Attachment A - PWS 3.27.2023 - SHEP IDIQ.docx

PERFORMANCE WORK STATEMENT (PWS)

DEPARTMENT OF VETERANS AFFAIRS

Veterans Health Administration (VHA)

VHA Office of Quality and Patient Safety / Analytics and Performance Integration (17API)

Project Title: Survey of Healthcare Experiences of Patients (SHEP) Program Project Number:

Date: 3 27, 2023 PWS Version Number: 1

1.0 BACKGROUND

The VHA Office of Quality and Patient Safety/ Analytics and Performance Integration (API) is the headquarters for the VHA Survey of Healthcare Experiences of Patients (SHEP) program. The SHEP program uses the Consumer Assessment of Healthcare Providers and Systems (CAHPS) family of surveys as the industry standard approach to measuring patient experiences of care and to support the goal of benchmarking VHA performance against private sector healthcare. Since 1995 variants of the SHEP program have focused on evaluating high volume healthcare services represented by patients receiving VA ambulatory care or discharged inpatients.

Currently, API has a core inventory of surveys that assess patient experiences in several patient populations using the CAHPS family of survey instruments. These include Inpatient (Hospital CAHPS), Patient Centered Medical Home (Clinician & Group CAHPS with the PCMH item-set), Specialty Care (Clinician & Group CAHPS), and VA Community Care (a CAHPS-like survey developed by API). Data collection is principally thru mail and online modes. Results are reported at various levels of the organization to internal and external stakeholders.

The SHEP program also employs a Veteran Insights Panel (VIP). The VIP is a carefully selected group of Veterans, reflective of those VA serves every day, that have agreed to participate in online focus groups, surveys, and other online activities.

API seeks to continue a coordinated system within the VHA for assessing patient experience, to support a culture of patient centered care, to meet the changing measurement needs of the field, and to construct opportunities for improving the healthcare experience of Veterans. The goal is to execute a contract that aligns national and local customer experience strategies. One important objective is to establish a two-pronged approach to quality improvement within VHA. The first prong will provide routine analytics and reporting of the core SHEP Program on a regular cadence: for example, SHEP survey data collection and results reporting, trending at various levels of the organization, key driver analyses, tracking and reporting of call center issues including transfers to VA Suicide Hotline etc. The second prong will have the capability to provide advanced analytics and reporting of collected SHEP data, development and production of educational and training materials, and other services as needed. These services may include the following: advanced analytics to better understand certain aspects of the patient experience (e.g., key measures or the impact on patient sub-populations of interest), newsletters/white-papers, collection and dissemination of best practices, training videos and podcasts, etc. These ad hoc services will be priced at the Hi-Med-Low level of effort.

API is seeking a contractor that is Hospital CAHPS (HCAHPS) approved. The contractor shall also have demonstrated experience in administering the CAHPS Clinician & Group survey and will conduct a core set of CAHPS-based and custom surveys for multiple service lines and Veteran populations. The contractor will provide multiple products and/or services such as conducting focus groups, cognitive testing of questions/surveys, survey design, experimental design, survey field testing, psychometric analysis, revised survey administration, routine results reporting, advanced analytics including key driver analysis, and providing data driven quality improvement tools.

Additionally, the SHEP program further contemplates a need to assess and/or make use of advancing technologies and testing alternative modes of survey administration, e.g., web, tablet, telephone, smartphone and/or mobile device administration and data collection methods.

2.0 SCOPE OF WORK:

API is seeking a contractor to provide the following products and/or services VHA-wide: use and administration of the CAHPS-based and custom survey instruments; access to detailed data files for comparable analysis; statistical guidance on an as needed basis; questionnaire development and printing; optimum envelope development and printing, address file cleaning, mail addressing, collating, matching, mailing, and data collection services; survey data file transfers via sFTP (secure File Transfer Protocol); white mail handling and management; survey/letter text translation into Puerto Rican Spanish; and selected data analysis and reporting. Additional services include access to quality improvement guidance and best practice methods and strategies. Note that any survey questions used by VHA must be approved by the Office of Management and Budget (OMB) in accordance with the Paperwork Reduction Act of 1995. Unapproved question sets must be sent to OMB for appropriate review and approval. Any surveys developed during performance of this effort shall be considered non-proprietary and shall not be subject to any form of proprietary restrictions for use. API has language to have contractor submit to OMB clearance for the CAHPS-based surveys currently in use. As the business of VHA changes and emerging needs of the organization are identified by leadership, new question sets shall be developed in accordance with OMB regulations and guidelines.

API is seeking a contractor that is HCAHPS approved with demonstrated experience in administering CAHPS surveys including Clinician & Group. Each month surveys will be administered to various patient populations in each of the 170 Medical Centers and approximately 1,063 Community Based Outpatient Clinics. This includes Puerto Rico and surrounding coverage area, and the Philippines, unless otherwise specified. The principal patient populations to be surveyed are recently discharged inpatients and patients receiving primary care or specialty care as outpatients. However, surveys for other populations may be developed and fielded, as necessary. The vendor’s HCAHPS approval must be maintained for the life of the contract. Vendors shall be capable of and prepared to submit VHA patient experience data to CMS’ Care Compare database in accordance with all HCAHPS protocols issued by CMS and Care Compare. A list of HCAHPS vendors can be found here: Approved Vendor List (hcahpsonline.org)

The VA operates a complex survey program which involves simultaneous administration of core surveys and multiple patient populations including

1) HCAHPS with supplemental questions administered to recently discharged inpatient population

2) CAHPS Clinician and Group (CG) administered to patients receiving Specialty Care in the outpatient setting

3) CAHPS Patient Centered Medical Home (PCMH) administered to patients receiving Primary Care in the outpatient setting.

4) VA Community Care survey (a CAHPS-like survey developed by API) administered to patients receiving VA-paid outpatient care in the community.

VHA is committed to administering the industry standard inpatient surveys using the HCAHPS protocol and the CAHPS family of surveys. VHA does not seek to implement alternative survey instruments as part of the core patient experience survey program. Alternative surveys will be considered as part of ad hoc services briefly described in section one.

The table below includes each of the core surveys with associated information on the length of each questionnaire, sample size of the target population, and scheduled administration for each survey. A sample timeline and survey cycle schedule is attached in Attachment D. The actual timelines must be negotiated with API and account for holidays and VHA database update schedules. Samples for the core surveys will be drawn at a minimum of once a month. This may include an increase in sample selection frequency or other such methods that are practicable and that will not reduce the reliability and integrity of the results

The current estimate of the total number of core surveys administered each year is approximately 1.8 million. The survey preparation phase shall involve intense collaboration between the API and the contractor as questionnaires are designed, all materials for the survey administration (both paper and online versions) are set-up and proofed, frames and samples are drawn, previous SHEP responders are removed from the frame, bad addresses are eliminated, and final sample sizes are determined. It is the prime responsibility of the contractor to complete active data collection, provide regular reports of progress, and delivery of accurate responses, final data sets, results reports, and related deliverables.

The forms to be used, the approximate numbers of patients, and the frequency for each study are described as follows:

Core Survey Description and Estimated Quantity

Approx. 30-35%*

Recently discharged to home from targeted Diagnosis-related Groupings (DRG),

**paper and online

60,375 approx.

**paper and online

**paper and online

Note: The chart above is based on historical data and is provided for informational purposes only.

*75-80% are sent a second questionnaire with follow-up cover letter (HCAHPS Wave 2 mailing to non-respondents approximately 21 days after the first questionnaire mailing).

** Modes of survey administration: Approximately 50% of the sample will have an email address. All patients will receive a paper copy of the survey. Those patients having an email address will also receive an online invitation.

The contractor shall be responsible for performing all tasks necessary to draw patient samples, design survey tools, produce surveys, field surveys, receive returns, retrieve, and collect data, analyze results, and produce reports. The core survey related tasks and services shall include the following:

· Create, produce, and execute analytical programs for: patient sample list creation from sample frames; de-duplication across recent and concurrent samples; tracking of “do not survey/no publicity” and deceased patients; data collection; results analysis; results reporting and trending.

· Sample list cleaning (bad addresses, incomplete records, etc.) and National Change of Address (NCOA) cleaning

· Survey material development and production (electronic survey invitation/printed pre-notification letter, electronic and paper cover letters, electronic and printed questionnaires, envelopes, postcard/email reminder) design and printing

· survey ID number assignment report production

· Invitation/pre-notification and survey emailing/mailing

· Survey returns receipt and processing

· Survey data collection

· Survey data analysis

· Infographic Reports

· Analysis results report(s) design and creation

· White mail processing (refer to sections 5.7 & 5.8 for additional details)

· scanned written marginal survey comment report(s)

· whitemail/email correspondence screening and routing

· Reviewing, analyzing, and trend reporting of issues discussed in written comments received

· “Critical service alert” processing and routing to API

· Survey data and report receipt and transmission to API

· Call center duties for inquiries about the survey (reprint requests, general inquiries, etc.); per HCAHPS QAG (Quality Assurance Guidelines) v17.0 or later

· Tracking and reporting of call center issues, including transfers to VA Suicide Hotline

· VHA facility specific response rate tracking and sampling adjustment (CCN response rate tracking).

· Survey data results reporting, trend reporting, and benchmarking

· Resource(s) for quality improvement/best practices

· Inpatient (HCAHPS) data submission to CMS Care Compare, and all required documentation, e.g. HCAHPS Quality Assurance plan and exception requests.

· Benchmarking (refer to section 5.3)

Any surveys or specific item sets developed by AHRQ, NCQA, VA, or other such agency or group may be incorporated into VHA versions of the survey(s) or added to the list of core business surveys on an as needed basis.

In an ongoing effort to be able to be responsive to new and emerging issues, API requires the creation and/or maintenance of a Veteran Insights Panel. The contract will create and maintain a carefully selected group of 3,000 – 5,000 Veterans, representative of those we serve every day. The panel will provide an online platform to offer Veterans an opportunity to provide valuable feedback on VHA programs and services and facilitate an ongoing dialogue between the VHA and its beneficiaries.

Please refer to section 6 for more detail.

3.0 APPLICABLE DOCUMENTS

Applicable documents are listed below. Additional documents may be listed in individual Task Orders.

1. 44 U.S.C. § 3541-3549, “Federal Information Security Management Act (FISMA) of 2002”

2. “Federal Information Security Modernization Act of 2014”

3. FIPS Pub 200, Minimum Security Requirements for Federal Information and Information Systems, March 2016

4. FIPS Pub 201-2, “Personal Identity Verification of Federal Employees and Contractors,” August 2013

5. VA Handbook 0710, Personnel Security and Suitability Program, May 2, 2016, https://www.va.gov/vapubs/index.cfm

6. VA Directive and Handbook 6102, “Internet/Intranet Services,” August 5, 2019

7. NIST SP 800-66 Rev. 1, An Introductory Resource Guide for Implementing the Health Insurance Portability and Accountability Act (HIPAA) Security Rule, October 2008

8. VA Directive 6500, “VA Cybersecurity Program,” January 24, 2019

9. VA Handbook 6500, “Risk Management Framework for VA Information Systems – Tier 3: VA Information Security Program,” March 10, 2015

10. VA Handbook 6500.2, “Management of Breaches Involving Sensitive Personal Information (SPI)”, July 28, 2016

11. VA Handbook 6500.5, “Incorporating Security and Privacy into the System Development Lifecycle”, March 22, 2010

12. VA Handbook 6500.6, “Contract Security,” March 12, 2010

13. VA Handbook 6500.8, “Information System Contingency Planning”, April 6, 2011

14. VA Handbook 6500.11, “VA Firewall Configuration”, August 22, 2017

15. VA Handbook 6510, “VA Identity and Access Management”, January 15, 2016

16. VA Directive and Handbook 6513, “Secure External Connections”, October 12, 2017

17. VA Handbook, 6300.1, Records Management Procedures, March 24, 2010

18. NIST SP 800-37 Rev 1, Risk Management Framework for Information Systems and Organizations: A System Life Cycle Approach for Security and Privacy, December 2018

19. OMB Memorandum M-07-16, Safeguarding Against and Responding to the Breach of Personally Identifiable Information, May 22, 2007

20. Trusted Internet Connections (TIC) Reference Architecture Document, Version 2.2, Federal Interagency Technical Reference Architectures, Department of Homeland Security, June 19, 2017, https://www.cisa.gov/

21. OMB Memorandum M-08-05, “Implementation of Trusted Internet Connections (TIC), November 20, 2007

22. COVID-19 Pandemic Response, Laboratory Data Reporting: Coronavirus Aid, Relief, and Economic Security (CARES) Act Section 18115, June 4, 2020

4.0 GENERAL REQUIREMENTS

The Contractor shall provide and/or acquire the services, hardware, and software required by individual Task Orders pursuant to the general requirements specified below.

4.1 Contract Type

This is a single award Indefinite Delivery/Indefinite Quantity (IDIQ) contract. Individual Task Orders shall be issued on a performance-based Firm-Fixed-Price (FFP) basis.

4.2 ORDERING PERIOD:

The ordering period for the IDIQ contract shall be five years from the date of award. Each Task Order issued will have a specific period of performance.

Work at a Government site shall not take place on Federal holidays or weekends unless directed by the Contracting Officer (CO).

4.3 Place of Performance

The place of performance shall be identified in individual Task Orders. Locations will be Government or Contractor sites within the continental United States (CONUS) and/or outside the continental United States (OCONUS).

4.4 Travel

Travel shall be in accordance with individual Task Order requirements. Travel details must be provided to and approved by the Contracting Officer’s Representative (COR) or the Government designee prior to the commencement of travel. All travel shall be in accordance with the Federal Travel Regulations (FTR) and may be on a direct- reimbursable basis.

4.5 Proposed IDIQ Kick-Off

The Government shall hold an IDIQ Post Award Meeting for the IDIQ contractor and API advisory group comprised of key stakeholders and subject matter experts (SMEs), Program Managers, Contracting Officer’s Representative (COR) and the Contracting Officer (CO). The Government shall schedule the Kick-Off Meeting to be held within seven (7) calendar days after IDIQ award or as agreed upon between the CO and IDIQ contractor. At the Kick-Off Meeting, the Government shall summarize anticipated number and type of task orders to be issued, IDIQ ordering guidelines, Task Order technical and price proposal submissions and the startup schedule. Vendor will be required to have a Business Associate Agreement (BAA).

5.0 CORE SERVICES:

The VHA Office of Performance Integration(API) is seeking a contractor to provide the following products and/or services VHA-wide: use and administration of the CAHPS-based and custom survey instruments; access to detailed data files for comparable analysis; statistical guidance on an as needed basis; questionnaire development and printing; optimum envelope development and printing, address file cleaning, mail addressing, collating, matching, mailing, and data collection services; survey data file transfers (via sFTP); white mail handling and management; survey/letter text translation into Puerto Rican Spanish; and selected data analysis and reporting. Additional services access to quality improvement guidance, best practice methods and strategies. Note that any survey questions used by VHA must be approved by OMB in accordance with the Paperwork Reduction Act of 1995. Unapproved question sets must be sent to OMB for review and approval. Any surveys developed during performance of this effort shall be considered non-proprietary and shall not be subject to any form of proprietary restrictions for use. API has OMB clearance for the CAHPS-based surveys currently in use. As the business of VHA changes and emerging needs of the organization are identified by leadership, new question batteries shall be developed in accordance with OMB regulations and guidelines and may be administered to appropriate populations on a periodic basis.

5.1 Current Core Data Collection Methodology

Surveys shall be sent via first class mail using a carefully timed mailing sequence in accordance with CAHPS requirements for core business. Survey materials and volumes are outlined in the table in the scope of work and section 5.4 of this document.

a. Inpatient:

The Inpatient sampling, survey administration, data collection and submission protocols, and data reporting shall be fully compliant with the latest HCAHPS Quality Assurance Guidelines (currently V17.0). Requirements may change depending on the needs of the organization. Currently, VA follows the mail only protocol.

days) Week 6 Close of data collection (42 days)

See Attachment D – Sample Mailed Survey Cycle for more detail.

b. CAHPS-based ambulatory care surveys include VA Specialty Care, VA Community Care, and PCMH:

The contractor shall provide an option for veterans to complete the Ambulatory Care surveys on-line by providing the web address in the pre-notification letter and by contacting the Veteran via email, text message or similar where available. It is estimated that API can obtain email addresses for 50% of the population. However, the accuracy of the email addresses is unknown.

The current timing sequence of patient contacts for each study is as follows:

See Attachment D – Sample Mailed Survey Cycle for more detail.

The contractor will be responsible for performing all tasks necessary to field the CAHPS-based ambulatory care surveys; draw eligible patient samples, produce survey materials based on input from API, construct survey website that complies with VA’s security policy, field surveys, receive returns, retrieve, and collect data, process white mail, analyze results, and produce results reports.

Sampling, survey administration, and data collection and reporting protocols may change depending on the needs of the organization.

Please note that any major revisions to current surveys or any newly developed surveys will require OMB clearance under the Paperwork Reduction Act of 1995 as noted above in sections 2.0 and 5.0.

5.2 Data Analysis and Results Reporting

The contractor shall manage survey data, conduct data analytics, and produce multiple reports. Critical analytic elements include Composites/Reporting Measures scores, peer index, sample sizes, response rates, trending, statistical significance analysis, appropriate external (non-VHA) comparisons, correlation analysis, and other analysis as appropriate.

The contractor shall provide standard reports (described below) that will be posted on VHA internal websites for direct access by VHA leadership, managers, and frontline staff. Other reports are required that will be used for data validation and data quality monitoring by API. In addition to these standard reports, all survey results will be provided by the contractor (more detail below) for use in an existing internal reporting platform maintained by API. The VA is not seeking to purchase a separate/different dashboard for reporting survey results.

The contractor shall establish a secure location that will house survey results including but not limited to patient-level data, weighted and scored composite and question scores, and question response-level summary. The results will be updated consistent with survey schedule (e.g., monthly survey results). The VA shall be able to conduct scheduled data-downloads to feed its internal reporting platform. Data structure and specific data elements/variables will be provided via Task Order.

The contractor shall provide all services and written materials required to support the analyses of data and report preparation needed to produce survey reports including, but not limited to:

· Scored Composite/Reporting Measures Reports of selected survey questions by month, quarter, and fiscal & rolling year for all surveys administered. The results shall be appropriately response weighted and may be risk adjusted for patient attributes according to API’s specifications. Such reports can be used for internal benchmarking by network, facility, or other administrative grouping within VHA

· Response-level reports of all survey questions by month, quarter, and fiscal & rolling year for all surveys administered. The results shall be appropriately response weighted according to API’s specifications.

· Patient characteristic/demographic reports for all surveys administered

· Periodic - “key driver” reports for all populations surveyed. This report identifies key themes (drivers) derived from survey questions that are significantly correlated with overall ratings of provider or the overall rating of healthcare experience.

· National, network, and facility-level infographic reports

· Key drivers reports

· Data deep dives

· Trending reports

· Relative performance reports (current vs. past performance

· Other reports as determined by API

The contractor shall develop above reporting at all levels of organization (i.e., national, District, VISN, facility, division, clinic-level, provider team, nursing unit or service line) as required by each report. The reports shall be integrated across survey instruments where possible, unless otherwise requested by API. Frequency of deliverables will be specified in the appropriate task orders.

The contractor shall provide documentation and, upon request, provide technical web-based training, education to API and other VHA field staff as needed to ensure maximum practical use of provided reports. The training and educational materials may be recorded for reuse and orientation for new staff or for refresher training.

The reports shall, at a minimum, include copies of results in a VHA approved format for VHA internal reporting, and reports containing basic descriptive elements about the surveyed group and their responses displayed in both text and graphical format.

All reports shall be produced according to the agreed upon Survey Cycle schedule (see sample in Attachment D).

The SHEP Inpatient survey must be administered in accordance with all HCAHPS protocols issued by CMS and Care Compare. All other CAHPS-based surveys in the SHEP program shall be administered, collected, analyzed, and reported using established definitions as specified by AHRQ, NCQA, other potential accrediting bodies or survey sponsors, or VHA as appropriate for the specific patient population or survey being administered.

The contractor shall create inpatient reports that also include use of HCAHPS Patient Mix Adjustment (PMA) methodology to create adjusted facility level scores. Although HCAHPS patient level data will be provided quarterly to CMS Care Compare, the VA will be internally reporting PMA hospital scores as the inpatient survey results are administered (monthly). VA will provide the methodology for calculating PMA hospital scores. Contractors shall also calculate HCAHPS Star Ratings using VA data. (https://hcahpsonline.org/en/hcahps-star-ratings/).

Periodically, VA collects data on subsets of the population, or from item-sets that are administered for a limited time. An example of this is the Specialty Care Pharmacy Report. The Pharmacy item-set is administered in the Specialty Care Survey, and the Pharmacy Report will be produced on a quarterly, year to date, and end of year schedule. Additional reports may be requested on a continuing ad hoc basis. Another example is an oversample of women for a limited time to provide better estimates of patient satisfaction for women especially in small facilities.

Contractors will be asked to provide proof of concept and demonstrate their ability to successfully analyze and report results according to API specifications.

5.3 Benchmarking with Comparative Databases

Contractor shall have the capability to access appropriate referent databases that can be used to compare VA CAHPS scores to external benchmarks (Internal benchmarking is described under the reporting requirement). The VA HCAHPS data will be submitted to CMS Care Compare which will serve as the primary external benchmark source for inpatient scores. This will incorporate the use of HCAHPS Patient Mix Adjustment methodology. Other appropriate databases are sought to compare results from VA CAHPS surveys (e.g. PCMH and Specialty Care surveys) to external referents. Because the VA population is significantly different than the non-VA population, we specifically require a benchmarking capability that includes statistical adjustments for key factors know to mediate patient perceptions of healthcare experiences (e.g., age, gender, health status and use of the CAHPS macro). Comparisons using raw or stratified analyses are not equivalent to statistical adjustments and will not be deemed acceptable.

5.4 Details of Survey Materials

API shall review and approve all survey materials received from the contractor before survey administration. Please note that it sometimes becomes necessary to add or remove questionnaire content. Any new or additional content added to the surveys must be translated by the contractor into Puerto Rican Spanish. The volume of Spanish/English mailings to qualifying patients is approximately 1% of the total outgoing volume for each patient population. All mail-out survey material must be printed on the stock specified (see Survey Material Description table below) and include a tracking mechanism. The tracking mechanism is used to monitor response rates and must include a unique identifier for each participant in each survey. API currently uses a numeric code assigned to each individual that has met the selection criteria and has been included in the survey sample. The unique identifier printed on the survey must also serve as a link with the name and address or other data elements provided to the contractor as appropriate. The tracking mechanism also must include an identifier designating which survey cycle and mailing sequence the survey questionnaire belongs to.

Contractor shall provide electronic and/or printed proofs of each item (email invitation/pre-notification letter, survey questionnaire, cover letter, post card, reminder email, envelope, etc.). API reserves the right to edit the electronic and/or printed proofs for content, layout, and design prior to final approval/printing.

A. Mail Survey Material Description Copies of existing materials are available upon request. VA Letterhead samples shall be supplied. The table below includes an example of materials that are currently in the field.

Note that the pre-notification and/or survey cover letters for the Recently Discharged Inpatient, PACT/PCMH and Specialty Care survey populations will be personalized with the address of the local facility and the name and signature block of the facility director. The contractor will be required to provide all labor and materials to implement this for the monthly surveys and update the list of leadership names and make appropriate edits to the survey materials on a quarterly basis. It is anticipated that as many as 10 leaders would change per quarter.

* For the patients serviced through San Juan, Puerto Rico VAMC, all materials will go out with an English language version and a Spanish language version. The post card for this group is printed in English and Spanish on one card.

5.5 Process

A. Sampling and de-duplication API obtains the population of eligible patients, patient addresses, and all necessary patient attributes by accessing various VA databases. These files will be provided to the contractor. Upon receipt of the file(s), the contractor shall verify all record counts by facility. Once verified by API the sample file shall be processed through Code 1 mail streaming and National Change of Address (NCOA) cleaning to remove any undeliverable addresses before printing begins. An output file containing the rejected names and addresses must be provided to API along with the reject or disposition code of the reason for rejection. The output containing the names and addresses of those records retained after NCOA cleaning (i.e. cleared for mailing) must be provided to API. Information regarding the NCOA process can be obtained from the Post Office or other survey contractors that provide mailing services. The contractor shall be responsible for obtaining its own NCOA. NCOA software must be updated at least monthly to guarantee accuracy.

The Inpatient samples shall contain patient discharge data from Department of Veterans Affairs medical and long-term care facilities throughout the United States and Puerto Rico. The contractor shall strictly follow all CMS/HCAHPS protocols pertinent to public reporting with respect to patient eligibility criteria, creation of the sample frame, de-duplication of individual patients, the creation and maintenance of “no publicity”, or “do not survey” lists, final mailed sample files, survey materials specifications, and mailing/data collection schedules.

The population of eligible patients for other SHEP surveys (PCMH, Specialty Care, and VA Care in the Community) shall be drawn after the inpatient sample to maximize the size of the mailing for this population.

There may be special populations that API shall target for oversampling or supplemental surveys on an as needed basis, such as OIF\OEF\OND patients, race groups, gender, etc.

The SHEP program may select qualified patient types that meet the inclusion criteria from each specified medical facility’s location. The contractor shall be supplied with appropriate files in a SAS (or approved equivalent) dataset, such that these special populations shall undergo NCOA cleaning and otherwise be included in the survey sample.

The API office is currently using Windows based SAS 9.4 and Enterprise Guide SAS 7.1 & 8.2 (most recent version, or VA approved system equivalent to SAS) and Microsoft Office 365 on a Windows 10 operating system (or most recent version). The contractor must have compatible systems in order to work with all VA systems and must adhere to Secure Socket Layer (SSL) Protocols and Public Key Infrastructure (PKI) in the transference of any sensitive patient identifiable data. Contractors must comply with all relevant VA information security policies and procedures and the procedures contained within section 10 of this Performance Work Statement.

B. Data Submission to CMS, and Other Benchmarking Databases as Warranted:

The contractor shall also be prepared to submit Inpatient survey results to CMS’s HCAHPS Data Warehouse in accordance with the specifications described in the most current HCAHPS QAG (currently V17.0). VHA has been submitting data to the CMS HCAHPS Data Warehouse since 2017. As such, the contractor must be fully compliant with CMS’ MyQualityNet requirements and be able to submit data on behalf of VHA. API may also be in a position to submit data to CAHPS and AHRQ or other organizations, if necessary, from surveys in use now, or developed in the future.

5.6. Call Center:

Per the HCAHPS QAG, survey contractors are required to maintain a toll-free customer support call center for questions or information needed by recipients of the Inpatient survey. Details on the requirements can be found in the Hospital CAHPS Survey (HCAHPS) Quality Assurance Guidelines or online at:

HCAHPS QAG V17.0 March 2022 (hcahpsonline.org)

In the event that a caller is perceived to be in emotional distress and in need of immediate care, the call center shall also maintain the capability to connect the caller to the Veterans Crisis Line via “warm transfer”, or if the caller doesn’t wish a transfer, to inform the caller of the availability of those resources and provide contact information. All contacts with the call center shall be categorized. Additionally, a separate written summary for any critical service alert transferred to the Veterans Crisis Line and reported to API on a monthly basis.

5.7 White Mail Screening and “Critical Service Alerts”

This section describes current policies and procedures used in processing White Mail and Critical Service alerts.

“White mail” is a term used to describe any additional information provided by a survey respondent in the form of email, written marginal comments on the surveys and/or letters, enclosures with the survey packet, cards, letters, attachments, photographs, non-survey related forms, e.g., benefit related forms, applications for benefits, statements in support of ongoing claims, invoices, etc. API currently sends approximately 150,000 core business surveys per month to veteran outpatients and inpatients who have received healthcare services in the previous month. Approximately 400-600 pieces of white mail are received per month from Veterans who receive these surveys and would like to comment on their VHA experiences, both good and bad). In the letter that accompanies the survey, we tell the Veteran “any additional information you provide including comments, letters, emails, and other enclosures will be shared with the Medical Center Director or appropriate staff at your facility if it is the best way to address your concerns, unless you instruct us not to.” Lastly, we tell veterans that a written letter to API experiences at least a two-week delay in reaching us due to mailing and processing. In API, we take these emails and letters from Veterans very seriously. The policy that follows is one that we have established to efficiently and appropriately handle correspondence that results from distribution of the SHEP surveys. Notes include notification of change of address, Veteran deceased, Veteran unwilling or unable to participate in the survey, and many other topics.

First Stage Review by the Contractor who sends/receives surveys:

This process will also apply to email correspondence received as part of the online survey option. Emails will be printed and reviewed in the same manner as white mail received from the paper and pencil survey. The review shall be done in two phases, one to identify and process “Critical Service Alerts” and the other to process non-critical and more routine correspondence. The contractor opens all returned surveys, separates any white mail and reviews it for “Critical Service Alerts”. Critical Service Alerts are defined as any correspondence making reference to suicide, major depression, PTSD, traumatic brain injury (TBI), threats to oneself or threats to others (see below). Approximately 2% of correspondence received is classified as a Critical Service Alert. All white mail shall be reviewed by a minimum of two contractor personnel. Each letter shall be labeled with a sticker containing the survey project number, the processors’ initials, the survey id number assigned to the Veteran, and the Critical Service Alert check. The contractor reviewer(s) bring any questionable letters to the project manager for review. Any questionable items are forwarded to API staff. Critical Service Alerts are transmitted electronically to the API Office for immediate response and original documents are sent via overnight express. Non-urgent white mail bundles are shipped once a week from the contractor to the appropriate facility.

· Approximately 2% of correspondence received is classified as a Critical Service Alert. Below is a list of references and keywords that qualify a comment to be classified as a Critical Service Alert:

· Threats of suicide

· Threats of homicide

· Threats of violence

· Any other indication of danger to the self or others

· Any of the following key words or phrases, if used in a context that suggests urgency or distress:

· “Post-traumatic stress disorder,” “PTSD,” or equivalent word or phrase

· “Traumatic brain injury,” “TBI,” other combination of these three letters, or equivalent word or phrase

· “Trauma,” “military sexual trauma,” “MST,” or equivalent word or phrase

· “Depression” or a variant (e.g., “depressed”)

· “Stress” or a variant (e.g., “stressed”)

· “Anxiety” or a variant (e.g., “anxious”)

· Indication that the veteran has contacted or will contact a member of Congress, the President, or the President’s Administration

· Indication that the veteran has contacted or will contact the media

5.8 White mail processing and routing.

The SHEP program receives approximately 400-600 pieces of white mail per month However the volume of white mail can fluctuate as the volume of outgoing surveys increase, depending on response rates. VHA requires the contractor to process the flow of white mail from receipt by the contractor and transmit/forward it directly to the facility director’s office without being routed to API.

VHA is interested in innovations in processing whitemail using advances in technology including timely electronic transmission to the appropriate facility. VHA is currently interested in the methods and technologies available to analyze free form text and turn it into usable information including transcription and systematic coding of written comments to allow for advanced analysis and reporting.

6.0 ADDITIONAL AD HOC SERVICES

6.1 Ad Hoc Advanced Data Analytics and Reporting, Animated Training Videos, and Education Material

The VA is seeking a contractor with the capability to provide a variety of advanced analytics, reporting, training, and education products. These products may be provided to the SHEP program, VHA program offices, VISNs, and/or facilities. All resulting products shall conform to VA graphic standards (Logos - VA.gov Design System). These products must provide added value and understanding about the SHEP program and patient experiences to frontline staff and VHA leadership. The SHEP program may request these ad hoc products via separate task order based on available funding. These products shall be categorized into low, medium, and high complexity tasks defined at the task order level.

The successfully completion of tasks at all levels of complexity will require close collaboration and iterative communication (e.g., in the form of progress reports and updates of findings) with the SHEP team in order to jointly decide on various aspects of the statistical analysis and/or the most effective tabular and graphic formats for reports to various stakeholder groups within VHA.

Examples of low, medium, and high complexity tasks are defined below. The VA would like to utilize pre-priced CLINS based on anticipated level of effort of the contractor’s staff.

Low Complexity tasks. An example of a low complexity task would be a key driver analysis. A key driver analysis investigates the most influential relationships between potential drivers (as defined by single or multiple survey questions) and patient behavior such as positive rating of provider /hospital, willingness to recommend, overall satisfaction, or other outcome as defined by the individual VISN/facility. It should be noted that key drivers can be associated with patient behaviors that move outcomes in either a positive or negative direction.

The relationships between potential drivers and patient behavior can be assessed using a variety of statistical methods such as simple correlation, multiple regression analysis, or other previously agreed upon and appropriate statistical method to assess and quantify the association between driver and outcome. The analysis shall be integrated and include all core SHEP surveys where sufficient data is available. The analysis shall include other factors readily available in the data such as responder demographics.

Medium Complexity tasks. An example of a medium complexity task would be a deeper dive into specific data (e.g. race/ethnicity, clinical cohorts, etc.). In addition to the low complexity task described above, the analysis can include facility metrics such as facility size and complexity, results from the All-Employee Survey (AES), employee turnover rates, actual vs. expected growth, and other appropriate facility factors. The analysis will attempt to determine what combination of facility factors (examples above) and customer experiences (specific survey questions) are most influential in improving the outcome of interest, and the overall Veteran patient experience.

High Complexity tasks. High complexity tasks would typically involve the application of multivariate analytic techniques to data from multiple: service lines (inpatient, outpatient, community care), time periods and/or levels of analysis (individual, facility, network). An example of a high complexity task could be an examination of attributes of high/low performing facilities. In addition to the medium complexity task described above, the analysis could examine facility characteristics and identify those that are most influential in driving and sustaining patient experiences in the VA.

Deliverables for all projects, irrespective of Complexity level, shall include a briefing of findings to the SHEP Program team and topline report for VHA leadership as appropriate; recommendations for quality improvement; a report/presentation of findings suitable for presentation at an academic conference or publication in a peer reviewed journal; a detailed report of findings complete with appropriate supporting tables and appendices. Appendices to include all data, programming, supporting documentation.

Examples are provided as a potential area of effort and over the course of the IDIQ there will be many areas that could be addressed.

Training and education products provided that may include local or regional presentations on performance improvement strategies, triangulation of patient experience results with other VA data sources (e.g., employee satisfaction), data analytics, creating custom reports and interpreting results.

Training/education Products:

· Global ad-hoc training and education products tailored for administrators and front-line staff directly responsible for monitoring and improving Veteran experience. Topics may include interpretation of key drivers, areas to improve patient experiences, trend analysis, etc.

· Series of educational videos for champions of Veteran Experience

· Production of short, animated videos contributing to a library of SHEP/CAHPS education material for the field. These are YouTube-like videos 3-5 minutes in length:

· Example 1: https://www.youtube.com/watch?v=eMhiR2o5O-A&feature=youtu.be

· Example 2: Introduction to SHEP - YouTube

· Example 3: Journey of the Survey - YouTube

· Example 4: Data Activation - YouTube

· Creation of white papers that support disseminating best practices throughout the organization

· Creation of presentations for academic conferences to publicize VHA Veteran experience successes, breakthroughs and body of knowledge related to patient experience and/or survey methodology.

6.2 Survey Development

In addition to fielding and reporting the results from the core SHEP surveys, API requires a range of survey questionnaire design and analysis including but not limited to: development and administration of focus groups; cognitive testing of questions/surveys; survey and experimental design; survey field testing; testing revised survey administration; psychometric analysis such as exploratory and confirmatory factor analysis, structural equation modeling, and reliability analysis; and development services that include rotating topical questions using a modular approach.

These will be priced at the task order level.

6.3 Additional Survey Administration

VA also anticipates the possibility of fielding existing surveys for particular patient populations, providing the necessary resources and funding become available. The table below identifies some existing surveys of key interest.

Ad Hoc Surveys – provided necessary resources are available

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