SECTION J_revised.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.

Advanced Participant Network (APN) in support of the Partnership for Patients (PfP)

II. BACKGROUND

The Partnership for Patients is a priority project designed to reduce preventable inpatient harm by 40% and readmissions by 20% (by targeting preventable readmissions) over a three-year period. This program was announced officially by the Secretary of the Department of Health and Human Services on April 12, 2011 and is on a “fast track” for testing and implementation, with procurements slated to be awarded by the end of fiscal year 2011.

The Center for Medicare/Medicaid Innovation (CMMI) in the Centers for Medicare & Medicaid Services (CMS) will support the initiative by seeking to create effective, large improvement networks that accelerate learning in participating hospitals. CMMI intends to engage all health care stakeholders – patients, providers, plans, employers and others – to discover, refine and spread best practices as broadly as possible; the intent of these activities will be the sought-after reduction in hospital-based harm and preventable readmissions. Additional background is provided as an attachment to this document outlining the overall goals of the PFP and the broader set of activities through which CMMI will seek to stimulate national change.

A. Purpose

The contractor selected for this activity will coordinate and oversee activities to establish the Advanced Participant Network (APN) of hospitals within the Partnership for Patients (PfP). The goals of the APN are to identify and measure all harms that occur in hospitals from the time of arrival at the door and continuing through the post acute period (i.e. care transitions); to identify and rapidly evaluate strategies for eliminating all forms of harm and complication; and to disseminate and diffuse these approaches to all hospitals participating in the Partnership for Patients.

The Board and executives of the hospitals selected to participate in the APN must publicly commit to decrease all-cause harm to patients by 40% and readmissions by 20% within an 18-month period and pursue more ambitious goals thereafter. APN hospitals will commit to identifying, reporting, and attempting to eliminate all harms and to share their failures and successes to the health care community so that all may learn and adopt effective strategies.

The contractor will develop and implement a process for enrolling self-identified 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 convener will set up and maintain learning platforms, communication networks, data repositories, and other resources necessary to carry out the goals and mission of the Network and will integrate and coordinate the activities of the Network with the other Partnership for Patients activities. The contractor will, in collaboration with the APN hospitals, the COTR, and CMS survey and certification contractors coordinate the network, devising strategies for organization-wide change that deeply engage leaders, managers and front-line care providers The APN Convener will, to the extent possible, and in collaboration with the other learning activities of the Partnership for Patients, support collaborative learning activities. Methods of delivery for the learning activities will include, but not be limited to, webinars, teleconferences, real time online reporting, and APN convener on-site visits. APN hospitals will, on a regular basis, share data on their progress with other participating organizations and frequently exchange ideas and solutions to pressing problems.

The ultimate objective of the APN is elimination of all harms caused by health care and evolution to a perfectly safe and functional health care system for all. This is audacious, but unless we commit to perfect safety and quality, we have no chance of obtaining it.

II. REQUIREMENTS

Independently and not as an agent of the Government, the Contractor shall furnish all the necessary services, qualified personnel, material, equipment, and facilities, not otherwise provided by the Government, as needed to perform the requirements of this Statement of Work.

A. Performance Requirements/Supporting Tasks

Task 1. APN Assembly (Base Year Only)

The contractor will establish an Advance Participant Network (APN) consisting of selected hospitals that accept Medicare, Medicaid, and CHIP (including non-IPPS hospitals) that desire to participate in the APN of Partnership for Patients (PfP). Tasks supporting this requirement are as follows:

The contractor shall solicit, screen, and identify organizations and hospitals who will publicly commit to fulfilling the following APN core requirements:

· Public commitment of Executive and/or Governing Board members to decrease all-cause harm to patients by 40% and preventable readmissions by 20% within an 18-month period.

· Commitment to pursue more aggressive goals in a subsequent 18-month period.

· Willingness to be recognized and participate in a “Safety Mentor” program.

· Commitment to transparently share experiences, report results, and diffuse new ideas with other advanced participants, as well as hospitals working with the Hospital Engagement Contractor (HEC).

The contractor shall conduct a review of applications in order to select and notify qualified hospitals for membership in the APN within sixty (60) days of the award of the contract. We ask that these hospitals that participate in the APN declare to do so exclusively. We ask that they do not simultaneously participate with the HEC. The contractor must submit a list of proposed APN Hospitals to the government for review.

The contractor shall convene the selected APN hospitals in order to develop and ratify the charter, structure, and operating procedures for the network, and establish collective goals for the APN in support of initiatives outlined by the PFP and as described in “Partnership for Patients Background” included as an attachment to this SOW.

The Contactor shall provide services, including, but not limited to, venue selection, logistics, material support, production support, technical support, audiovisual support and promotional support for the initial convention. The Contractor shall be required to provide advance information to the COTR for the conference, including the schedule and agenda in the event the COTR chooses to attend (or chooses to provide other Government personnel that opportunity).

The contractor shall incorporate inputs generated from the convention of APN hospitals to establish an organizational charter and operational framework to be implemented by the APN. A report detailing the findings of this convention will be submitted to CMS for review within 15 days of conclusion.

Task 2. Support development of assessment, implementation and evaluation strategies

The contractor shall develop approaches that will help hospitals to identify and address all forms of harm and injury, thereby reducing all-cause harm and readmission, and to evaluate progress accurately. These strategies developed within this task may be utilized to augment the activities of the National Content Developer (NCD) and Hospital Engagement Contractors (HEC) supporting PfP. The subtasks to support this requirement are to be implemented as follows:

Sub-Task 1. The contractor shall collaborate with APN hospitals to develop evaluation methodologies to measure all-cause harm and re-admissions. The evaluation methodologies proposed will utilize qualitative and quantitative measures that, at a minimum, capture the following issues:

· events that require a prolonged hospital stay

· events that result in permanent harm

· events that require intervention to sustain a patient’s life

· events that contribute to/result in patient death

· multiple harm events per admission

· harms that occur through the transition of care to include after hospital discharge

· all-cause, all-payer, 30-day re-admissions to the APN hospital

The contractor shall monitor and ensure that all APN hospitals are measuring and reporting all-cause harm and 30-day readmissions through the implementation of proposed evaluation methodologies. APN Hospitals are required to express harm as a rate of harm events per admission, and readmissions as a percentage of admissions with a readmission.

The contractor shall consolidate evaluation methodologies and results generated by APN Hospitals to be submitted to the NCD for posting on a web portal accessed by all PFP participants and the general public.

Sub-Task 2. The contractor shall collaborate with APN hospitals to identify and design implementation strategies to reduce all-cause harm and readmissions. The strategies produced in support of this task should include, but not limited to:

· rapid-cycle evaluation tools

· use of electronic health records as quality improvement tools

· clinical and science-based interventions

· process oriented implementation models

· providers, and staff in organization-wide culture change The contractor shall work with the APN Hospitals and the NCD to refine and format the proposed strategies so that the materials are scalable and can be implemented by hospitals at various levels of ability.

The contractor shall consolidate implementation strategies and results generated by APN Hospitals to be submitted to the NCD for posting on a web portal accessed by all PFP participants and the general public.

Task 3. Coordinate and Moderate Collaborative Learning Network events

The contractor shall coordinate and moderate collaborative learning events that will allow for the regular participation and sharing of best practices amongst APN organizations. These collaborative learning sessions must include at a minimum, but are not limited to:

Subtask 1. Bi-annual Convention of APN Hospitals

The contractor shall coordinate bi-annual conventions of the APN Hospitals to engage senior board members and executives representing each hospital in order to report on organization-wide progress. The contractor shall also engage attendance of point people and senior sponsors on each adverse event/topic area from APN Hospitals to present implementation and evaluation strategies being utilized within their hospitals. The contractor shall invite key system, state or association stakeholders (e.g., regulators, payers, employers) to attend every meeting. Every meeting will be open to the public.

The Contactor shall provide services, including, but not limited to, venue selection, logistics, material support, production support, technical support, audiovisual support and promotional support for conventions. The Contractor shall be required to provide advance information to the COTR for the conference, including the schedule and agenda in the event the COTR selects to attend or provide other Government personnel that opportunity.

The contractor shall provide the government with a report within 10 days of convention conclusion to identify:

· APN Hospitals in attendance and their representative personnel

· key system, state or association stakeholders

· attendance from the general public Subtask 2. Monthly virtual learning sessions

The contractor shall coordinate monthly virtual learning sessions (e.g., webinars, conference calls) covering and addressing recurrent patterns of success or failures that are emerging across the APN Hospitals. The topic of each session will identify commonalities of success and challenges throughout the APN and address methods of attaining all-cause harm reduction and re-admissions. The session must include, at a minimum, one story of success, one common challenge, and proposed tests of change for all participants to introduce. Each learning session will be attended by a project team and senior sponsor (i.e., a middle manager or higher) to include front-line staff (e.g. nurses and clinical staff) from APN Hospitals.

The Contractor shall be required to provide advance information to the COTR for the learning session, including the schedule and agenda in the event the COTR selects to attend or provide other Government personnel that opportunity.

The contractor shall provide the government with a report of attendance 5 days after conclusion of the learning session. The report should identify at a minimum the APN Hospitals represented and staff.

Subtask 3. Coordinate the use of PfP resources to supplement and diffuse APN activities

The contractor shall facilitate the use of NCD evaluation and training support to supplement and reinforce best practices being implemented by APN Hospitals. The contractor shall encourage APN hospitals to regularly and independently contribute to collaboration forums and events to diffuse best practices being implemented by APN Hospitals.

Task 4. Project Reporting Requirements

The contractor shall submit a quarterly report sharing measurement results for each participating APN Hospital as reflected through evaluation models developed by the hospitals. The report must include, but is not limited to hospitals improvement on all-cause harm reduction and readmissions measures.

The contractor shall submit a quarterly report that contains a qualitative review of progress made to-date of APN hospitals on the implementation of strategies being developed by the hospitals. Examples of inputs for this report include:

· success stories

· examples of adversity and widespread challenges

· identification of positive or negative commonalities emerging across all APN hospital The contractor will coordinate with the NCD to make the reports available in a format that can be posted to the web-portal.

Task 5. Safety Mentor Program (optional task)

The contractor shall develop a Safety Mentors program by which APN hospitals achieving outstanding improvement and demonstrating high quality care will be recognized as “Partnership for Patients Safety Mentors”. The implementation of this task will be determined at the end of the initial eighteen (18) month period of performance.

Selection and evaluation of Safety Mentors will be conducted by the government with the assistance of the contractor. The criteria for evaluation and selection of an APN hospital as a Safety Mentor shall include, but not limited to:

· Independent audit by the government to verify that the APN Hospital meets the benchmarks of decreasing all-cause harm to patients by 40% and readmissions by 20% within an 18-month period

· Demonstrated participation of APN Hospital in network activities

· Development of evaluation models and implementation strategies that can be scaled and incorporated by hospital systems APN Hospitals identified as a “Safety Mentor” will enter into a sub-contractor agreement with the contractor that will meet the following requirements:

· agreement to establish and conduct outreach support to hospitals participating in PfP utilizing evaluation and implementation tools developed as a part of the APN

· agreement to continue decreasing all-cause harm and re-admissions that will be verified through a government evaluator The contractor will, upon award of sub-contracts, coordinate with their Safety Mentors to conduct outreach and support activities in order to support the activities of the NCD and HEC.

National Education Campaign Contractor (NEC) in support of the Partnership for Patients (PfP)

BACKGROUND

Medical errors and complications of care, though unintentional, harm millions of American patients each year and needlessly add billions of dollars to health care costs. Many medical injuries – perhaps a majority – are preventable, and leading hospitals and clinics have shown that substantial improvements in patient safety are achievable by leveraging existing knowledge and best practices.

Progress has been slow and isolated, and the time for incremental change has passed. We must stop this epidemic in its tracks, and become the safest, most reliable health care system in the world. In order to further heighten awareness of these problems and mobilize the field around change, the Department of Health and Human Services (DHHS) through the Centers for Medicare and Medicaid Services (CMS) is working to create a new reality in which unsafe care is untenable. We will simultaneously raise public awareness of the problem, create business incentives to change, audit poor performance and offer support to those organizations that seek to improve. Drawing on all of these levers, the President and the Secretary of DHHS are together initiating a three-year national effort called the Partnership for Patients (PFP) to reduce hospital-based harm by 40% and hospital readmissions by 20% (targeting preventable readmissions), saving more than $35 billion in total.

The PFP 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)

1. Catheter-associated urinary tract infections (CAUTI)

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

1. Injuries from falls and immobility

1. Obstetrical adverse events

1. Pressure ulcers

1. Surgical site infections

1. Venous thromboembolism (VTE)

1. Ventilator-associated pneumonia (VAP)

1. Preventable readmissions In alignment with several ongoing public and private sector efforts to improve safety and a number of strong incentives that will be introduced through Federal Legislation in PPACA section 3021, CMS will promote greater learning on how to rapidly reduce harm in facilities and communities. It will test the introduction of models of regional, state and system-level collaboration, advanced measurement strategies and new approaches to stimulating public engagement in change to support massive improvement in hospitals across the country.

The lessons learned from this work will directly inform the larger national effort, refining its design and offering improved methods for introducing safer care, throughout – and after - its three-year duration . Insights on effective practice will inform dissemination through multiple channels, including:

• Performance Measures - Identification of what constitutes exceptional performance by a hospital will influence design of Medicare’s hospital payment programs, public reporting programs in the Inpatient Quality Reporting Initiative, and payment under the electronic health record meaningful use standards;

• Federal Technical Assistance Efforts – Successful approaches to technical assistance will influence federal technical assistance networks, including CMS’s Quality Improvement Organization (QIO) program and AHRQ research and learning networks.

• Private-Sector Technical Assistance Efforts - Successful approaches to technical assistance will influence the ways that private sector groups can modify, continue or revise support for hospitals’ learning and quality improvement efforts.

• Survey and Certification Processes – Deepened understanding of effective practice and performance standards will influence the evolving design of the mandatory survey and certification process that all hospitals serving Medicare, Medicaid and CHIP populations must complete.

Purpose

Patients and families have a critical role to play in helping improve the quality and safety of the care they receive, from being active members of their health care team to advocating for safety in the settings where they receive services to setting the health care priorities for their communities. The PFP will pursue a series of tests to engage Medicare, Medicaid and CHIP beneficiaries, their families and caregivers and health care professionals in specific activities, including:

1. generating their support for achieving improvements in hospital safety and care transitions;

1. securing active involvement of organizations that represent beneficiary interests; engaging beneficiaries and their families in designing and carrying out improvement activities;

1. encouraging beneficiaries to negotiate and implement care plans during hospital and nursing home visits, and transitions between those settings and home.

A highly visible part of the work will be the establishment of a voluntary National Patient and Public Engagement Council (NPPEC/The Council). The Council will be made up of groups representing beneficiaries, other consumers and patients, as well as providers who have had success at engaging patients in self-care and improvement activities. The Council will test and establish methods for obtaining input from organizations and will implement strategies proven to effectively engage patients and the public. The Council also will serve as an important feedback loop for those implementing improvement activities in the larger effort to improve awareness and resultant safety.

The work performed by the contractor under this National Education Campaign Contract will include providing support staff for the Council as the Council develops and maintains a compilation of existing information and resources, filtered for quality and usefulness, and will test these through placement on an interactive website. The resources will be designed to mobilize communities through established and innovative methods, using social networking and other technologies, collecting contributions from users, and enabling self-care through MyMedicare.gov. This work will develop, test and disseminate public information on ways to improve patient safety and care transitions, and the role that patients and citizens can play in accomplishing those goals.

Scope

The contractor selected as the National Education Campaign (NEC) contractor supporting the Partnership for Patients (PfP) shall be responsible for the development and implementation of a series of tasks designed to increase awareness and engagement among patients, families, care givers, professionals and communities with the activities and goals of the PfP. The tasks, defined in detail in the requirements section of this statement of work, will include:

· informing and engaging Medicare, Medicaid and CHIP beneficiaries, their families and care givers, health care providers and their communities around a set of specific PFP goals and activities;

· generating their support for achieving improvements in hospital safety and successful care transitions; securing active involvement of organizations that represent beneficiary and care givers’ interests;

· engaging beneficiaries, families and care professionals in designing and carrying out improvement activities; and,

· encouraging beneficiaries to negotiate and implement care plans during hospital and nursing home visits, and transitions between those settings and home.

REQUIREMENTS

Independently, and not as an agent of the Government, the Contractor shall furnish all the necessary services, qualified personnel, materials, equipment, and facilities not otherwise provided by the Government to perform the requirements of this Statement of Work, unless otherwise identified herein. The Contractor shall:

1. Establish a voluntary national Patient and Public Education Council

2. Establish and maintain materials for an online interactive resource center

3. Acquire and develop Information for beneficiaries, families, care givers, health care providers and other target audiences

4. Dissemination of media and marketing campaign components/resources

5. Monitor impact of the Outreach and Education Efforts

6. Media Relation support (optional task)

Supporting Tasks

Task 1: Establish a voluntary national Patient and Public Education Council

A highly visible and important part of the work will be the establishment of a voluntary national Partnership for Patients Initiative - Public Engagement Council (PFP-PEC). The Council will test and otherwise help develop tools and strategies (discharge plans, SMS text reminder services, medication adherence tools, etc.) that patients can use to help make their care experiences safer and their transitions smoother. The council will also establish methods for obtaining input from organizations on key Partnership goals and activities and will implement strategies proven to effectively engage patients and the public. The Council also will serve as an important feedback loop for those implementing improvement activities in the larger effort to improve awareness and resultant safety. The Council will have broad representation from patients and families and the groups that represent them, including (but not limited to):

• Senior citizen advocacy groups.

• Representatives from minority communities.

• Health communications experts.

• Health care providers and practitioners

• Patient Safety experts and advocates

• Health IT experts.

The Contactor shall provide services, including, but not limited to, venue selection, logistics, material support, production support,…