING ADEQUATE COVID-19 SAFETY PROTOCOLS FOR

FEDERAL CONTRACTORS (OCT 2021) (DEVIATION)

C.7 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.8 VAAR 852.203-71 DISPLAY OF DEPARTMENT OF VETERAN AFFAIRS

HOTLINE POSTER (DEC 1992)

C.9 MANDATORY WRITTEN DISCLOSURES

C.10 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA

ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

C.11 VAAR 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND

COMPLIANCE (JUL 2018)

C.12 VAAR 852.219-77 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SERVICES AND CONSTRUCTION (SEP 2021)

(DEVIATION)

C.13 VAAR 852.237-75 KEY PERSONNEL (OCT 2019)

C.14 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020) . 61

C.15 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

ATTACH A - BPA LCATS LABOR RATES

ATTACH B - Small Business Participation Worksheet ATTACH C - Background Investigation Worksheet ATTACH D - Non Disclosure Agreement VA Form 0752 ATTACH E - VFTHE BPA Call Order 1 - v9 ATTACH E.1 - First Call Price Schedule - Labor Rates ATTACH E.2 - VFTHE Cost Range Model Illustration - v1 ATTACH E.3 - VFTHE Feasibility Study Performance Work Statement for Raleigh

Durham VAMC - v3 ATTACH E.4 - VFTHE Feasibility Study Performance Work Statement for Washington

DC VAMC - v3 ATTACH E.5 - VFTHE Master Planning Statement of Work - v1 ATTACH E.6 - VFTHE Master Planning Statement of Work Deliverables - v1

ATTACHMENT F- RFQ Questions ATTACH G - Past Performance Questionnaire

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (NOV 2021)

E.2 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.3 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (AUG

2020)

E.4 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.5 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020) . 88

E.6 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS (OCT 2019)

E.7 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.8 52.232-18 AVAILABILITY OF FUNDS (APR 1984)

E.9 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN

2008)

E.10 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

(FEB 1998)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 BLANKET PURCHASE AGREEMENT (BPA) ADMINISTRATION DATA

A. Blanket Purchase Agreement (BPA) Administration: All BPA administration matters will be handled by the following individuals:

(1) CONTRACTOR: TBD (to be completed at time of establishing BPA)

(2) GOVERNMENT:

a. BPA Contracting Officer (CO):

Tiffany Rivers, Contracting Officer Construction and Facilities Management (003C4A) Department of Veterans Affairs

Washington, DC 20001

b. The BPA CO is responsible for providing overall scope oversight, maintaining communication between the contractor and VA, ensuring contract compliance, administering base BPA and modifications, administering BPA Calls and Call modifications (including overseeing payment or rejection of invoices), and ensuring that annual performance evaluations are completed at the order level.

c. The CO reserves the right to designate a Contracting Officer’s Representative (COR) at the base BPA or individual order level. The CO will issue a designation letter to the COR and the contractor to ensure that all parties understand the limited authority of the COR.

B. BPA Call Procedures

The contractor shall provide services as requirements are identified and ordered throughout the ordering period. Requirements may span the tasks listed within the Scope of Work (SOW) limited by the contractors’ labor categories and rates established in the BPA. The Government anticipates annual Calls placed in conjunction with the implementation phases; however, the Government may issue Calls at any time throughout the life of the BPA for additional work within the scope of the BPA. Resulting orders will be Firm Fixed Price Calls. Each Call will specify details as they relate to deliverables, performance and other technical items.

(1) VA Office of Construction and Facility Management (CFM) will follow ordering procedures as outlined in FAR 8.405-3. In accordance with FAR 8.405-3(c)(1), authorized Contracting Officers at CFM may place Calls directly under the established BPA when the need for the services arises.

(2) As requirements for the Veteran Facility Transformation & Healthcare Enhancement (VFTHE) are defined, the CO will issue a Call Quote Request (CQR) in accordance with the procedures as outlined below.

(3) Each CQR will include, at a minimum:

a. the due date and instructions for quote submission,

b. a Scope of Work (SOW) with a description of the requirements, including deliverables, minimum qualifications, and applicable information,

c. the place and period of performance, and

d. any additional information deemed necessary by the CO.

(4) Each Call requirement will have a unique Price Schedule that will be developed by the CO and detailed in the CQR. In response to the CQR, the BPA holder will respond with firm fixed prices for the CLINs being ordered, as well as a supporting labor basis that will be evaluated by the Government in accordance with FAR 8.405-3(d)(c)(3). The CO is responsible for considering the level of effort and the mix of labor proposed to perform the specific task being ordered, and for determining that the total price is reasonable through appropriate analysis techniques and documenting the file accordingly. Once price is determined fair and reasonable (and associated labor mix/ level of effort is acceptable), the Government will issue a firm fixed-priced Call for services.

(5) Upon Call award, the Call will be sent via email to the contractor. The contractor is not authorized at any time to commence Call performance prior to issuance of a signed Call or other written approval provided by a CO.

(6) Calls may only be modified by written modification, executed by a warranted CO.

The contractor shall not perform or provide services that are not expressly stated in the BPA or Call. A Contracting Officer Representative (COR) does not have the authority or means to obligate the Government or change the terms and conditions of the BPA or Calls.

C. BPA Total Estimated Value

The estimated BPA total for the five years is $100,000,000.00. (To be completed by Government at time of award, using Year One Pricing and Future Year Labor Rates as basis.)

D. Options

In accordance with FAR 17.2, Calls/Orders may contemplate the use of options.

Inclusion of options at the Call level will be properly documented and approved in accordance with the FAR and agency procedures and will be clearly stated in the CQR and resulting Call. FAR 52.517-9 will be included in any Calls that include options.

E. Invoicing

(1) All payments by the Government to the contractor will be made in accordance with 52.232-33, Payment by Electronic Funds Transfer – System for Award Management.

(2) Specific invoicing instructions will be identified at the Call level.

F. Subcontracting Commitments – Monitoring and Compliance

This solicitation includes VAAR 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, and VAAR 852.215-71, Evaluation Factor Commitments. Accordingly, any BPA/Calls resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing contractor compliance with the subcontracting commitments incorporated into the contract. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding contract compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, Obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting commitments.

G. Small Business Participation Commitment/Plan - Monitoring and Compliance

This solicitation includes a 30 percent minimum small business participation requirement (with at least 10 percent of the value to SDVOSB concerns or 12 percent of the value to VOSB concerns). Accordingly, any BPA and Calls resulting from this solicitation will include this requirement. Note that the Small Business Participation must meet or exceed the minimum established percentage consistently each year of BPA Call performance (not just over the life of the BPA).

The contractor is advised that the CO, in performing contract administration functions, may use the services of a support contractor(s) to assist in assessing the contractor's compliance with its Small Business Participation Commitment/Plan, including reviewing the contractor's accomplishments in achieving the subcontracting goals in the plan. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non- Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, Obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the commitment/plan.

H. BPA Period of Performance

This BPA will have a base period of 12 months from the date of award and will have three (3) 12-month option periods.

I. Sub-Contracting Plans

For all call orders at and above $750,000.00, a Sub-Contracting Plan shall be required for all large businesses in accordance with VAAR 819.219-70, VA Small Business Subcontracting Minimum Requirements.

J. Travel

Contractor personnel may be required to travel in the Contiguous United States

(CONUS) to support certain requirements of call orders. Travel must be approved in advance and in writing by the Contracting Officer (CO) and the Contracting Officer’s Representative (COR) / Alternate Contracting Officer’s Representative

(ACOR). Travel and will be reimbursed in accordance with Federal Travel Regulations. Please refer to FAR 31.205-46, Travel Costs. The Contractor will consult their Company, the CO, COR and/or ACOR to determine if travel requests are authorized in accordance with a given call order. The contractor shall submit the request form to the COR/ ACOR a minimum of two weeks prior to departure.

Travel arrangements shall not be made prior to receipt of the approved contractor travel request.

K. Security Considerations

a) Security and Privacy Position Sensitivity: The position sensitivity and the level of background investigation commensurate with the required level of access for all tasks within the Statement of Work is Moderate/Tier 2 in accordance with Appendix A of Department of Veterans Affairs 0710 Handbook, “Personnel Suitability and Security Program. The submitted Contractor Staff Roster must indicate this required Background Investigation Level for each Contractor individual in accordance with its submitted quotation. See Addendum A and Addendum B of the SOW for full details.

b) Tier 2/Moderate Background Investigation (MBI): A Tier 2/MBI is conducted by OPM and covers a Five-year period. It consists of a review of National Agency Check (NAC) records [OPM Security Investigations Index (SII), DOD Defense Central Investigations Index (DCII), FBI name check, and a FBI fingerprint check], a credit report covering a period of 5 years, written inquiries to previous employers and references listed on the application for employment;

an interview with the subject, law enforcement check; and a verification of the educational degree. (See ATTACHMENT C - BACKGROUND

INVESTIGATION REQUEST WORKSHEET)

B.2 STATEMENT OF WORK

1. Background The Department of Veteran Affairs is charged with developing a National Realignment Strategy optimizing VHA market area health care delivery to establish high performing health care networks for VHA services and facilities. VA operates the largest integrated healthcare system in the country and employs ~400 thousand employees to meet the needs of Veterans (~19 million Veterans in total, ~9 million enrolled, and ~6 million patients). It is imperative that VA optimize its system to provide the best care to Veterans, ensure that VA remains a best and safe place for the workforce (people), to provide the right services (practice), within 21st century facilities (place). In past efforts, VA did a significant amount of work to strengthen plans for facility modernization;

however, VA understands there is a need to do more to analyze, assess, and evaluate other aspects of the healthcare system and further solidify plans for infrastructure modernization.

The median age of VA’s hospitals is nearly 60 years old, and much of VA’s health care infrastructure was built in the 1940s and 1950s to meet the needs of World War II Veterans. As the Department has said, VA has a clear need and an obligation to modernize VA facilities to provide Veterans the best possible health care outcomes and provide the VA workforce the safest and most efficient means and environment possible to deliver care. VA market assessments will be completed in partnership with local VA healthcare market leaders, and a team of contractors who will collectively assess VHA capabilities, community resources, and provide objectivity and external validation in collaborative application of the standardized, data-driven, principles-based methodology.

The genesis of this initiative is the VA Mission Act of 2018 (VA Maintaining Systems and Strengthening Integrated Outside Networks Act) .

Section 106 of the Mission Act requires VA to perform market area assessments at least once every four years and prescribes the elements that need to be included in the assessments, to include:

1. Demand, disaggregated by geographic market areas determined by VA, including requests for VA services.

2. An inventory of VA’s health care capacity across all medical facilities.

3. An assessment of the capacity provided by contracted private providers, including the number of providers, the geographic location of the providers, and the categories or types of health care services provided by the providers.

4. An assessment obtained from other Federal direct delivery systems of their capacity to provide health care to veterans.

5. An assessment of the health care capacity of non-contracted providers where there is insufficient network supply.

6. An assessment of the health care capacity of academic affiliates and other VA collaborations as it relates to providing health care to veterans.

7. An assessment of the effects on VA health care capacity by the access and quality standards established under this bill.

8. The number of appointments for health care services, disaggregated by VA medical facilities and non-Department health care providers.

This section requires VA to submit the market area assessments to Congress in 2022 and use the market area assessments to determine the capacity of the health care provider networks to inform VA’s budget, to assess the appropriateness of the access and quality standards established under this bill, and to develop recommendations for changes to those standards as needed.

This section also requires VA to submit a strategic plan to Congress, no later than one year after the date of enactment and at least every four years thereafter and to specify:

1. Demand, disaggregated by geographic market areas determined by VA.

2. The health care capacity to be provided at each VA medical center.

3. The health care capacity to be provided through community care providers.

This section directs VA to take a number of elements into consideration in the strategic plan, including Veterans’ satisfaction, the access and quality standards established under this bill, and conditions and needs of Veterans with service-connected disabilities.

In preparing the strategic plan, it also directed VA to identify emerging issues, challenges, and opportunities; develop long-term and short-term recommendations to address them; conduct a comprehensive examination of VA programs and policies; and assess the remediation of medical services lines described in section 1706A.

This section required VA to be responsible for overseeing the transformation and organizational change to achieve a high-performing integrated health care network (HPIHCN), developing the capital infrastructure planning and procurement processes required, and developing a multi-year budget process that is capable of forecasting future budget year requirements.

2. Project Description From a facility perspective, VA has a clear need and an obligation to modernize VA facilities to provide Veterans the best possible health care outcomes and provide our VA workforce the safest and most efficient means and environment possible to deliver care.

Veterans in the 21st century should not be forced to receive care in early 20th century buildings. The median age of VA’s hospitals is nearly 60 years old. This is why the President requested nearly $20 billion in new VA infrastructure spending last year, and why he requested the largest ever investment in VA infrastructure in his fiscal year 2023 budget.

To identify and prioritize health care infrastructure investments that will improve Veteran access to quality VA health care, VA will execute a new collaborative approach for conducting market area assessments to increase access and improve outcomes for all Veterans. The new field-driven and transparent approach to market assessments will reflect the valuable stakeholder feedback that has been received and the lessons learned. It will also include using up-to-date data; deep collaboration with our networks and medical centers across the country; and early and robust engagement with

Overarching Framework for Market Area Assessments

STRATEGIC PLANNING

VA QSPP

VA Strategic Plan VA Data Strategy

VA Spa�al Data Strategy VHA Long Range Plan VHA Opera�ng Plans

Values Principles

Vis ion Statement Miss ion Statement

VHA Priori�es VHA Strategic Enablers

Goals/Objec�ves/Strategies Key Ac�ons

Outcome Measures/Targets Mi lestones

POLICY ANALYSIS

US Code/Bi l l s Regula�ons

Execu�ve Orders State Pol icy Profiles

Direc�ves Proposa ls

STRATEGIC ANALYSIS

Strategic Analys is informed by the Field & Governance

Assess Markets on Rol l ing Bas is Key Analy�cal Ques�ons (KAQs )

People (Veterans/Workforce) Prac�ce (Ski l l s/Services )

Place (Faci l i�es/Infrastructure) Access/Qual i ty/Cost

Demand by Geography Inventory of Capaci ty by DC/CC/WOG/NCC/AA Capaci ty by Providers/Categories of Services

Effects of Capaci ty on Access/Qual i ty Standards Appointments DC/CC

Risk Assessments Performance/Efficiency

Readiness/Tra ining/Learning Partnerships

Data Sets/Source/Parameters/Qual i ty Analy�c Models

Standards Metrics/Measures/Thresholds

Mul�variate Analys is Sens i�vi ty Analys is

Independent Market Area Assessments Evalua�on (High/Mod/Low Performing)

SCENARIO ANALYSIS

Scenarios

Opportuni�es (1 to N) Impact Analys is

Forecas�ng/Projec�ons Enrol lment U�l iza�on

Expenditure/Budget Key Facts

Assump�ons Constra ints (Must Do) Limita�ons (Can’t Do)

Courses of Ac�on

RECOMMENDATION

Decis ion Making Framewor

Screening Cri teria Evalua�on Cri teria

Recommenda�ons (1 to N) Priori�za�on (1 to N) stakeholders. Stakeholders include Veterans, employees, unions, VISN leaders, Congress, Veterans Service Organizations, and leaders in the community.

VA will create a strategy focused on building VA health system infrastructure to support Veterans with the right facilities, in the right places, to provide the right care in every part of the country.

The iterative VA market area assessments will be completed in partnership with local VA healthcare market leaders and staff, VISN leaders and staff, VA and VHA Corporate office leaders and staff, stakeholders and partners external to the VA, and a team of contractors who will collectively produce enterprise-wide strategic assessments of current and projected future capacity and capabilities all 95 VHA market areas that include, at a minimum, strategic analysis of VA Direct care, community care, other Federal health care organizations that provide care to Veterans, and non-contract community care. These market area assessments will be Veteran centric, using evidence-based strategic analysis to address access, quality and cost in relation to People (Veterans and the Workforce), Practice (Skills and Specialties), and Place (Infrastructure and Facilities). These market area assessments will provide deterministic assessment and evaluation that can be replicated and repeated, externally validated, and provide objective collaborative application of a standardized, data-driven, principles-based methodology.

3. Market Area Health System Optimization (MAHSO) and Veteran Facility Transformation and Healthcare Enhancement Objectives

To enable enterprise-wide, strategic analysis and market area assessments, the VA is building on the lessons learned from the first Quadrennial Market Area Assessment called Market Area Health System Optimization (MAHSO) that will serve as the VA’s objective assessment of all 95 VHA Markets which will informed VA Governance and decision making on strategies, opportunities and recommendations with the desired outcome that all 95 Markets be assessed as high-performing integrated health care networks that provide world class healthcare that improves access and health outcomes to Veterans, their families and caregivers.

Effective strategic analysis for the Market Area Assessment and the planning for Veteran care will be enhanced by contractor support and facilitation in key areas

• Informed by the needs of Veterans

• Responsive to stakeholders

• Driven and informed by local leader input, (e.g., VISN and VAMC leaders), VHA program office collaboration and enterprise-wide considerations

• Supported by VA Central Office, Office of Construction and Facilities Management, and the BPA contractor

4. Task Areas

4.1 Market Area Health System Optimization (MAHSO) Market

Area Assessments

Comprehensive market area assessments that allow VA to thoroughly analyze, assess, and evaluate its healthcare markets to determine best allocation of resources to support its journey to becoming a high-performing integrated health care delivery network. The assessment will help determine how and where to best meet the needs of Veterans through VA-owned/leased infrastructure, innovative care delivery approaches (including virtual care), and partnerships with academic, DoD, other federal, and community providers. This will likely include:

A. Enterprise-wide Strategic Analysis B. Evidence-based Advanced Data Analytics C. Other Domains of Analysis D. Consistency Analysis E. National Planning Strategies/Planning Thresholds F. Scenario Analysis G. Expansion and Enhancement of Automated Report Development Capabilities H. VHA Strategic Plan to Meet Healthcare Demand

4.2 Data Management

Data management solutions that drive effective health care planning and align with VA Data Governance requirements

A. IT Maintenance and Development B. Data Discovery and Findings

4.3 Data Management Applications

Systems and Tools leveraging data management to best enable healthcare planning, facility planning, capital investment planning, facility life cycle management planning, market assessments, and national strategy.

A. Health Systems Planning Application – Sustainment

A VHA internal facility planning tool to enable local planners to assess their local Veteran population, including eligible and enrolled Veterans, as well as trends impacting Veterans associated health care, Identifying projected imbalances in health care capacity, and visualizing market supply and demand.

B. Health Systems Planning Application – Evolution

To allow for enhanced alignment between the VFTHE database and the HSPA, continued support is required.

C. Cost Range Model

VA tool which estimates criteria-based modernization requirements for every VAMC installation and includes a resource allocation element to project and distribute workload

VA requires the financial expertise develop or enhance VA tools which clearly compares the cost of care in the VA Direct Care System by Service to the cost of care for comparable Services in the Community and estimates criteria-based modernization requirements for every VAMC installation and includes a resource allocation element to project and distribute workload.

D. Veterans’ Health Administration Conversion of EHCPM Workload for Use in VA Space Calculator and Full Review and Update of Workload-Related Elements of VA Space Planning Criteria (PG-18-9) to Allow for Development of Future Project Space Programs Using VA Space and Equipment Planning System (SEPS)

Support is needed to convert the latest Enrollee Health Care Projection Model (EHCPM) workload into space conversion factors based on changes in care delivery models and the shift to outpatient Health System Planning Categories (HSPCs) from Strategic Planning Categories (SPCATs).

E. Interactive Mapping Tools.

VA requires Geospatial expertise to supplement and integrate all Geospatial Data and Analytics used in the Market Area Assessments with the VHA GIS Planning Portal, a geographic database of capacity, healthcare locations (internal and external) and analytical tools to enable effective distribution of capacity where it is most needed.

4.4 Implementation Planning

Support for the field and VACO in helping VA convert high-level strategies into executable, acquisition-ready capital projects. As needed, this may include support for VA in executing strategic partnerships to facilitate expansion of Veteran access to care.

A. Implementation Planning – Continuation B. Campus and Facility Masterplan Standardization

4.5 Strategic Prioritization

Support for a process to update approaches for prioritization based on changes in Veteran need and VA/VHA strategic direction. The process would incorporate extensive input from VISN and VAMC leaders regarding the needs of local markets and would align with VA enterprise strategies and priorities, including clinical priorities.

A. Strategic Prioritization including Alternative COA Development (Infrastructure Strategy)

4.6 Stakeholder Management and Strategic Communications

Support for the field and VACO in creating and executing a Stakeholder Engagement plan to appropriately engage with a broad range of stakeholders.

A. External Stakeholder Response Support – Continuation B. Strategic Communications

4.7 Program Management and Executive Support

Program management oversight, meeting management support to relevant governance bodies, and support for the development of briefings for executive leadership.

A. Planning Strategy Support and Governance B. VFTHE Program Management C. Change Management D. Executive Briefing Support

4.8 Special Studies

Support for additional studies and analyses that will enable VA to appropriately plan for Veteran-centric care or efforts to implement any opportunities. These studies should be stand-alone documents focused on topic areas to be identified during the 4-year cycle of this BPA.

5.0 Government Prerogative

The general deliverables in the task areas below represent the government’s intended effort across the four years of the VFTHE BPA. However, since it is impossible to predict what other VA initiatives might intersect with these deliverables and how evolving VA strategy might impact them, the government cannot guarantee that we will elect to exercise each of these general deliverables. On the other hand, we reserve the prerogative to add to and expand on these deliverables consistent with the VFTHE BPA framework outlined above.

6.0 SOW Guiderails

The task areas under this contract are to be funded with Advance Planning and Design Funds (APDF) and thus must fit within the prescribed use of these funds. The latest parameters for APDF are as published in the VA FY23 Budget Submission:

The APDF is also used in VA, VHA, NCA, and VBA for assessments of health care needs, design programs, facility condition assessments, and needs assessments that may or may not lead to capital investments and other capital investment activities, such as portfolio development and management activities and investment strategies. The fund can also be used for studies of utilities and capital facilities, to develop public private ventures (EULs), for costs of acquiring contracting services, to prepare campus and facility master plans, for feasibility studies relative to alternative sites and/or historic preservation plans, to conduct environmental assessments, impact studies, and energy studies or audits, to dispose of excess land, to conduct any due diligence studies in advance of land acquisition or lease contract, and design and construction-related research studies, including post-occupancy evaluations.

In accordance with this definition, all of the task areas and deliverables in this BPA must contribute to the determination of which health care needs will require capital investments and which will not. Likewise, the actual and projected scale of our capital investment program must synergistically inform these decisions. To the extent that we must ration capital investment, VA must consider service alignments including development of national strategies, partnerships and community care networks, to match anticipated funding with VHA’s in-house service delivery portfolio and vice versa.

This BPA represents a VA-wide undertaking that must include most VHA clinical and resource-orientated program offices, and all VA offices charged with planning, capital programs, innovation, integration, service delivery strategy, visioning, and care connectivity. Deliverables will necessarily include deep dives into population health, any unique Veteran health dynamics, geographical distribution of Veterans, availability and appropriateness of private sector care, community network design, and partnerships, etc. Specific domains such as rural health cannot be optimized without continual tracking progressive evolutions in home health services, telehealth and telemedicine services, network optimization.

7.0 Task Area 1 – MAHSO Assessments

Following the “Overarching Framework for Market Area Assessments” above and working closely with VA staff, evolve the VHA’s national enterprise strategy to create high-performing integrated health care networks by defining an optimum health care service delivery system design for each and all VHA’s 95 identified markets that will continue to improve access, quality, cost, health outcomes, satisfaction, and deliver efficient, high-quality care in a Veteran-centric way. This effort will be executed in a partnership with representatives of VHA and VACO program offices, local and regional VHA healthcare market leaders, and external stakeholders such as other federal, state, and local partners. All future Market Area Assessments will be conducted in a transparent manner in accordance with all PHI/PII security and privacy laws and regulations that ensures routine updates and collaboration opportunity with VISN, VAMC, Veteran, Employee, Congressional and other internal and external stakeholders during the 4-year cycle. You are responsible to provide market area assessments that will be Veteran centric, using evidence-based strategic analysis to address access, quality and cost in relation to People (Veterans and the Workforce), Practice (Skills and Specialties), and Place (Infrastructure and Facilities). These market area assessments will provide deterministic assessment and evaluation that can be replicated and repeated, externally validated, and provide objective collaborative application of a standardized, data-driven, principles-based methodology.

General Direction

Initially assess the relative health of the markets, using the “Overarching Framework for Market Area Assessments” aligned to enterprise measures of success and calibrated to performance thresholds for both internal and commercial leading practice.

Use relevant VA and commercial data to operationalize this methodology. Apply the methodology to all markets to focus assessments. Allow for flexibility to address adjustments to the methodology due to evolving legislative requirements and/or VA policy.

Completing the market area assessments will result in high level recommendations for investment throughout the health care networks to include people, practice, and place.

The work is data driven and reinforced by national performance benchmarks to inform recommendations and will be developed as an iterative process with VA and other stakeholders.

Individual market health care delivery alternatives must be iteratively juxtaposed against capital investment options (e.g., consolidations, investment in new or modernized infrastructure, and divestments) to flesh out a best-infrastructure modernization plan.

This will require ballpark parametric capital investment estimates and a methodology to ensure consistency of evaluation across markets and VISNs.

The methodology provided will include specific data collection at the market and VA Central Office level. The supporting documentation will be archived, by market, using VA provided link with a vendor developed content management system application.

In close coordination with VA leadership and external stakeholders, provide continuous evaluation by revisiting any markets where new policies or large demographic changes might impact options defined during the first round of market assessments. Also, in close coordination with VA leadership, make course corrections to existing and future market assessments to address evolving strategic input from internal and external stakeholders.

Using market insight and market alignment methodology, identify local and regional healthcare delivery opportunities to target and prioritize for optimal VA provided care and Direct/Community Care integration as well as capital asset alignment. Evaluate geography and demographic data from each market. Use data collected centrally and from the field to identify trends that affect care delivery in each market. Consider current clinical capacity and any planned future capacity in the VA and commercial market. VA demand will be assessed in accordance with the Enrollee Healthcare Projection Model (EHCPM), and commercial leading practice as well as VA planning criteria and standards.

Estimate Current and Future Market Supply/Service Delivery – Utilize commercial thresholds and VA capacity measures to understand VA in house capacity as well as what types of care are available in the market, and through telehealth capabilities.

Evaluate market data against VA and commercial thresholds to determine which services VA should provide and which should be purchased from the Department of Defense, Affiliated Academic Medical Centers, or the community. This evaluation must include high level analyses of healthcare metrics (e.g., capability, capacity, strategic expansion plans, long-term viability, quality, cost, and accessibility) of community capacity where Veteran demand exceeds VA capacity.

Assess Quality, Access, Satisfaction, Cost and Mission Impact of Care – Assess quality of care, access, satisfaction, productivity, and efficiency as well as current and future workforce/staffing.

Conduct Site Visits and Interviews – A high-Performing integrated health care network provides appropriate focus on specialties and skills (practice), faculties and infrastructure (place), but also on Veterans and the workforce (people). Veterans have unique cultural (e.g., military history) and population health needs that require special attention—examples include expanded support for integrated team of primary care providers, social workers, mental health providers, pharmacists, and nutritionists.

Therefore, a key facet of any market area assessment must involve VA staff interaction and engagement to uncover unique Veteran considerations and trends that impact care delivery in the market.

Assure review of the preliminary analysis results and conclusions with local market and VISN – Gather VISN/local input toward general preliminary analysis finding. Review preliminary analyses, results, and conclusions with local market and VISN staff. Provide Data-Driven Service Delivery Model Maps summarizing service capabilities by facility for each market area. Convey the results of the analysis in written and graphic form to be utilized for comparison with existing service delivery by Market.

Recommend Market Optimization Plan based on Enterprise Guiding Principles and performance against Quality, Satisfaction, Access, Cost and Mission Standards – Include recommendation of future disposition of each VHA asset/site of care and its services as well as site/market specific documentation (data/reports/documentation/external reports) that support each conclusion that led to a recommendation.

Integrate Market Optimization Recommendations into modernization plans.

Infrastructure – Identify physical infrastructure capabilities and health care delivery resources to be integrated into the future operating vision, to include capabilities, funding strategies, delivery sites, consolidation of services, virtual modalities, and opportunities for divestiture and indications for leveraging local capacity. Develop capital consolidation investment or divestment options that support the high-performing integrated health care network. Provide Physical Asset Assessment Report.

7.1 Enterprise-wide Strategic Analysis

Development of an enterprise-wide strategic analysis to assess and evaluate the current and the future state of all 95 VHA Market Areas to inform planning.

Anticipated Tasks

1. Publish a strategic analysis plan informed by the Field, and aligned to the VA Strategic Plan, VA Data Strategy, VA Spatial Data Strategy, and VHA Long Range Plan that is approved by VA Governance and provides the guidance, process, procedures, techniques, key actions, desired outcomes, measures, milestones, targets/threshold for enterprise-wide strategic analysis to be used for market area assessments focused on People (Veterans & Workforce), Practice (Skills & Specialties s) and Place (Facilities & Infrastructure)

2. Incorporate any additional strategic plans from Program Offices, which will help to incorporate existing Program Office work efforts, as appropriate, in the Market Area Assessments and the strategic analysis plan.

3. Define key policies and how policy analysis will be used for Market Area Assessments.

4. Define and publish the approach to assess and evaluate all Market Areas on a rolling basis and key milestones required to activate an evolved market assessment methodology and publish each market area assessment as they are completed. Include how these market area assessments will be incorporated into the VA Governance decision making and budget formulation process.

5. Develop key analytical questions for VA Governance approval that provide the basis for the assessment of Access, Quality, and Cost; Demand by Geography; Inventory of Capacity by VA Direct Care (DC), VA Community Care (CC), Whole of Government (WOG) Federal Health Facilities; Non- Contracted Community Care (NCC), and Academic Affiliates (AA); Capacity by Providers/Categories of Services; Effects of Capacity on Access/Quality Standards; Appointments DC/CC; Risk Assessments;

Performance/Efficiency; Readiness/Training/Learning; and Partnerships

6. Define and publish required Data Sets/Sources/Parameters and provide an assessment of the Data Quality used for the strategic analysis that can be repeated and replicated.

7. Define and publish evidence-based advanced data analytics and Analytic Models to be used for the strategic analysis to include the evidence-based Standards/Metrics/ Measures/Thresholds (Benchmarks) by health service categories. This includes quantitative and qualitative analytic models, such as logic, causal, and conceptual modeling that assess how a program or process is supposed to work by exploring how outcomes are associated with the process and how it is assumed to work; that identify cause and effect of Veteran centric relationships; that show how one aspect of healthcare influences other different aspects by describing how different parts of a problem interact with each other.

8. Define and publish data analytic techniques to be used for strategic analysis and assessment of the market areas such as regression analysis, Monte Carlo simulation, factor analysis, cohort analysis, cluster analysis, time series analysis, sentiment analysis, discrete-event simulation, social network analysis, agent-based simulation, epidemiological analysis, population health analysis, et cetera

9. Define and publish the multivariate analytical approach to assess and evaluate all 95 Market Areas using standardized methodologies and techniques that can be repeated and replicated, and that provide an objective, numerical rating of all 95 Market Areas that provides a conclusive deterministic assessment and evaluation of each market area ranging from a high performing integrated network to a moderate performing integrated network, to a low performing integrated network.

10. Define the criteria used for the multivariate analytical approach.

11. Define and publish the approach to incorporate Sensitivity Analysis to ensure there is a consensus enterprise-wide on the multivariate analytic approach to assess and evaluate each market.

12. Define and publish distinct scenarios and assumptions to be used to assess and evaluate the future state of each market area to include the opportunities that are developed to mitigate the assessment and evaluation of the current state of each market.

13. Define screening criteria and evaluation criteria used evaluate all opportunities and recommendations that evolve from the market area assessment.

14. Technical support of the maintenance and development of the Health System Planning Application tool.

15. Provide training to better enable the VA planning community to engage in evidence-based data analytics.

16. Publish independent market area assessments for all 95 market to include high, moderate, low performing evaluations of each.

7.2 Evidence-based Advanced Data Analytics, VA and

Commercial Healthcare Planning Expertise, and Training

Delivering evidence-based advanced data analytics, VA and commercial healthcare planning expertise, and training. Support may also include supporting engagement with potential external partners to identify opportunities and assess their feasibility including emerging healthcare technology and delivery processes.

Anticipated Tasks

1. Implement the published approach to assess and evaluate all Market Areas on a rolling basis and key milestones required to activate an evolved market assessment methodology and publish each market area assessment as they are completed.

2. Commence with data collection and strategic analyses

3. Define and deliver evidence-based advanced data analytics that can be validated by GAO and OIG, replicated and repeated.

4. Define and publish VA and commercial healthcare analytic and planning subject matter experts contributing to the strategic analysis to include input and engagement from stakeholder to include the Veterans, VAMCs, VISNs, VA Program Offices, VSOs, Labor Unions, OMB, and Congress.

5. Publish independent market area assessments for all 95 market to include high, moderate, low performing evaluations of each: assessment of the appropriateness of the access standards and standards for quality with recommendations for any changes to such standards

6. Define and publish the data sets, sources and parameters used for strategic analysis and assessments; identify which data sets are authoritative and who the data stewards are of each data set.

7. Define and publish quantitative and…