Draft_SOO_Health_Systems_Technology_Integrator_VCC.pdf

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DEPARTMENT OF VETERANS AFFAIRS

Veterans Health Administration

Office of Veterans Community Care

STATEMENT OF OBJECTIVES

Health Systems Technology Integrator in Support of the

Veterans Accountable Care Operating Model

Solicitation No.: [TO BE ASSIGNED]

Contracting Activity: [TO BE COMPLETED]

Version: DRAFT 0.1 | Date: [DATE]

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Table of Contents Table of Contents

1.0 Purpose

2.0 Background

3.0 Scope

4.0 Period and Place of Performance

5.0 Program Objectives

5.1 Objective 1 — Enterprise Integration Architecture and Data Governance

5.2 Objective 2 — Member Identity, Eligibility, and Attribution

5.3 Objective 3 — Multi-EHR and Community Clinical Data Interoperability

5.4 Objective 4 — Financial Systems and Payment Integration

5.5 Objective 5 — Semantic Normalization and Reference Data

5.6 Objective 6 — Quality, Cost, and Performance Measurement

5.7 Objective 7 — Artificial Intelligence Enablement and Governance

5.8 Objective 8 — Workflow Orchestration Across Organizational Boundaries

5.9 Objective 9 — Security, Privacy, and Authorization to Operate

5.10 Objective 10 — Transition-In, Knowledge Transfer, and Transition-Out

6.0 Constraints, Standards, and Assumptions

7.0 Government-Furnished Information, Property, and Services

8.0 Desired Outcomes and Candidate Performance Measures

9.0 Contractor Proposal Expectations

10.0 Organizational Conflict of Interest

11.0 Deliverable Expectations

Appendix A — Acronyms

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1.0 Purpose

This Statement of Objectives (SOO) describes the outcomes the Department of Veterans Affairs (VA), Veterans Health Administration (VHA), Office of Veterans Community Care (VCC) intends to achieve through the services of a Health Systems Technology Integrator (hereafter, "the Integrator").

Consistent with RFO Part 37.1 and performance-based acquisition principles, this SOO states what the Government requires, not how the requirement is to be met. Offerors shall propose a Performance Work Statement (PWS), a Quality Assurance Surveillance Plan (QASP), performance metrics, and an Integrated Master Schedule (IMS) that, taken together, demonstrate how the offeror will achieve the objectives in Section 5.0 within the constraints in Section 6.0.

The Government will evaluate the credibility, technical soundness, and risk profile of the offeror’s proposed approach. Offerors are encouraged to propose alternatives to any Government assumption stated herein, provided the alternative is clearly identified and its rationale, benefit, and risk are explained.

2.0 Background

VHA is establishing the Office of Veterans Community Care to consolidate policy, operations, and financial accountability for care delivered to Veterans by non-VA providers, and to transition the community care program toward a value-based, accountable care operating model. Approximately 40 percent of VA care is currently delivered through community providers.

The Office of Veterans Community Care operates in an environment defined by three concurrent large-scale transitions:

• Dual electronic health record (EHR) operations. VA is deploying the Federal EHR (Oracle Health) on an accelerated schedule while continuing to operate VistA at the majority of facilities. Full deployment is not expected to conclude before the early 2030s. Dual-EHR operation is therefore a sustained operating state, not a short transition window. A separate dental EHR may also be operated during this period.

• Community Care Network (CCN) restructuring. VA is consolidating community care administration from five regional networks into two (East and West) under a multiple-award, long-duration IDIQ structure in which third-party administrators (TPAs) are responsible for network management, customer service, quality outcomes, performance metrics, and claims processing and payment.

• Financial systems modernization. VA is migrating from legacy financial systems to the Integrated Financial and Acquisition Management System (iFAMS), deployed in waves. VHA financial operations are affected by, and dependent upon, the sequencing of that migration.

Current VCC business capabilities — eligibility determination, referral management, care coordination, scheduling, claims processing, quality reporting, and provider payment — are supported by a portfolio of loosely coupled applications with limited shared data, redundant data entry, extended processing timelines, and constrained analytic capability. These conditions are incompatible with an accountable

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The Government seeks an Integrator to establish and sustain the enterprise integration, data, and measurement capabilities required for the accountable care operating model, while VA retains ownership of the target architecture, the data model, and the underlying intellectual property.

3.0 Scope

The scope of this requirement encompasses the integration, data management, measurement, and artificial intelligence enablement capabilities necessary to support the Office of Veterans Community Care accountable care operating model across VA-delivered and community-delivered care.

3.1 Within Scope

• Design, implementation, and sustainment of an enterprise integration and data layer serving VCC business capabilities.

• Bidirectional integration with VA clinical, administrative, and financial systems of record, and with external payer, provider, and health information exchange counterparties.

• Semantic normalization, terminology management, patient and provider identity resolution, and reference data management.

• Computation and reconciliation of quality, utilization, cost, and performance-based payment measures.

• Artificial intelligence and automation capabilities, together with the governance, validation, and monitoring apparatus required for their responsible operation.

• Security engineering, privacy engineering, and support to Authority to Operate (ATO) processes for capabilities delivered under this effort.

• Transition-in, knowledge transfer, and transition-out services.

3.2 Outside Scope

• Replacement, configuration, or sustainment of the Federal EHR or VistA as clinical systems of record.

• Performance of TPA functions under the CCN contracts, including network development, credentialing, or claims adjudication as a payer of record.

• Delivery of direct clinical care or clinical decision-making.

• Replacement of iFAMS or of VA’s system of record for financial accounting.

4.0 Period and Place of Performance

[TBD: Anticipated period of performance: a base period of [__] months with [__] option periods, structured to permit incremental scope release. The Government intends to align option exercise to demonstrated achievement of the outcomes in Section 8.0.]

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[TBD: Place of performance: primarily contractor facilities, with on-site presence at [TBD LOCATION(S)] as required for integration events, testing, and governance activities. Work shall be performed within the United States by personnel meeting the citizenship and background investigation requirements of Section 6.0.]

5.0 Program Objectives

The Government has organized its objectives as a layered capability architecture. Offerors shall address each objective and shall describe the dependencies and sequencing among them. Objectives are stated as end states; the means of achieving them are for the offeror to propose.

5.1 Objective 1 — Enterprise Integration Architecture and Data Governance End state: VA holds a documented, implemented, and maintainable target architecture for VCC data and integration, and exercises effective control over it.

• A canonical data model and integration architecture exists, is documented to a standard permitting independent maintenance, and is owned by VA.

• Integration is achieved through published, versioned, and governed interfaces rather than point-to-point connections; the number of undocumented interfaces decreases measurably over the period of performance.

• Data lineage is traceable from source system to any figure used in reporting, payment, or executive decision-making.

• Architectural decisions are recorded, reviewed through VA governance, and are not embedded solely in contractor-held artifacts or personnel knowledge.

• The architecture accommodates federated and centralized data patterns as appropriate, and does not require the physical consolidation of all data as a precondition to delivering value.

5.2 Objective 2 — Member Identity, Eligibility, and Attribution End state: VCC can reliably determine, for any point in time, which Veterans are attributed to which accountable care arrangement, what their eligibility status is, and which providers bear accountability for their care.

• Veteran identity is resolved to a single enterprise identifier across VA clinical, administrative, and community care systems, with measurable reduction in duplicate and unmatched records.

• Eligibility determination for community care is automated to the maximum extent supportable by policy, with exceptions routed for human adjudication and with determinations rendered auditable.

• An attribution capability assigns Veterans to accountable populations and to accountable providers using rules that VA can configure, version, and defend under audit.

• The limitations of VA-only data on total cost of care are explicitly addressed. The offeror shall describe how coverage from Medicare, TRICARE, and other payers is incorporated or, where data is unavailable, how the resulting measurement bias is quantified and disclosed.

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5.3 Objective 3 — Multi-EHR and Community Clinical Data Interoperability End state: A clinically usable, longitudinal view of Veteran care is available across both VA EHRs, the dental EHR, and community providers, and referral loops close reliably.

• Clinical data from VistA, the Federal EHR, and the dental EHR is normalized into the canonical model with a documented, domain-by-domain reconciliation strategy establishing source precedence for problems, medications, allergies, encounters, results, and immunizations.

• Community provider data is ingested through available exchange pathways — including referral management systems, the Joint Health Information Exchange, and TEFCA-aligned networks — and is rendered comparable to VA-originated data.

• The referral lifecycle closes: an authorization issued in VA is traceable through scheduling, delivery, documentation return, and payment, with unclosed referrals identified and aged.

• Interoperability is delivered using HL7 FHIR R4 and USCDI-conformant representations, with legacy formats supported only where a modern pathway does not exist.

• Duplicate and conflicting clinical records arising from dual-EHR operation are detected and surfaced rather than silently resolved.

5.4 Objective 4 — Financial Systems and Payment Integration

End state: Every dollar of community care spend is traceable from clinical event to claim to obligation to disbursement, and performance-based payments can be computed, explained, and defended under audit. This objective is of primary importance to the Government.

• Claims and encounter data from CCN third-party administrators and other payer counterparties is ingested, validated, and normalized at production volume, including ASC X12 transaction sets (837, 835, 834, 278, 270/271) and any successor or supplementary formats.

• Financial data flows integrate with iFAMS and with VA cost accounting so that community care obligations, accruals, and disbursements reconcile to the general ledger without manual bridging.

• A payment capability supports value-based arrangements — including shared savings and loss, bundled and episode-based payment, care management payments, and quality withholds — with configurable rules, versioned methodologies, and reproducible results.

• Risk adjustment is applied to cost and utilization comparisons using a documented, testable methodology.

• Payment integrity controls are in place, including duplicate detection, coordination of benefits, and controls sufficient to support compliance with the Payment Integrity Information Act.

• Every performance-based payment is reproducible: given a payment amount, VA can regenerate the underlying member months, claims, measures, and calculations without contractor intervention.

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Offerors shall specifically describe prior work integrating payer financial operations with an enterprise financial system of record, and shall identify any experience with CGI Momentum or comparable federal financial platforms.

5.5 Objective 5 — Semantic Normalization and Reference Data

End state: Clinical, administrative, and financial data from heterogeneous sources is comparable, and the rules making it comparable are transparent and VA-owned.

• Terminology is normalized to national standards (including SNOMED CT, LOINC, RxNorm, ICD-10- CM/PCS, CPT/HCPCS) with mappings maintained, versioned, and available to VA.

• Provider identity is resolved across NPI, VA credentialing, TPA network rosters, and taxonomy data, supporting accurate attribution and payment.

• Episodes of care are constructed consistently across VA-delivered and community-delivered services.

• Site of care, place of service, and program authority are normalized so that spend and utilization can be analyzed on a consistent basis.

• Reference data changes are governed, with impact analysis performed before changes affecting measurement or payment take effect.

5.6 Objective 6 — Quality, Cost, and Performance Measurement

End state: VCC can measure quality, utilization, access, and total cost of care for accountable populations, and can publish results that providers and oversight bodies accept as accurate.

• A measure computation capability supports nationally recognized measure specifications and VA-specific measures, with specifications versioned and results reproducible for prior periods.

• Total cost of care and utilization are computed for attributed populations, with benchmarks and comparison groups that VA can define and defend.

• Measure results are available to VA leadership, VISNs, facilities, and community providers at a cadence sufficient to change behavior, rather than only in retrospective annual settlement.

• Discrepancies between contractor-reported and VA-computed results are detectable and reconcilable.

• Measurement capability is available before the first performance-based payment period concludes, not after.

5.7 Objective 7 — Artificial Intelligence Enablement and Governance End state: AI and automation measurably improve VCC operations, and every deployed model is inventoried, validated, monitored, and reversible.

• AI and automation are applied to defined operational problems — candidate areas include eligibility and referral triage, utilization management support, care coordination prioritization, DRAFT — Pre-Decisional Page 8 of 14 coding and documentation integrity, network leakage detection, and claims anomaly detection — with benefit demonstrated against a pre-established baseline.

• Every model is registered in a use case inventory with a stated purpose, training and validation evidence, known limitations, and an identified accountable VA official.

• Human-in-the-loop requirements are explicit for any use affecting a Veteran’s access to care, eligibility, or benefit determination.

• Performance drift, subgroup performance, and data quality dependencies are monitored continuously, with defined thresholds triggering review.

• Every model can be disabled or rolled back without interrupting the underlying business process.

• AI capabilities comply with applicable Federal and VA policy on artificial intelligence, including requirements applicable to rights-impacting and safety-impacting uses.

5.8 Objective 8 — Workflow Orchestration Across Organizational Boundaries End state: Work moves across VA, TPA, and community provider boundaries without re-keying, without loss of status visibility, and without dependence on manual reconciliation.

• Referral, authorization, scheduling, care coordination, and documentation return operate as an orchestrated end-to-end process rather than as discrete system transactions.

• Status is visible in near real time to VA staff, and, where appropriate, to community providers and Veterans.

• Exceptions and stalled work are detected and routed automatically.

• Manual re-entry of data already held in a VA or TPA system is eliminated for the highest-volume workflows.

• Orchestration is resilient to the differing capabilities of VistA sites, Federal EHR sites, and community counterparties.

5.9 Objective 9 — Security, Privacy, and Authorization to Operate End state: Capabilities are authorized, sustained in an authorized state, and handle protected information in accordance with the specific statutory regime applicable to VA health data.

• Capabilities achieve and maintain ATO in accordance with VA Directive and Handbook 6500 and applicable NIST guidance, with ATO milestones reflected in the Integrated Master Schedule rather than treated as a downstream activity.

• Cloud services carry FedRAMP authorization at a level appropriate to the data handled.

• Privacy protections satisfy HIPAA, the Privacy Act, 38 U.S.C. § 5701, and 38 U.S.C. § 7332. Offerors shall specifically address how records subject to § 7332 special protections are segmented, consent-managed, and excluded from onward disclosure where consent does not exist — including in analytic, measurement, and AI training data sets.

• Capabilities conform to Section 508 accessibility requirements.

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• Data minimization is applied: data is moved and retained because a defined use requires it, not because it is available.

5.10 Objective 10 — Transition-In, Knowledge Transfer, and Transition-Out End state: VA is never dependent on a single vendor’s continued performance to operate, understand, or modify its own accountable care infrastructure.

• Transition-in occurs without degradation of existing VCC operations and without interruption of in-flight referrals, claims, or payments.

• Knowledge transfer is continuous and evidenced, not concentrated at the end of the period of performance.

• The data model, mappings, transformation logic, measure specifications, configuration, and operational documentation are delivered to VA in usable, non-proprietary form throughout performance.

• A transition-out plan is delivered and maintained from the outset of performance, is priced, and is executable by a successor without contractor-unique tooling.

• The Government can demonstrate, through periodic exercise, that it can stand up a successor or in-source a capability within a defined interval.

6.0 Constraints, Standards, and Assumptions

6.1 Operating Constraints

• Dual-EHR operation shall be treated as a sustained state through the full period of performance.

Approaches predicated on the completion of EHR deployment are unacceptable.

• The Integrator shall not assume authority over systems of record owned by other VA programs, and shall operate within established VA Office of Information and Technology governance.

• Delivery shall accommodate the sequencing of the iFAMS wave deployments and of the CCN Next Generation task order awards, neither of which the Integrator controls.

• VA shall retain architectural decision authority. The Integrator advises and implements; it does not unilaterally set the target state.

6.2 Data Rights and Intellectual Property

The Government requires unlimited or Government purpose rights, as appropriate, in the data model, mappings, transformation logic, measure specifications, configuration, interface definitions, and documentation developed under this effort. Offerors shall identify any proposed use of proprietary or commercial components, state the license terms, and describe the consequence to VA of discontinuing that component. Solutions in which the semantic layer or measurement logic is not portable to a successor environment will be viewed as high risk.

6.3 Standards

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Solutions shall conform to applicable standards including, at minimum: HL7 FHIR R4; USCDI; ASC X12 for administrative transactions; NCPDP where pharmacy data is in scope; SNOMED CT, LOINC, RxNorm, ICD- 10, and CPT/HCPCS for terminology; and applicable NIST and VA security standards.

6.4 Government Assumptions

The Government has made the following assumptions. Offerors may challenge any of them, with rationale.

• Access to TPA data will be established through CCN task order requirements rather than through negotiation by the Integrator.

• Acquisition of external payer claims data is a Government workstream on an independent timeline.

• Existing VCC systems will continue to operate during the period of performance; this effort is not predicated on their retirement.

7.0 Government-Furnished Information, Property, and Services

The Government anticipates furnishing the following.

• Current-state system inventory, interface catalog, and data dictionaries for in-scope VCC systems.

• Access to VA cloud environments, development tooling, and test environments.

• Synthetic or de-identified data sets sufficient for design, development, and evaluation activities.

• VA policy, architecture, and security artifacts necessary to inform design.

• Government subject matter experts and a designated decision authority for architectural and business-rule questions, with a defined response interval.

8.0 Desired Outcomes and Candidate Performance Measures

The following outcomes express what success looks like. Offerors shall propose measures, baselines, targets, and surveillance methods in the QASP. The Government will negotiate final measures at award.

Baseline values are to be established during transition-in.

Outcome Candidate Measure Target

Faster, more consistent eligibility determination

Share of determinations completed without manual intervention; median time to determination

[TBD] / [TBD]

Referral loops close reliably Percent of referrals with documentation returned within [__] days; aged open referral count

[TBD]

Clinical data is usable across both EHRs

Percent of attributed Veterans with a complete longitudinal record; unresolved duplicate rate

[TBD]

Claims and financial data reconcile

Percent of community care spend reconciled to the general ledger without manual adjustment

[TBD]

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Outcome Candidate Measure Target

Payments are defensible Percent of performance payments independently reproducible by VA from source data

100%

Measurement is timely Interval between period close and publication of quality and cost results

[TBD]

AI is governed Percent of deployed models with current validation, monitoring, and rollback evidence

100%

VA retains control Percent of architecture, mappings, and measure logic delivered to VA in portable form

100%

Security posture is sustained ATO maintained; no unremediated high findings beyond agreed intervals

[TBD]

Exit is feasible Successful periodic demonstration of transition-out readiness

Annual

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9.0 Contractor Proposal Expectations

In response to this SOO, offerors shall submit, at minimum:

• A Performance Work Statement addressing each objective in Section 5.0, including tasks, deliverables, and the offeror’s proposed approach.

• A Quality Assurance Surveillance Plan with proposed measures, baselines, targets, surveillance methods, and remedies.

• An Integrated Master Schedule showing sequencing, dependencies, critical path, and ATO milestones.

• A technical approach describing the target architecture, the treatment of dual-EHR reconciliation, and the financial integration design.

• A staffing approach identifying key personnel, their commitment terms, and the offeror’s approach to continuity of expertise.

• A data rights and transition-out approach, including a priced transition-out.

• An organizational conflict of interest disclosure and mitigation plan (Section 10.0).

• Past performance references demonstrating payer-side financial integration, multi-EHR integration, and federal delivery at comparable scale.

The Government may conduct a technical demonstration or evaluation exercise with a down-selected group of offerors, using synthetic data and Government-defined end-to-end scenarios. Candidate scenarios include: a referral issued at a VistA site and delivered in the community; a Veteran with records in both EHRs and in the dental EHR; end-to-end computation of a single quality measure from mixed VA and TPA data; and calculation and reconciliation of a performance-based payment to the general ledger.

10.0 Organizational Conflict of Interest

The Integrator will have access to data, business rules, and performance results bearing directly on entities that compete for, or perform under, VA community care and EHR contracts. Accordingly, the Government will evaluate organizational conflicts of interest under RFO Subpart 9.5 as a substantive matter.

Offerors shall disclose any affiliation, teaming arrangement, subcontract, or financial interest involving:

a CCN third-party administrator or an offeror for a CCN task order; the Federal EHR vendor or its affiliates; any entity performing claims adjudication, utilization management, or network administration for VA; and any entity whose performance would be measured by capabilities delivered under this effort.

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11.0 Deliverable Expectations

Deliverables are to be proposed by the offeror. The Government expects, at minimum, that the following exist, are maintained current, and are delivered in portable form: the target architecture and architectural decision record; the canonical data model and data dictionary; interface specifications and the interface catalog; terminology mappings and reference data; measure specifications and computation logic; the AI use case inventory and supporting validation and monitoring evidence;

security and privacy artifacts supporting ATO; operational runbooks; and the transition-out plan.

The Government does not require the delivery of contractor-internal management artifacts that do not contribute to VA’s ability to operate, understand, or transition the capability.

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Appendix A — Acronyms

Acronym Definition

ATO Authority to Operate

CCN Community Care Network

CPT/HCPCS Current Procedural Terminology / Healthcare Common Procedure Coding System

EHR Electronic Health Record

FHIR Fast Healthcare Interoperability Resources

GFI Government-Furnished Information iFAMS Integrated Financial and Acquisition Management System

IMS Integrated Master Schedule

LOINC Logical Observation Identifiers Names and Codes

VCC Office of Veterans Community Care

OCI Organizational Conflict of Interest

PWS Performance Work Statement

QASP Quality Assurance Surveillance Plan

SNOMED CT Systematized Nomenclature of Medicine Clinical Terms

SOO Statement of Objectives

TCOC Total Cost of Care

TEFCA Trusted Exchange Framework and Common Agreement

TPA Third-Party Administrator

USCDI United States Core Data for Interoperability

VHA Veterans Health Administration

VISN Veterans Integrated Service Network