HT0011-21-P-0014 DHA NCQA HEDIS Sole Src Determination signed 21-07403_Redacted.pdf

DETERMINATION & FINDINGS

Authority to Solicit from a Single Source

Upon the basis of findings and determination which I hereby make pursuant to Federal Acquisition Regulation (FAR) 13.106-1(b)(1)(i), Contracting officers may solicit from one source if the contracting officer determines that the circumstances of the contract action deem only one source reasonably available (e.g., urgency, exclusive licensing agreements, brand-name or industrial mobilization), a new purchase order to be issued for one base year plus four option years.

FINDINGS

1. BACKGROUND.

The Military Health System utilizes the NCQA HEDIS® methodology to develop health plan measures for clinical quality performance evaluation in both the direct and private care systems.

This entails significant programming and data analysis to ensure the methodologies are technically correct. As the Defense Health Agency (DHA) uses the NCQA methodologies for the health plan performance measures, the HEDIS® benchmarks are needed to analyze the data. DHA relies on these civilian sector benchmark data to compare the performance of the Military Treatment Facilities and purchased care providers both internally and externally to the MHS. No other nationally recognized organization has the variety of measures with sufficient data to support the health plan performance analysis of DHA.

The HEDIS® benchmarks were developed to assist consumers to compare health plan performance with other plans and to national benchmarks. It is also frequently used for trending to track year to year performance. It is one of health care’s most widely used performance tools with over 90 percent of health plans using the benchmarks and over 191 million people enrolled in health plans reporting HEDIS results.

This service requirement will provide compliance with the Secretary of Defense MHS 90 Day Review (May 2014); the DHA Procedural Manual, 6025.13, Volume 6 (August 2019; and the National Defense Authorization Act (NDAA 2021), Section 744.

Clinical Support Division, Medical Affairs requested to obtain a new sole-source award for a 12-month base plus four (4) 12-month option periods to provide benchmarks for health plan measures based on the data submitted to the National Committee for Quality Assurance (NCQA). The product is the Commercial Quality Compass® Healthcare Effectiveness Data and Information Set (HEDIS®) Benchmarks user product. In addition to the first year, the contract will have four (4) option years. The HEDIS® benchmarks provide:

a. Valid, risk-adjusted outcome measures for outpatient care to include categories of effectiveness of care; access and availability of care; utilization; and risk-adjusted utilization.

b. Compare the performance of Military Treatment Facilities (MTFs) and purchased care providers both internally and externally to other healthcare plans.

c. The program’s cybersecurity and agreements meet and comply with Department of Defense and Federal Law requirements upon selection by the contracting office.

d. Provide regular reports (minimum annually) comparing outcomes to private sector healthcare plans.

e. Provide online support and tools for quality improvement

f. The data includes all age categories represented in MHS the active duty and beneficiary population.

2. PERIOD OF PERFORMANCE AND COST.

Base Period: 30 September 2021- 29 September 2022 Option Period 1: 30 September 2022 - 29 September 2023 Option Period 2: 30 September 2023 - 29 September 2024 Option Period 3: 30 September 2024 - 29 September 2025 Option Period 4: 30 September 2025 - 29 September 2026

Base Year Option

Period 1 Option

Period 2 Option

Period 3 Option

Period 4 Total

National Commission Quality Assurance (NCQA) Quality Compass Healthcare Effectiveness Data and Information Set

(HEDIS®)

benchmarks

IGCE

TOTAL

3. DETERMINATION ON INHERENTLY OR CLOSELY ASSOCIATED WITH

GOVERNMENTAL FUNCTIONS.

the requirements were thoroughly reviewed of the functions considered inherent to the Government, set forth in FAR 7.503, has been completed and it was determined that the functions to be performed under the follow-on contract, are not inherently Governmental functions. None of the functions to be performed are exempt from private sector performance as addressed in DoD Instruction 1100.22 and none of the functions to be performed violate the provisions of FAR subpart 37.104(b) on contracting for personal services.

4. MARKET ANALYSIS

. There are no small business opportunities for this requirement. In addition, this requirement cannot be provided by the Committee for Purchase from People Who Are Blind or Severely Disabled operating as te U.S. Ability One Program.

Results of the search revealed one entity: The National Committee for Quality Assurance (NCQA)

The National Committee for Quality Assurance (NCQA) is a private, not for profit organization founded in the 1990s dedicated to improving health care quality. NCQA is the only organization that can provide the national HEDIS® benchmark data because the date is the proprietary property of NCQA. No other organization produces this data in the United States. This data is published annually by NCQA in August for the prior year’s data.

The benchmarks are based on the data submitted to NCQA by participating health plans and is contained in a NCQA’s proprietary data base. Thus the only supplier of HEDIS® benchmarks required by the MHS is NCQA. There isn’t another legal source for the benchmarks.

6. OTHER FACTORS: The acquisition does not exceed the simplified acquisition threshold.

The government continues to require clinical NCQA benchmarks for quality management of the TRICARE Health Plan. A new contract to obtain Quality Compass® is required. No market changes in the source of the NCQA proprietary data has occurred.

HEDIS® is designed to provide purchasers and consumers with the information they need to reliably compare the performance of health care plans. HEDIS® results are included in Quality Compass®, an interactive, secure web-based tool that allows users to view benchmark information. Quality Compass® users benefit from the largest database of comparative health plan performance information and are able to identify quality improvement opportunities and benchmark plan performance.

The acquisition strategy to pursue for this requirement is a firm fixed price sole source contract with NCQA due to the proprietary nature of the NCQA Quality Compass®.

DETERMINATION

Based on the foregoing information, I hereby recommend, it is in the Government’s best interest to issue a sole source contract to the National Committee for Quality Assurance (NCQA).

, Senior Contract Analyst

APPROVAL

I hereby approve, in accordance with FAR 13.106-1(b)(1)(i), to issue a sole source contract to the National Committee for Quality Assurance (NCQA).

DHA Contracting Officer