SECTION J.docx

SECTION J—ATTACHMENTS

J-1 - Background

J-2 - Partnership for Patient Contract SOWs

J-3 - 10 Areas of Focus J-4 - Subcontracting Plan

J-1 Background

The Partnership for Patients Initiative There are proven models for reducing and even eliminating many hospital acquired conditions, as well as demonstrated ways to dramatically reduce preventable readmissions. What has not been proven is how much can be achieved if the public and private sectors expand their efforts in unison, using common tools to reach common goals. The Center for Medicare & Medicaid Innovation as part of a wide-scale Departmental initiative will test models for achieving significant improvements in health care service delivery that will reduce harm and complications. The model to be tested combines the power of large learning networks aimed at rapidly modifying, studying and informing care delivery, along with robust data analysis and measurement, and robust patient education – all set against a backdrop of increasing incentives (i.e., payment, regulation) - to determine how quickly and effectively known best practices can be adopted throughout the health care system. The goals of the Partnership for Patients Initiative related to hospital acquired conditions and preventable readmissions are to achieve results that, to date, have only been achieved at relatively small scale in selected states or hospitals or hospital units. The Administration aims to show that, with common leadership, purpose, and aligned activities; we can achieve systemic change and make substantial progress toward eliminating hospital acquired conditions and reducing preventable readmissions. The Innovation Center hopes to test how a broad scale model using multiple interventions on a national scale can impact health care problems that have otherwise been relatively intractable.

There are two goals of this partnership – keeping patients from getting injured or sicker in the health care system and improving transitions between care settings.

• Preventing Harm

CMS will dedicate significant funding to test different models of improving patient care and patient engagement and collaboration in order to reduce hospital-acquired conditions with an aim of reducing HACs by 40%. The Partnership will target all forms of harm to patients but will start by asking hospitals to focus on nine types of medical errors and complications where the potential for dramatic reductions in harm rates has been demonstrated by pioneering hospitals and systems across the country, including preventing adverse drug reactions, pressure ulcers, childbirth complications and surgical site infections. The Innovation Center will help hospitals adapt effective, evidence-based care improvements to target preventable patient injuries on a local level, developing innovative approaches to spreading and sharing strategies among public and private partners in all States.

• Improving Care Transitions:

The initiative will also seek to reduce avoidable readmissions by 20%, will ensure consistency exists between the Community Based Care Transitions Program (central to the Partnership for Patients) and the other care transitions activities associated with the initiative.

A retrospective review of Medicare fee-for-service claims conducted by Jencks, et al., found that one-fifth of Medicare beneficiaries discharged from hospitals were readmitted within 30 days, and one-third were readmitted within 90 days. (fn) 1(Stephen F. Jencks, M.D., M.P.H., Mark V. Williams, M.D., and Eric A. Coleman, M.D., M.P.H. Rehospitalizations among Patients in the Medicare Fee-for-Service Program, N Engl J Med 2009; 360:1418-1428 April 2, 2009) While some of these hospital readmissions are planned and others are related to the follow-up treatment for specific conditions, Medicare beneficiaries are being increasingly readmitted for avoidable conditions indicative of poor quality of care.

The new Community-based Care Transition Program at the CMS Innovation Center will provide funding to community-based organizations partnering with eligible hospitals for care transition services that include timely, culturally, and linguistically-competent post-discharge education, medication review and management, and patient-centered self-management support within 24 hours of discharge. Starting April 12, 2011, eligible community-based organizations and acute care hospitals that partner with community based organizations can begin submitting applications for that funding.

Impact to Medicare, Medicaid and Beyond

The primary and most important benefit of this Initiative is that it will support the efforts of clinicians and hospitals to save lives and prevent harm from happening to millions of Americans. Helping make hospitals safer will benefit all Americans – whether they are in Medicare or Medicaid, have insurance they buy themselves or through their employer, or are uninsured. Based on the current estimates, what follows is a summary of the potential benefits of this Initiative for different key stakeholders in health care over the next three years if targeted goals are attained:

Medicare: If the targeted goals are attained, more than 900,000 Medicare beneficiaries would be saved from injury and more than 32,000 deaths would be averted. The direct costs to the Medicare program would be reduced by $1.2 billion over the three years from avoided Medicare Part A payments for harms. In addition, over 690,000 Medicare beneficiaries would benefit from more effective care transitions, as a result of avoided unnecessary hospitalizations and Medicare would save an additional $9.2 billion over the three years.

State Medicaid Programs: If the targeted goals are attained, an estimated 270,000 beneficiaries of State Medicaid programs would be saved from injury and about 10,000 deaths would be averted. In addition there would be a reduction in direct costs to State Medicaid programs which could be reduced by over $350 million over the three years from avoided payments for harms. In addition, over 250,000 Medicaid beneficiaries would potentially benefit from more effective care transitions, as a result of avoided unnecessary hospitalizations and State Medicaid programs would save an additional $2.3 billion over the three years.

Privately Insured/Employer-Based Coverage: If the targeted goals are attained, an estimated 600,000 Americans with private insurance would be saved from injury and more than 20,000 deaths would be averted. The direct costs to private insurers, employers and to patients themselves would be reduced substantially – with an estimate based on cost reductions that parallel those in Medicare of almost $800 million over the three years from avoided payments for harms. In addition, over 350,000 commercially insured individuals would potentially benefit from more effective care transitions, as a result of avoided unnecessary hospitalizations and private payers and patients would save an additional $3.6 billion over the three years.

Reduced System Costs for Hospitals: Most of the costs incurred by hospitals related to hospital acquired conditions are not directly reimbursed by either public or private sector purchasers – rather they are covered by hospitals as part of their operating costs. For the harms this Initiative sets out to avoid, if the targeted goals are attained, we estimate the associated hospital costs reductions that are not realized by payers to be almost $17 billion (the difference between the payment reductions from purchasers and the estimated total costs incurred addressing the harms avoided). Reductions in these system costs due to avoided harms would hopefully in future years, be reflected in reduced charges to all payers. An additional $500 million would be saved by hospitals from avoiding over 70,000 preventable readmissions to hospitals of uninsured individuals.

The Initiative is designed as a three-year effort. However, the hope is that the benefits of the Initiative will continue into future years. Assuming the goals of the Initiative are reached and sustained at a similar rate through 2020, avoided harms in hospital would have prevented over 9 million injuries to patients, averted the deaths of more than 300,000 patients and resulted in savings of $100 billion. The Initiative would help foster improved care transitions that would result in 8 million fewer readmissions, with savings of over $75 billion.

The Need to Improve Patient Safety

In 1999, the landmark Institute of Medicine study, “To Err is Human,” estimated that as many as 98,000 Americans die every year from preventable medical errors. Despite progress in some areas, meaningful improvement was not made in the decade that followed. Numerous patients continue to get injured or sicker from preventable, adverse events after being admitted to a hospital. Patients are also vulnerable once they leave the hospital to continue healing at home, in an assisted living facility, or in other care settings; many are readmitted due to preventable complications.

• A study published in April, 2011 in the journal Health Affairs found that on average, 1 in 3 patients admitted into a hospital suffer a medical error or adverse event – nearly 10 times greater than previously believed. (Classen, David C., et al, “Global Trigger Tool Shows That Adverse Events in Hospitals May Be Ten Times Greater Than Previously Measured,” Health Affairs 30, no. 4 (2011): 581-9.)

• On any given day, about 1 in every 20 patients is affected by an infection related to hospital care.

• On average, 1 in 7 Medicare beneficiaries is harmed in the course of care, costing the government an estimated $4.4 billion every year. Despite progress on improving hospital inpatient care, the pace of improvement needs to accelerate. The National Healthcare Quality Report published by the Agency for Healthcare Research and Quality (AHRQ) reported that the median annual rate of improvement for 179 measures of healthcare quality was only 2.3 percent annually. (AHRQ, National Healthcare Quality Report 2010, February 2011.)

• Nearly 1 in 5 Medicare patients discharged from the hospital is readmitted within 30 days – that’s approximately 2.6 million seniors at a cost of over $26 billion every year.

Successful efforts to improve patient safety have shown that collaboration and use of innovative practices to target specific types of medical errors and complications work. For example, a collaborative effort in Rhode Island between insurers and hospitals reported a 42 percent decrease in central line-associated bloodstream infections. In New Jersey, approximately 150 health care facilities reduced pressure ulcers by 70 percent. And more than 65 Institute for Healthcare Improvement Campaign hospitals reported going more than a year without a ventilator-associated pneumonia in at least one unit.

Stakeholder Participation

Achieving the goals of the Partnership for Patients will take the combined effort of many key stakeholders across the health care system – physicians, nurses, hospitals, health plans, employers and unions, patients and their advocates, as well as the Federal and State governments. Many important stakeholders have already pledged to join this Partnership in a shared effort to save thousands of lives, stop millions of injuries and take important steps toward a more dependable and affordable health care system. They include:

• Hospitals and national organizations representing physicians and nurses: America has the best-trained and equipped health care system and workforce in the world, striving hard every day to care for patients. These providers are committed to improving their care processes and systems, and enhancing communication and coordination to reduce complications for patients.

• Patient and consumer organizations: Patients and their families are deeply affected by the harms from preventable health care complications. These organizations are committed to raising public awareness and developing information, tools and resources to help patients and families effectively engage with their providers to avoid preventable complications.

• Employers, unions, health plans and States: Employers, unions, health plans and States can provide the incentives and support that will enable clinicians and hospital to deliver high-quality health care to their patients, with minimal burdens.

Members of the Partnership will identify specific steps they will take to address reduce preventable injuries and complications in patient care. For example, the Association of American Medical Colleges also launched a complementary harm reduction effort – Best Practices for Better Care – a multi-year initiative to improve the quality and safety of health care. More than 200 teaching hospitals and health systems have joined the effort, and are pledging to take simple steps such as using surgical checklists for safer surgery and using proven practices to reduce central line infections. In addition, Partnership member California Public Employees' Retirement System (CalPERS), has already implemented an integrated care program that has reduced hospital readmissions by 22 percent, and has pledged to continue its efforts to improve patient safety.

Outline of the Overall Work of the Partnership for Patients Initiative

The Partnership for Patients consists of activities focused on improving patient safety from across the Department of Health and Human Services. It also introduces major new supports, created through the Affordable Care Act, the will provide as much as $1 billion in additional supports, including $500 Million from the community Care-Transitions program and as much as $500 million from the Innovation Center at CMS focused on improving care in hospitals. The Innovation Center plans to engage contractors and provider organizations to perform the following work. This description is for overall context only. The material describing activities other than the national content developer is a general summary and subject to change.

National Content Developer – The NCD will be tasked with identifying, modifying, and/or developing training materials aimed at improving patient safety, as well as engaging national experts in the field. The NCD will also be tasked with providing materials and research – at no cost – to hospitals and other Partnership contractors and participants for use in training and dissemination.

Advanced Participant Network – The APN will be tasked with developing and implementing a process for enrolling self-selecting hospitals that have already successfully improved their quality of operations in isolated areas and seek to reduce harm and readmissions more comprehensively and rapidly. The APN convener will be further tasked with creating and running learning activities and collaboration communities amongst these “vanguard hospitals” and with engaging the hospitals in providing education and outreach to other hospitals participating in the Partnership if they meet exceptionally high levels of performance.

Beneficiary and Medical Professional Engagement – This contractor will be tasked with establishing a patient engagement council, creating an online resource center for patients, implementing media and marketing components of the initiative and potentially engaging in agreements with disease advocacy organizations, consumer groups and professional associations of clinicians to incorporate patient safety education aimed at beneficiaries and patients into their ongoing communication programs, as well as to develop new improvement programs that would utilize the perspectives of beneficiaries and patients.

Safety Data Measurement Contractor – This contractor will be tasked with analyzing Medicare and Medicaid claims and other data to determine baseline measurements for safety. The contractor will conduct chart reviews at the Vanguard hospitals to validate their success against specific safety measures. Through continuous monitoring and review of CMS data, as well as qualitative assessment and surveying, the contractor will also help to evaluate the Patient First initiative and its component pieces.

J-2 Partnership for Patient Various Support Contract Statements of Work

National Content Developer in support of the Partnership for Patients Initiative

I. SCOPE

The National Content Developer (NCD) contractor will support the Partnership for Patients (PFP) by developing and adapting materials and methods to support hospitals to meet the goals of major reductions of 40 percent in harm to hospital patients. The contractor will produce training materials, consulting methods, implementation management, and support to the Center for Medicare & Medicaid Services (CMS) and to hospital engagement contractors (HECs) in accomplishing this goal. It will support HECs to hire trainers and consultants to staff conferences and meetings, and support HEC efforts to visit hospitals to provide assistance in reducing harm to patients. The NCD contractor will also directly operate a national program of training done through scalable, distance learning methods such as webinars, video conferences, dissemination of research and training materials directly to hospitals, etc.

The Partnership for Patients also has the major goal of improving care transitions in order to improve post-acute care and reduce avoidable readmissions by 20 percent. Much of the focus in this area is to be provided through the Community-based Care Transition Program (CCTP), already underway. The National Content Developer will cooperate with the CCPT, and will also develop and disseminate information about improving transitions of care in conferences and other training events that it sponsors or helps to implement with the HEC organizations. The NCD contractor will expand promising work to a national scale by coordinating closely with – and giving active technical guidance to - state and system improvement efforts in order to avoid redundant effort and support rapid introduction of good practice. The contractor will publicly declare aims for broad, reliable dissemination of the practices they have pioneered; they will support communities of practice for the interventions on which they are expert; they will help to measure and analyze performance in different states and systems; and they will offer targeted improvement strategies for those facilities struggling to improve. Thus, the contractor will be the technical expert whose work will fuel state and system-level improvement, and it will share accountability for national success, joining the national learning network of system and state leaders.

II. BACKGROUND

The Partnership for Patients has identified ten areas of focus. Although the Partnership will not limit its work to these areas and will pursue the reduction of all-cause harm, these focus areas are those for which content will be developed and learning activities conducted and made available to hospitals participating in the partnership.

0. Adverse drug events (ADE)

0. Catheter-associated urinary tract infections (CAUTI)

0. Central line-associated blood stream infections (CLABSI)

0. Injuries from falls and immobility

0. Obstetrical adverse events

0. Pressure ulcers

0. Surgical site infections

0. Venous thromboembolism (VTE)

0. Ventilator-associated pneumonia (VAP)

0. Preventable readmissions For additional information detailing the supporting components of this program, refer to the attached PFP Initiative –Background included as an appendix to this Scope of Work.

III. REQUIREMENTS

The contractor shall provide the necessary personnel, materials, equipment, support, and supplies (unless government supplies, data, or equipment are indicated) to accomplish the work described below. The contractor will be required to complete the tasks and report to CMS on the findings. All work done under this contract shall be performed under the general guidance of the CMS project officer, and is subject to project officer approval.

Task 1. Develop Project Design.

The contractor shall develop a project plan that will describe the proposed methods and activities to carry out the objectives of the project. The design will be revised as needed after review by CMS. The project design will be continually modified throughout the project, as needed, primarily through design memoranda.

2. Organizational Evaluation Tool and Training Support Packages The contractor shall develop and produce an Organizational Evaluation Tool and training support package materials for use in the training of hospitals and caregivers on methods to reduce harm to inpatients and reduce avoidable readmissions as identified by PFP.

The organizational evaluation tool will be utilized by PFP participants and NCD outreach specialists to assess the root causes and identified deficiencies that result in the ten (10) core HACs and Preventable Re-admissions. This tool will assist PFP participants in the identification of training that can be implemented to reduce the occurrences of HACs and Preventable Re-admissions to meet the goals outlined by the PFP. The organizational evaluation tool will collect quantitative and qualitative measures that will be reported to the Measurement and Data collection activity of the PFP.

Training support packages will be developed to address each of the ten (10) HACs and Preventable Re-admissions as identified in the PFP. The training support packages must include, but are not limited to, the following elements:

1. Training/Course Outline and description of the issue being addressed

2. Training Support Materials (i.e. presentation slides, webinar videos, online learning modules, implementation models)

2. Training Evaluation and Monitoring tool

3. Disseminate and Support Implementation of Organization Evaluation Tool and Training Support Packages to PFP particpants.

The contractor shall disseminate evaluation tools and training support packages developed by the NCD to PFP participants through the use of education outreach teams and a web-based training portal.

The contractor will establish education outreach teams that will assist Hospital Engagement Contractors (HEC) and Advance Participant Networks (APN) with the implementation of organization evaluation tools and training support packages developed by the NCD upon request. The education outreach activities may be conducted on-site or through the use of virtual methods (i.e. webinar or video conference). Requests for training will be available only to organizations that are identified as participants in the PFP.

The contractor shall develop and implement a web-based training portal that will provide a hub for knowledge transfer to supported entities of the PFP and be freely accessed by the general public. The website must include, but is not limited to, the following elements:

a. Access to organizational evaluation tools and training support packages developed by the NCD

b. Access to reports generated from activities supporting the PFP.

c. Collaboration forum to allow the sharing of professional questions and discussions on topics related to PFP. The contractor shall also provide collaboration facilitators to oversee the appropriate use of the collaboration forums.

d. Research materials and informational papers related to the reduction of HACs and Preventable Re-admissions.

e. Links to governmental resources associated with PFP.

4. Monitor and collect data resulting from training activities conducted by HEC and APN activities of the PFP The contractor shall monitor and collect training data generated by HEC and APN activities and provide technical assistance in the production of organization specific training materials to meet the needs of their target population. Specific data to be collected in this task will be:

1. Operational Metrics – number of training sessions conducted, attendance of training sessions, number of organizations participating in projects, etc.

2. Improvement measures – identifying quantifiable improvements to care delivered in participating organizations through the use of the organizational evaluation tool and training evaluation methods

3. Training Materials and Implementation Model documentation produced by HEC and APN participants

The contractor shall provide quarterly reports to the government detailing data collected through the monitoring of HEC and APN activities as identified in this task.

5.Project Reporting Requirements.

The contractor shall provide quarterly reports detailing activities conducted in support of each task in the SOW.

The contractor shall write a final report the activities carried out during the project during the initial operating period, and describe lessons learned about the best methods to identify and solve problems in improving inpatient safety processes. The report will be reviewed and evaluated by CMS, and the contractor will make revisions as needed. The NCD contractor shall deliver final versions of all training materials developed in the project to CMS in a format that may be easily reproduced and disseminated.

J-3 Ten Areas of Focus

The Partnership for Patients has identified ten areas of focus. Although the Partnership will not limit its work to these areas and will pursue the reduction of all-cause harm, these focus areas are those for which content will be developed and learning activities conducted and made available to hospitals participating in the partnership.

1. Adverse drug events (ADE)

2. Catheter-associated urinary tract infections (CAUTI)

3. Central line-associated blood stream infections (CLABSI)

4. Injuries from falls and immobility

5. Obstetrical adverse events

6. Pressure ulcers

7. Surgical site infections

8. Venous thromboembolism (VTE)

9. Ventilator-associated pneumonia (VAP)

10. Preventable readmissions

J-4 Subcontracting Plan

GENERAL INFORMATION:

3. Contractor’s Name and Address:

4. Period of Performance (Base & Options)

From ___________ To: ____________

5. Total Contract Amount (including options) Total MOD Amount (if applicable) BASE YEAR Amount (If there are options)

6. Option #1 (if applicable)

Option #2 (if applicable)

Option #3 (if applicable)

Option #4 (if applicable)

7. Contracting Officer/Specialist Name, Bldg., Room, Phone, Fax & E-mail:

8. Date Received by SBS for Review:

SUBCONTRACT PLAN TYPE:

1. Individual Master Commercial

SUBCONTRACT PLAN REQUIREMENTS:

CO

SBS

SBA/PCR

2. Subcontracting Goal Data

a. Total Subcontracting Dollars [ (b + g), except when subcontract baseline equals contract value]

A

U

A

U

A

U

b. Total Subcontracting Dollars and Percentage with Small Businesses (incl. SDB, WOSB, HUBZone, VOSB, SDVOSB) - [Percentage of 2.a.] $ and %

c. Total Subcontracting Dollars and Percentage with Small Disadvantaged Businesses - [Percentage of 2.a.]

d. Total Subcontracting Dollars and Percentage with Woman-Owned Small Businesses - [Percentage of 2.a.]

e. Total Subcontracting Dollars and Percentage with HUBZone Small Business concerns - [Percentage of 2.a.]

f. Total Subcontracting Dollars and Percentage with Service-Disabled Veteran Owned Small Businesses - [Percentage of 2.a.]

g. Total Subcontracting Dollars and Percentage with “other” than Small Businesses - [Percentage of 2.a.]

Subcontracting Opportunities (description of all principal products/services to be subcontracted to all types of concerns)

Methodology used to develop goals and identify potential sources (e.g. historical trends, information on technical and competitive bidding, formula for calculating the goals, etc.)

3. Subcontracting Plan Administrator’s Name and Duties

4. Description of efforts to ensure the Small, Disadvantaged, Woman, HUBZone, Veteran, Service-Disabled Veteran -owned entities have equitable opportunity to compete for subcontracts

PART B - PLAN REQUIREMENTS - CONTINUED

SBS

5. Required flow-down clause to be included in prime contractor’s subcontracts

A

U

A

U

A

U

6. Reports and Records:

a. Agreement to submit required reports

b. Agreement to cooperate in studies and surveys

PART C - CO DETERMINATION -

SBS AND SBA RECOMMENDATION:

SBS

1. The proposed plan meets the requirements of FAR 19.704 and, in accordance with 19.705-4, past performance has been considered when determining acceptability of this plan.

Y

N

Y

N

Y

N

2. The proposed plan requires an additional pre-award review

COMMENTS: If any elements are determined to be unacceptable, summarize below:

CO Signature DATE

SBS Signature DATE

SBA/PCR Signature DATE

A=ACCEPTABLE U=UNACCEPTABLE Y= Yes N= No

NOTES:

Contracting Officers are responsible for distribution of award documents in accordance with 19.705-6

Subcontracting Plan Review Form