D.22 Past Performance Questionnaire Worksheet - RFP 36C25726R0018 - Sherman CBOC - Amendment 0002.docx
DOCX document 34 KB Posted
- Attached to
- The VA North Texas Health Care system requires community based Outpatient clinic (CBOC))
- Solicitation number
- 36C25726R0018
About this file
This is a Past Performance Questionnaire Worksheet for RFP 36C25726R0018 concerning Community Based Outpatient Clinic (CBOC) services in Sherman, Texas. The worksheet is a template designed to evaluate contractor performance on similar past contracts and does not address specific products or services required under the current solicitation.
The questionnaire requests bidders to provide detailed information about their prior experience operating CBOC services, including the legal entity name, contract numbers, and performance period. Respondents must address their effectiveness in meeting Performance Work Statement requirements across five key evaluation areas: quality, management, experience and staffing, transition plan, start-up plan, and geographic location. The worksheet also requires submission of specific performance metrics, including annual per member per month (PMPM) costs, clinical quality outcomes and improvement initiatives, Survey of Healthcare Experience of Patients (SHEP) domain results, staffing vacancy and turnover rates, and provider coverage plans. Additionally, bidders must provide floor plans demonstrating knowledge of Primary Care team (PACT) space design with provisions for expansion and explain clinic opening timelines and any obstacles encountered. A point of contact with verifiable information is required for each referenced contract.
View the file
Other files
Show all 31
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
D.21 Past Performance Questionnaire Worksheet – RFP 36C25726R0018 – Sherman CBOC
1. The legal name of entity with whom the Contractor held the contract.
Click or tap here to enter text.
2. Contract Number(s)
Click or tap here to enter text.
3. Overall, how has the contractor performed services required for the Community Based Outpatient Clinic, met the requirements of the Performance Work Statement (PWS) and detail how did they effectively achieve the performance objectives of the referenced Quality, management, experience and staffing, transition plan, start-up plan, and geographic location requirements.
Click or tap here to enter text.
4. In what geographic location the contractor performed these services.
Click or tap here to enter text.
5. What are the dates during which the contractor performed the contract.
Click or tap here to enter text.
6. What is the annual size of the per member per month (PMPM) for the CBOC services.
Click or tap here to enter text.
7. What is the clinical quality performance measure outcomes, combined and by individual CBOC. Provide two examples of related quality improvement initiatives.
Click or tap here to enter text.
8. What is the Survey of Healthcare Experience of Patients (SHEP) domain outcomes, combined and by individual CBOC. Provide examples of related quality improvement initiatives.
Click or tap here to enter text.
9. What were the vacancy rates, combined and by individual CBOC? If vacancy rates are not available, provide turnover rates.
Click or tap here to enter text.
10. What was the plan for provider coverage for leave, unscheduled access, and vacancies with list of currently VA credentialed providers available for coverage.
Click or tap here to enter text.
11. Provide your floor plan that demonstrates knowledge of current PACT space design and explain how allowance for expansion over the life of the contract were included. Did the clinic open within the timeframe specified in the contract and if not, what attempts were made to mitigate obstacles to an on time opening?
Click or tap here to enter text.
12. The name, phone number, and email address of a person at the entity with whom the Offeror held this contract who can verify the information the Offeror provides in the narrative description for this contract.
Click or tap here to enter text.
File details come from the government source that posted it. Updated .