36C10G23Q0058 0001.docx

SUBJECT*

RFI CCN NEXT GENERATION

GENERAL INFORMATION

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SET-ASIDE

OPAL | Strategic Acquisition Center

10300 Spotsylvania Ave | STE 400 Fredericksburg VA 22408-2697

POINT OF CONTACT*

Contracting Officer Jacqueline Boudreaux jacqueline.boudreaux@va.gov see email

PLACE OF PERFORMANCE

ADDRESS

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ADDITIONAL INFORMATION

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DESCRIPTION

This informational purposes only.

Modification to a Previous Notice Modification to a Previous Notice

Modification to a Previous Notice

Community Care Network Next Generation Request for Information

Department of Veterans Affairs Integrated Veteran Care Veterans Health Administration

Date: May 5, 2023

36C10G23Q00058 Amendment #1

FAR Part 52.215-3 (a) The Government does not intend to award a contract on the basis of this solicitation or to otherwise pay for the information solicited except as an allowable cost under other contracts as provided in subsection 31.205-18, Bid and proposal costs, of the Federal Acquisition Regulation. (b) Although "proposal" and "offeror" are used in this Request for Information, your response will be treated as information only. It shall not be used as a proposal. (c) This solicitation is issued for the purpose of information and planning.

TABLE OF CONTENTS

REQUEST FOR INFORMATION

1.0 INTRODUCTION

THIS IS NOT A SOLICITATION.

The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) is issuing this Request for Information (RFI) as Market Research used for the potential procurement of services for a contractor to develop and maintain a national or regional network of high-performing licensed healthcare providers and practitioners. In addition to developing and maintaining this provider network, where providers deliver standard healthcare services to include medical, surgical, complementary and integrative services, durable medical equipment, pharmacy, and dental, the contractor shall provide enhanced community care services such as scheduling appointments, case management, disease management, population health management, and other innovative industry best practices and lessons learned. VHA looks to become the trend-setter and standard-bearer for streamlined healthcare services and to deploy an innovative healthcare model throughout the nation via the Community Care Network Next Generation (CCN Next Gen).

This RFI is issued solely for information and planning purposes. There is no obligation for the Government to acquire any products or services described in this RFI. In accordance with the Federal Acquisition Regulations (FAR) Subpart 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. No funds have been authorized, appropriated, or received for this effort. The information provided may be used by VA in developing its acquisition strategy and informing, refining, and finalizing a Performance Work Statement (PWS). Interested parties are responsible for adequately marking proprietary, confidential, restricted, or competition sensitive information contained in their response. Only electronic responses to this RFI will be accepted. The Government will not pay for any time expended or information submitted in response to this RFI. Eligibility in participating in a future acquisition does not depend upon a response to this RFI.

2.0 BACKGROUND

The VA provides care to Veterans through community providers when VA cannot provide the care needed or when Veterans are unable to access local VA medical centers. Community care is based on specific eligibility requirements, availability of VA care, and the needs and circumstances of individual Veterans.

In an effort to streamline VA’s community care programs, the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act was signed into legislation on June 6, 2018, providing more choices and robust care coordination for Veterans using one consolidated program instead of multiple programs. Over time, community care program needs evolved with requirements for expanded healthcare services and improvements in customer service, accountability, health information exchange, referrals, scheduling, and provider payments. This evolution led to development of the VA Community Care Network (CCN).

The Contractor shall serve as a third-party administrator with responsibility to provide regional or national managed healthcare services. The Contractor shall (i) provide exemplary customer service; (ii) monitor and manage quality outcomes; (iii) use data and performance metrics to improve services; and (iv) process and pay claims for services ordered against the contract.

CCN is VA’s direct link with community providers to ensure Veterans receive timely, high-quality care. CCN uses industry and VA standard approaches and guidelines to administer services, promptly pay for services, and manage the network to its full potential.

CCN is comprised of five (5) regional networks that serve as the primary contract vehicles for VA to purchase care for Veterans from community providers, covering all U.S. states and territories. VA is currently in its market research phase of its acquisition planning schedule for CCN Next Generation. The solicitation phase is tentatively scheduled for the latter part of fiscal year 2024. These dates are subject to change.

While the CCN program has sought to address expanding Veteran healthcare requirements and needed improvements, VA’s Office of Integrated Veteran Care (IVC) plans to further streamline and enhance community care processes and services through the CCN Next Generation (Next Gen) contract initiative. CCN Next Gen looks to build upon CCN lessons learned and implement industry best practices through extensive market research, innovative acquisition strategies, and review and analysis of acquisition and contract requirements.

3.0 PURPOSE

VA seeks industry’s input regarding potential paths forward and recommendations as to where the VA should focus its efforts in developing a solicitation for proposals. The intent is to gain information from industry relative to the North American Industry Classification Code (NAICS) 524114 and the incorporation of small business size standards that are to be determined.

The information included in this RFI looks to:

0. Communicate a vision of the scope of services that VHA would ideally like to implement; to convey context regarding VHA’s needs.

0. Review approaches that VA might pursue to accomplish its priorities.

0. Collect information about market capabilities and state of practice.

0. Understand the processes, procedures, resource requirements, operations, and systems used in developing and maintaining a network of healthcare providers.

VA’s goal in this exercise is to 1) communicate the challenges/opportunities faced by the VA, and 2) gather input on how industry would address these challenges and opportunities. To that end, the more specific your answers are, the more useful your response will be to the VA.

4.0 INFORMATION SOUGHT

The VA is seeking the following information to be provided by the vendors when responding to the RFI:

· Vendor Information

· Vendor Responses to Questions

4.1 Vendor Information

Vendors shall provide the following information:

· Vendor Name

· Vendor Address

· DUNS Number

· Vendor Website

· Vendor Point of Contact name, telephone number, and email address

· Unique Entity Identifier (EUID), number under which the vendor is registered in SAM.gov and/or VetBiz.gov

· Vendor Socioeconomic Status; Business Size and Status [e.g., Large Business, Service-Disabled Veteran-Owned Small Business (SDVOSB), Veteran-Owned Small Business (VOSB), Small Business (SB), etc.]

· GSA or similar Governmentwide contract vehicle to include contract number, schedule, and SIN category(s), if applicable.

· The number of years in business operating under NAICS 524114, if applicable.

4.2 Vendor Responses to Questions

The vendor shall provide answers to each question in the List of Questions in Paragraph 6.0 below of this RFI. The Vendor’s response shall address the company’s approach to satisfy the objectives, constraints, and requirements described in this notice and shall consider all additional information contained in this RFI.

5.0 SUBMISSION INSTRUCTIONS

Please submit responses via email only to NextGenRFI_Industryday@va.gov. Submissions are due no later than May 22, 2023 at 4:00 p.m. EST. The email subject line must contain the following: “Response to RFI 36C10G23Q00058 Amendment #1, Community Care Network Next Generation.” VHA reserves the right to not reply to any emails, responses, questions, and materials submitted in response to the RFI.

Mark your response as “Proprietary Information” if the information included is considered to be business sensitive and/or includes trade secrets. Interested vendors are directed to respond to this RFI with documents in PDF format and RFI responses shall not exceed 20 pages total (exclusive of the title/cover page, and table of contents). VA will not review any other data or attachments that are in excess of the 20-page limit. All documents must measure 8.5 x 11-inches (charts may be landscaped but must be 8.5 x 11-inches) and shall be in Times New Roman, font size (12), with 1” margins. All pages of the response shall be appropriately numbered, and identified with the RFI number (i.e., 36C10G23Q00058 Amendment #1). Any documents not in conformance with these requirements may not be reviewed.

6.0 LIST OF QUESTIONS

When responding to the questions below, please provide examples from within the last five (5) years, if applicable.

Per Member Per Month (PMPM)

1. Describe the administrative and operational costs you incur in the networks you administer. Please include a distinction between fixed and variable costs, as well as the drivers influencing the variable costs.

Information Technology

2. Describe how your organization uses real time Admission, Discharge, and Transfer (ADT) notifications for inpatient hospitalizations.

3. Does your organization manage or have visibility into providers scheduling grids? If so, what tools and (Application Programming Interfaces) APIs are you using with providers? Would APIs be available into providers scheduling grids for VA scheduling use or would your organization be open to requirements surrounding this effort?

4. Explain how your organization would ensure providers in your network utilize VA’s recommended systems for managing the referral and authorization process and sharing of medical documentation. Provide any specific steps you may take to meet the highest use of this system.

5. What is your organization’s experience in utilizing and deploying Enterprise Precision Scanning and Indexing (EPSI) today and what areas within CCN could benefit the most from adopting this solution?

6. What is your organization’s current adoption rate of Fast Healthcare Interoperability Resources (FHIR) as it becomes industry standard?

7. Describe your organization’s current level of adoption of EDI X12 transaction standards, including but not limited to the following, among your business associates and providers?

· 278: Authorization and Referral Request

· 274: Healthcare Provider Information

· 275: Patient Information Attachment (Medical Documentation)

· 834: Enrollment Information What is your organization’s plan for increasing adoption of these standards among your business associates and providers? If VA were to mandate use of these standards as a condition of participation in the network how would that affect your organization’s ability to provide an adequate network of providers?

Network

8. Is there potential for organizations contracting your services to directly review and monitor electronic credentialing files such as primary source verifications for both inhouse and outsourced providers?

9. Do you have the capability to contract providers certified to conduct exams required for the purposes for certain occupational series (e.g., Department of Transportation Registries) such as, the Federal Motor Carrier Safety Administration’s National Registry of Certified Medical Examiners to provide Health Checks for Veterans who want to become Truck Drivers? If not, would you be able to build in this capability and how?

10. Do you centralize customer service platforms to route provider inquiries and complaints through a single channel? What is your operational model for ensuring providers know how to reach out and to whom? How do you ensure their issue is handled expeditiously and effectively? How would you coordinate appropriate inquiries with the VA, and what reporting mechanisms do you use to demonstrate the efficacy of your customer service program?

Training

11. What is your organization’s approach on managing VA mandated training (e.g., opioid safety) requirements for providers in your network?

· How is the training communicated to providers? What are barriers you’ve encountered that prevent providers from completing mandatory trainings within a given timeline?

· What incentives and disincentives does your organization employ to encourage compliance and how is non-compliance addressed?

Incentive/Disincentive

12. Provide recommendations on how VA should manage incentives and disincentives. Please provide examples of incentive and disincentive factors that VA should consider (e.g., network, claims payment, customer service, etc.).

Clinical

13. What telehealth and/or virtual monitoring disease management programs does your organization have to support patients with chronic conditions? What recommendations would you have for the VA if they were interested in offering such a service in the community?

Payment Accuracy

14. Describe your approach in performing post payment analytics and how those are applied to operation and continuous improvement. How would adjustments to adjudication logic, including business rule testing with VA, be handled based on post payment analytics findings by your organization or the VA. Describe any approaches you have through incentives and disincentives for payment accuracy.

15. Describe your organization’s internal controls processes and how this is used to prevent improper payments or to identify potential needs to adjust adjudication business logic.

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