DRAFT

Statement of Objectives (SOO) Project Title: VA Health Care Actuarial Support Services Customer: VHA Modeling & Forecasting, Strategic Planning Division

GENERAL INFORMATION

SET-ASIDE

OPAL | Enterprise Procurement Office

10300 Spotsylvania Ave | STE 400 Fredericksburg VA 22408-2697

POINT OF CONTACT*

Contract Specialist Shemika Wray Shemika.wray@va.gov

PLACE OF PERFORMANCE

ADDRESS

POSTAL CODE

COUNTRY

ADDITIONAL INFORMATION

AGENCY’S URL

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AGENCY CONTACT’S EMAIL ADDRESS

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DESCRIPTION

VA Health Care Actuarial Support Services

The Department of Veterans Affairs (VA) Enterprise Procurement Office (EPO) on behalf of the Veterans Health Administration (VHA), Modeling and Forecasting, Executive Office of Strategic Planning is issuing a Request For Information (RFI) and comment as a form of industry engagement to solicit industry feedback on the attached DRAFT Statement Of Objectives (SOO) for Health Care Actuarial Services. Industry feedback and comments received will contribute to the method of procurement and the final SOO issued for this requirement.

The applicable North American Industry Classification System (NAICS) code assigned to this procurement is 524298. The Product Service Code is R408.

This is a Request for Information/ Sources Sought only. This is not a Request for Quotes (RFQ), or Request for Proposal (RFP). This notice in no way represents a commitment by the Government to issue a solicitation or award a contract. Any information provided in response to this notice is solely for market research purposes nor does the Government intend to pay for any information submitted because of this request. All information received in response to this RFI that is marked proprietary will be handled accordingly.

Industry Feedback – Request for Information and Comments

The attached DRAFT SOO is provided for review and comment. Interested parties:

1. Should submit capability statement addressing the particulars of the requirement.

2. Provide your business size and type of ownership for the organization.

3. List any alternate NAICS and PSC codes that might be applicable to this requirement, and

4. Answer the questions provided and the attached excel titled, Vendor Questions.

5. Provide any comments and/or questions on the DRAFT SOO as applicable.

** Do not forward compress (zip) proposal files. zip file extensions will be permanently stripped from email traffic and will not be recoverable. **

All interested parties should submit responses/feedback NLT 2:00PM, October 21, 2026. Please send all submissions to the following POC’s:

Shemika Wray, EPO Contract Specialist Shemika.wray@va.gov

Brian Love, EPO Contracting Officer Brian.love@va.gov

Sources Sought Notice Sources Sought Notice

Sources Sought Notice

CONTENTS

1. Purpose.

a. What: The health care actuarial services contract is a mission critical need for Veterans Affairs which requires a wide range of health care actuarial expertise and experience to project Veteran enrollment, demand for VA health care, and associated costs to support the VA medical care Presidential Budget submission, strategic, capital, and workforce planning, and policy analysis. At a high level, modeling is required to project:

1) Veteran enrollment in VHA for health care,

2) their utilization of health care services, and

3) associated costs for 21 years into the future.

Models provide projections for Veterans, eligible Veterans, enrolled Veterans, patients, and additional costs for beneficiaries, including the CHAMPVA program, portions of the Program of Comprehensive Assistance for Family Caregivers, and Readjustment Counseling Service

b. Why: The Veterans Health Administration (VHA) uses actuarial projection models to understand risk and to determine and justify the resources required care for Veterans. Projection models produced under this contract allow VHA leaders to understand resources needed to provide health care to our nation’s Veterans at a detailed level. The models provide projected outputs based on the assumptions and decisions made, to help leaders understand potential impacts of system changes so that they may make informed decisions about what courses of action VHA should take. VA’s appropriated medical care budget is allocated to VA hospitals and health care settings to provide health care; analytically based cost projections directly impact how the VA system is resourced to accommodate the volume of care needed in the future, matching health care services and demand, and therefore directly impacts Veterans’ ability to receive timely health care.

c. Who: The following are the main customers of these projections and their general purposes:

Market Area Health Systems Optimization (MAHSO) VHA Support Service Center (VSSC) Health Systems Planning Application (HSPA) The projection models are a foundational part of VHA’s strategic planning processes. They project workload (utilization and RVUs) at a very detailed geographic level; VHA VISNs and facilities access this data to support planning for the needs of enrolled Veterans using the system. The projections are also part of the Strategic Capital Investment Planning (SCIP) process and have supported workforce planning activities.

Additionally, VHA DIRECTIVE 1229(1), notes the EHCPM to be used for identifying an underserved area or population in order to request a new site of care and VHA DIRECTIVE 1075, notes the EHCPM is to be used by the Strategy Office for developing and coordinating VHA's national strategic-operational planning guidance.

2. Background. Veterans Health Administration (VHA) first contracted with a provider of actuarial services and products to develop a model to project Veteran demand for VA health care following the enactment of the Veterans’ Health Care Eligibility Reform Act of 1996, Public Law 104-262. Eligibility Reform transformed the VA health care system from an episodic, inpatient care provider into a comprehensive health care provider and expanded eligibility for health care to all Veterans. To manage resources, the law required VA to implement a priority-based enrollment system and to annually assess the resources required to provide care to enrolled Veterans. Models are custom to VAs needs; requirements evolve based on the broader environment and a dynamic health care system with each year since the passage of this law and the modeling must reflect the impact of these changes.

3. Scope.

a. Model Inputs. Complex actuarial modeling is required to incorporate nearly 100 data files and information sources each year, including VHA data, VA data, organizational assumptions and input, other governmental and non-governmental data, and health care benchmark data. The Contractor will need to identify appropriate ways to work through issues that arise due to VA data system transitions and updates.

b. Model Outputs. These inputs are analyzed and about 1,000 deliverables are produced each year for stakeholders describing and quantifying the actuarial output of the model. Each year, multiple scenarios are produced to reflect new assumptions, new data, and recent experience. VHA requests multiple scenarios for the need to look at different views of the future and therefore, the modeling needs to be built at a very detailed level and account separately for all major drivers of enrollment, workload (utilization and RVUs), and cost. See the following seven tables displaying the level of detail required:

TABLE 1. Assumptions Used by Enrollment Projections

Enrollment Rates

Bands 1a1, 1a2, 1b, 2, 3, 4, 5, 6, 7a, 7c, 8a, 8b, 8c, 8d Post-9/11 Combat Veteran (CV), non- Post-9/11

CV

1) Sex

2) Economic adjustments

3) Adj for Market Saturation over time

4) Vietnam Cohort adjustment

Geographic Migration

1) Sex

2) Source Sector/VISN

Enrollee Mortality

1b, 2, 3, 4, 5, 6, 7a, 7c, 8a, 8b, 8c, 8d

Sex & Fiscal Year (mortality improvements)

Priority Level Transition

1b, 2, 3, 4, 5, 6, 7a, 7c, 8a, 8b, 8c, 8d Post-9/11 CV, non- Post-9/11

CV

1) Transitions are influenced by changing Morbidity Class

2) Economic adjustments

Morbidity Class Transition

65+ 1a1, 1a2, 1b, 2, 3, 4, 5, 6, 7a, 7c, 8a, 8b, 8c, 8d

Starting Morbidity Class (1–5)

TABLE 2. Utilization Assumptions Used by Private Sector-Based Service Projections

Benefit, Loosely Managed, Well Managed

Benefit

Benefit, Fiscal Year, Loosely Managed / Well Managed

Benefit, Fiscal Year

Benefit, Fiscal Year, Service Location

Benefit, Sex

Benefit, Birth Year Range

Benefit, Sex

Benefit, Fiscal Year, Service Location

Benefit, Fiscal Year, Service Location

Benefit, Fiscal Year, Service Location

TABLE 3. Global RVU Assumptions Used by Private Sector-Based Service Projections

Benefit, Service Location, GTRVU / GWRVU

Benefit, Sex, Service Location

Benefit

Benefit, Fiscal Year, Service Location

Benefit, Fiscal Year

Benefit, Fiscal Year, Service Location

Benefit, Fiscal Year, Service Location

Benefit, Fiscal Year, Service Location

TABLE 4. Cost Assumptions Used by Private Sector-Based Service Projections

Benefit, Fiscal Year, Service Location, Loosely Managed / Well Managed

Benefit, Fiscal Year, Service Location

Benefit, Sex, Service Location

Benefit, Fiscal Year, Service Location

Benefit, Fiscal Year, Service Location

Benefit, Fiscal Year, Service Location

TABLE 5. Utilization Assumptions Used by VA Experience-Based Service Projections

Benefit

Benefit, Fiscal Year

Benefit, Fiscal Year

Benefit, Sex

Benefit, Birth Year Range

Benefit

Benefit, Fiscal Year, Service Location

Benefit, Fiscal Year, Service Location

Benefit, Fiscal Year, Service Location

TABLE 6. Global RVU Assumptions Used by VA Experience-Based Service Projections

Benefit, Service Location, GTRVU / GWRVU

Benefit, Sex, Service Location

Benefit

Benefit, Fiscal Year

Morbidity

Benefit, Fiscal Year, Service Location

Benefit, Fiscal Year, Service Location

Benefit, Fiscal Year, Service Location

TABLE 7. Cost Assumptions Used by VA Experience-Based Service Projections

Benefit, Fiscal Year, Service Location

Benefit, Sex, Service Location

Benefit, Fiscal Year, Service Location

Benefit, Fiscal Year, Service Location

Benefit, Fiscal Year, Service Location

c. Actuarial Consulting. VHA must be able to understand, quantify, and communicate individual drivers of enrollment, health care demand, and costs at a granular level reflecting adjustments for the factors detailed above. This requirement must be produced through actuarial modeling in order to meet stakeholder needs to understand risk to the organization. Through required modeling and consulting, VHA needs to achieve the following:

i. Ability to project the enrolled population VHA must understand the Veteran population and determine those Veterans who will enroll in VHA for health care. VHA must further understand the eligibilities for enrollment (“enrollment priority”) of that population, as well as demographics (age, sex, geographic location). Then, VHA must have the ability to project this population into the future, reflecting mortality, geographic migration, and other factors.

ii. Ability to understand enrollees’ health care requirements VHA must understand the health care requirements of its enrolled Veteran population. This includes understanding their relative morbidity as compared with the general population, as well as accounting for changes in the health care environment that will impact enrollees’ use of health care (e.g., new drugs, new diagnostics). Actuarial approaches use large benchmark data sets to understand these health care requirements on a population level. Projected utilization is needed for more than 150 health care service categories.

Further, VHA provides certain services that are unavailable in the private sector (e.g., certain specialized mental health programs) or are provided in a unique way by VHA (e.g., prosthetics services). VHA must understand enrollees’ utilization patterns for these services at a granular level in order to project future use.

VHA must also be able to understand service utilization on a comparable basis across the system, including both direct care and community care. Thus, utilization metrics, such as global RVUs, are required.

iii. Ability to understand enrollees’ reliance on VHA for health care Most enrollees (80-85%) have other sources of health care, such as Medicare, TRICARE, or private sector insurance. In general, of all enrollees’ health care needs, they receive approximately 45% of it through VA, either in the direct care system or purchased for them through community care. This is known as enrollee reliance. Reliance varies considerably by demographics (e.g., enrollment priority and age) as well as by service category (e.g., pharmacy or inpatient care), and changes over time. Actuarial modeling must account for these reliance factors, which are analyzed by using a CMS data match (coordinated through VHA’s Medicare and Medicaid Analysis Center (MAC)), VHA’s Survey of Enrollees, and actuarial approaches such as regression analyses.

iv. Ability to project costs to meet enrollees’ health care requirements VHA must also project the costs of providing the health care enrollees are projected to receive through VA. VA needs to understand the cost of VA direct care, including overhead and personnel costs, as well as the costs of purchasing care in the community, at Medicare and other payment schedule rates.

Additionally, VA must understand health care trends impacting these costs into the future. These include inflation trends (both on goods and service as well as federal wage rates), utilization trends (increases in health care utilization due to changes in health care practice), and intensity trends (more expensive drugs, diagnostics, etc.). These trends, which impact all health care systems, must be adjusted to reflect the unique VA system and enrollee population. Further, cost projections must be provided at a detailed level, enabling internal and external stakeholders to identify specific drivers of cost changes from year to year, or between different modeled scenarios.

v. Ability to understand the VHA health care system and unique considerations VHA is an idiosyncratic health care system in the United States, with no equivalent. It has an enrollee population with unique demographic characteristics (predominately male, more than half 65 or older, more than half with service-connected health conditions) and unique health care needs (specialized mental health, prosthetics, and other services). VA must understand the nuances of this population, and the way these factors overlap and intersect.

Further, as a Federal system, VHA is subject to congressional oversight, legislation with specific directives for the agency, and requirements for full transparency. VA must be able to respond to system changes (e.g., changing access standards for community care) and provide stakeholders with detailed information about the impact of those changes.

4. Period and place of performance: The period of performance shall be a twelve (12) month base period and four (4) twelve (12) month option periods.

5. Performance objectives, i.e., required results.

a. Program Management. VA requires project management planning activities and materials, regular weekly meetings to ensure contract performance and define objectives, documentation of quality assurance processes, and documentation of key decisions made when developing the EHCPM, the rationale for decisions, and tracking of required deliverables for each scenario.

b. Maintain, Enhance, Validate, and Annually Update the Enrollee Health Care Projection Model (EHCPM). VA requires the EHCPM to be annually updated. The model validation is to analyze the predictive power of the EHCPM at a very detailed level and provide recommendations for future model enhancements based on this analysis. The annual model will evolve with each update using new data from the most recently completed fiscal year and other newly available data shall build on the enhancements to the prior EHCPM to more accurately support integrating new or updated projections, assumptions, and attain enhanced methodologies. The contractor shall provide documentation which identifies the data, assumptions, and methods used with sufficient clarity that another actuary qualified in the same practice area could evaluate the reasonableness of the actuary’s work.

c. EHCPM Health Care Actuarial Analysis and Modeling. VA requires the ability to reflect the impact of an evolving VA health care system and the broader environment, proposed policies, regulations, and legislation within enrollment, utilization, and cost projections.

d. Projections for Strategic, Capital, and Workforce Planning. The actuarial projections are integrated into many system-wide processes that enable VA to address the strategic, capital, workforce, and resource requirements needed to meet the projected demand for VA health care. VA requires projections for market-based planning to address gaps between current capacity and projected utilization growth or decline; to support decisions about what services to provide in VA facilities and/or purchase in the community; for facility footprint planning; to assess access, capacity, productivity, and staffing requirements; and to inform VA’s Strategic Environmental Assessment.

e. Trainings and Briefing Materials. VA requires trainings, which are an essential part of quality assurance and performance improvement for VA and its stakeholders. Understanding the projections is paramount for VA and stakeholders to increase transparency.

i. The Contractor develops trainings, briefings, and briefing materials for VA staff to increase the transparency of the EHCPM and additional actuarial models for stakeholders and oversight entities. prepare VA staff to conduct the trainings/briefings and respond to technical questions on the models.

ii. The Contractor provides trainings and materials designed to prepare VA staff to discuss the analyses and methodology supporting the updated models and the impact of the updates on the projections with stakeholders. Examples of types and number of annual trainings vary based on need but may the following is an estimate:

f. Transparency Tools, Exhibits, and Reporting. VA requires the development of educational tools to increase the transparency of the projection models. These include tools that organize data in usable formats for programs or planners; tools that separately quantify the key drivers of changes in the enrollment, utilization, and cost projections over time; and tools that explain why the projections change from one version of a model to the next. Tools may be required at varying levels of demographic and geographic detail. Tools, exhibits and reporting may be required by stakeholders external to the VA. Required reports and documentation will evolve with each annual update and based on individual requests.

g. Additional Actuarial Models. VA requires actuarial analysis and modeling services to produce methodology, assumptions, and projections for models outside the EHCPM. The methodology, analyses, and assumptions will evolve with each annual model update to meet stakeholder needs. The models include:

i. The Civilian Health and Medical Program of the Department of Veterans’ Affairs (CHAMPVA) Projection Model

ii. The Program of Comprehensive Assistance for Family Caregivers (PCAFC) Projection Model

iii. Cost projections to support the provision of Newborn Care Services

iv. Cost projections to support the provision of Fertility Services to spouses of eligible Veterans

v. Cost projections for non-enrolled OTH Veterans to receive select mental health care and related services

vi. Projections of a total number of users across all Mental Health Residential Rehab Treatment Program Diagnosis and Demographic-Based Demand (MH RRTP) treating specialties

vii. Readjustment Counseling Service (RCS) Projection Model

h. VA Projection Requirements in Law. Within the objectives a through g, the Strategic Planning Division’s (SPD) actuarial contractor supports the following requirements which are imposed on the VA programs:

i. 38 CFR 17.36(c) Enrollment—provision of hospital and outpatient care to veterans – Requires VA Secretary to determine categories of Veterans eligible to be enrolled each year, considering factors including projections of demand for enrollment.

ii. 38 U.S.C. § 117(b) and (d), Advance appropriations for certain accounts – The VA Secretary will submit detailed estimates of the funds necessary, in support of the President’s budget, for the fiscal year following the fiscal year for which the budget is submitted. The Secretary is required to annually report to Congress on the sufficiency of the Department’s resources for the provision of Medical Care, including estimates of the workload and demand data for that fiscal year.

iii. 31 U.S.C. § 1105 (a) (5), Budget contents and submission to Congress – The President shall submit a budget of the United States Government for the following fiscal year, including in each budget, estimated expenditures and proposed appropriations the President decides are necessary to support the Government in the fiscal year for which the budget is submitted and the 4 fiscal years after that year.

iv. 38 U.S.C. § 7309(e), Readjustment Counseling Service (Hannon Act of 2019) – Expanded reporting requirements on the Readjustment Counseling Service, requiring the VA Secretary to assess resource requirements and predict demand for Vet Centers, community access points, and mobile Vet Centers.

ii. 2 U.S.C § 1532, and 5 U.S. C. § 553, Regulatory Impact Analyses – Requires Federal agencies, when issuing proposed rulemaking to provide a qualitative and quantitative assessment of the anticipated costs and benefits of the Federal mandate.

iii. 38 U.S.C. § 7330C(a), Quadrennial Veterans Health Administration review (VA MISSION Act of 2018) – The VA must conduct a quadrennial market area assessment regarding VHA health care services. Such assessment must consider the demand for VA health care.

iv. 38 U.S.C. 8104, Congressional approval of certain medical facility acquisitions – The VA Secretary must submit to Congress a request for the funding of a major medical facility project a prospectus of the proposed medical facility that includes: 1) demographic data, 2) current and projected workload and utilization data, and 3) projected operating costs of the facility

v. 38 U.S.C. §1704A, Independent assessments of health care delivery systems and management processes (Cleland-Dole Act of 2022) – Requires VA, not less frequently than once every 10 years, to enter one or more contracts with a private sector entity or entities to conduct an independent assessment of the hospital care, medical services, and other health care furnished by the VA. Each assessment shall address related items including the reliability and accuracy of models and forecasting methods.

vi. 38 U.S. Code §8134, General regulations – The Secretary shall prescribe for each State the number of nursing home and domiciliary beds for which assistance under this subchapter may be furnished. Such regulations shall be based on projected demand for such care 10 years after the date of the enactment of the Veterans Millennium Health Care and Benefits Act by veterans who at such time are 65 years of age or older and who reside in that State. In determining such projected demand, the Secretary shall take into account travel distances for veterans and their families.

6. Operating constraints.

a. The requirements met by this contract can only be produced through actuarial modeling. Actuarial science is a specialized field requiring highly trained and certified actuaries as well as access to large health care benchmark data sets; The firm must possess the capacity to flexibly allocate workforce resources to reflect cyclical work cycles and fast turnaround requests, including providing:

i. 35,000-40,000 consulting hours per year

ii. Surge support to cover monthly consulting hour requirements ranging from 1,500 to 3,500 per month

iii. Availability for consultation 8 a.m. to 5 p.m., ET, M-F

iv. Services on a nation-wide basis

v. On-site support in Washington, D.C., estimated at six trips per year

vi. Must meet citizenship, background investigation, and security clearance requirements to ensure full compliance with federal regulations

b. Timeline. In addition to the timelines of over 1,000 deliverables produced annually, the actuarial firm must be able to produce updated cost models in June based on the Budget and Advance Appropriation Timeline (see Figures 1 and 2 below) and updated strategic planning models in August for the VA Strategic Capital Investment Plan (SCIP) submission to support proposed new sites of care.

(Source: CRS Report R48968: VA FY2026 Appropriations)

c. Key personnel.

i. Describe the experience, certifications, and qualifications of the positions listed proposed. The contract program manager is expected to be at a minimum an Associate of the Society of Actuaries (ASA) and the Tenured Principal Actuaries, Principal Actuaries, and Actuary II labor categories are expected to be at a minimum, Fellows of the Society of Actuaries (FSA), and shall have health care actuarial subject matter expertise. Additional expertise required includes SAS and SQL, project management and quality control.

ii. Have a minimum of five (5) years of relevant health care actuarial experience required for key personnel.

iii. Notify the COR/CO at least 30 days prior to voluntarily diverting any of the specified individuals to other programs or contracts. the Contractor submit a justification for the diversion or replacement and a request to replace the individual. The request must identify the proposed replacement and provide an explanation of how the replacement's skills, experience, and credentials meet or exceed the requirements of the contract.

d. Benchmark Data. Describe in detail the methodology and benchmarks that will be utilized/incorporated in private sector-based utilization projections to meet the requirements. Describe how the benchmarks were developed, the number of covered lives represented in the benchmarks, provide a detailed definition of each benchmarked service, and describe the methodology for adjusting the benchmarks due to the impact for age, gender, geographic location, morbidity, other relevant factors; or similar factors related to these specified.

See attached document: Questions to Vendors - 36C10G27Q0001.

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