Bidders Conference_Final 062112.pptx

ESRD Bidders Conference Waiting Room

End Stage Renal Disease

Network

Bidders Conference

Thursday, June 21, 2011 12:00 noon -1:30pm (EST)

RFP Solicitation Number: CMS-2012-ESRD-FFPCOMP

07/16/2012

Agenda Welcome--Jean Moody Williams Remarks--Dr. Patrick Conway ESRD Patient Subject Matter Expert (SME) Perspectives Overview of Contracting Work--Brian Hebbel Overview of Redesign Approach--Jean Moody Williams Background Alignment of National Priorities Approach to SOW Redesign: Aims, Domains, and Sub Domains Questions

*Participants are not permitted to record this call.

Patrick’s Talking Points:

Welcome

Excitement about this Statement of Work that represents new areas of work for the ESRD Network Program

SOW was drafted as a culmination of the following:

o Statutory and Regulation enhancements o National initiatives to improve beneficiary care o Recommendations from invested stakeholders including the following:

Patients and patient advocates ESRD Network Organizations Providers Federal Partners; and others

SOW promotes innovation, rapid cycle improvement and sustainability of outcomes

SOW demonstrates a heightened focus on patient centeredness and involvement

Introduction of Patient Subject Matter Experts

Pulse Check

Agenda Welcome--Jean Moody Williams Remarks--Dr. Patrick Conway ESRD Patient Subject Matter Expert (SME) Perspectives Overview of Contracting Work--Brian Hebbel Overview of Redesign Approach--Jean Moody Williams Background Alignment of National Priorities Approach to SOW Redesign: Aims, Domains, and Sub Domains

The Patients Perspective

Past. Present. Future.

Agenda Welcome--Jean Moody Williams Remarks--Dr. Patrick Conway ESRD Patient Subject Matter Expert (SME) Perspectives Overview of Contracting Work--Brian Hebbel Overview of Redesign Approach--Jean Moody Williams Background Alignment of National Priorities

Questions and Discussion

ESRD Network Eligibility Social Security Act 1881 (c)(1)(A), (B) and (C):

(A) Network Council and Medical Review Board Membership must include at least one patient representative and physicians, nurses, and social workers engaged in treatment relating to end stage renal disease.

(B) Patient Representation on Network Council and Medical Review Board At least one patient representative shall serve as a member of each network council and each medical review board.

(C) Ethical, Confidentiality and Conflict of Interest Must provide for the definition, disclosure, and, to the maximum extent consistent with effective administration, prevention of potential or actual financial or professional conflicts of interest with respect to decisions concerning the appropriateness, nature, or site of patient care.

*For more details, please go to http://www.ssa.gov/OP_Home/ssact/title18/1881.htm

ESRD Mandate:

SSA 1881(c)(1)(A)(i) For the purpose of assuring effective and efficient administration of the benefits provided under this section, the Secretary shall, in accordance with such criteria as he finds necessary to assure the performance of the responsibilities and functions specified in paragraph (2)—

(I) establish at least 17 end stage renal disease network areas, and (II) for each such area, designate a network administrative organization which, in accordance with regulations of the Secretary, shall establish (aa) a network council of renal dialysis and transplant facilities located in the area and (bb) a medical review board, which has a membership including at least one patient representative and physicians, nurses, and social workers engaged in treatment relating to end stage renal disease.

The Secretary shall publish in the Federal Register a description of the geographic area that he determines, after consultation with appropriate professional and patient organizations, constitutes each network area and the criteria on the basis of which such determination is made.

(ii)(I) In order to determine whether the Secretary should enter into, continue, or terminate an agreement with a network administrative organization designated for an area established under clause (i), the Secretary shall develop and publish in the Federal Register standards, criteria, and procedures to evaluate an applicant organization’s capabilities to perform (and, in the case of an organization with which such an agreement is in effect, actual performance of) the responsibilities described in paragraph (2). The Secretary shall evaluate each applicant based on quality and scope of services and may not accord more than 20 percent of the weight of the evaluation to the element of price.

(II) An agreement with a network administrative organization may be terminated by the Secretary only if he finds, after applying such standards and criteria, that the organization has failed to perform its prescribed responsibilities effectively and efficiently. If such an agreement is to be terminated, the Secretary shall select a successor to the agreement on the basis of competitive bidding and in a manner that provides an orderly transition.

(B) At least one patient representative shall serve as a member of each network council and each medical review board.

(C) The Secretary shall, in regulations, prescribe requirements with respect to membership in network organizations by individuals (and the relatives of such individuals) (i) who have an ownership or control interest in a facility or provider which furnishes services referred to in section 1861(s)(2)(F), or (ii) who have received remuneration from any such facility or provider in excess of such amounts as constitute reasonable compensation for services (including time and effort relative to the provision of professional medical services) or goods supplied to such facility or provider; and such requirements shall provide for the definition, disclosure, and, to the maximum extent consistent with effective administration, prevention of potential or actual financial or professional conflicts of interest with respect to decisions concerning the appropriateness, nature, or site of patient care.

ESRD Network Service Areas

Contract Type Firm Fixed Price Contract For Competitive And Renewal ESRD Networks

There will be a separate RFP for Renewal ESRDs for Firm-Fixed Price contracts for Networks 3, 5, 6, 8, 9, 12 and 17.

There will also be a separate RFP for Competitive ESRDs for Cost-Plus-Fixed-Fee type contracts for Networks 2 and 7 and Firm-Fixed Price type contracts for Networks 1, 4, 10, 11, 13, 16 and 18.

07/16/2012

Overview of Contract Requirements Transition Period In the event that CMS required transition services from the incumbent ESRD contractor to a successor ESRD contractor, CMS will request a separate technical and business proposal for these services. Refer to Section H.18 for guidance.

The transition period will be from November 1, 2012 through December 31, 2012.

(Section L.13) The proposal shall consist of a technical, business and conflict of interest proposal. The page limitation for the technical proposal is 60 double sided pages. There is no page limitation for the business and conflict of interest proposal.

The technical proposal must not contain reference to price/cost; however, resource information such as data concerning labor hours and categories, materials, subcontract(s), etc., must be included in the technical proposal.

A separate business and technical proposal shall be prepared and submitted for each ESRD Network Area (Number), regardless of whether the contractor holds one or more ESRD contracts.

One (1) electronic copy of the proposal (technical, business and conflict of interest) must be submitted on CD-ROM. Each CD-ROM must be clearly labeled with the Network’s name, ESRD Network contract for which it is submitted, and identify if the contents on the CD-ROM (e.g., technical proposal; business proposal; conflict of interest proposal).

Overview of Contract Requirements Delivery of Proposals (Section L.15)

Proposals must be received on or before August 2, 2012

Delivery of proposals must be made so that the proposal is received at the designated place (7500 Security Boulevard, Mail Stop B3-30-03) prior to 11:00 a.m. local prevailing time on August 2, 2012.

1 electronic copy on CD-Rom, 1 Original and 6 Hard copies to:

Centers for Medicare & Medicaid Services (CMS) Office of Acquisition and Grants Management 7500 Security Boulevard, Mail Stop B3-30-03 Baltimore, Maryland 21244-1850 Attn: Brian Hebbel RFP No. CMS-2012-ESRD-FFPCOMP

Questions must be submitted in accordance with Section L.11.

Questions must be submitted by email to: esrd_nw_sow_questions@cms.hhs.gov

Proposal Evaluation Factors

2 Experience Experience will be evaluated based on meeting and collaborating with vested stakeholders proposed including past performance.

In accordance with FAR 9.104-1, General standards, the Offeror must have a satisfactory performance record in order to be considered for award. See also FAR 9.104-3(b), Satisfactory Performance Record, and FAR 42.15, Contractor Performance Information.

Past performance information will be used to assess responsibility and to evaluate technical merit in accordance with FAR 15.305 and any requirements of this solicitation.

When developing the past performance factor rating, CMS may consider information available to CMS up to the date of the most recent proposal submission.

3 Management And Staff Plans Plan will be evaluated on:

The extent to which they possess the appropriate technical knowledge, expertise, and experience on programs and issues described in the Statement of Work (Section C.)

The ability to provide a clear demonstration that they are available and dedicated to this effort and will meet the needs of the CMS customer.

Ability to conduct and manage all of the areas described in the Statement of Work (Section C.)

4 Personnel Offerors shall provide resumes of all key personnel for this contract.

For additional details, see Section L in the SOW released on Thursday, June 14, 2012

Proposal Evaluation Factors

This process will consist of review and evaluation of specific elements of each offeror’s proposed cost estimate to determine whether the estimated proposed cost elements are realistic for the work to be performed.

All Offerors are required to submit a business proposal in accordance with the format provided in the applicable Section J-7 ESRD Network Business Forms and Instructions, Attachments (including all documentation as necessary to support the proposed costs).

No costs shall be proposed for Special Projects.

At the time a Special Project is agreed to, a supplemental budget will be required.

For additional details, see Section L in the SOW released on Thursday, June 14, 2012

Conflict of interest certificates will be reviewed in accordance with contract section H.11 and Section L.13 of the solicitation.

The Government will review the Offeror’s Conflict of Interest (COI) submission of information required in Section H.11 and Section L.13 and make a determination if the Offeror meets the COI requirements.

CMS will not enter into a contract with an entity that CMS determines has, or has the potential for, an unresolved organizational conflict of interest unless CMS determines the rick can be sufficiently mitigated or unless the conflict is waived following FAR procedures and requirements.

CMS will treat COI’s consistent with the FAR.

CMS may ask for clarification questions related to COI’s prior to an apparent awardee being identified by CMS.

Conflict of Interest

Request for information concerning the RFP should be directed to the Contracting Officer by phone at

410-786-5159 or

Brian.Hebbel@cms.hhs.gov Don’t Forget…

Agenda Welcome-- Jean Moody Williams Remarks--Dr. Patrick Conway ESRD Patient Subject Matter Expert (SME) Perspectives Overview of Contracting Work--Brian Hebbel Overview of Redesign Approach--Jean Moody Williams Background Alignment of National Priorities

Background ESRD Network SOW has been operating under the same general provisions since 2003 OCSQ acknowledged the need to evaluate the ESRD Network Program in an effort to achieve optimal results Medicare Improvements for Patients and Providers Act (MIPPA) July 15, 2008 MIPPA § 153(b) of the ESRD PPS, for Medicare outpatient ESRD facilities beginning January 1, 2011 MIPPA §153(c) by creating the ESRD quality incentive Program (QIP), safeguard for quality Patient Protection and Affordable Care Act (ACA) March 23, 2010 ACA §3011 National Quality Strategy CMS Strategic Areas of Focus 2010 Better Care for the Individual through Beneficiary and Family-Centered Care Better Health for the ESRD Population Reduce Costs of ESRD Care through Improvement of Care

Purpose Align ESRD Network Activities with the HHS National Quality Strategy, the CMS three aims and other CMS priorities designed to result in improvements in the care of individuals with ESRD;

Specify the tasks and activities of the Networks to accomplish the stated goals: and Measure Network performance and impact in achieving stated goals

2011 USRDS ESRD Report Data More than 116,000 people began treatment for end-stage renal disease (ESRD) Almost 571,000 patients receive treatment for ESRD The rate of new ESRD cases is 3.5 times higher among African Americans than among whites 81,000 patients waiting for a kidney transplant African-Americans account for 34% of the waiting list

2.3 years median time on transplant wait list 5,780 dialysis facilities 6 out of 10 patients dialyze at an LDO

ESRD SOW Aligned with National Priorities Supports the HHS National Quality Strategy Make care safer Promote effective coordination of care Assure care is person and family-centered Promote prevention and treatment of the leading causes of mortality Helping communities support better health Making care more affordable for individuals, families, employers, and governments by reducing costs through continual improvement Supports the Three Aims Better healthcare for individuals Better health for people and communities Affordable care through lowering costs by improvement Supports the aims of the Partnership for Patients Campaign and the HHS HAI Action Plan Decrease preventable HACs by 40% Supports the HHS Disparities Reduction Action Plan

Approach to SOW Redesign Employed a Collaborative Multi-Disciplinary Approach to Create a New Baseline for ESRD Network Program Design process representation included Patients Advocacy Groups ESRD Facilities ESRD Networks CMS ESRD COTRs/GTLs Nephrologists DQIPCAC Staff CM Staff ESRD Network Forum CMCS Staff Survey and Certification Centers for Disease Control & Prevention Health Resources and Services Administration National Institutes of Health

Quality Incentive Program (QIP)—Background

Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) revises the Centers of Medicare and Medicaid ESRD bundled payment (PPS) in January, 2011 and authorized the first federal Value-based Purchasing program, the ESRD Quality Incentive Program (QIP).

The ESRD QIP introduces new performance measures and standards that foster continuous improvements in quality. The ESRD final rule for Payment Year (PY) 2012 was put on display December 29, 2010 and published January 5, 2011.

Beginning January 1, 2012, the ESRD QIP will implement a payment reduction of up to 2 percent (2%) of the bundled payment amount on ESRD facilities and providers that do not meet CMS established quality metrics demonstrating the quality of delivered care is high and improving. CMS posted the proposed rule for the ESRD QIP and the final rule implementing the ESRD PPS in the Federal Register.

The ESRD PPS payment method will apply to 100% of Medicare certified facilities by 2014 based on rules that allow a 3-year phase in period. The ESRD QIP will apply to all Medicare certified facilities.

*QIP Open Door Forum will be held today at 2:00pm - 3:00pm (EST)

Announcement: QIP Open Door Forum will be held today at 2:00pm -3:00pm (EST)

ESRD NW SOW AIMS and Drivers Drivers of Change “How the work will be done”

Learning and Action Networks Breakthrough Collaboratives Patient Engagement and Stories Campaigns Technical Assistance Learning Laboratories Focused Technical Assistance On-site Visits Intensive Consultation Distribution of Resources Care Reinvention through Innovation Spread Identification of stakeholders Spread Strategies Multi-media management

Strategic Aims “What will be done”

AIM 1: Better Care for the Individual through Beneficiary and Family-Centered Care

AIM 2: Better Health for the ESRD Population

AIM 3: Lower Costs of ESRD Care through Improvement of Care

Other Rapid Cycle Special Projects

Network Tasks Help to Achieve the Three Aims

Domains are high-level outcome areas related to the national goals of The national quality strategy & the three aims.

Network Tasks Help to Achieve the Three Aims

Project A: Increase Hepatitis B (HBV), Influenza, and Pneumococcal Vaccination Rates Project B: Improve Dialysis Care Coordination with a Focus on Reducing Hospital Utilization Project C: Improve Transplant Coordination Project D: Promote Appropriate Home Dialysis in Qualified Beneficiaries Project E: Support Improvement in Quality of Life

Domains are high-level outcome areas related to the national goals of the National Quality Strategy & the Three Aims.

Aim 1: Better Care for the Individual through Beneficiary and Family-Centered Care Tasks Beneficiary and Family Engagement Defined requirements for patient participation in Network activities Patient Experience of Care Standardize definitions and resolution processes for grievances.

Perform further investigation of trends detected by CMS Monitoring & Evaluation activities Appropriate Access to Outpatient Dialysis Care Standardize definitions and resolution processes for IVD/IVT and failure to place.

Perform Root Cause Analyses of Targeted Facilities for Quality Improvement and/or Spread of Best Practices Design Interventions focusing on rapid cycle change Patient Safety: Reduction in Healthcare Acquired Infections Working to reduce CLABSI in coordination with CDC initiatives and the Partnership for Patients Campaign

Aim 2: Better Health for ESRD Population

Tasks Vascular Access Management Build upon the successes of FFBI Implementation of evidence-based interventions for targeted facilities Population Health: Increasing Immunization Rates Increase vaccination rates for pneumococcal, influenza and HBV Population Health: Transplant Coordination with a Focus on Reduction of Disparities Increase number of patient referrals for transplant Develop strategies to increase patient’s becoming and remaining “active” on the list for transplant.

Aim 3: Reduce Costs of ESRD Care through Improvement of Care Tasks Support for ESRD QIP for Performance Improvement Provide education and technical support for targeted facilities related to QIP measures Maintain knowledge on QIP measures, measure specifications, CROWNWeb, resources available to facilities.

Assist in making facilities aware of their QIP Performance Score Report Support facility data submission for CROWNWeb Oversee the timely and accurate submission of facility data into CROWNweb Serve as a resource for CROWNweb facility users Actively support facilities’ quality data submission into CROWNweb or other QIP related system

Maximizing Impact For success in the ESRD Networks will lead transformation by… Being conveners, organizers, motivators and change agents.

Leveraging technology to provide outreach and education.

Serving as a partner in improvement with other health care organizations, beneficiaries, health care providers, practitioners, and stakeholders.

Securing commitments to create collaborative relationships.

Achieving and measuring changes at the patient level through data collection, analysis and monitoring for improvement.

Disseminating and spreading best practices including those relating to clinical care, quality improvement techniques and data collection through information exchange.

Participating in CMS national framework for providing emergency preparedness services through the Networks.

Next Steps

*Please be advised that any amendment to this RFP will be issued and posted electronically on Fed Biz Opps. It is strongly recommended that offerors monitor Fed Biz Opps regularly for information related to this RFP.

Remember…

Please submit RFP related questions by email to: esrd_nw_sow_questions@cms.hhs.gov image5.jpeg image6.gif image7.jpeg image8.png image9.jpeg image10.jpeg image11.jpeg image12.gif image13.jpeg image2.jpeg image3.png

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