ATTACH E - VFTHE BPA Call Order 1 - v9.docx

MAHSO/VFTHE BPA Call Order 1

Scope

This Call Order provides the Department of Veterans Affairs (VA) with support in the completion of the VA MISSION Act requirements related to the ongoing market assessments, activities, and special studies as detailed in Task Areas 1 – 7 in the Blanket Purchase Agreement (BPA).

Period of Performance

This BPA Call Order addresses the objectives and requirements for the contractor’s efforts to provide VA services outlined in the scope for 12 Months (March 15, 2023 – March 14, 2024.) Unless otherwise specified, the contractor will have 12 months to complete each major deliverable; however, except for the continuous support deliverables such as those in task areas 6 and 7, the contractor can execute deliverables short of 12 months and can initiate deliverables as appropriate in coordination with VA.

Project Description

VA has a clear need and an obligation to modernize VA facilities to provide Veterans the best possible health care outcomes and provide our VA workforce the safest and most efficient means and environment possible to deliver care. Veterans in the 21st century should not be forced to receive care in early 20th century buildings. The median age of VA’s hospitals is nearly 60 years old. This is why the President requested nearly $20 billion in new VA infrastructure spending last year, and why he requested the largest ever investment in VA infrastructure in his fiscal year 2023 budget.

To identify and prioritize health care infrastructure investments that will improve Veteran access to quality VA health care, VA will execute a new collaborative approach for conducting market assessments to increase access and improve outcomes for all Veterans. The new field-driven and transparent approach to market assessments will reflect the valuable stakeholder feedback that has been received and the lessons learned. It will also include using new, better, and up-to-date data; deep collaboration with our networks and medical centers across the country; and early and robust engagement with stakeholders. Stakeholders include Veterans, employees, unions, VISN leaders, Congress, Veterans Service Organizations, and leaders in the community.

VA will create a strategy focused on building VA health system infrastructure to support Veterans with the right facilities, in the right places, to provide the right care in every part of the country.

Effective planning for Veteran care will be enhanced by contractor support and facilitation in the several key task areas outlined below. This initial Call Order will intersect with most of these task areas:

1) Market Area Health System Optimization (MAHSO) Market Area Assessments: Conducting comprehensive market assessments that allow VA to determine how and where to best meet the needs of Veterans through VA-owned/leased infrastructure, innovative care delivery approaches (including virtual care), and partnerships with academic, DoD, other federal, and community providers. This will likely include:

Development of enterprise-wide strategic analysis to assess and evaluate the current and the future state of all 95 VHA Market Areas to inform planning

Delivering evidence-based advanced data analytics, VA and commercial healthcare planning expertise, and training. Support may also include supporting engagement with potential partners to identify opportunities and assess their feasibility including emerging healthcare technology and delivery processes.

Additional domains of analysis including visioning, rural healthcare, education and research, health and wellness aspirations, health equity, population migration, pandemic and PACT Act implications, enrollee reliance, population density distribution, population health, telehealth, and cost accounting

2) Data Management: Data management solutions that drive effective health care planning and align with VA Data Governance requirements.

IT Maintenance and Development – Across the four years of MAHSO BPA, tools have been developed to manage and automate data related to VA facilities, health care planning, and market assessment recommendations. Further support is required for the maintenance and upgrade of these data repositories and analytics tools. In particular, database management is essential to maintain and improve the data used across the market assessments.

Data Discovery & Findings – Providing the VA with the comprehensive market analysis data set(s) derived from authoritative or validated data sources that include data domains pertaining to People (Workforce and Veterans), Practice (Skills and Specialties) and Place (Infrastructure and Facilities) to assess market areas at a minimum by Access, Quality, and Cost standards and to clearly evaluate demand, aggregated by geography, internal and external health care capacity by market, and productivity.

3) Supporting Data Management Applications: Systems and Tools leveraging data management to best enable healthcare planning, facility planning, capital investment planning, facility life cycle management planning, market assessments, and national strategy.

Health Systems Planning Application (Sustainment and Evolution) – Provide the expertise to integrate all data used in the market area assessment with the VHA internal facility planning to enable local planners to Assess their local Veteran population, including eligible and enrolled Veterans, as well as trends impacting Veterans associated health care, Identifying projected imbalances in health care capacity, and visualizing market supply and demand

Cost Range Model – Provide the financial expertise develop or enhance VA tools which clearly compares the cost of care in the VA Direct Care System by Service to the cost of care for comparable Services in the Community, and estimates criteria-based modernization requirements for every VAMC installation and includes a resource allocation element to project and distribute workload

Conversion of EHCPM Workload for Use in VA applications – Support to convert the latest Enrollee Health Care Projection Model (EHCPM) workload into space conversion factors based on changes in care delivery models and the shift to outpatient Health System Planning Categories (HSPCs) from Strategic Planning Categories (SPCATs).

Interactive Mapping Tools – Provide Geospatial expertise to supplement and integrate all Geospatial Data and Analytics used in the Market Area Assessments with the VHA GIS Planning Portal, a geographic database of capacity, healthcare locations (internal and external) and analytical tools to enable effective distribution of capacity where it is most needed.

4) Implementation Planning: Helping VA convert high-level strategies into executable, acquisition-ready capital projects. As needed, this may include support for VA in executing strategic partnerships to facilitate expansion of Veteran access to care. It will include prototype facility master plans for complex VAMC campuses in dire need of modernizations and/or possible decanting of functions off campus.

5) Strategic Prioritization: A process to update approaches for prioritization based on changes in Veteran need and VA/VHA strategic direction. The process would incorporate extensive input from VISN and VAMC leaders regarding the needs of local markets and would align with VA enterprise strategies and priorities, including clinical priorities.

6) Stakeholder Management and Strategic Communications: Facilitating a Stakeholder Engagement plan through VISN and local leadership to appropriately engage with a broad range of stakeholders.

7) Program Management and Executive Support: Program management oversight, meeting management support to relevant governance bodies, communications support, legislative support, and support for the development of briefings for executive leadership.

8) Special Studies: Additional studies and analyses that will enable VA to appropriately plan for Veteran-centric care or efforts to implement any opportunities.

Deliverable Nomenclature

First Digit (Number) = Call Order Sequence Second Digit (Number) = Task Order Sequence Third Digit (Upper Case Letter) = Major Deliverable Sequence Fourth Digit (Number) = Subordinate Deliverable Sequence Fifth Digit (Lower Case Letter) = Sub Subordinate Deliverable Sequence Example: 1.1.A.1.a

1.1 MAHSO Market Area Assessments

1.1.A: Development of Enterprise-wide Strategic Analysis

Deliverables:

1.1.A.1: Publish a strategic analysis plan informed by the Field, and aligned to the VA Strategic Plan, VA Data Strategy, VA Spatial Data Strategy, and VHA Long Range Plan that is approved by VA Governance and provides the guidance, process, procedures, techniques, key actions, desired outcomes, measures, milestones, targets/threshold for enterprise-wide strategic analysis to be used for market area assessments focused on People (Veterans & Workforce), Practice (Skills & Services) and Place (Facilities & Infrastructure)

1.1.A.2: Define key policies and how policy analysis will be used for Market Area Assessments.

1.1.A.3: Define and publish the approach to assess and evaluate all Market Areas on a rolling basis and key milestones required to activate an evolved market assessment methodology and publish each market area assessment as they are completed. Include how these market area assessments will be incorporated into the VA Governance decision making and budget formulation process.

1.1.A.4: Develop key analytical questions for VA Governance approval that provide the basis for the assessment of Access, Quality, and Cost; Demand by Geography; Inventory of Capacity by VA Direct Care (DC), VA Community Care (CC), Whole of Government (WOG) Federal Health Facilities; Non-Contracted Community Care (NCC), and Academic Affiliates (AA); Capacity by Providers/Categories of Services; Effects of Capacity on Access/Quality Standards; Appointments DC/CC; Risk Assessments; Performance/Efficiency; Readiness/Training/Learning; and Partnerships.

1.1.A.5: Define and publish required Data Sets/Sources/Parameters and provide an assessment of the Data Quality used for the strategic analysis that can be repeated and replicated.

1.1.A.6: Define and publish evidence-based advanced data analytics and Analytic Models to be used for the strategic analysis to include the evidence-based Standards/Metrics/ Measures/Thresholds (Benchmarks) by health service categories. This includes quantitative and qualitative analytic models, such as logic, causal, and conceptual modeling that assess how a program or process is supposed to work by exploring how outcomes are associated with the process and how it is assumed to work; that identify cause and effect of Veteran centric relationships; that show how one aspect of healthcare influences other different aspects by describing how different parts of a problem interact with each other.

1.1.A.7: Define and publish the domains to be used for the strategic analysis and assessments to include access, quality and cost analysis all healthcare provided by the VA and VA Community Care; by provider; services; facility; VAMC; Market; VISN; rural healthcare; education and research; health and wellness; health equity; home health; healthcare policy; VA’s fourth mission on preparedness; population health; telehealth; Policy (current and emerging like PACT Act), et cetera.

1.1.A.8: Define and publish data analytic techniques to be used for strategic analysis and assessment of the market areas such as regression analysis, Monte Carlo simulation, factor analysis, cohort analysis, cluster analysis, time series analysis, sentiment analysis, discrete-event simulation, social network analysis, agent-based simulation, epidemiological analysis, population health analysis, et cetera.

1.1.A.9: Define and publish the multivariate analytical approach to assess and evaluate all 95 Market Areas using standardized methodologies and techniques that can be repeated and replicated, and that provide an objective, numerical rating of all 95 Market Areas that provides a conclusive deterministic assessment and evaluation of each market area ranging from a high performing integrated network to a moderate performing integrated network, to a low performing integrated network.

1.1.A.10: Define the criteria used for the multivariate analytical approach.

1.1.A.11: Define and publish the approach to incorporate Sensitivity Analysis to ensure there is a consensus enterprise-wide on the multivariate analytic approach to assess and evaluate each market.

1.1.A.12: Define screening criteria and evaluation criteria used evaluate all opportunities and recommendations that evolve from the market area assessment.

1.1.A.13: Technical support of the maintenance and development of the Health System Planning Application tool.

1.1.A.14: Define distinct scenarios and assumptions to be used to assess and evaluate the future state of each market area to include the opportunities that are developed to mitigate the assessment and evaluation of the current state of each market.

1.1.A.15: Provide training to better enable the VA planning community to engage in evidence-based data analytics.

1.1.B. Delivering Evidence-based Advanced Data Analytics, VA and Commercial Healthcare Planning Expertise, and Training

Note: Support may also include supporting engagement with potential external partners to identify opportunities and assess their feasibility including emerging healthcare technology and delivery processes.

Deliverables:

1.1.B.1: Define and deliver evidence-based advanced data analytics that can be validated by GAO and OIG, replicated and repeated.

1.1.B.2: Define and publish quantitative and qualitative analytic models, such as logic, causal, and conceptual modeling that assess how a program or process is supposed to work by exploring how outcomes are associated with the process and how it is assumed to work; that identify cause and effect of Veteran centric relationships; that show how one aspect of healthcare influences other different aspects by describing how different parts of a problem interact with each other.

1.1.B.3: Implement the published approach to assess and evaluate all Market Areas on a rolling basis and key milestones required to activate an evolved market assessment methodology and publish each market area assessment as they are completed.

1.1.B.4: Publish the data sets, sources and parameters used for strategic analysis and assessments; identify which data sets are authoritative and who the data stewards are of each data set.

1.1.B.5: Publish independent market area assessments for all 95 market to include high, moderate, low performing evaluations of each; assessment of the appropriateness of the access standards and standards for quality with recommendations for any changes to such standards

1.1.C. Additional domains of analysis including visioning, rural healthcare, education and research, health and wellness aspirations, health equity, population migration, pandemic and PACT Act implications, enrollee reliance, population density distribution, population health, telehealth, and cost accounting analyses.

Deliverables:

1.1.C.1: Define and publish the domains to be used for the strategic analysis and assessments to include access, quality and cost analysis all healthcare provided by the VA and VA Community Care; by provider; services; facility; VAMC; Market; VISN; rural healthcare; education and research; health and wellness; health equity; home health; healthcare policy; VA’s fourth mission on preparedness; population health; telehealth; Policy (current and emerging like PACT Act) and et cetera.

1.1.C.2: Define and publish domains to be used for strategic analysis and assessment of PEOPLE to include demographics and health of the Veteran population/cohorts/Priority Groups that address eligibility, enrollment, reliance, population health (Dx/CPT/Vitals), HEDIS Measures, Social Determinates of Health; CHAMPVA Population; Caregiver population; VA Workforce population; staffing (FTE) and skills requirements; Veteran and Staff satisfaction; etc.

1.1.C.3: Define and publish domains to be used for strategic analysis and assessment of PRACTICE to include all inpatient and outpatient specialties, skills, and services (Clinical, Ancillary, and Administrative) provided by VA DC and CC; Productivity, Utilization, and Efficiency measures and thresholds; cost of care by service for DC and CC; balance of care by service; board certification rates; quality of care provided by service, etc.

1.1.C.4: Define and publish domains to be used for strategic analysis and assessment of PLACE to include all facility types; age; location; size; land; levels of care; staffed Bed types; ORs; ICUs; Exam Rooms; EHRM; etc.

1.1.C.5: Define and publish the data sets, sources, parameters for the strategic analysis and provide an assessment of the data quality of all data sets used.

1.1.C.6: Identify and publish VA and commercial healthcare analytics and planning subject matter experts contributing to the strategic analysis to include input and engagement from stakeholder to include the Veterans, VAMCs, VISNs, VA Program Offices, VSOs, Labor Unions, OMB, and Congress.

1.1.C.7: Publish the data sets, sources, parameters for the strategic analysis and provide an assessment of the data quality of all data sets used.

1.2) Data Management

1.2.A. IT Maintenance and Development

Recommended Approach

Across the four years of MAHSO BPA, tools have been developed to manage and automate data related to VA facilities, health care planning, and market assessment recommendations. Further support is required for the maintenance and upgrade of these data repositories and analytics tools. In particular, database management is essential to maintain and improve the data used across the market assessments.

Deliverables:

1.2.A.1: Host weekly status meeting with CSO to review weekly progress and discuss upcoming work.

1.2.A.2: Update and maintain the scripts, processes, and reports that validate the CDW cubes are still available and accessible for data import into the MAHSO/VFTHE Database.

1.2.A.3: Update and maintain the MAHSO/VFTHE Database schema, data imports, and Power BI reports.

1.2.A.4: Maintain the Strategic Prioritization Application.

1.2.A.5: Update the MAHSO/VFTHE Database schema, data imports, and Power BI reports with recent fiscal year data, comparing updated data to data used in different planning stages.

1.2.A.6: Update and maintain the tools and processes that enable the synchronization of the MAHSO/VFTHE environment between the Development, Test, and Production environments.

1.2.A.7: Develop 3.0 versions of the Data Issues Log and Key Takeaways and Findings SharePoint tools and the Supplemental Data Analysis Request application.

1.2.A.8: Maintain and support the MAHSO/VFTHE Collaboration Portal SharePoint site and the Facility Hierarchy application.

1.2.A.9: Maintain and provide usability enhancements to the Automated Opportunity Listing 3.0.

1.2.A.10: Automate with the VA ArcGIS Portal the existing maps developed for the DD&F to be refreshed along with the DD&Fs.

1.2.A.11: Maintain the interactive maps, including maps updated during reviews prior to any budget request submissions.

1.2.A.12: Perform all required tasks as defined in the VA Risk Management Framework and Authorization Requirements SOP, e.g., POAMs, Annual Risk Assessment, Technical Scans, etc.

1.2.A.13: Documentation of the MAHSO/VFTHE architecture and systems to continue support post task order.

1.2.A.14: Provide usability enhancements to the Cost Range Model as needed.

1.2.B. Data Discovery and Findings

Providing the VA with the comprehensive market analysis data set(s) derived from authoritative or validated data sources that include data domains pertaining to People (Workforce and Veterans), Practice (Skills and Specialties) and Place (Infrastructure and Facilities) to assess market areas at a minimum by Access, Quality, and Cost standards and to clearly evaluate demand, aggregated by geography, internal and external health care capacity by market, and productivity.

Deliverables:

1.2.B.1: Define and publish the data sets, sources and parameters used for strategic analysis and assessments; identify which data sets are authoritative and who the data stewards are of each data set.

1.2.B.2: Define the data categories to be used to include but limited to:

a. Market Geography and Demographics (Geographic Hierarchy; VA Current Site Locations; Current Demographics; Projected Demographics; Rurality; Enrollee Demographics; Enrollment Key Drivers; Reliance Data);

b. Demand (Historical Workload Data; Community Care Workload Data; Telehealth Data; Projected Future Workload; Projections Assumptions; Referral Data);

c. Supply (Clinical FTE/Staffing; Physician Efficiency; Capacity; Staffing and Vacancies; FQHC Listing; DoD Listing; DoD Historical Workload, Capacity, and Future Projects; IHS Listing; National Survey Results);

d. Access, Quality, Cost, and Patient Satisfaction (Appointment Wait Times; SHEP Patient Satisfaction; SAIL Data; Drive Times/Enrollee Proximity to Closest VA Site; Patient-level Costs (Inpatient); Patient-level Costs (Outpatient);

e. Supplemental Data (Acuity Data; Rural Health Projects; Academic Affiliations);

f. Facilities Data (SCIP Projects; Site Plans; FCA Projects/Other Projects; Building Inventory (Leased and Owned) List; Facility Complexity Level; Active and Planned Capital Projects Facility Operating Costs; Historic Sites);

g. Community Market Data (Current and Future Market Inpatient and Outpatient Demand; Commercial Market Hospitals by Type and Bed Total; Current Commercial Market Physician Supply and Demand; Major Commercial Healthcare Changes; Commercial Hospitals Quality and Satisfaction Data; Health Service Area (HAS)/ Hospital Referral Region (HRR).

1.2.B.3: Publish independent market area assessments for all 95 market to include high, moderate, low performing evaluations of each.

1.2.B.4: Physical Product Deliverables:

a. Weekly IT status meeting.

b. Maintain CDW Schema Validation Pipeline and Integrated Dashboard.

c. Update and maintain the MAHSO/VFTHE DB schema, core data elements, and Power BI reports to facilitate annual updates to the DD&F.

d. Cloud based Strategic Prioritization Application Enhancements.

e. Maintain MAHSO/VFTHE Environment Synchronization functionality.

f. Migrate MAHSO SharePoint applications to the MAHSO/VFTHE common application framework.

g. MAHSO/VFTHE Collaboration Tools support and maintenance including enhancing data tools and systems to incorporate multiple rounds of market assessments.

i. Integration of the Existing State Mapping Application into ArcGIS Enterprise Portal 4.0 with enhancements.

j. Maintain the interactive maps.

k. Maintain the MAHSO Authority to Operate (ATO).

l. MAHSO/VFTHE Transition Plan.

1.3) Supporting Data Management Applications

1.3.A. Health Systems Planning Application (HSPA) – Sustainment

A VHA internal facility planning tool to enable local planners to assess their local Veteran population, including eligible and enrolled Veterans, as well as trends impacting Veterans associated health care, Identifying projected imbalances in health care capacity, and visualizing market supply and demand.

Deliverables:

1.3.A.1: Support the annual 12-month development cycle for HSPA which begins in Q3 of each fiscal year and concludes at the end of Q2 the following fiscal year.

1.3.A.2: Within the MAHSO ATO maintain the HSPA artifacts, which will include updates to documents and artifacts within eMASS that are impacted by application enhancements, as well as any activities required to satisfy the continuous monitoring requirements outlined in the Authorization Requirements Standard Operating Procedure (SOP), including application code and database scans with necessary remediation of any findings.

1.3.A.3: Develop written documentation with visual aids on the transformation steps required to update the HSPA database and application as new fiscal year Enrollee Health Care Projection Model (EHCPM) data is received from Milliman including code for any scripts that are used to facilitate new Base Year (BY) updates.

1.3.A.4: Develop additional user interface (UI) enhancements that build upon the improvements provided in HSPA 5.1.

1.3.A.5: Develop project management plan outlining key milestones for HSPA development.

1.3.A.6: Work with VA to identify required enhancements and develop plan for implementation.

1.3.A.7: Develop plan for training users on functions included in new release.

1.3.A.8: Develop transition plan capturing all technical specifications of the applications.

1.3.A.9: Develop bi-weekly status report capturing progress against key milestones.

1.3.A.10: Conduct weekly status meetings to discuss progress, risks, and issues.

1.3.A.11: Provide general maintenance of application and handle support requests.

1.3.A.12: Develop a web-based dashboard to track facility projects in SCIP, modernization efforts, and MAHSO/VFTHE recommendations.

1.3.A.13: Develop a set of VISN and national-level DD&Fs to supplement the existing market DD&Fs.

1.3.A.14: Physical Product Deliverables:

a. HSPA Project Management Plan and updates.

b. HSPA Enhancement Plan and updates.

c. HSPA Training Plan and updates.

d. HSPA Transition Plan and updates.

f. HSPA Development and updates.

g. HSPA VISN and National-Level DD&Fs.

h. HSPA Dashboard.

1.3.B. Health Systems Planning Application – Evolution

To allow for enhanced alignment between the MAHSO/VFTHE database and the HSPA, continued support is required.

Deliverables:

1.3.B.1: Define and publish how the strategic analysis and assessments are integrated into the VA’s Health Systems Planning Application (HSPA) to enable VA planners and health systems analyst to replicate and repeat the analysis and assessments at the strategic/enterprise-level for cross comparison purposes and at operational level (VISN, Market, VAMC) in order to analyze and assess their local Veteran population, including eligible and enrolled Veterans, as well as trends impacting Veterans associated health care, Identifying projected imbalances in health care capacity, and visualizing market supply and demand.

1.3.B.2: Reconcile and ensure the data, discovery & findings are accurately captured in the HSPA to ensure enterprise-wide transparency, coordination, and synchronization of the market area assessments.

1.3.C. Cost Range Model

VA tool which estimates criteria-based modernization requirements for every VAMC installation and includes a resource allocation element to project and distribute workload.

For an overview of VA’s current Cost Range Model application and future aspirations see attached “VFTHE Cost Range Model Illustration.”

Deliverables:

Betterments

1.3.C.1: Deliver betterments identified in the attached documents.

a. Estimate healthcare delivery costs in addition to capital costs. Obtaining and implementing VA and non-VA healthcare unit costs in the CRM, make this the first singular VA tool to be able to plan from workload, to space, to cost

b. Support pre-planning and business case development by measuring timeline and facility life cycle variations

c. Measure opportunity costs of not moving forward with capital investment or service delivery projects

d. Conduct make vs. buy analyses to determine the appropriate mix of VA provided vs. Community Care based on operational costs and infrastructure capabilities

e. Apply thresholds for service delivery planning

f. Help stakeholders make decisions on the consolidation of care by measuring impact of pulling in workload from community

g. Illustrate how estimates for modernization would grow based on cost escalation by parent station

h. Illustrate how the balance between VA delivery, VA facility investment, and Community Care costs might shift over time

i. Include projections of full costs of ownership including:

1. Initial capital investment

2. Projected lifetime operational and maintenance costs

3. Reinvestments and rehabilitation

4. Disposal and residual value

j. Process and cadence to update modernization cost estimates with VAMC Cost Guide, operational costs, CAI and VAST data, and workload allocations

1.3.C.2: Establish Plan and cadence to integrate operational costs

1.3.C.3: Develop Approaches to automate VISN Cost Guide updates, CAI and VAST data, and workload projection updates to the model

CRM enhancements

1.3.C.4: Integrate CRM with Market Assessment

1.3.C.5: Integrate CRM with VA and non-VA healthcare delivery unit costs

1.3.C.6: Incorporate existing community care workload volumes into CRM

1.3.C.7: Develop full costs of ownership for each proposed new space in the CRM tool (e.g., operational and maintenance costs, reinvestments and rehabilitation, and disposal/residual values), and

a. Incorporate time horizon impacts

b. Individualize user flows based on the type of analysis

1.3.C.8: Expand CRM to accommodate CBA and Cost Benefit Indexing (CBI) of any suite of services at a VHA facility

1.3.C.9: Expand the CRM platform to enable more granular CBA analysis.

1. 3.C.10: Augment CBA to receive evolved input from CRM and HISP via the CRM.

CRM Data Updates and Analysis

1. 3.C.11: Update CRM with latest VAMC Cost Guide and updated workload data

1. 3.C.12: Update CRM with latest Capital Asset Inventory (CAI) and VHA Site Tracking (VAST) System data

1. 3.C.13: Re-run modernization estimates after new data loaded into model and incorporation into single report

CRM Implementation Planning

1. 3.C.14: Develop process to deploy CRM application to market- and facility-level planning efforts across VISN and VAMC planning teams

a. Identify users to be prioritized for future feature development

1. 3.C.15: Develop Training process to roll out CRM tool

b. Develop Training and communications plan

Publishing’s

1. 3.C.16: Develop and publish an evidenced-based cost range model used to assess the cost of care for VA DC and CC providers, services, supplies, equipment, pharmaceuticals, facilities (VA owned and leased), and land.

1. 3.C.17: Define and publish cost accounting methodologies and standards used for the cost range model.

1. 3.C.18: Provide and publish a cost comparison and assessment of care provided by the VA and by the commercial sector by market.

1.3.C.19: Develop and publish an assessment that compares and contrasts the cost range model with the VA’s VERA model and activity-based costing models.

1.3.D. Veterans’ Health Administration Conversion of EHCPM Workload for Use in VA Space Calculator and Full Review and Update of Workload-Related Elements of VA Space Planning Criteria (PG-18-9) to Allow for Development of Future Project Space Programs Using VA Space and Equipment Planning System (SEPS)

Support is needed to convert the latest Enrollee Health Care Projection Model (EHCPM) workload into space conversion factors based on changes in care delivery models and the shift to outpatient Health System Planning Categories (HSPCs) from Strategic Planning Categories (SPCATs).

For VHA to better develop rough-order-of-magnitude capital portfolio requirements, future Veteran demand for care needs to be readily translated into physical facility requirements. The current version of EHPCM produces demand forecasts in units that have not yet been translated into physical facility needs in terms of clinical, administrative, support, and special use space. For rough-order-of-magnitude requirements development, the VA Space Calculator has been an effective high-level tool to estimate future capital portfolio budget needs, but it cannot ingest the new HSPCs. A methodological approach and the application of that approach is needed to update and re-tool the VA Space Calculator.

Similar to the high-level capital portfolio budgeting that this conversion supports for the VA Space Calculator, the VA Space and Equipment Planning System (SEPS) program also benefits from the effort. SEPS provides detailed Programs for Design (PFDs) at the room level to create Office of Management and Budget (OMB) 300 Budget Request and DD1391 programming documentation. In order to effectively build budget-ready, detailed, project-specific PFDs in SEPS, the conversion of EHCPM forecast workload aligned to every SEPS/VHA Space Planning Criteria service planning category is critical. This will entail more granular conversions of workload than the VA Space Calculator requires. While creating updated conversion factors for the Space Calculator will be the first priority due to the more immediate need for portfolio-level capital budgeting, a survey of both systems’ needs for service line workload conversion is necessary to determine the full universe of conversion requirements.

Before attempting to reverse engineer RVU-based workload into existing VA space planning criteria, it might be good to take the opportunity to survey other large healthcare systems and healthcare Architecture/Engineering (A/E) firms for best practices in translating workload demand into physical space. Large healthcare systems like Kaiser Permanente, Sutter Health, and HCA currently work from RVU-based projections to determine clinical facility needs. These systems often have a corporate capital planning group that works in conjunction with specialty healthcare A/Es like NBBJ, HDR, AECOM, etc. to develop and evolve space planning standards. After surveying and highlighting best practices that VA might adopt from these types of leading practitioners, a report recommending a way forward on VA’s conversion approach, leveraging industry best practice, could be produced. This report would also recommend the scope of any new RVU-driven space planning pilots; the prioritization of service lines to attempt conversion of first; and the timeline, level-of-effort, identification of necessary stakeholders to participate in the effort, and the data gathering, coordination, and criteria validation/adjudication process across the entire domain of VA’s planning criteria.

Following from any recommendations made in the report described above, prioritization of service line conversion calculations—first by Space Calculator needs, then SEPS needs—will be undertaken. Conversion may involve clarifying interviews with service line work groups, program offices, and subject matter experts. Test run results after initial conversion will be collaboratively shared with relevant stakeholders to get feedback and improve the accuracy of model output. A second iteration will then be undertaken for pre-final validation of the conversion output. Any last adjustments will then be made for the final version of the service line workload conversion model. Lastly, many elements of VA Space Planning Criteria are dated. There is an opportunity with a review to introduce updated thresholds for whether services/procedures should be included in the planning of new projects.

Methodology – Survey of Leading Practices in RVU-based Clinical Space Planning

· Special study team, in close collaboration with VA, identifies a representative group of both leading healthcare systems and healthcare A/Es utilizing RVU-based planning

· Conduct in depth interviews with planning representatives at each organization to identify leading practices

· Group leading practices by type and focus, and assess feasibility of adopting some or any of these practices in a new VA space planning paradigm

· Recommend leading practices that VA could quickly adopt as well as long-term strategies to enhance RVU-based clinical planning

· Help VA determine which project(s) would be suitable to pilot the application of new RVU-based planning criteria

· Develop a roadmap for conversion of all criteria based on lessons learned from any initial pilots

· Roadmap should include process flows, key stakeholders, and integrated timeline for the conversion process

Methodology – Update of VA Space Calculator (Following from Report Roadmap)

· Confirm with VA stakeholders which departments should be included in the Space Calculator moving forward

· May be an opportunity for VA to better align Space Calculator with the individual VA Space Criteria chapters and with the Capital Asset Inventory (CAI)

· Identify all VA Space Calculator workload-driven pacing inputs

· Initiate contact with relevant stakeholder groups to present conversion approach; agree on timeline for developing initial, secondary, and final conversion deliverables

· Initiate conversion model update first instance, provide results, obtain feedback from stakeholder work groups

· Update pre-final model with results from initial run, run second version of the model, provide results, obtain feedback from stakeholder work groups

· Update final model with results from pre-final run, provide final version deliverable to stakeholder work group for approval

Methodology – Update Workload Assumptions for VA Space Planning Criteria (Following from Report Roadmap)

Note: This work is anticipated in a subsequent Call Order.

· Identify all VA Space Criteria workload-driven pacing inputs

· Develop a work plan to begin converting service lines grouped logically to align with common stakeholder groups

· Initiate contact with relevant stakeholder groups to present conversion approach; agree on timeline for developing initial, secondary, and final conversion deliverables

· Initiate conversion model update first instance, provide results, obtain feedback from stakeholder work groups

· Update pre-final model with results from initial run, run second version of the model, provide results, obtain feedback from stakeholder work groups

· Update final model with results from pre-final run, provide final version deliverable to stakeholder work group for approval

Deliverables:

1.3.D.1: Survey of Leading Practices and Report Roadmap for RVU-based Space Planning

a. Identification and survey of leading practitioners: ~2 months

b. Capturing and classifying leading practices that VA might adopt: ~1 month

c. Identification of pilot projects to apply leading practices identified: ~1 month

d. Roadmap with recommendations for future conversion approach system-wide ~2 months

1.3.D.2: Updated VA Space Calculator

a. Assessment of agreed upon departments to include in update: ~1 month

b. Calculator update, first instance ~2 months

c. Calculator update, second instance ~1 month

d. Calculator update, final instance ~1 month

1.3.E. Interactive Mapping Tools

Includes the VHA GIS Planning Portal, a geographic database of capacity, healthcare locations (internal and external) and analytical tools to enable effective distribution of capacity where it is most needed.

Deliverables:

1.3.E.1: Develop, implement, and publish the standards for the geospatial data and the geospatial analytics used as a part of the strategic analysis and assessments and how it integrates, and will can be used with the existing VA Enterprise Geospatial Information Systems (GIS) Architecture and Interactive Mapping Tools/Applications.

1.3.E.2: Conduct and publish geospatial analysis that can be replicated and repeated for geocoded data for Veteran location, Facility location by level of care and capability (DC/CC, and non-CC commercial facility); internal capacity and facility condition assessment for each VA facility); climate and environmental impact; social determinates of health; health equity; referral patterns; population health by disease pattern; etc.

1.4) Implementation Planning

1.4.A. Implementation Planning—Program Management Office

In the preceding MAHSO BPA, an organized approach was established to outline implementation pathways for future state market strategy, recommendations, and associated initiatives. Implementation planning must take the next step in documenting the sequential order of all efforts, necessary tasks, interdependencies, timeline, and associated milestones to advance strategy to execution. Given the range of market strategy and opportunities developed, a structured, flexible approach to outline advancement of prioritized recommendations best aligns resource planning and associated budget cycles. A centralized, controlled approach to outline implementation pathways creates the necessary central leadership oversight and allow for the significant collaboration across VA offices and with facility, market and VISN leadership to ultimately execute the plan. In this MAHSO/VFTHE BPA Call Order 1, the contractor will develop key elements of Implementation Planning, including prototypes, and use all findings and results as feedback to adjust the Implementation Planning approach developed in the preceding MAHSO BPA. In addition, the contractor will maintain a PMO for Implementation Planning to coordinate all activities and intersections with other programs across the VA.

Deliverables:

1.4.A.1: Support the establishment of an Implementation Planning Program Management Office (PMO) in preparation for the pre-design development of capital projects that align with market assessment recommendations, including:

1.4.A.2: Structure and processes for pre-design development (requirements development)

1.4.A.3: Facilitate VA executive leadership planning sessions to develop PMO structure and associated tools (ex: business plans, staffing plans)

1.4.A.4: Formalize charter to define the scope, responsibilities, and memberships of PMO, meeting cadence, oversight/conflict resolution, and deliverables

1.4.A.5: Create project management tools and templates

1.4.A.6: Implementation planning structure and approach including key task structure, timelines, dependencies, and key decision points/timelines

1.4.A.7: Review VA business case and requirements development processes and suggest improvements

a. Review and revise business case template, as needed

1.4.A.8: Support the development of processes, structure, and tools for creating programmatic plans (‘functional programs’) from market assessment recommendations. The process must be scalable and leverage the data and learnings from market assessments. Creating a standardized approach seeks to establish a bridge from market assessment recommendations to facilities requirements planning and associated pre-design implementation planning. Key elements should include:

a. Programmatic Summary

b. Updated demand drivers and projections

c. Staffing analysis/impact

1.4.A.8: Execute a complex VAMC pilot to work with CFM, CSO, VHA facilities, VISN, and local facility staff to develop detailed requirements for a single project to test standardized approach. Effort will include review and validation of planning data

1.4.A.9: Develop and pilot in one market an economic impact assessment approach including:

a. Market Summary Statement

b. Local Economy Impact (financial and non-financial) such as:

1. Direct impact of the change (e.g. a capital investment or divestment),

2. The indirect impact (supplemental business-to-business spend as a result of the change, e.g. supply chain impacts) and

3. Other impacts (increase/decrease of spend from households to local business as a result of the change)

c. Risks

d. Timeline

1.4.A.10: Develop plans for pre-design activities (e.g., recommendation prioritization, incorporating considerations as a result of programmatic plans, staffing analysis, and economic impact assessments) that outline the following:

a. Key tasks

b. Timeline

c. Key Decision Points/Milestones

d. Dependencies

1.4.A.11: Interface with external stakeholder workgroups:

a. Align/realign requirements with partnership deals

b. Align/realign requirements with architecture/engineering/construction feasibility studies

c. Align requirements with other adjustments (i.e. emerging VA priorities)

1.4.A.12: Physical Product Deliverables:

a. PMO planning structure and associated tools and templates

b. Review of VA business case and requirements development processes and suggestions for improvements

c. Processes, structure, and tools for creating programmatic plans

d. Complex VAMC Pilot to work with CFM, CSO, VHA facilities, VISN, and local facility to develop detailed requirements for a single project to test standardized approach.

e. Development and piloting of economic impact assessment approach

f. Plan for pre-design activities

g. External stakeholder engagement

1.4.B. Master Planning

As VA has prioritized notional campus renewal investments by station; we need to deliver Feasibility Studies, Campus Master Plans, and Facility Master Plans. These deliverables overlap but are generally distinguished as such:

· Feasibility Study – Takes a comprehensive look at the VAMC and makes an assessment as whether the long-term healthcare delivery requirement can be met on campus, will require a new campus, or some combination thereof.

· Campus Master Plan – Takes a comprehensive look at the VAMC campus agnostic of specific projects to assess condition and capacity for continued and evolving healthcare delivery. This Plan would clearly assess all impacting elements such as utility distribution and capacity (including central energy plant), environmental conditions, historic preservation needs, existing facility conditions and highest and best uses, capacity for new facility footprint, functionality, etc.

· Facility Master Plan – Takes a comprehensive look at delivering an on-site VAMC renewal once the decision has been made to remain at the existing campus. This plan is informed by the Campus Master Plan and/or Feasibility Study where one was required and executed.

Deliverables:

1.4.B.1: Deliver a Feasibility Study for Raleigh VAMC with a PRV roughly $4B. Comply with the attached “VFTHE Feasibility Study Performance Work Statement for Raleigh Durham VAMC.”

1.4.B.2: Deliver a Feasibility Study for Washington, DC VAMC with a PRV roughly $4B. Comply with the attached “VFTHE Feasibility Study Performance Work Statement for Washington DC VAMC.”

1.4.B.3: In conjunction with the two previous Feasibility Study deliverables for Raleigh Durham and Washington, DC VAMCs, evolve and deliver a standard process and user guide for a Phase 1 Facility Master Plan. Follow instructions in the attached “VFTHE Master Planning Statement of Work” and associated “VFTHE Master Planning Statement of Work Deliverables.” A Phase I Facility Master Plan is a high-level agnostic assessment of a medical center’s current physical condition. The assessment is broken into four categories: Architectural Review, Environmental Baseline, Historical Review, Service Delivery Plan Review, and a review of approved or pending construction projects. The goal of Phase I is for the A/E to evaluate each facility’s strengths, Weaknesses, Opportunities, and Threats (SWOT) as they relate to its capital inventory and strategic / service delivery plan. This initiative will serve as a pilot for Phase 1 Campus Master Planning.

1.5) Strategic Prioritization

1.5.A. Strategic Prioritization

Recommended Approach

This MAHSO/VFTHE BPA Call Order 1 Strategic Prioritization workstream will refine and continue the Strategic Prioritization Framework and Process previously developed in the preceding MAHSO BPA based on VA leadership feedback and will conduct the final prioritization of approved recommendations. While the Strategic Prioritization framework and an initial prioritization of opportunities occurred under the MAHSO BPA, it is anticipated that feedback will necessitate additional refinements to the methodology and cyclical (at least annual) re-prioritization. The Strategic Prioritization Application should be enhanced to incorporate updates to criteria and allow for the review of recommendations and related data, as well as provide the ability to select and prioritize recommendations or groups of recommendations (e.g., by VA-defined prioritization criteria, by market, recommendation-type, building topology, funding programs—NRM, Minor Construction, and leasing—etc.). Once the framework and application are enhanced, it will be necessary to prioritize the recommendations from all phases of the previous MAHSO BPA assessments and subsequent opportunity development and refinement according to the updated prioritization criteria and receive approval of the prioritized recommendations from VA leadership.

While initial prioritization is a critical step towards implementation, prioritization will need to be refined and coordinated with existing VA processes and stakeholders on an ongoing basis until projects are fully executed. Ongoing prioritization will need to reflect the shifting health care, regulatory, and budget environment, and VA’s ability to execute projects. VA must create a methodology to understand and execute approved recommendations within the broader landscape of Department priorities outside of MAHSO recommendations.

Deliverables:

1.5.A.1: Enhance the Strategic Decisional Framework to prioritize market assessment recommendations and strategies and subsequent opportunity development and refinement in collaboration with VA stakeholders as necessary.

1.5.A.2: Document a revised Strategic Decisional Framework in a methodology report

1.5.A.3: Gather change requirements from VA stakeholders for the Strategic Prioritization criteria and Application

1.5.A.4: Finalize and receive approval of the prioritized recommendations

1.5.A.5: Develop a methodology to evolve the prioritization process and incorporate it into implementation planning as the health care, budgetary, and overall VA landscape evolves

1.5.A.6: Study and recommend a process for sustainable prioritization and execution

1.5.A.7: Physical Product Deliverables:

a. Revised Strategic Decisional Framework

b. MAHSO/VFTHE Strategic Prioritization Recommendation Report including methodology and prioritized recommendations

c. Sustainable Prioritization Report including process for refining prioritization process as the health care, budgetary, and overall VA landscape evolves

d. Support for prioritization based on changes in the health care, budgetary, and overall VA landscape

1.5.A.8: Evolve prioritization modeling tool to include automated “what if” scenario analyses

1.5.A.9: Establish prepopulated scenarios for the basic universe of health care delivery alternatives to include a VHA limited to, outpatient MH, CBOCs including outpatient MH, foundational services, ambulatory health care, full inpatient services meeting critical…