Attachment A_CRT PWS RFI.pdf

Attachment A_CRT PWS RFI

PERFORMANCE WORK STATEMENT (PWS)

1.0 TITLE OF CONTRACT

Community Care Clinical Review Tool (CRT)

2.0 BACKGROUND

The Department of Veterans Affairs (VA) Veterans Health Administration (VHA), Office Integrated Veteran Care (IVC), Integrated Optimization Directorate is committed to a healthcare system that treats its Veteran patient population effectively, efficiently, and appropriately. The VHA IVC Utilization Management program focuses on clinically appropriate and timely care for Veterans while using resources efficiently and responsibly to purchase medical services in the community. The objective of the IVC program is to develop and guide the field with implementation of IVC standardized Operating Model. This is supported by standard processes for how resources (people, process, technology and data) should be organized and operate within their local VA community care departments to best enable community care for Veterans with focus on

1) clear roles and responsibilities across clinical and administrative functions, 2) consistent processes to make serving Veterans more efficient, 3) active partnerships to manage the care of each Veteran, 4) standardized care coordination to align level of interventions with Veteran needs, and 5) responsive customer service to meet Veteran needs at the point of service.

The purpose of this PWS is to acquire a web-based application that provides evidence-based clinical review reference materials for both inpatient and outpatient services.

Clinical review helps reduce unnecessary costs and improve the quality of care by ensuring that healthcare services are medically necessary and appropriate before they are referred to the community. Clinical review tools (CRTs) streamline the clinical review process by providing consistent, objective guidelines for clinical, referral coordination and community care staff to follow when evaluating Veteran needs and determining if community care services are appropriate. CRTs that use evidence-based guidelines grounded in industry best practices, clinical data, and medical literature result in the following benefits: 1) Increased quality of care consistent with industry standard best practices, 2) Improved timeliness in the authorization of clinically necessary healthcare, and 3) Reduced costs associated with clinically inappropriate care.

All reference to this evidence-based clinical review application will be referred to as “guidelines” throughout this PWS. Evidence-based clinical care guidelines will enhance oversight of and provide standardization of the clinical review process to determine clinical appropriateness of services referred to and provided by the community-based providers.

3.0 SCOPE OF WORK

3.1 VHA LICENSING AGREEMENT

The Contractor shall provide licensing for up to 2,700 users, across approximately 170 VA facilities, in community care and referral coordination offices nationwide. Licenses shall be made available upon contract award to 2,200 users. The remaining 500 licenses shall be exercised as needed in increments of 100 licenses and shall be priced separately. The licensing shall include complete, unrestricted access to the care guidelines application, updates, and any embedded resources.

Deliverable 3.1.1: The Contractor shall provide login information to identified VA staff, via the contracting officer representative (COR), NLT 10 business days after receipt of personnel information for initial list of users and NLT 2 business days for subsequent requests.

Deliverable 3.1.2: The Contractor shall provide login information to additional VA staff via the COR NLT 2 business days after optional tasks licenses are exercised and subsequent users are identified.

3.2 COMPREHENSIVE CARE GUIDELINES

The web-based application shall include, at a minimum, comprehensive clinical guidelines and supporting evidence/references for alternative plans of care for as many as possible of the 37 categories of care and 129 services on the VA Delegation of Authority Medical Services (DOAMS) List as listed in Attachment C. The services included in the DOAMS list which require clinical review for appropriateness are of critical importance as they require higher scrutiny because they are high cost, high risk services including, but not limited to, Chemotherapy, MRI/MRA, PET Scans, and Trans Aortic Valve Replacement (TAVR) as well as the high volume, high-cost services including, In addition, the guidelines search functionality must be easy to use. With the volume of community care consults growing exponentially because of the MISSION Act implementation, the clinical review process must be efficient and streamlined. Staff often do not have access to the Current Procedural Terminology (CPT) codes and there are frequently multiple CPT codes for the required services, and staff are unable to spend an inordinate amount of time searching the tool.

Deliverable 3.2.1: The contractor shall provide access to the guidelines NLT 10 business days after award.

3.3 INFORMATION TECHNOLOGY (IT) COMPATIBILITY

The Contractor shall ensure the application is compatible with web browsers in common use (e.g. Internet Explorer and Google Chrome).

Deliverable 3.3.1: The Contractor shall provide an attestation statement that the clinical care guidelines application meets W3C (World Wide Web Consortium), or similar, compatibility checks for the Google Chrome and Microsoft Internet Explorer browsers NLT 10 business days after award.

3.4 PERIOD OF PERFORMANCE

The period of performance shall be one year from the award date of the contract and will include two, six-month option periods.

3.5 CONTRACTING OFFICER’S REPRESENTATIVE AND PROGRAM MANAGER

COR: TBD

Program Manager: TBD

3.6 PLACE OF PERFORMANCE

Contract performance shall be at the contractor’s site. Planning and Training services will be organized and completed in a virtual environment, if necessary. Travel may be required for the initial training.

3.7 CONTRACT AWARD MEETING

The contractor shall not commence performance on the tasks in this PWS until the Contracting Officer (CO) or COR has conducted a kick-off meeting or has advised the contractor that a kick-off meeting is waived.

3.8 CUSTOMER SUPPORT

The Contractor shall provide both clinical (i.e., the explanation and interpretation of the guideline, use of applications, and guidance with complex cases) and technical (i.e., access to the web-based program, account login and password assistance) support.

The Contractor shall provide a single email and phone number for support and respond to support requests no later than the end of the next business day. The Contractor shall ensure the availability of both clinical and technical support during the hours of 7:00AM

– 6:00PM (ET) Monday through Friday.

Deliverable 3.8.1: The contractor shall provide a single email and phone number for customer support NLT 10 business days after award.

3.9 DATA REPORTING

The Contractor shall capture data relevant to:

• Overall utilization. Data shall include the number of available licenses to access the care guidelines application.

• User access. Data shall include, at a minimum, a breakdown by VISN, station, and unique user of the most recent login.

• Content accessed. Data shall include, at a minimum, page hit counts, trending and top keyword searches, and category of care groupings (as outlined in §3.2) of content accessed within the care guidelines application.

• Customer support provided. Data shall include, at a minimum, the number of support requests received by email and telephone, the average time to complete support requests, the nature of the request, the facility of the requestor, and if the request was new or a follow-up to an existing request.

Deliverable 3.9.1: The Contractor shall make available raw data and provide a summarized report of an analysis of the data monthly and upon request.

3.10 CARE GUIDELINE UPDATES

The Contractor shall ensure each facility community care office has access to the most current version of the care guidelines – to include, at a minimum, clinical revisions, technical enhancements, and system patches – not less than annually to reflect the most current clinical care guideline best practices. The Contractor shall ensure that all guidelines are compliant with applicable federal, state, and local regulations and laws.

The Contractor shall notify the COR at least 30 calendar days prior to implementing updates to the care guidelines.

Deliverable 3.6.1: The contractor shall provide access to the updated guidelines to all users annually.

4.0 TRAINING

The Contractor shall provide educational resources and training to support VHA in maintaining certifications for a core group of certified clinical trainers not to exceed 60 VHA users who are experts in the interpretation, application, and content delivery of care guidelines.

The Contractor shall provide certification and re-certification training relative to the vendor’s specific platform. The training sessions will occur during normal business hours using a web-based with instructor format or face-to-face at a centralized location to be determined. The normal tour of duty is Monday thru Friday, excluding US Federal Holidays (https://www.opm.gov/policy-data-oversight/pay-leave/federal-holidays/) as established by law (5 U.S.C. 6103).

The Contractor shall provide access to all training materials (e.g. documentation, videos) to the COR no later than 10 business days prior to the instructor-led face-to-face or web-based learning session.

4.1 INITIAL TRAINING AND CERTIFICATION AND REFRESHER TRAINING AND

RE-CERTIFICATION (FACE-TO-FACE OR WEB-BASED WITH INSTRUCTOR (E.G.

ADOBE CONNECT, TEAMS, ETC.)

https://www.opm.gov/policy-data-oversight/pay-leave/federal-holidays/ https://www.opm.gov/policy-data-oversight/pay-leave/federal-holidays/

The Contractor shall provide clinical instructor-led overview of the current version of the care guidelines and facilitate up to five sessions via face-to-face or web-based training for up to 60 identified certification candidates (up to 15 candidates per training session) within 30 days of contract award. The Contractor shall provide refresher and re-certification training at a future timeframe to be jointly determined. The Contractor shall ensure that the training supports the efficient and effective use of the care guidelines and software is a web-based format. The Contractor shall provide a minimum of one (1) copy of all training resources (e.g. documentation, videos).

Deliverable 4.1.1: The contractor shall provide at least one (1) copy of all training materials in either 360 Articulate or Adobe Captivate interactive web-based software format NLT 14 business days after award.

Deliverable 4.1.2: The contractor shall provide the training plan NLT 10 business days after award.

5.0 PROJECT IMPLEMENTATION

NLT 10 business days after contract award, the Contractor shall develop and deliver a detailed Project Work Plan to be approved by the COR. The Project Work Plan shall include, at a minimum, requirements management, schedule management, resource management, communications management, and the process for implementation of updates, support, and other PWS requirements as well as the Contractor’s contact information for this project.

Deliverable 5.0: The contractor shall provide their Project Work Plan NLT 10 business day after award.