36C10X18Q0171-0001000.docx

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(Signature of person authorized to sign) (Signature of Contracting Officer) 06-14-2018 N/A Strategic Acquisition Center - Frederick Department of Veterans Affairs 321 Ballenger Center Drive, Suite 125 Frederick

MD

21703 Strategic Acquisition Center - Frederick Department of Veterans Affairs 321 Ballenger Center Drive, Suite 125 Frederick

MD

21703 To all Offerors/Bidders

36C10X18Q0171 06-01-2018

X X The purpose of this amendment is to:

1) Amendment 00001 will be issued to provide responses to questions received in response to the solicitation.

2) There are changes to the solicitation, see revised RFQ attached.

Questions on RFQ 36C10X18Q0171

1. RFP, Section 4.1, page 9 The performance period is identified as 20 months comprised of one base and four option periods (each four months); however, the Tasks detailed in subsequent sections only represent 16 months (through Task 5.7). Should there be Task 5.8 which represents the spread to the remaining VISNs and remaining deep dives. For example, during 5.7, four VISNs will be addressed with 10 deep dives and for a new “5.8”, the remaining four VISNs will be addressed with the last 10 deep dives being completed by the contractor? Please confirm the deliverables and scope for 5.7 and the last option period which is not currently documented. Please clarify the VISN spread approach for each of the last two options relative to how many VISNs will be addressed by the government during each period.

RESPONSE: The period of performance is revised to 16 months, see PWS for details. Base = 4 months, options = 4 months X 3 (5.5. 5.6 & 5.7) = 12 months. The total should be 16 months. NOTE: the optional tasks/CLINs can be exercised at any time during the 16 months. The period of performance will be further defined each time a CLIN is exercised.

2. RFP, Section 5.4, page 14 “Additionally, during the implementation phase, feedback from the units regarding the monitoring of performance on the pillars of excellence will be collected and evaluated to use in the development of dashboards that may be used or adapted at the service level for improved alignment of daily work with organizational outcomes.”

What is the definition of a “unit” and how does it relate to the “Service” level?

RESPONSE: A unit is a medical ward, surgical ward or team that provides healthcare. There may be multiple units or wards, that make up the medicine service.

3. RFP, Section 5.5, page 15 Will the Government perform the gap assessment at all VAMCs within all six VISNs for Option 1 - 4? Will the Contractor repeat the assessment at a selected sample of VAMCs or review assessment results and supporting evidence provided by the Government for Option 1? By when will the Government complete its assessments? What is the number of assessments expected in the sample?

RESPONSE: This PWS is set up to increase the responsibility of the government to build sustainment. In 5.5 the government will use the tool developed during the base period to conduct a gap assessment. The contractor will use the same tool on a sample from what the government uses so that we can ensure that the government is using the tool as designed and getting the same results. The tool will be used in all sites where spread is going to occur, up to 6 VISNs but the number of sites has yet to be determined. As the total # of sites has yet to be determined, the sample size would be dependent upon that. Progress in the base period, organizational change, modernization and other factors may influence the rate of spread to other VISNS. The government will complete the assessments within 30 days for the gap assessment, using the same time frame from the base period. For planning purposes, please consider that the maximum number of VISNs (6) will be involved with the spread during the option periods.

4. RFP, Section 5.6, page 15 Please clarify / specify when the contractor will be provided the results of the self-assessments by the participating sites in order to understand when the contractor will be able to compile the change management plan (Deliverable A).

RESPONSE: Using the dates from the base period, the government will have the gap assessments completed within 30 days or sooner. Ideally, the government may use the tool from the base period prior to exercising an option, to help determine the number of sites and the grouping of sites to support logical and optimal spread.

5. RFP, Section 5.7, page 16 What is the Contractor’s scope relative to Deliverable F? For example, will the Contractor be responsible for developing an initial draft in partnership with the VA? Will the VA be the co-author or primary author on the article? Will the VA be responsible for journal selection, review coordination activities and submission?

RESPONSE: The contractor/vendor will collaborate with VA designated subject matter experts to develop and submit an abstract providing project summary to include outcomes, acceptable for publication in a peer reviewed journal.

6. RFP, Section 6.0, Delivery Schedule, page 16 For the second paragraph, should “Days” be defined as calendar days instead of business days?

RESPONSE: The PWS has been revised to state that the days are calendar days.

7. RFP, Section 6.0, pages 17 – 18 What was the approach for defining the quantities for the following deliverables - 5.5 C, 5.5 D, 5.5 E, 5.5 F, 5.6 B-E, 5.7 A, D and the last currently undefined option period? For example, for 5.5 C, does 10 imply 10 training sessions and does 20, in 5.5 D imply 20 hours? Further, does 12 for 5.5 F, imply 12 distinct practice sessions across all six VISNs and national oversight groups? What is the expected duration of such practice sessions? Finally, should it be assumed based on the current allocation of units in the PWS and responses provided for Task 5.5 deliverables that the same units will apply for subsequent Tasks?

RESPONSE: The Price schedule has been revised to reflect the unit as EA. This is to be priced per item and the quantity will be exercised as needed. This provides the flexibility to maximize participation around clinicians’ schedules and to keep virtual class sizes manageable for the vendor, to encourage participation rather than passive training.

8. RFQ, Section 6.0, page 18 Should 5.1 B and 5.1 C be added to option periods 2 - 4 with also the addition of a 5.8 section to map to the quantities stated on page 25?

RESPONSE: These items are already included in the Price schedule as CLINs 1001 and 1002. See price schedule for revised quantities.

9. RFQ, Section 6.0, Delivery Schedule, page 19 For the last paragraph in Section 6.0, is the Draft deliverable due on the due date stated in the delivery schedule table or the Final deliverable?

RESPONSE: The final deliverable is due on the due date as indicated in the PWS, section 6 delivery schedule.

10. RFP, p Section E.1.2, page 49 and pages 53-54, Volume II - Factor 2 Performance Risk Page 49 states the prime contractor past performance (PP) is more important than the subcontractor; however, page 53 states that major subcontractors may also submit past performances as long as they will execute 20% of the total contract effort. How will subcontractor past performances be evaluated relative to importance and impact for performance risk?

RESPONSE: The balance between the prime contractor and the subcontractor to meet the performance work requirements will be evaluated. A standard source selection process will be used to evaluate previous success in meeting the identified deliverables.

11. On RFP, Section “Quote Submission”, pages 52 – 54 Please clarify the number of contracts that should be submitted for Volume II: Performance Risk as well as the number of PPQs

p. 52: “The offeror shall submit a list of the last three contracts completed during the past five years or currently being performed that are similar to the solicitation size, scope and complexity”

p. 53: “The offeror may submit a maximum of three Past Performance Questionnaires (PPQs)” p.54: “The Government will accept only one completed PPQ per reference and a maximum of five completed PPQs” RESPONSE: Three, See revised RFQ for details.

12. General For the purposes of facilitating the virtual training and coaching environment, may the Contractor assume the ability to leverage the VA’s Learning Management System for user access, tracking and storage of training materials and recorded sessions?

RESPONSE: Yes, if it is 508 compliant we can house the content on the VHA LMS platform.

13. General Given the level of virtual implementation and intensity of knowledge transfer, what is the projected level of effort for VHA resources which will be dedicated during each base and option period from each VAMC, VISN, and from VHA, VACO and the other national oversight committees? Will a program coordinator, logistics and data extraction support resource(s) be dedicated from each VAMC? Will each VISN dedicate a resource for coordination? Please specify the VA FTEs anticipated for each period.

RESPONSE: The PWS does include travel allocation to support the virtual training. VA will have leadership support at each facility and VISN as part of determining the spread across the organization. Additionally, we will ensure that a minimum of 1 POC for each facility and VISN is identified. An overarching governing body made up of leadership from facility, VISN and national will stay engaged throughout the process to address participation in activities associated. Governance spread is part of VHA strategic plan.

14. General Can a certified SDVOSB partner with a large business and still have their proposal evaluated in the SDVOSB tier? The SDVOSB will assume 51% of the workshare and the large business will assume 49%. The SDVOSB will be the prime contractor.

RESPONSE: Yes, as long as the company is VIP verified on (VetBiz.gov).

15. General Is an incumbent contractor? If so, could you please provide the current or previous contract number? Or is this a new requirement for the government?

Does the Combined Synopsis/Solicitation posted as solicitation number 36C10X18Q0171 on FBO contain requirements similar to a existing contract or will this be a new requirement?

RESPONSE: Although these is not a current contract, the previous support was received under the Federally Funded Research Development Center (FFRDC) contract # VA118A-15-D-0004, MITRE.

16. General Based on the RFP requirements, the pool of small businesses that can fit the criteria to prime this effort is exceedingly small. To qualify for Tier One it requires and/or significantly advantages a business to: be SDVOSB, and qualify for the $15M size standard, and have prior quals/experience in HRO Governance using the Fractal Model (since quals/experience of prime are significantly more heavily weighted). This severely restricts the number of small businesses who can compete for this effort and the government would benefit from greater competition. Would the government explain:

a) why these 3 criteria were used in combination: and

b) whether the government will consider allowing the quals and experience of subcontractors to be equally weighted with those of the prime?

RESPONSE: The solicitation was issued under NAICS 541611, SBA considers the size standard for such NAICS $15M.

17. General The Utilization of NAICS 541612 and the $15M size standard represents a significant risk to the Government. This effort anticipates an enterprise-wide deployment which represents a large and complex effort. It would be very difficult for a small business of the size standard to reliably and consistently execute 51% of the effort, which adds performance, cost and schedule risks for the Government. Would the government please explain:

a) the rationale for the NAICS and size standard utilized for this requirement; and

b) whether the government will consider adjusting the NAICS code to one which more accurately fits the scope of work and has a higher size standard?

RESPONSE: RFI responses as well as market research performed indicated that the NAICS 541611 was appropriate for this requirement.

18. General Would the incumbent who executed the pilot have a Conflict of Interest based on the principles of FAR 9.5 due to their involvement in the development of the proof of concept? If not, can the Government explain how risks of Conflict of Interest were mitigated?

RESPONSE: The previous contract was through an FFRDC. If an Organizational Conflict of Interest (OCI) should occur, a mitigation plan shall be submitted with the quote.

19. General This procurement’s focus on a Fractal governance model seems excessively restrictive and aimed at a particular offeror, Johns Hopkins Armstrong Institute, which has branded their quality and safety governance structure as “Fractal.” This approach limits competition and precludes the government from evaluating a broader set of solutions which may represent equally or more valid and relevant approaches. These include governance models adopted by a greater range of large-scale integrated health systems some of which have significantly more evidence of having positively impacting quality and safety outcomes. Failure to allow the evaluation of these models limits competition and value to the government, and further disadvantages the government and the Veterans it serves. Can the Government explain:

a) how the Fractal model became the only governance solution determined to meet the requirements;

b) whether a requirements decision document was developed by the Government that substantiates why the Fractal model was chosen,

c) and if so, would you release this information to allow industry to better understand the Governments position?

d) whether the Government would consider an industry day or other means by which the Government can better convey to industry the goals and objectives of this procurement.

RESPONSE: In 2017, the government convened facility, VISN and national stakeholders to co-design a governance model to address findings and recommendations from the OIG and GAO for oversight and accountability. The team looked at a variety of high reliability resources. Through this iterative process, the team identified the fractal model as having strong accountability structures, front line focus on improvement across both quality and safety domains, and an enterprise risk based approach that aligned with other modernization activities occurring in the organization. An FFRDC was utilized to implement the proof of concept and the PWS is revised to state fractal model or comparable.

20. General The publication requirement in Section 6.2 is particularly problematic because it suggests the only successful bidder must have published on the Fractal Approach. In section 3.0, “Scope of Work” on page 8 of 74, the PWS cites the Fractal Model as a well published approach. In section 6.2 it says publications will be reviewed for alignment with PWS goals for shared governance, accountability, and improvement in areas of quality, safety and satisfaction. This implies that the publications should reflect the goal of using the Fractal model. We believe this further restricts competition not just to those who have used the Fractal model but those who have published on it, and we don’t believe these publications are critical to being able to successfully support the scope of work. Can the government explain why it has included this requirement?

RESPONSE: Section 6.2 states the “some of the key personnel, should be doctorly prepared clinicians with experience in research, quality governance, quality improvement and/or implementation science. They should be considered experts in the field with publications from academic or industry regarded peer reviewed journal publications.” The expertise is quality governance and not fractal governance. Furthermore, the publications are being reviewed for “shared governance, accountability, and improvement in areas of quality, safety and satisfaction” not fractal model.

21. General Section 1 of the PWS includes the following objective: “To achieve this vision, VHA is spearheading transformative efforts to operate as a High Reliability Organization (HRO), which involves creating a healthcare environment that focuses on continuous quality improvement where every patient experiences safe, high-quality, efficient and timely care.” However, the performance evaluation criteria (Section 7.0, page 20, “Evaluation”) do not include reporting on improvement in safety or quality outcome measures, that will enable the government to monitor and assess whether safety and clinical outcomes for veterans have been improved. This is particularly concerning because it will be difficult to otherwise know whether the Fractal model has or can be successfully adapted to a government health care system. We recommend that this procurement put a premium on demonstrating improving quality and safety outcomes in adapting HRO governance in a government provider system. Can the government explain why it has not taken that approach to selecting a methodology and then measuring that methodology’s success based on achieved improvements in safety and quality outcomes, e.g. in successful reduction of adverse events?

RESPONSE: The government is placing a significant amount of attention to establishing a solid foundation for governance. This includes building the structure, team and culture during an aggressive and short-period. The tools and processes will ultimately help to support organizational outcomes. The approach focusing on structure, process and culture will afford us better sustainment.

22. General Given the challenges of implementing a successful HRO governance structure and operating model, particularly in the government setting, past performance criteria should have included the direction that offerors demonstrate:

- Experience of successfully implementing an HRO governance structure, operating model and culture change in large complex Government healthcare system;

- Experience of improving quality and safety after implementing an HRO governance structure, operating model, and culture in a large complex government health care system.

- Experience integrating HRO governance implementation within broader enterprise-wide health system transformation efforts

- The ability to coordinate enterprise wide HRO implementation with enterprise wide Electronic Health Records implementation Can the government explain why these or other past performance criteria were not included in this procurement?

RESPONSE: The government realizes that a successful HRO is not going to occur in 16 months. The PWS was established to help us build a foundation of structure, processes and culture of assessment and improvement that the Government will own and operate thereafter.

25. General The set aside states total small business. My concern is the advantages of a VOSB with this solicitation. Will a VOSB with a total small business take precedence over other set asides, via WOSB, EDWOSB. Or is there no relevance, it’s just a total small business solicitation?

RESPONSE: The responses will be evaluated in the following tiers:

Tier 1 - Service-Disabled Veteran-Owned Small Business (SDVOSB) Concerns Tier 2 - Veteran-Owned Small Business (VOSB) Concerns Tier 3 - Small Business (SB) Concerns with HUBZone Small Business Concerns and 8(A) Participants Having Priority

26. RFQ, E.1

I understand that a JV entity, so long as it is VA CVE-verified as a SDVOSB, will be evaluated under Tier 1. Outside of a JV arrangement, do the prime contractor and subcontractor for non-JV teams both have to be VA CVE-verified as SDVOSBs in order to be evaluation under Tier 1?

RESPONSE: Only the prime will need to be SDVOSB verified in order to be evaluated in Tier 1.

27. RFQ, 4.2 (“The primary places of performance for the base period will be in VISN 10, mid-west area.”) and 4.3 Will the personnel supporting this effort be required to be on-site at VISN 10 full-time during this effort or will non-mid-west consulting teams be able to work with VISN 10 remotely and the program office in Washington D.C. in-person, supplementing this with visits to VISN 10 as cov-ered under the “Travel” listed under section 4.3 in the “Base Travel Estimate” table?

RESPONSE: The contractor shall perform efforts under the PWS primarily at contractor facilities and at Government site(s) as directed by the Government. The primary places of performance for the base period will be in VISN 10, mid-west area. Optional periods will involve scale and spread for Enterprise-wide implementation.

28. RFQ, PWS 8.0

Can one “Subject Matter Expert” cover for more than one SME category? For example: could one person cover for “SME for Clinical Governance Development and Over-sight” as well as “SME for Clinical Quality Oversight De-velopment” assuming their qualifications are sufficient to meet the requirements of both categories?

RESPONSE: Yes.

29. General How will the fractal governance/HRO effort integrate with other VA/VHA Modernization efforts?

RESPONSE: The work is creating a foundation of employee engagement and accountability at all levels. This foundation of structure, processes and culture will optimize the ability of the facilities to respond to any changes that may come from modernization, regulatory or other efforts.

30. General In accordance with FAR Subparts 5.1 and 12.6 and when using the combined synopsis/solicitation procedure, the synopsis must include a statement ‘…that all responsible sources may submit a response which, if timely received, must be considered by the agency.’ Given this, how does the VA intend to demonstrate that small businesses from Tiers 2 and 3 were ‘considered’ in the event the VA awards to a SDVOSB from Tier 1?

RESPONSE: Once the quote is received and a delivery receipt is requested, we will respond accordingly. Additionally, as each tier is evaluated, the unsuccessful offerors will be notified.

31. General Given the nature of the tiered evaluation and the number of required SMEs and in the interest of competition, would the Government allow a small business to participate in a response under one tier as a subcontractor and submit another response as a prime subcontractor in another tier for which they qualify?

RESPONSE: Yes, this is the contractor’s business decision.

32. RFQ, 4.2 Scope of Work, pg. 8 Can the Government make the identified “proof of concept strategy” available for review as part of this solicitation process in order for responders to more accurately understand the starting point of this effort and price this scope of work accordingly?

RESPONSE: The VA does not plan to follow the exact direction of the pilot thus any proof of concept or strategy does not yet exist.

33. RFQ, 4.2 Place of Performance, pg. 9 Per the PWS language, “Optional periods will involve scale and spread for Enterprise-wide implementation,” is the overall expected implementation timeline for all VISNs 20 months from the contract start date?

RESPONSE: It is possible that the options will spread to all VISNs during the period of performance, but if during an option period 6 VISNs are not chosen, the following option will still not exceed 6 VISNs in total. The government will be responsible for addressing the gaps in spread following the end of performance.

34. RFQ, 4.2 Place of Performance, pg. 9:

If replication is not performed at all sites (considering implementation is decided in 4 month option periods), what will happen to the fractal governance model?

RESPONSE: The intent is to spread to all sites, but the government is maintaining flexibility to change the pace and approach based on the current environment at the time.

35. RFQ, 4.3 Travel, pg. 9 A Base Travel Estimate is given for the number of trips, length of each trip and number of staff traveling per trip. However, there is no indication of a budget estimate for the estimated travel in B.4 Price Schedule. Will the Government be providing the estimated not to exceed budget for Travel in both the Base and Option Periods?

RESPONSE: Travel and per diem, if required, shall be reimbursed in accordance with FAR 31.205-46, Travel costs. Each contractor invoice must include copies of all receipts that support the travel costs claimed in the invoice.

36. General Due the challenge (and influx) of change management at VA/VHA, how and to whom has this effort been socialized in preparation for this effort?

RESPONSE: Feedback from the proof of concept was shared with VA and VHA leadership.

37. RFQ, 8.0 Key Personnel, pg 21 Is it possible for one resource identified and proposed as a SME to play multiple requested SME roles if the resource meets the requested criteria and if applicable? Or is it the Government’s request to have each identified Key Personnel staffed by separate individuals?

RESPONSE: Yes, one person can provide expertise in multiple areas.

38. RFQ, 8.0 Key Personnel, pg. 21 Are the general preferences for key personnel listed in order of priority/preference for the contract award?

RESPONSE: No.

39. RFQ 6.2 General personnel requirements, pg. 23 Can the Government provide clarification as to which Key Personnel roles specifically need to have which of the identified required criteria?

· Among some of the key personnel, should be doctorly prepared clinicians with experience in research, quality governance, quality improvement and/or implementation science. They should be considered experts in the field with publications from academic or industry regarded peer reviewed journal publications. Publications will be reviewed for alignment with PWS goals for shared governance, accountability, and improvement in areas of quality, safety and satisfaction. Note* Blogs, brochures and marketing materials and non-peer reviewed publications will not be reviewed in lieu of manuscripts that have been through a rigorous peer reviewed process.

· Some of the key personnel should be subject matter experts and clinicians with past experiences in the implementation and integration of high reliability organization (HRO) practices and processes throughout the healthcare delivery system.

· Some of the key personnel should be subject matter experts in the application of the Three Lines of Defense into governance structures. This would include examples of how they developed internal auditing capability for front line staff and leadership to monitor healthcare delivery across quality, safety and satisfaction domains, as well as how auditing and 2nd and 3rd line of defense functions are incorporated into the governance processes.

RESPONSE: The general requirements of key personnel are not attributed to a singular individual. The vendor may identify additional key personnel experts that the government didn’t consider. Any of your key individuals on your team that brings the breadth and experience of research and publication would be acceptable.

40. RFQ, 6.2 General personnel requirements, pg. 23 “They should be considered experts in the field with publications from academic or industry regarded peer reviewed journal publications”.

15.a. What is the government’s justification for requiring academic or peer-reviewed publications as a criteria for these key personnel?

15.b. Are key personnel required to have academic appointments. Can past consulting advisory services or government experience be substituted for this requirement?

RESPONSE: No, key personnel are not required to have academic appointments. VHA employs many clinicians with academic appointments and we strive to use evidence based practice in our care of patients. This clinical population is a critical stakeholder in our governance implementation and this optional task resonates with their background, experiences and expectations.

41. RFQ, 2. Performance Risk, pg.49 The paragraph states, “Projects performed by contractors other than the quoter, such as subcontractors, will not be evaluated as prime contractor experience or past performance, unless those other contractors are part of a joint venture quoter as demonstrated by a signed joint venture agreement.”

However, 2. Volume II – Factor 2: Performance Risk, pg. 52 states, “Offerors may also submit past performance information regarding predecessor companies, key personnel who have relevant experience or subcontractors that will perform major or critical aspects of the requirement when such information is relevant to the acquisition. For the purposes of this solicitation, a major subcontract is defined as 20% of the total contract effort. Data concerning the prime contractor shall be provided first, followed by each proposed major subcontractor, in alphabetical order.”

Can the Government clarify as to whether the Prime contractor is able to submit Past Performance of proposed team Subcontractors for evaluation and what the parameters are in order for the Past Performance to qualify for the Performance Risk factor?

RESPONSE: The Performance Risk evaluation will only consider references which are timely, defined as services performed within the last five (5) years, and relevant, defined as services which, when considered as a whole, are similar in size, scope and/or complexity. The Government will consider experience and past performance for the proposed prime contractor to be significantly more important than experience and past performance submitted for any other member of the vendor structure. For the purposes of evaluating prime contractor experience and past performance, the prime contractor is defined as the contractor identified in Block 17a of the SF 1449. Projects performed by contractors other than the quoter, such as subcontractors, will not be evaluated as prime contractor experience or past performance, unless those other contractors are part of a joint venture quoter as demonstrated by a signed joint venture agreement. For past performance which is timely and relevant.

42. RFQ, Page 13 in Section 5.2 Deliverables C. Report on clinician time utilization (Due 90 days post award).

a. Is there an existing database (primary data) of clinician time available for analyzing utilization? If so, please describe the database and the desired outcome of analyzing this data set. If not, does the Government expect the contractor to collect data (secondary data) for analysis during the gap assessment?

b. If the latter (i.e. contractor must collect secondary data), please describe the breadth of the data collection requirements such as number clinicians, types of clinicians, number of facilities, quantitative or qualitative data, etc.

RESPONSE: This refers to clinician time in performance improvement, not in providing patient care. This assessment will look at governance structures, such as committee reporting structures to identify duplication and redundancies that might decrease clinician time of administrative burden.

43. RFQ, Page 7 in Section 1.0 Background "To begin the HRO journey, the VHA implemented a proof of concept, new clinical quality, safety and value oriented governance structure leveraging high reliability principles and cascading accountability structures to support and enable care teams at every level of the organization. Research, academic and healthcare contract support were utilized to co-design a governance structure based on previous published fractal models."

a. Can the Government provide a final report from the proof of concept project?

b. If a final report is not available, could the Government provide a copy of the design plan from the proof of concept project?

c. Could the Government also provide detailed agendas and/or course outlines of all training sessions conducted during the proof of concept project?

d. Can the Government provide copies of existing dashboards from the proof of concept project?

RESPONSE: The VA does not plan to follow the exact direction of the pilot thus any proof of concept or strategy does not yet exist.

44. RFQ, Page 22 in Section 8.0 Key Personnel:

D. SME for Patient Safety Oversight Development, "...Key Role 4 with an experienced clinical expert (MD, RN, SW, Pharm D, etc.)..."

a. Can the Government please spell out the meaning of "SW" clinical qualification? Does it mean Social Worker?

RESPONSE: Yes, MD is Medical Doctor (OD is osteopathic doctor and even though not identified, would be acceptable) RN is Registered Nurse, SW is Social Worker, PharmD is a pharmacist. Clinical experts could be anyone licensed to provide healthcare support in a healthcare environment.

45. RFQ, Page 53-54. Section IV - Past Performance Questionnaires (PPQs)

1) The first line states "the offeror may submit a maximum of three PPQs" but later in the paragraph it states "the Government will accept only one completed PPQ per reference and a maximum of five completed PPQs".

a. Would the Government please clarify the number of PPQs allowed to be submitted?

RESPONSE: Three references and one PPQ per reference are allotted.

46. RFQ, Page 51 Section E.1 Instructions to Offerors QUOTE FILES a) "Page number, company logos, and headers and footers shall be within the page margins only and are not bound by the 12-point font requirement."

a. Does this mean that the page number, company logo, header and footers do not fall under the 1" page margin restriction (i.e., they can be closer to the edge of the page than 1")?

RESPONSE: The PWS is revised to show 3 PPQs.

47. RFQ, On Page SF 1449, referencing due date 02 July

a. Would the Government approve a two-week extension for the due date based on the scale of the programming, the complexity of the work breakdown, and to allow small businesses to improve the quality of their response once vendor questions have been answered by the Government?

RESPONSE: No

48. RFQ On page 23, sub section J. Consultants This SME..." has no other words after this statement.

a. Can the Government complete that sentence if other content inadvertently was omitted?

RESPONSE: “This SME” has been removed from the document.

49. RFQ, In sections 5.3, 5.5, and 5.6 The Government refers to “virtual training for unit-based teams.”

a. Is there an existing virtual training for unit-based teams program available from the proof of concept project? If so, please describe the training contents in detail. If there is existing virtual training for unit-based teams, will the Government make the existing training content available to the new Contractor upon award?

b. Can the Government provide examples of acceptable “virtual training”?

c. Does the Government’s definition of virtual training include asynchronous online learning?

d. If asynchronous online learning for unit-based teams is acceptable virtual training for unit-based teams, will the Government host the online learning content on a Government learning management system (LMS)? If so, please provide more information about the specifications and requirements of the Government LMS.

e. Can the Government provide more detailed information about the unit-based virtual training audience (physicians, nurses, lab, anesthesia, administrators, managers, etc.)? On average, how many learners are expected to attend training from each unit?

f. Does the Government have an expectation of the contractor to provide contact hours (CE credit) for the virtual training for unit-based teams?

g. How much virtual training time will be made available for unit-based teams (i.e. the number of training hours available for each member of the unit-based team to participate in virtual training)?

RESPONSE:

a. The government is reviewing the training used in the pilot with existing training throughout the organization a final training curriculum has not been determined by the government at this time.

b. Live meeting, Lync, Skype, Adobe Connect are platforms that have been used previously and successfully in the VHA.

c. Yes, this is acceptable so long as there is a pathway to ask questions and receive feedback

d. Yes, if it is 508 compliant we can house the content on the VHA LMS platform.

e. The audience will be primarily physicians and nurses, but not restricted to this audience if a facility chooses a larger audience.

f. No, contact hours are not needed for the trainings

g. Facilities will determine which trainings are appropriate for their team members and work to ensure their availability.

50. General Will the Government accept more than one response to the RFQ from the same prime contractor?

RESPONSE: No.

51. General The VHA Quality Governance requirements appear to significantly overlap existing contracts related to VHA’s Modernization initiatives, especially around governance and performance reporting. Can the government clarify the rationale for a separate contract to develop an additional governance model to those already in existence or being contemplated as part of Modernization?

RESPONSE: This PWS is focused on quality and safety governance and does not appear to conflict or overlap with Modernization efforts.

52. General The specific technical approach (e.g., HRO governance/Fractal model), the tiered evaluation model, the $15M size standard, and the commercial and academic nature of the requirements seemingly limit the pool of qualified bids. Would the government consider allow subcontractors’ past performance to be equally weighted as those of a prime to allow more qualified bids?

RESPONSE: No.

53. General Given the inherent risks associated with small business executing the large-scale deployment anticipated by this PWS, would the government consider requiring a staffing plan to determine the feasibility and risk of submitted bids?

RESPONSE: No.

54. General Would the Government please clarify its rationale for stipulating in Section 6.2 “General Personnel Requirements” that key personnel are expected to have documented publications from academic or industry-regarded peer reviewed journal publications? These personnel requirements create excessive barriers for small business and will further limit competition.

RESPONSE: No, not all key personnel are required to have these qualifications. The key personnel section 8, defines the requirements (see A-J for specific requirements for each labor category).

55. RFQ, Section E, Quote Submission, b) Intent to propose Please confirm date to provide intent to propose email. Instructions point to date specified on the SF1449, Block 20. The date to provide intent is not provided.

RESPONSE: Bid intentions are due on 6/20/2018 by 12 noon.

56. RFQ, PWS 4.2 and 5.5 In section 4.2. it states “Optional periods will involve scale and spread for Enterprise-wide implementation.”. In section 5.5 the title states “REPLICATION UP TO SIX VISNs (OPTIONAL 4 MONTH TASK)” and also in section 5.5 it states “Taking the lessons learned and tools identified for sustainment in the base period, the contractor shall implement the fractal model in up to 6 more VISNs and their associated healthcare systems.” Can VA please clarify how many optional VISNs are likely to be included? Can VA please clarify what is meant by “Enterprise-wide for section 4.2? Are vendors required to use the patented ‘fractal model’ or is an approach achieving the expressed objectives acceptable?

RESPONSE: During a given option period the government will identify 1, 2, 3, 4, 5 or 6 VISNS to participate in the spread. Enterprise wide means the intent is to spread to every facility across the enterprise. A fractal approach is not a patented approach.

57. RFQ, Provisions 8.0 and the Table on Page 52 under Volume 1 Page Limitations.

Are resumes required to be submitted for the Key Personnel positions listed?

RESPONSE: Yes

58. RFQ

How will Past Performance be weighted if the prime does NOT have direct experience in applying an HRO model and the Fractal approach, but the sub does?

RESPONSE: The balance between the prime contractor and the subcontractor to meet the performance work requirements will be evaluated. A standard source selection process will be used to evaluate previous success in meeting the identified deliverables.

59. RFQ

Are bidding teams required to use an HRO model or the patented ‘fractal model’ or is an approach achieving the expressed objectives and results acceptable?

RESPONSE: There is no patented fractal model. The government used this approach in their proof of concept.

See attached document: 36C10X18Q0171_Revised.