S02_36C77623R0149_FINAL.docx

36C77623R0149

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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

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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

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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

09-15-2023 Orangella Bittick 314-894-6460 10-12-2023 14:00

EDT

36C776 Department of Veterans Affairs Program Contracting Activity Central

6100 Oak Tree Blvd, Suite 490 Independence OH 44131

X

Y 541611 $24.5 Million

N/A

36C776 Department of Veterans Affairs Program Contract Activity Central

6100 Oak Tree Blvd, Suite 490 Independence OH 44131 36C776 Department of Veterans Affairs Program Contracting Activity Central

6100 Oak Tree Blvd, Suite 490 Independence OH 44131

VAFSC

Department of Veterans Affairs Financial Services Center Invoices to be Submitted Electronically https://www.fsc.va.gov/einvoice.asp e-Invoice Setup Info Phone 877-489-6135 877-353-9791 512-460-5429

See CONTINUATION Page

This Solicitation is being conducted in accordance with FAR Part 12, and in conjunction with FAR Part 15, and

FAR 16.2, where appropriate.

The Department of Veterans Affairs [VA] Program Contracting Activity Central [PCAC] is issuing this Request for Proposal

[RFP] with the intent of awarding a single award Firm Fixed Price contract for Integrated Collections Forecasting Model

[ICFM] - Collections Expected Results and Business Intelligence Analytical Support Services.

Period of Performance: Base Year Plus Four [4] Option Years

See CONTINUATION Page

Charles Hampton

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C776 Department of Veterans Affairs Program Contracting Activity Central

6100 Oak Tree Blvd, Suite 490 Independence OH 44131

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

PERFORMANCE WORK STATEMENT

INTEGRATED COLLECTIONS FORECASTING MODEL [ICFM]

COLLECTIONS EXPECTED RESULTS AND BUSINESS INTELLIGENCE ANALYTICAL SUPPORT

1. TITLE OF PROJECT:

The Veterans Health Administration [VHA], Office of Finance/Revenue Operations [OF/RO] Integrated Collections Forecasting Model, Collections Expected Results, and Business Intelligence Analytical Support

2. BACKGROUND:

The Veterans Health Administration [VHA] Office of Finance/Revenue Operations [OF/RO] is responsible for ensuring the integrity of business operations supporting Veteran health care delivery. OF/RO manages medical information management and a broad range of revenue and recovery activities specific to billing and collections.

When Veterans receive care from the Department of Veterans Affairs [VA] for non-service-connected conditions, the Balanced Budget Act of 1997 [PL 105-33], allows VA to retain collections from third party payors. The passage of PL 105-33 represented a significant shift for VHA as, prior to the passage of the law, collections were returned to the Department of the Treasury.

With the authority to retain collected funds, VHA has a meaningful incentive to ensure optimal collections. The collected funds are used to supplement available medical care services, and overall collections in one fiscal year are applied in the form of an appropriation offset in the ensuing fiscal year. When Veterans receive care from VA for non-service-connected conditions, VA is allowed to bill the Veterans’ private health insurers and retain these third-party collections to supplement its appropriations for health care. Third-party insurers include individual and group insurance plans, Medicare supplemental insurance plans, and self-insured employer plans. In addition, VA may also bill and collect copays from Veterans who receive non-service-connected care or prescriptions from VA medical facilities.

To manage revenue cycle process effectively, provide corporate oversight, and further professionalize healthcare revenue activities, the VHA OF/RO [formerly VHA Chief Business Office] was established in April 2002. Because the Medical Care Collections Fund [MCCF] collections are a significant portion of VHA’s budget and are returned to the facilities to supplement healthcare provided to Veterans, VHA is keenly interested in tracking and enhancing revenue performance. For instance, in FY 2022, MCCF collections totaled over $3.939 billion. These funds are then used by the VA medical centers to provide medical services to care for America’s Veterans.

To collect from health insurers, VHA uses five related processes to manage the information needed to bill and collect:

· Patient intake involves gathering insurance information and verifying that information with the insurer;

· Medical documentation involves properly documenting the health care provided to patients by physicians and other health care providers;

· Coding involves assigning correct codes for the diagnoses and medical procedures based on the documentation;

· Billing creates and sends bills to insurers based on the insurance and coding information; and

· Accounts receivable includes processing payments from insurers and following up with insurers on outstanding or denied bills.

In May 2018, VA awarded Cerner Corporation [merged with Oracle Corporation in June 2022] a contract to replace its current Electronic Health Record [HER] systems [i.e., VistA system] with a new EHR based on the same commercial off-the-shelf platform currently being deployed by the Department of Defense [DOD], Cerner Millennium. The Electronic Health Record Modernization [EHRM] initiative will leverage this existing commercial solution to achieve interoperability within VA, with DOD, the U.S. Coast Guard [USCG] and with community care providers. Health records residing in a common system will eliminate the need for multiple complex clinical interfaces and manual data entry. VA’s new EHR will provide clinicians with quick and efficient access to the complete picture of Veteran health, improving VA’s delivery of health care to our nation’s Veterans. As of April 2023, VA’s EHRM program is implemented and operated at five initial operating capability [IOC], or ‘Go-Live’ sites. Future IOC deployments are anticipated over the potential span of this contract but there is not a definitive implementation schedule.

OF/RO has the responsibility to determine the yearly national MCCF collection goals and allocate the goal to each facility. OF/RO is seeking contractor support to develop, maintain and enhance the Integrated Collections Forecasting Model [ICFM] that OF/RO will use for the collections goal development process. In addition, ad-hoc data analyses derived from this model will be utilized to support OF/RO’s responsiveness to stakeholders across VA, other government agencies, the White House and Congress.

3. OBJECTIVES:

The objectives of this contract are to develop, operate a collections forecasting model which can produce the following outputs: 1) station-level collections potential as a proxy for the maximum amount of collections a station can achieve under optimal conditions; 2) station-level collections goals by MCCF funds; 3) 10-year MCCF collections forecast for inclusion in the President’s Budget; and 4) to provide specialized reports by data analytics for OF/RO.

4. SCOPE:

OF/RO requires analytical and healthcare econometric modeling contractor expertise to support management information needs in model forecasting, data analytics using SQL codes, metric development and outcome measures for OF/RO and other program areas within the VHA organization.

5. GENERAL REQUIREMENTS:

· For every task, the contractor shall identify in writing all necessary subtasks [if any], associated costs by task together with associated sub-milestone dates. The contractor's subtask structure shall be reflected in a detailed project management plan.

· All written deliverables will be phrased in layperson language. Statistical and other technical terminology will not be used without providing a glossary of terms.

· Where a written milestone deliverable is required, the VHA will complete their review of the deliverable within 31 calendar days from date of receipt. The contractor shall have 15 calendar days to deliver the final deliverable from date of receipt of the government’s comments.

· The contractor shall meet the Delivery Schedule for each deliverable specified.

· Unless otherwise specified, an electronic copy shall be placed in the designated OF/RO SharePoint site or other OF/RO-designated secured site.

· The contractor shall conduct data analytics using SQL codes to query available objects in Corporate Data Warehouse [CDW] databases and extract needed dataset to support model forecasting efforts.

· The contractor shall provide daily, support to accomplish the tasks of this requirement and shall make available as needed thought-leader participation and availability in performing the tasks of this requirement.

6. SPECIFIC MANDATORY TASKS AND ASSOCIATED DELIVERABLES

Description of Tasks and Associated Deliverables: The contractor shall provide the specific deliverables described below within the performance period. For every task, the contractor shall identify in writing all necessary subtasks [if any], associated costs by task together with associated sub-milestone dates.

TASKS AND DELIVERABLES

6.1 Task One – Project Management:

The contractor shall provide and maintain a detailed, product based, resource loaded, project management plan/schedule [PMP] compliant with Project Management Body of Knowledge [PMBOK] guidance in MS Project format. The contractor will ensure that the Work Breakdown Structure [WBS] elements incorporate a sufficient level of detail to adequately delineate a comprehensive overview of the level of effort of the work tasks. The PMP will also incorporate a Risk Management Plan/Risk Register together with a Quality Control Plan [QCP] incorporating QCP elements which are quantifiable and measurable. The contractor’s plan shall illustrate the PWS and describe in further detail the approach to be used for each aspect of the task order as defined in the technical proposal. The work plan shall include a schedule of the deliverables and shall be kept up to date throughout the life of the project to ensure it represents all tasks and current timelines. The contractor is responsible for maintaining and revising the PMP and providing version-controlled revisions. In event of any change or impact to the PMP which would affect the Baselined elements, the contractor shall notify the Contracting Officer’s Representative [COR] in writing within 7 days after the identification of the event/issue. The contractor shall establish a bilaterally acceptable date [but within 21 days of contract award] for a meeting to review the QCP and the QASP to define what methodologies and metrics will be used to track contract performance. This meeting may be held remotely [e.g., Live Meeting, teleconference etc.].

6.2 Task Two – Collections Forecasting & Modeling:

The Veterans Health Administration [VHA], Office of Finance/Revenue Operations [OF/RO] is responsible for the development of Fiscal Year [FY] Medical Care Collections Fund [MCCF] Expected Results [ER]. OF/RO is also required to distribute each Fiscal Year ER in its entirety for all funds to all Stations. Currently, OF/RO uses the Integrated Collections Forecasting Model [ICFM] to forecast and allocate the President’s Budget.

The following attributes are drivers of ICFM predicted collections:

· Service volume;

· Priority Group status;

· Demographics;

· Economic market conditions;

· Insurance coverage; and

· Historical billings and collections performance

OF/RO intends to develop a new version of the Integrated Collections Forecasting Model [ICFM]. Accordingly, the contractor shall explore, design, validate, and implement a model with any variables for enhancements. All variables and enhancements will be validated, and the results presented to and approved by OF/RO leadership prior to their deployment.

There are three main outputs of the ICFM model: the first output is a 10-year MCCF collections model, which projects the maximum amount of collections a medical facility can achieve under optimal conditions for each of the VHA’s MCCF funds – first party pharmacy copays, first party inpatient and outpatient copays, first party community care collections, third party collections, third party community care collections, third party pharmacy collections, long term care copayments and miscellaneous collections [i.e. parking, leases; etc.]. The second output of the model distributes the annual President’s Budget amount to each Veterans Integrated Service Network [VISN] and VA medical center [VAMC] by MCCF fund, using a regression approach. The third output of the model is a monthly year-to-date collections projection that uses historical collections data to project year-end collections by VAMC and MCCF funds. The model output should be presented in both tabular and graphic forms, using geographic information system [GIS] software. The contractor will establish, maintain, and update the system documentation for ICFM concurrent with any changes [e.g., additions, subtractions, etc.] in the model’s components. Finally, the contractor is expected to present additional refinements for OF/RO consideration and to provide periodic briefings to OF/RO leadership, as requested by the COR.

Potential deliverables include, but not limited to, the following:

· Deliver a thorough conceptual framework for the collections forecasting model including: data sources, data elements, methodology [i.e., algorithms, weighting, regression analyses] and development/implementation timeline. The ICFM contractor must have familiarity with the EHCPM and actuarial modeling.

· Develop and implement a plan to house and secure the model and associated data sources within the VA network to secure highly sensitive VA information within VA network to prepare for the upcoming Oracle/Cerner EHRM implementation/deployment across the VA system.

· Develop model logic that would allow flexibility by inserting an historical sample of bill and collection data across time.

· Adapt the model logic to produce revenue-cycle performance estimates for future time periods [i.e., months, quarters, years – annual / fiscal].

· Work in conjunction with OF/RO stakeholders to examine additional factors and/or other fund type [e.g., third party community care collection] for inclusion into the model and propose future enhancements.

· The contractor shall provide health data analytics, revenue cycle management, and health econometric modeling expertise to support the on-going administration of the ICFM and estimate the impact of proposed policy changes on MCCF collections. ICFM utilizes EHCPM for the annual model refresh along with any ad-hoc modeling [e.g., new legislation or policy impacts]. This includes updating the ICFM for multiple budget scenarios throughout the year in addition to the initial annual update

· The contractor shall provide Ad hoc expenditure estimates that Enrollment and Forecasting provides need in order to have a coordinated collections estimate from the ICFM. These ad hoc estimates frequently have a short turn around of several business days. The ICFM contractor must meet with the Office of Enrollment and Forecasting as needed to understand assumptions for each EHCPM scenario, communicate ICFM needs, and to coordinate transfer of data

· The contractor shall mitigate all data quality and/or availability issues, as the future-state model MUST be able to operate entirely within the VHA data environment.

· Incorporate the VHA Office of Policy and Planning’ Enrollee Health Care Projection Model [EHCPM] 10-year projection, for explicit comparison with ICFM estimates and develop model logic to analyze and select appropriate collection goals, by fund, at the station and VISN levels. These projections will support the annual President’s Budget development of MCCF collection targets for the President’s Budget submission.

· The contractor shall track national monthly performance of debt management and Treasury program collections to project performance during the fiscal year. This tracking is necessary to monitor the impact analyses described in Task Six.

· The Contractor shall review Community Care models for enhanced modeling opportunities. Incorporate impacts to workload, billings and collections of payer changes, new Community Care services, Video Telehealth, and PACT Act. Additionally, future iterations should include projections for Community Care First Party.

· Thoroughly test the integrated model using historical data and present additional refinements to the VHA COR for consideration. The contractor shall develop model logic to export customized and summarized first party, pharmacy, third party and long-term care model results [e.g., by FY and station], and any other user-selected options.

· Include the capability to enter a clinical profile for a VISN, which would indicate an increase or decrease in the clinical services provided. These changes could occur at various times within the projection scope and thus the model should account for these adjustments accordingly. Explicit clinical profiles could improve average bill size projections and allow for greater control over forecast scenarios.

· Incorporate the impact of policy and Revenue Operations process changes. As VA revises policies about eligibility, coverage, and other policy changes, it will be imperative that the integrated model quickly estimate the impact of these changes.

· Account for changes in economic environment, which could impact collections [e.g., loss of third-party insurance coverage, medical cost indices, economic hardships to meet co-payment requirements, etc.].

6.3 Task Three – Budget & Legislation Support:

The contractor shall support the President’s Budget negotiations with identified VA program offices throughout the period of performance using ICFM outputs. The contractor shall be solely responsible for developing scenarios and estimates of revenue impact on collections for consideration based upon policy guidance and/or changes to current revenue operations processes. OF/RO estimates a minimum of a dozen analyses will be required annually.

The model outputs should be presented in Microsoft Excel format. The contractor shall also document the methodology for all alternative scenarios presented for consideration in Microsoft Word – establishing a historical record of negotiated and approved changes. Additionally, the contractor is responsible for briefing OF/RO leadership on both methodology and aggregate collections impact for each requested study. All briefings shall be produced in Microsoft PowerPoint. Where appropriate, geographic information systems [GIS] should be used to improve the quality of presentation materials.

6.4 Task Four – Annual Collections Target Development and Allocation Support:

The contractor shall work collaboratively with OF/RO, CPACs, and VISN representatives to identify and evaluate improvements to the annual Expected Results process. Currently, annual Expected Results are derived from a regression-based model that considers service volume, acuity mix, patient demographics, third party insurance coverage, and business performance; as a predictive measure of collections performance. In support of this process, the contractor shall convert the output of the ICFM into monthly collections Expected Results by station by MCCF fund. The contractor shall implement improvements in the annual Expected Results process. With each annual budget cycle, the contractor shall provide advanced revenue cycle and health econometric expertise in support of this process.

Additionally, the contractor shall manage the Expected Results [ER] process, including facilitation of periodic conference calls and coordinate the efforts of multiple VA and VHA organizations. In support of these meetings, the contractor shall develop the agenda, create all briefings, organize meeting logistics, reproduce materials, and take minutes.

Once the annual Expected Results have been finalized, the contractor shall develop and distribute VISN packets that describe the goal-setting methodology, establish the Expected Results by station and by fund for the subsequent three [3] fiscal years, and provide summary data used in the integrated model. If needed, the contractor shall develop alternative monthly allocation methodologies, which reflect the impact of the Electronic Health Record Modernization [EHRM] implementation and other applicable OF/RO initiatives.

The contractor shall work collaboratively with each network to evaluate potential re-distributions of their Expected Results across the stations within their respective networks and implement requested changes into the model output. The contractor shall conduct individual VISN and facility calls to answer questions and resolve issues. The contractor shall produce and distribute updated Expected Results materials in the event of modifications to current year Collections goals. The contractor shall continuously incorporate changes to the alignment of VHA [i.e., VISNs, CPACs, Regions, etc.] into the structure and outputs of the Expected Results process.

The contractor shall produce monthly Expected Results by MCCF fund and station, once an allocation methodology is selected, and validate that the appropriate Expected Results are loaded correctly into OF/RO reporting platforms. Additionally, quarterly collections forecasts may also be required at the VISN-level to monitor performance against Expected Results.

Finally, the contractor shall develop third party Billing Targets based on the corresponded monthly Expected Results for third party funds. It is anticipated the billing targets will be established three times per fiscal year to provide monthly target for Aug – Sep, Oct – Jan, and Feb – Jul. Contractor shall develop necessary documents required for VHA finance to finalize goals.

6.5 Task Five – Ad-Hoc and Routine Data Analytics:

OF/RO estimates up to ten [10] ad-hoc/routine data analytics each month during the period of performance. The contractor shall support the following specific BIO initiatives:

Annual Metrics Report: The contractor must work with BIO to establish new metrics targets for the new Fiscal Year. The contractor will work with BIO to update related document including metrics definitions document, metrics target sheet, and annual collections and billings proration tables.

Monthly Outliers Analysis: The contractor must be familiar with VHA datasets [e.g., VDE and CDW] and VHA web-based reporting system currently available [e.g., mPower, POWER+, and VSSC] to analyze outliers of selected performance metrics. Additionally, since VHA revenue operations are constrained by legislative, regulatory and systems limitations, the contractor must understand these differences and their impact on establishing benchmark performance levels for VHA.

Corporate Data Warehouse [CDW] Data Analytical Support: BIO is the business owner of the Integrated Billing [IB] domain which contains numerous objects from the VistA integrated billing [IB] and account receivable [AR] files [e.g., Files 350, 399, 430, 433, etc.]. Those objects are refreshed every night and reside in the CDW production server. At the request of the COR, the contractor shall analyze all available objects [e.g., Patient, enrollment, workload, and IB] in CDWWORK to discover and report on meaningful data which will enhance OF/RO’s business analytic capabilities and improve monitoring and managing the revenue-cycle performance of its CPACs, VISNs and facilities. These reports range in level of effort from some requests taking less than a day to complete and other requiring several business days due to complexity of the requirements. The contractor shall provide support in both routine and ad-hoc reporting.

Examples of typical ad-hoc/routine data requests include:

· Routine Reporting to support requests from various stakeholders for monthly/quarterly/annual data.

· Ad-hoc Reporting to support requests from various stakeholders including but not limited to CPAC Directors, RO leadership, eBusiness, etc.,

· eBusiness – requesting monthly Contractor Service related to third party billing/collection.

· CPAC – Additional reporting of community care claims as community care continues to grow; Requests rely on CDW reporting to continue with the billing process

· Workgroup requests – To determine impacts of proposed process changes.

· EHR Implementation Support – Requests from OF/RO leadership on various aspects of clinical and revenue reporting to support EHR data needs. This may include data gathering for patient eligibility, billable insurance information and billing/collections activities pulled from CDW production server to support data analytics and data migration efforts.

6.6 Task Six – Specialized Analyses:

The contractor shall coordinate efforts of OF/RO, BIO, and others to support specialized data analytics studies requested by the COR. The contractor shall produce specialized analyses on an ad-hoc basis to include white papers, statistical analyses, slide presentations, and other work products, as requested by the COR. The scope of these studies requires the contractor to provide OF/RO with revenue cycle subject matter expertise with extensive understanding of available VHA and OF/RO reporting systems and database systems, entire revenue cycle activities, including: Patient Access, Health Information Management, Patient Financial Services, and Compliance. The contractor shall use data derived from ICFM, such as Veteran demographics, along with other VHA data from existing data sources and reporting platforms, such as VistA Data Extract [VDE] database, Corporate Data Warehouse [CDW] database, the Performance and Operational Web-Enabled Reports Plus [POWER+] reports which will sunset to mPower and the VHA Support Service Center [VSSC] reports to provide specialized reports to OF/RO and other requesting entities. Thus, the contractor must have detailed knowledge of SQL codes and expertise querying systems similar to VHA and OF/RO’s reporting platforms [i.e., POWER+, mPower, VSSC , VDE, CDW data warehouse].

OF/RO estimates up to four [4] specialized studies each month during the period of performance.

Examples of recent studies include:

· Reimbursement relative to commercial claims

· Impact of Pharmacy Tiered Copayment changes

· Impact of COVID-19 on revenue

· EHR IOC site implementation performance

· Impact of coding backlogs on monthly collections projections

· Value-based insurance design

· Impact of enrollment expansion

· Industry trends and best practices

· Future State Revenue Cycle metrics.

· Revenue backstory for OF/RO

· Priority group migration expectation from EHCPM vs actual

· Impact of proposed policy changes

· Community Care billings and collections analysis

· Impact Analysis for updated PACT Act

· Response preparation requested by VA stakeholders, government agencies, the White House and Congress

6.7 Task Seven – Business Analyses impacted by VA’s EHR transition VA is transitioning to a new EHR solution over a multi-year time frame across the VA enterprise. The deployment will occur in waves and the annual transitioning site schedule is subject to change. To date a limited number of VAMCs are operating on the new EHR platform. VA will continue to maintain and support its legacy EHR systems until every VA medical facility has the new EHR solution.

The deployment of the new EHR system represents a significant change in both business processes and business data for revenue activities and could have major impacts on ICFM activities.

The contractor shall provide data analytical supports for selected sites as appropriate to their transition phase.

Examples of recent analyses include:

Pre-Implementation Phase:

· Data Analytics:

Before the transition of any sites to the new EHR system, site specific data analytics will be required. We estimated one-quarterly analysis and three-monthly analyses are needed before the EHR implementation. Types of analyses include, but not limited to, workload analysis, impacts on community care activities, billings, AR, and collections impacts due to temporary operational lags/delays. The results will be used to evaluate potential impacts to National results. The contractor shall:

· Coordinate with CPAC billing staffs to estimate potential delays and its impacts

· Develop communications plans to inform key stakeholders of status

· Monitor collections against projected impact to document lessons learned and revise impact analysis for subsequent implementation dates

· Monitor potential impacts on aged receivable and first party copays due to delay and/or loss of First Party billing activities.

Post-Implementation Phase:

· EHR Data Analytics:

It is anticipated that data integration from both the CDW data elements and Cerner data elements are necessary after EHR ‘Go-Live’ implementation. Currently, a data syndication team is put into action to integrate Cerner EHR data back into VA’s Corporate Data Warehouse [CDW] environment [i.e., CDWWork2, SPV2 and CDWWork3] to support existing applications. The contractor shall:

· Participate in routine data syndication workgroup weekly meetings

· Get familiar with Millennium data structure loaded in CDWWork2 and SPV2

· Provide QA of CDWWork2/CDWWork3 environments

· Document questions and issues related to IB/AR data mapping in CDWWork3

· Performance Management and Executive Level Briefing:

When more sites are transitioned to the new EHR system, OF/RO will need ways to establish baseline metrics for performance management. The contractor shall evaluate reports and metrics from the new EHR system and develop feasible dashboards to track performance of VHA’s revenue activities. Tasks include, but not limited to, the followings:

· Routine tracking of transition schedule and assessment of impact on National collections/Expected Results

· Development and maintenance of monthly Cerner dashboard

· Analysis of key metrics net IOC sites

· Monthly briefing to summarize collections for Cerner sites

· Summary ad-hoc briefings to address VHA leadership questions

· Numerous impact analyses to assess collection impacted by transition

· Catalogue lessons learned from transitioned sites and leverage the knowledge gained in pending/ongoing transition sites.

· ICFM Model Updates and ER Allocation:

ICFM model depends on data inputs from the Enrollee Health Care Projection Model [EHCPM] for utilization projections and from the CDW for billings and collections data. These sources will be immediately impacted as facilities transition to the new EHR system. The contractor shall evaluate available data from the new EHR system and make necessary adjustment and/or assumptions to continuously support data needs by the ICFM models. Additionally, the contractor shall analyze collections impacted when more sites are transitioned to the new EHR system and consider those impacts for future ER allocation. Such as:

· Research activities on billing and collection trends to generate an impact

· Incorporate unsustainable adjustment on revenue activities for Cerner sites into Impact Reports

· Expected Results goals distribution accounting for unsustainable activity for Cerner transition sites

6.8 Task Eight – Progress Management:

The contractor shall provide a status report bi-weekly throughout the period of performance, identifying progress on tasks, issues, and expected due dates of deliverables. Additionally, the contractor shall conduct a weekly status briefing with the COR.

SCHEDULE FOR DELIVERABLES

6.1.1

6.1.2

6.2.2

6.4.1

Annual Collections Target Development and Allocation Support

6.4.2

6.4.3

6.4.4

6.4.5

6.4.6

7. PERIOD OF PERFORMANCE. The period of performance shall be from the date of award for a base period of 12 months plus Four [4] 12-month option periods, exercisable at the sole discretion of the Government.

There are eleven [11] Federal holidays set by law [U.S.C. Title 5 Section 6103]:

Contractor shall work Monday through Friday but not on holidays as specified below.

If any of the below falls on a Saturday, then Friday shall be observed as a holiday. Similarly, if one falls on a Sunday, then Monday shall be observed as a holiday.

Under current definitions, five are set by date:

The other six are set by a day of the week and month:

8. PLACE OF PERFORMANCE:

The contractor shall support this effort via virtual meetings or at approved contractor facilities as directed by the COR and mutually agreed to by the contractor. If the work is performed at the Department of Veterans Affairs, the VA will provide adequate on-site workspace and ADP equipment for contractor personnel.

9. KEY PERSONNEL:

Certain skilled experience professional and/or technical personnel are essential for accomplishing the work to be performed. Key personnel for purposes of this contract will be defined as those individuals preparing the deliverables. These individuals are defined as “Key personnel” and are those persons whose resumes were submitted and marked by the vendor as “Key Personnel”. Key Personnel are required to have certain levels of experience, as detailed below, in order to meet the minimum acceptability requirements of this PWS. Each year of relevant work experience may be substituted for one year of education, and vice versa. Certifications, professional licenses, and specific technical training may also be substituted for equivalent experience or education. Substitutions shall only be accepted if in compliance with “Substitution of Key Personnel” provision identified below. The following Contractor personnel are considered Key Personnel:

Project Manager Project Manager must have expert level qualifications serving in a lead capacity, with enterprise-wide knowledge managing multiple complex projects in one or more areas of business modeling, healthcare econometrics, commercial medical care revenue-cycle processes and performance metrics, business management, strategic planning, development, and organizational performance support. Demonstrated ability analyzing problems, defining solutions, communicating recommendations, developing procedures, building consensus with the client, providing implementation direction, and developing and managing work plans. Project Manager shall possess excellent presentation, written and verbal communications skills across multiple levels of leadership.

· Minimum Education Level: Master’s degree in health care, business, or related field or equivalent.

· Minimum Experience: 5 years’ experience with healthcare econometrics, Project management methodology consistent with PMBOK guidelines and principles, commercial medical care revenue–cycle processes and performance metrics, healthcare account receivable management and business analyses and strategies

Lead Analyst Lead Analyst must have expert level qualifications with the ability to perform multiple complex projects in one or more areas of business modeling, healthcare econometrics, commercial medical care revenue–cycle processes and performance metrics. Expert level must be capable of providing unique insight, business analysis utilizing end-user tools, documentation, data mining, evaluation and recommendations for improvements, optimization, development, and/or maintenance efforts, and project management methodology consistent with Project Management Body of Knowledge [PMBOK] guidelines and principles. Lead Analyst must be able to define concepts and insights regarding the applicability of best industry practices. Expert brings demonstrated ability to participate in project activity at the individual, team member and/or management level. Contractor shall possess excellent presentation, written and verbal communication skills.

· Minimum Education Level: Bachelor’s degree in related field or equivalent.

· Minimum Experience: 5 years’ experience with healthcare econometrics, Project management methodology consistent with PMBOK guidelines and principles, commercial medical care revenue–cycle processes and performance metrics, healthcare account receivable management and business analytical skills, business modeling, producing documentation of revenue domains and associated metadata, complex business analysis, business strategies and processes in diverse enterprise architectures.

Database Engineer Database Engineer must have advanced level hands-on data warehousing experience, healthcare claims data knowledge, and a proven track record for timely project delivery with high quality. Interpret and assist in technical definition of healthcare claims or healthcare claims-based research algorithms. Design and develop conceptual prototypes for potential future features or upgrades. Maintain standards for data modeling within database/data warehouse including logical and physical models. Design and optimize database schema, architecture. Create code that meets design specifications, follows standards, and is easy to maintain. Test and peer review code for technical accuracy, standards, and functional compliance to the design Support and maintain data and database systems to meet business delivery specifications and needs. Design and optimize database queries, and complex stored procedures, for OLTP and OLAP data services. Develop and implement ETL processes Database and ETL performance tuning. Assist with ad-hoc report generation and data analysis for customers. Partner with the business and other technologists to determine the technical database design options.

· Minimum Education Level: Bachelor of Science degree in a scientific or quantitative field, or equivalent experience.

· Minimum Experience:

· 5+ years database development/maintenance of Microsoft SQL-Server database and Oracle 10g or above database.

· Expert understanding of both T-SQL and PL-SQL coding techniques and practices

· 5+ years of relevant experience in SQL Server Development Integration Services and Reporting Services with emphasis on large scale enterprise data warehouse design

· 5+ years ETL/performance optimization experience

· 3+ years healthcare experience in a claims data or medical record data capacity

· Knowledge of HIPAA and privacy practices associated with healthcare data

Healthcare Economist/Statistician Healthcare Economist/Statistician must be able to define concepts and insights regarding the applicability of best industry practices. Expert brings demonstrated ability to participate in project activity at the individual, team member and/or management level. Demonstrated ability analyzing problems, defining solutions, communicating recommendations, developing procedures, building consensus with the client, providing implementation direction, and developing and managing work plans. Contractor shall possess excellent presentation, written and verbal communications skills across multiple levels of leadership.

Healthcare Economist/Statistician must have expertise with Microsoft SQL Server Database and Oracle Database and experience in data collection, analysis and manipulation of computerized data sources are required in supporting a variety of tasks.

· Minimum Education Level: Master’s degree in health care, business or related field or equivalent or Doctoral degree in in health care, business or related field or equivalent.

· Minimum Experience: 5 years’ experience in healthcare finance, healthcare, econometrics, advanced statistics, data science, etc. Recognized thought leader/presenter on a wide range of topics in the financing and delivery of healthcare. Expert published in health profession journals or author of academic research on related subjects.

9.1 Substitution of Key Personnel. All Contractor requests for approval of substitutions hereunder shall be submitted in writing to the COR and the Contracting Officer at least thirty [30] calendar days in advance of the effective date, whenever possible, and shall provide a detailed explanation of the circumstances necessitating the proposed substitution, a complete resume for the proposed substitute, and any other information requested by the Contracting Officer necessary to approve or disapprove the proposed substitution. New personnel shall not commence work until all necessary security requirements, as defined in Section J, have been fulfilled and resumes provided and accepted. The COR and the Contracting Officer will evaluate such requests and promptly notify the Contractor of approval or disapproval in writing.

9.2 The Contractor shall be responsible for managing and overseeing the activities of all Contractor personnel, as well as subcontractor efforts used in performance of this effort. The Contractor’s management responsibilities shall include all activities necessary to ensure the accomplishment of timely and effective support, performed in accordance with the requirements contained in the performance work statement.

9.3 The Contracting Officer may notify the Contractor and request immediate removal of any personnel assigned to the task order by the Contractor that are deemed to have a conflict of interest with the government or if the performance is deemed to be unsatisfactory.