APEX PROVIDER DIRECTORY - Part806.3_Atch7_FAR6_JA_OVER_SAT -jcc.docx

Part 806.3 Other Than Full and Open Competition (OFOC) Attachment 7: Request for Sole Source Justification Format >SAT

DEPARTMENT OF VETERANS AFFAIRS

Justification and Approval (J&A) For Other Than Full and Open Competition (>SAT)

Acquisition Plan Action ID:___________________________________________

1. Contracting Activity:

Department of Veterans Affairs (VA) Regional Procurement Office (RPO) East NCO 5-VA Capitol Healthcare Network Hershel "Woody" Williams VAMC 1540 Spring Valey Drive Huntington, WV 25704

2. Nature and/or Description of the Action Being Processed: The proposed Sole-Source action is for a Firm-Fixed-Price contract to:

Apex Data Solutions, LLC (Apex) 334 East Lake Road, #116 Palm Harbor, FL 34684

3. Description of Supplies/Services Required to Meet the Agency’s Needs: The VA often relies on the services of other third party providers to expedite services to Veterans. These third party providers are part of the Centers for Medicare and Medicaid Services (CMS) National Plan & Provider Enumeration System (NPPES) National Provider Identifier (NPI) record database. The proposed action is to test and evaluate as part of a post NAII AI Tech Sprint pilot study, an Apex previously developed proprietary technological solution to a critical problem (noted by the Government Accountability Office (GAO) in a recent VA audits), a problem area of healthcare data interoperability that is out of sync (not kept current). The Apex solution may be scaled to address other enterprise healthcare data interoperability problem areas in VA as well. Specifically, Apex will implement a technical framework, which will enable both the VA and the Centers for Medicare and Medicaid Services (CMS) to more efficiently update and manage the Provider data supporting their respective internal Master Provider Directories. The implementation of such a framework will improve CMS’ ability to update the NPPES NPI record data in near real-time and to transform the previously static data into linked data, thereby offering internal Enterprise Shared Services (ESS) and Third Party Administrators (TPAs) consuming that data more accurate data in a format more consumable by those end users of the data (when someone updates their data, it updates all systems that use the NPPES in real-time). This will enhance patient utilization of those community-based programs, as well as offering a powerful tool to CMS and the TPAs to combat the billions of dollars lost annually to fraud, waste and abuse of such programs. As the largest, most complex Payer in the healthcare space, CMS offers the largest Provider data sets. For testing purposes, in the Pilot Use Case, successful implementation in this context can be exported to other federal Payer programs (e.g., Mission Act, TriCare Program and the Federal Employees Health Benefits (FEHB) Program) as well as commercial Payers. Additional benefits to be derived from this Use Case include offering beneficiaries improved access to providers, costs, and coverage information. These improvements will also help the Payers to process claims more timely, improving their ability to process related claims payments quickly, improving their respective Clean Claims rates. VA uses this Provider data to support various Enterprise Shared Services (ESS) such as public-facing Provider Directories through the Vets.gov web portal, as well as the VA’s claims adjudication and processing efforts related to the community-based care programs. This proposed action will provide the VA with the tools necessary to make this data more consumable by internal VA customers. As part of the proposed action, Apex will ensure that all targeted provider data will be compliant with the HL7 Fast Healthcare Interoperability Resources (FHIR) Specification, which is a standard for exchanging healthcare information electronically. The Period of Performance (POP) is 12 months. The total estimated value of the proposed action is $928,000.

4. Statutory Authority Permitting Other than Full and Open Competition: The statutory authority permitting other than full and open competition is 41 U.S.C. 3304(a)(1) as implemented by the Federal Acquisition Regulation (FAR) Subpart 6.320-1 entitled “Only One Responsible Source and No Other Supplies Services or Supplies Will Satisfy Agency Requirements.”

5. Demonstration that the Contractor’s Unique Qualifications or Nature of the Acquisition Requires the Use of the Authority Cited Above (applicability of authority): Apex, a small business, is the inventor and creator of Apex Accelerate and DomainMaster. Apex wholly-conceived, developed, and has the proprietary rights to this code, which uniquely permits enterprise alignment of data in near-real time across n-number of internal systems of record and other logical organizational boundaries by maintaining a “single source of truth” that is locally scoped to one or more organizational participants as part of an interoperable platform. Apex, as the owner of the source code for Apex Accelerate and DomainMaster, is the only vendor, which can implement this technological approach to system of record (SOR) alignment and sharing of data across organizations and organizational boundaries. Apex’s approach to interoperability and data alignment across disparate systems of record is unlike any other commercially available technology in that it eschews the common “systems talking to each other” metaphor for interoperability, and instead proposes a pure architectural strategy and infrastructural approach to sharing data across organizational boundaries, which ensures Systems of Record (SORs) maintain current functionality without respect to transient data exchange standards de jure. Importantly, it allows disparate SORs across participating organizations to remain essentially autonomous (and entirely unaware of each other) in their day-to-day operations through an advanced version of the well-known “adaptor” pattern. Moreover, it has proven Apex’s approach to interoperability and data alignment across disparate systems of record is unlike any other commercially available technology and has been proven successful at the proof of concept phase in the VA, Veterans Health Administration (VHA), Office of Research and Development (ORD), National Artificial Intelligence Institute (NAII) 2020-2021 Tech Sprint initiative. Through the NAII AI Tech Sprint initiative, Apex demonstrated the utilization of an IT infrastructure that would provide the foundational support for an interoperable data system. While this pilot technology will initially focus on solving the issues surrounding Provider Directory inaccuracy, and build a Master Directory, which creates accessible, real-time information, in support of multiple consuming ESS, this technological approach can be scaled to address other enterprise interoperability problem areas. Provider Directory data accuracy has been a focal point for many industry initiatives over the past decade, and GAO as noted prior, but none show the promise evidenced by Apex’s success as part of the NAII Tech Sprint program. Despite significant annual investment in its IT infrastructure, the VA itself currently lacks the technical ability to properly align data across its internal systems of record to ensure that data related to unique identities is complete and the same in all applicable databases. The uniqueness of Apex technological approach to interoperability supports the justification for Use of the Authority Cited Above, as this approach will enable the VA, and other federal entities, to leverage this technology to solve a wide range of interoperability challenges.

6. Description of Efforts Made to ensure that offers are solicited from as many potential sources as deemed practicable: Market research was conducted, details of which are in the market research section of this document. This effort did not yield any additional sources that can meet the Government’s requirements, and there is no competition anticipated for this acquisition. In accordance with FAR 6.302-1(c)(1)(ii)(c) and 5.102, this justification shall be made publicly available on Contracting Opportunities within 14 days of award.

7. Actions to Increase Competition: The Government will continue to conduct market research to ascertain if there are changes in the marketplace that would enable future actions to be competed. As this technology is still emerging, it is possible that another company will develop a strong competitive product.

8. Market Research: Over the past Five (5) years, the epicenter of the industry focus on Provider Directory accuracy has been the Health Information and Management Systems Society (HIMSS) annual conference. This conference has been the primary forum for industry discussion, debate and efforts to solve this problem. Because this is of primary concern to a specific set of companies (Payers), the efforts to solve this problem have largely been driven by these companies. These efforts range from company specific efforts to group efforts in the form of Alliances and Consortiums. Over this Five year period, there have been many presentations about the problem space and ongoing industry efforts to improve the accuracy of these Directories. These efforts have been split in their focus on non-technology related solutions (increased personnel to manually collect data) to efforts attempting to introduce cutting edge technologies such as block chain to help solve the data capture and data alignment problems associated with producing accurate Provider Directories. One such effort is the Synaptic Alliance whose members include UnitedHealth Group, Optum, Humana, Quest Diagnostics, Centene, Cognizant, Corvel and MultPlan. The Alliance was formed in 2017. At its most recent public presentation in 2021, the Alliance discussed the progress they have made to date and the steps they are taking to solve this problem. Their most recent pilot in the State of Texas demonstrated some success in improving overall Directory accuracy rates, but these efforts were largely focused on enhanced human data collection efforts. Their primary technological advancement was to create a block chain enabled community forum where participating members could purchase and sell updated Provider information generated by individual Alliance Members. Notably, the Alliance’s efforts did not result in a reduction of the individual efforts by its Members to collect and curate data related to their respective Provider networks. There are 3 key components to this problem space which must be addressed by any proposed solution(s): (i) a secure, reliable means of getting Provider data near-real time from community-based Providers to the Payers; (ii) a technological means to enable the Payers to ingest the Provider data in near real-time and reconcile this data against their respective Master Provider Directory databases; and (iii) a technological means to enable the Payers to propagate changes in the Provider data (new or updated information) from their respective Master Provider Directory databases to each internal subsystem of record that knows about those Provider identities. Currently the industry (Payers) are struggling in each of the three phases listed above. None of the presentations at HIMSS over the past Five years has proposed or demonstrated a technological solution(s) to address each of these key components to solving this problem space. As a result, industry accuracy rates for Provider Directories remain stagnant around 50%-60% accurate. To date, most Payers are attempting to solve the problem of collecting Provider data by increasing call center resources, increasing direct in-person contact with local providers and utilization of Provider-focused web portals. These efforts mostly involve non-technology solutions and have proved largely unsuccessful at improving Provider Directory accuracy rates. Some Payers have begun to utilize third-party Provider Directory data sources, such as the Council for Affordable Quality Healthcare, Inc. (CAQH), as another source for updated Provider data. CAQH is the largest and most recognized of these third-party data sources, but it only contains Provider information on less than 10% of the total Provider population. In addition, CAQH provides quarterly batch file releases to subscribing Payers who are then still confronted with the challenges of ingesting this data, reconciling it against their own Master Provider Directory databases and then propagating changes to internal subsystems of record that know about those Provider identities. Notwithstanding the data capture challenges, Payers (and enterprises generally) struggle generally with data sharing across organizational boundaries (interoperability). Currently, many Payers aggregate their data collection efforts into quarterly batch updates, which are used to update their Master Provider Directory databases. This process is both time-consuming and disruptive to operations. Additionally, given the legacy problems with existing data collection efforts which have not been solved, these batch updates often contain incorrect data which is brought into the Payers’ databases through their batch update processes. Neither Payers nor outside third party vendors have demonstrated a successful approach to this interoperability problem. The VA itself has spent hundreds of millions of dollars on interoperability related efforts that have produced no tangible, scalable results. To improve Provider Directory accuracy, Payers must first ensure that all internal systems of record are aligned with the Master Provider Directory database so that each system of record (Master and all subsystems of record) share the same information about any given Provider identity. While this sounds relatively straightforward, it is in fact a critical problem area for many enterprises, including Payers. Their IT infrastructure reflects their growth history, often through acquisitions, which has resulted in a fragmented environment in which systems of record do not easily share information. It was precisely this problem that was the highlight of Apex’s 2021 NAII Tech Sprint. Because Apex’s technologies treat interoperability as part of the overall technology architecture, they have demonstrated a novel ability to address this core problem. Their approach is very different from current industry efforts that attempt to solve interoperability through an open-API driving point-to-point integration approach between disparate systems of record. At the present time, Apex is the only company with demonstrated technology taking this novel approach and whose technology (through the NAII Tech Sprint) has demonstrated an ability to solve this core problem area. The Apex technology offers a unique approach to solving the Provider Directory accuracy problem space by addressing the concerns and challenges faced by both the Providers (how to cost-effectively submit Provider data to multiple Payers) and Payers (helping them with the interoperability issues related to data sharing across organizational boundaries, reconciling that data in near real-time and propagating those changes to all affected internal subsystems of record). The unique, generalized approach of the Apex technology stack, which centers around the creation and maintenance of a single yet distributed “source of truth” for unobtrusive alignment of diverse systems of record using adapters to facilitate a sophisticated “network transparent” change propagation mechanism, offers the opportunity to extend its application beyond Provider Directory accuracy to other interoperability problem areas. These include interconnected domains, such as Prior Authorization & Consent and sharing of clinical data across organizational boundaries, whether between VA & DoD or between VA and community-based Providers. There is no other technology available today that takes this approach or offers such impact on high cost interoperability problem areas currently facing the VA. Moreover, Apex technologies interoperate with other well-known data aggregation technologies, such as InterSystems HealthShare and MarkLogic, allowing VA and CMS to leverage existing investments. VIP search and market research efforts were unsuccessful at locating any equivalent AI solutions equivalent to the proposed Apex solution.

References:

· Veterans Community Care Program: VA Should Improve Its Ability to Identify Ineligible Health Care Providers | U.S. GAO

· Incorrect Provider Directories Associated With Out-Of-Network Mental Health Care And Outpatient Surprise Bills | Health Affairs

· Can blockchain improve provider directories? 5 insights from Humana, EY Advisory (beckerspayer.com)

· Healthcare Directories Workshop Focuses on Secure Validation of Clinician Data - Health IT Buzz

· CAHIE-Knowledge-Network-2016-06-24-Healthcare-Directory.pdf (ca-hie.org)

· How to fix the persistent inaccurate health plan directory problem | American Medical Association (ama-assn.org)

· Improving the Accuracy of Health Plan Provider Directories | Commonwealth Fund

· Medicare Advantage provider directories are riddled with errors. They're not the only ones | Fierce Healthcare

· Online Provider Directory Review Report (cms.gov)

· defining-provider-data-white-paper.pdf (caqh.org)

· Ensuring Provider Data Isn’t the Source of SurprisesGMT20220519 165840 - YouTube

9. Determination by the CO that the Anticipated Cost to the Government will be Fair and Reasonable:

1. PROJECT TITLE Apex Provider Directory Data Accuracy and System of Record Alignment

2. PROJECT MANAGER

Zachary Savarie Janet Chrosniak Period of Performance

DESCRIPTION OF COST ELEMENTS

$96,000.00

$144,000.00

$86,400.00

$59,500.00

$86,400.00

$98,000.00

$37,500.00

Misc Overhead

$365,000.00

$0.00

$0.00

Each period of performance requires an IGCE – (base award, and all option periods require an IGCE)

10. Description of the Market Research Conducted and the Results, or a Statement of the Reasons Market Research Was Not Conducted:

As required by FAR Part 10 VAAR 810.001-70, Market Research Policy, the NAII market research efforts did in fact include searches through the Vendor Information Pages (VIP) database in accordance with VAAR Class Deviation 810.001-70 to determine if two or more service-disabled veteran-owned businesses (SDVOSBs) and veteran-owned small businesses (VOSBs), in the appropriate NAICS code, are listed as verified in the VIP database. There were no target hits for these searches as required by policy and regulation with tangible results. As described in Section 6 above, market research, in accordance with FAR Part 10, was conducted by synopsis of the proposed acquisition, advising industry of the pending acquisition and soliciting inquiries from interested parties” and with no exception… all efforts to obtain full and open competition have been exhausted. There is no existing technology today in industry or government employed or readily available for us outside of this proposed Apex solution. Full scan of VIP was performed and no viable solutions were obtained as an equivalent AI solution (as noted) simply does not exsit.

11. Any Other Facts Supporting the Use of Other than Full and Open Competition: Apex’s Acceλerate solution, which include, but are not limited to, (i) automatic identity resolution in the absence of an National Provider Index (NPI) number to detect discrepancies about a given NPI from disparate sources, (ii) ability to reconstruct state of provider information over time in a way that is conducive to automated data reconciliation, and (iii) Apex’s proprietary AI (utilizing a unique combination of machine learning and automated reasoning techniques, such as neuroevolutionary algorithms and real-time neural network training), is used to maintain a "current" cache of domain information, suitable for aligning systems of record downstream via both automated and workflow-based reconciliation of discrepancies that invariably arise from disparate sources of the same data (i.e., multiple instances of VistA, information coming from external partners/networks). No other solution exists.

12. Listing of Sources that Expressed, in Writing, an Interest in the Acquisition:

VA/ORD/NAII, DoD and CMS

13. A Statement of the Actions, if any, the Agency May Take to Remove or Overcome any Barriers to Competition before Making subsequent acquisitions for the supplies or services required:

The National Artificial Intelligence Institute held a fully advertised, open competition advertised via Challenge.gov to any and all interested parties to solve problems (using trustworthy and ethical AI principles) using AI technology to resolve problems, which impact underserved Veterans. This method encourages all citizens to partake and develop solutions and promote them through competition and future pilot research efforts. The NAII recognized the Apex effort and has done a full canvass of industry and academia and there is no other solution available as of the date of this J&A. The Apex solution still remains the only available resources to solve this complex problem documented in industry and government.

14. Requirements Certification:

I certify that the requirement outlined in this justification is a Bona Fide Need of the Department of Veterans Affairs and that the supporting data under my cognizance, which are included in the justification, are accurate and complete to the best of my knowledge and belief.

Fund Control Point Officer DC VA Medical Center (DC VAMC)

15. Approvals in accordance with the VHAPM Part 806.3 OFOC SOP: This part if filled out by Contracting Staff as part of the Justification

a. Contracting Officer or Designee’s Certification (required): I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief.

Title Facility

b. One Level Above the Contracting Officer (Required over SAT but not exceeding $750K): I certify the justification meets requirements for other than full and open competition.

NCO/PCO XX Duty Title Facility

c. VHA RPO HCA Review and Approval: I have reviewed the foregoing justification and find it to be complete and accurate to the best of my knowledge and belief and recommend approval (if over $75 million) or approve ($750K to $75 million) for other than full and open competition.

VHA Head of Contracting Activity (HCA)

Rev: 13 Effective Date: 02/01/22 Page 1 of 4