HT0011-24-RFI-0191 (for release).pdf

DEFENSE HEALTH AGENCY (DHA)

REQUEST FOR INFORMATION/SOURCES SOUGHT - HT0011-24-RFI-0191

HEALTH CARE OPERATIONS AND OTHER PROGRAM MANAGEMENT

SUPPORT

The Professional Services Contracting Division, Defense Health Agency, is seeking capable sources of executive level support and program management support services to the Deputy Assistant Director, Health Care Operations, and Director, TRICARE Health Plan.

NAICS Code: 541611

PSC: R408

BACKGROUND:

DESCRIPTION OF THE SUPPORTED ACTIVITY:

The TRICARE Health Plan (THP) Directorate is a Direct Reporting Organization (DRO) under the Assistant Director, Healthcare Administration (ADHCA), and is comprised of five divisions:

Health Plan Design, Integration Support, Private Sector Care Delivery, Private Sector Care Integration Program Management Office, and Customer Support. Collectively, the THP identifies opportunities and executes improvements for increased integration in program and patient care, the development and implementation of metrics, and improves understanding of statutory and contractual requirements. The THP Directorate proactively identifies, actively engages, and fully supports new opportunities for integration to eliminate discrepancies between direct and purchased care; leads comprehensive initiatives to improve integration of care and sharing of information across the direct and purchased care health plan services in support of DHNs and Military Medical Treatment Facility (MTF) Prime Service Areas.

Major missions and functions of THP to include the following:

• Develop and execute program and operational guidance for the delivery of the TRICARE Prime, TRICARE Select, TRICARE Young Adult and TRICARE for Life, health care benefits.

• Provide program and contract management for centralized TRICARE purchased care contracts and program management support for managed health care programs.

• Provides drafting and editing TRICARE Manual language.

• Provides front office support to the Deputy Assistant Director (DAD), Healthcare

Operations (HCO).

• Coordinate and administer the Military Health System (MHS) Dental Program.

• Coordinate TRICARE Overseas Programs

• Communicate and market the TRICARE Program and other MHS initiatives to beneficiaries and stakeholders.

• Implement, manage, and oversee beneficiary education/services and customer support programs.

• Provide centralized DHA human resources management, security, facilities, logistics, correspondence management, and other administrative services.

• Conduct studies/evaluations to improve internal DHA operations.

• Conduct patient satisfaction surveys and special studies for the TRICARE health plan and its health programs.

• Assist with determination of medical benefits, and actions necessary to continue support for the Health Plan Shared Services Initiatives

DESCRIPTION OF REQUIRED SERVICES:

The principal objectives of services are to assist, support, and facilitate the effective and efficient accomplishment of mission tasks, business, functions/activities, and daily operations of the THP enterprise, including but not limited to: functions associated with TRICARE Health Plan programs/activities, purchased health care services, human resources programs, ADHCA, DAD HCO, THP Front Office operations, TRICARE Acquisition of various TRICARE Healthcare program contracts, drafting and editing TRICARE Manual language, assisting Program Managers with contract transitions, providing program integration support, and analytical support to Program Managers.

Additionally, the services will assist with determination of medical benefits, and actions necessary to continue support for the Health Plan Shared Services Initiatives and administrative tasks associated with the responses to DoD Inspector General, Government Accountability Office audit requirements, Congressional testimony, and responses to Congressional correspondence or other Federal audit entities.

The agency estimates the level of effort for the requirement described here to exceed 65 full-time equivalent contractor personnel based on historical performance. The agency intends a performance-based service acquisition where a particular approach to requirements could employ a different level of effort.

The agency requires executive-level program management support to offices of one Senior Executive Service official, one senior leader and one director. This includes a wide range of services from office administration functions to expert program analysis. Administrative functions include correspondence management, suspense tracking, calendar management, meeting/conference planning, and travel planning. Program analysis services integrate information from subordinate programs and other sources to inform senior leaders on status including project milestones, risk assessment, lessons learned, workload data, and performance metrics. Program analysis also assists in monitoring areas of concern and providing decision support for resolving complex challenges. Services maintain the HCO and THP SharePoint sites, including portals, extranets, team sites and record repositories. Collectively, these services comprise more than 25 percent of the total estimated effort.

The agency requires services supporting examination of TRICARE reimbursement program policies in comparison to other Government and private health care programs. Services assist to identify the need for and evaluate the effectiveness and efficiency of reimbursement program changes. Services also assist to identify practices designed to circumvent TRICARE reimbursement cost controls, to incorporate policy projects in the TRICARE Manuals, and to support development of national guidelines regarding TRICARE program coverage in the areas of medical benefits, provider certification, reimbursement and special benefits. These services comprise approximately ten percent of the total estimated effort.

The agency requires services to assist in the contract acquisition, administration, and transition of purchased care services, monitoring of provider networks, Contract Data Requirements List (CDRL) administration. Services also include assistance to track contractor performance, project milestones and schedules, resolve procurement issues, develop performance incentive strategies, prepare staff products for senior leader information or action, technical evaluation of non-competitive proposals, and evaluation of Requests for Equitable Adjustment. These services comprise less than 20 percent of the total estimated effort.

The agency requires support to assist in the production, enhancement, and maintenance of the TRICARE Manuals, to include development, editing, publication, and notification of manual changes. The TRICARE Manuals total over 6,000 pages between the T2017 contract and T5 contract versions. Services assist in needs assessments, collection of required changes, estimation of change costs, generation and coordination of change drafts, collection of comments, staffing of approval packages, and distribution of approved changes to publishing.

Publishing services include creating/editing of master files using Adobe FrameMaker, maintaining cross-reference links, migrating master files between software and application upgrades, exercising configuration control and change management, performing testing and quality assurance, and assuring compliance with Section 508 of the Rehabilitation Act. Where the TRICARE manuals address systems, these services include integration of purchased care contractor systems with Defense Enrollment and Eligibility Reporting System (DEERS), support to the Duplicate Claims System program, and integration testing of systems.

The agency requires services supporting analysis and performance reporting of TRICARE Encounter Data (TED). TED records provide detailed information for each treatment encounter and are required for agency health care and financial reporting. TED records are part of the claims history file. Services include support to MCSC transition, daily benchmarking, and other reports, resolving report discrepancies, analyzing TED record errors, and recommending corrections. Services for TRICARE Manuals and TED records collectively comprise more than 30 percent of the total estimated effort.

The agency requires services supporting aspects of Utilization Management and Medical Management, Disease Management, Records Management, Case Management/Special Needs performance, and Behavioral Health for performance of care delivered primarily for the MCSC and the six US Family Health Plan designated providers. Services include assessment of compliance to standards, advocacy of beneficiary needs, clinical assessment site visits, and liaison to various committees. These services comprise less than five percent of the total estimated effort.

The agency requires services to support training on proper methods and guidelines, review medical and dental pre-authorizations and assist in the development of denial, and approval codes used in both medical and dental preauthorization review requests. These services comprise less than 10 percent of the total estimated effort.

The agency recognizes a risk of Organizational Conflict of Interest (OCI) such that terms of any award for the services described in this notice would prohibit the awardee from performance under TRICARE purchased care services T2017, T5 or related contracts. An agency solicitation for the services described in this notice would require companies considered for award to identify existing commitments or interest in performing TRICARE purchased health care services and seek mitigation of any resulting OCIs.

The work will be primarily performed at Government facilities located in Falls Church, VA, Aurora, CO, San Antonio, TX, and San Diego, CA. Performance may involve travel to DHA locations, worldwide.

DISCLAIMERS AND IMPORTANT NOTES:

THIS NOTICE IS NOT A REQUEST FOR PROPOSALS. In accordance with FAR 15.201, responses to this notice cannot be accepted by the Government to form a binding contract. This notice constitutes part of a market research effort as described under FAR 10.002.

This notice does not obligate the Government to award a potential contract or otherwise pay for the information provided in response. The Government reserves the right to use results of the communications with industry for any purpose consistent with, and not otherwise prohibited by FAR Part 10. In accordance with FAR 10.001(b), potential sources are not to submit more than the minimum information necessary.

The agency intends to review responses to this notice to inform the acquisition strategy for the competitive follow-on.

Employees of Amyx, Inc., under contract to the Defense Health Agency, will receive responses to this notice and administer their review.

INSTRUCTIONS FOR SUBMISSION OF RESPONSE

Points of contact for this notice are:

• John Kelley, john.j.kelley36.ctr@health.mil, Senior Contract Analyst (Contractor)

• Vicki Whiteman, vicki.l.whiteman.civ@health.mil, Contracting Officer

The agency requests responses by May 1st, 2024, submitted by email to the points of contact, above. The agency will review all responses received on or before this date. The agency may review late responses where such review is in the agency’s interest but makes no commitment to do so.

The agency requests responses of 20 pages, or less. The agency may not review excess pages, or other attachments and addenda to the response.

In the context of the anticipated tasks, please address the following requests for information.

Responses must demonstrate clear and convincing evidence of capabilities or credible intent to achieve capabilities.

1. Provide:

• Company Name

• Address

• Point of Contact (POC)

• POC Phone Number

• POC E-mail

• Entity Unique Identifier

• Size representation under the NAICS code at the top of this notice

• Socioeconomic Designation (if applicable)

2. Describe capability to monitor, evaluate, and report indicators for a large government health plan.

3. Describe capability to examine and develop guidelines for medical reimbursement programs.

4. Describe capability to draft, edit, and publish large policy and procedural manuals similar to the TRICARE Manuals (https://manuals.health.mil/).

5. Describe capability to support Case Management/Special Needs and Behavioral Health performance, beneficiary advocacy, and dental preauthorizations. Address the medical competencies required to perform these services.

6. Given system access, describe capabilities to run reports, resolve discrepancies, and identify errors in large record sets similar to TED records.

7. Describe capability to manage sponsored contractor travel outside of the continental United States.

8. Describe capability to research high-level inquiries and support response within 1 to 3 days at a volume of 450 inquiries per month.

9. Describe capability to hire and retain highly qualified medical, professional, and administrative support staff within the job markets covering the anticipated places of performance.

10. Describe the impact on company interest, if any, arising from the agency’s intent to mitigate Organizational Conflicts of Interest and limit certain future contracting opportunities.

11. Identify any delivery vehicles through which the agency could procure the company’s services for the general scope described in this notice.

CONFIDENTIALITY:

No proprietary, classified, confidential or sensitive information should be included in the response. Industry responses will be shared with DHA staff for the purpose of market research.

The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s).

HEALTH CARE OPERATIONS AND OTHER PROGRAM MANAGEMENT SUPPORT