Solicitation_Amendment_HT0011-15-T-0014-03.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83) Prescribed by GSA

FAR (48 CFR) 53.243

The purpose of this amendment is to do the follow ing:

1. Extend the response due date to 23 September 2015 at 1:00 pm. EST

2. Revise the PWS. All new changes are highlighted in blue

3. Revise the Q&A document.

1. CONTRACT ID CODE PAGE OF PAGES

S 1 49

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

16C. DATE SIGNED

BY 18-Sep-2015

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)(Signature of person authorized to sign)

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X HT0011-15-T-0014

X 9B. DATED (SEE ITEM 11)

31-Aug-2015

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer X is extended, is not extended.

Offer must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended by one of the following methods:

(a) By completing Items 8 and 15, and returning copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN

REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(B).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

18-Sep-2015

CODE

DEFENSE HEALTH AGENCY-COD FC

7700 ARLINGTON BLVD

FALLS CHURCH VA 22042

HT0011 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

HT0011-15-T-0014

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 30 - BLOCK 14 CONTINUATION PAGE

The following have been modified:

QUESTIONS & ANSWERS

Questions & Answers Solicitation Number HT0011-15-T-0014

1. The amendment corrected the Proposal due date in block 8 of page 1 of the original solicitation as due on September 18 at 10a. However, on page 16 of the solicitation, the proposal due date and time is reflected as September 18th at 1pm. Which is the correct time?

Government Response: The Instructions to Offerors section was updated but not re-attached. It has now been included in this amendment. The correct proposal due date was changed to 18 September 2015 at 10:00 am EST.

However due to timing, the response date has now been extended to 23 September 2015 at 1:00pm EST.

2. Section 2, Price Proposal Content instructions, Factor 3: Price, third paragraph on page 19 says, "Offerors shall include on the front page of the solicitation block 26, or in a separate roll-up sheet, a grand total that includes costs for all years within their price proposal." Block 26 says, "For Govt. use Only." Should we focus on a separate roll-up sheet?

Government Response: At this point this is just a solicitation, so the Government will not be including an amount in that space. In your response to the solicitation, as part of your proposal you may include a TOTAL proposed amount in block 26.

3. For travel estimates, the solicitation notes that the Contractor may be required to travel CONUS and within the NCR during the performance of this contract to attend meetings, conferences, and training. Will the government provide travel reimbursement for any on-site evaluations?

Government Response: “On-site” evaluation is not a requirement of the PWS.

4. Can you provide us a list of the locations of the 95 centers and confirm whether any have current PCMH certification status?

Government Response: This has been included in the solicitation. The government will provide locations, addresses and points of contact for each of the 95 practices. Of the 95 PCMHs, 55 are currently recognized as PCMHs and will require renewal; the remaining 40 are newly transformed clinics and require first-time recognition as PCMHs. The 10 specialty practices require first-time recognition.

5. The NCQA standards were tailored to incorporate areas that are unique or are of greater importance to military health. Can you share the specific areas that were incorporated? Will this impact upon the award decision?

Government Response:

1. The current vendor, in collaboration with DHA Program Office, has made the decision to confer credit in several areas, which are military specific. Examples include: 1. Consideration that our direct care system does not include disenfranchised populations as far as access to care is concerned: all TRICARE Prime beneficiaries are covered equally by the TRICARE benefit and we have no uninsured population; 2. Our TRICARE Prime population enrolled to our direct care military Medical Treatment Facilities (MTFs) are, in aggregate, younger and with less associated disease burden than the general population in the United States. Moreover, some of our PCMHs are located overseas (subject to an overseas health screening process) and some PCMHs are enrolled only with young, active duty soldiers, sailors, airman or marines with populations; each of these populations (overseas and young, active duty), typically do suffer from typical chronic illness/co-morbidities but may instead have more acute, population-specific conditions.

The government expects offerors to work collaboratively with the DHA Program Office to ensure consideration is made for military/TRICARE-specific situations such as those outlined above.

2. Impact on award decision: We will need offerors to be able to accommodate recognition standards to military specific issues. For example, we will need accommodation for various populations (young healthy populations). As importantly, we need the offerors to recognize that we do not have “uninsured” or “historically disenfranchised” populations regarding insurance coverage. 100% of our beneficiary population is covered by TRICARE. Therefore, any standards requesting us to show proof that we provide access to patients who are uninsured or have low insurance coverage do not apply.

6. On page 39 of the RFP, the contractor is required to provide a consolidated Service report (Deliverable 3) and a consolidated enterprise report (Deliverable 4) on a quarterly basis. Additionally, the contractor is required to develop a Quality Control Plan (Deliverable 11). We would like direction on where the resources needed to produce these deliverables should be budgeted in our proposal. Should they be incorporated into the unit price of Item No. 0001 or does the government want us to price these activities under a separate item?

Government Response: The information required in Deliverables 3 and 4 include: The government needs to know the status of recognition by practice, at what stage the practice is in the recognition process for those undergoing recognition, and any final decision on recognition.

Any costs associated with deliverables related to CLIN 0001 would need to be rolled up into that CLIN. Any costs associated with deliverables related to CLIN 0002 would need to be rolled up into that CLIN and so on (same for the option years). The proposal pricing detail that you submit with your proposal will need to include a break out of these and any other costs.

7. Regarding Item No. 0003: The description for this items states it covers “contractor travel . . . to attend meetings, conferences, and training.” From our past experience, travel under this contract has been for the contractor to deliver training to Military Health System personnel. Is this still the expectation for the majority of the travel?

Government Response: Yes; please see 14.a. and 28.a below. The training events will be organized and publicized by Defense Health Agency (DHA) PCMH and Service on centrally located military installations. Location, AV equipment and other logistics provided by government. Slides/curricula and faculty will be provided by the offeror.

Offeror travel and attendee travel will be paid for by government.

Any costs associated with training related to CLIN 0001 should be rolled up into that CLIN. Any costs associated with travel related to CLIN 0002 should be rolled up into that CLIN and so on (same for the option years). The proposal pricing detail that you submit with your proposal will need to include a break out of these and any other costs.

Also, note that a change has been made to the PWS, Section 1.6.13 Contractor Travel. Changes are highlighted in yellow.

8. Regarding Item No. 0003 What are the expectations regarding the number of contractor staff members that would travel per trip? For training sessions, we have found that it is preferable to have two staff members conduct the training. Benefits of having two staff members include higher participant satisfaction driven by having diversity in presentations styles, greater variety of survey experience among faculty, and better ability to have focused 1:1 conversations during the day.

Government Response: It is the expectation that the offeror will provide the appropriate mix of staff members to travel per trip. The MHS expects the vendor to have trained staff available to answer questions remotely throughout the recognition process via telephone and/or email.

9. Regarding Item No. 0003 Where should labor costs associated with the travel (e.g., development/refinement of presentation and training material, time spent at meetings/conferences/training) be budgeted? We are assuming that labor costs should be added it Item No. 0003.

Government Response: CLIN 0003 is only for travel. Any other costs associated with training related to CLIN 0001 should be rolled up into that CLIN. Any costs associated with training related to CLIN 0002 should be rolled up into that CLIN and so on (same for the option years). The proposal pricing detail that you submit with your proposal will need to include a break out of these and any other costs.

Also, note that a change has been made to the PWS, Section 1.6.13 Contractor Travel. Changes are highlighted in yellow.

10. Under delivery information, the POP for CLINS 4001, 4002, and 4003 is listed as 29 Sep 2019 to 28 Aug 2020.

In all other locations in the RFP the duration for Option Year 4 is 12 months which ends 28 Sep 2020. What is the correct end date for Option Year 4?

Government Response: Base year will be 12 months. Each option year will be 12 months. Option year 4 POP dates have been corrected in the delivery schedule

11. Please provide demographic information on the PCMHs. Many care organizations have multiple or satellite facilities. Is a PCMH, as used in this RFP, a single physical location or multiple? At what level will the PCMHs be recognized by a group of clinics supporting multiple disciplines or by each address?

Government Response: There are a total of approximately 440 PCMHs currently. They are internal medicine, family medicine, pediatric, combined (one or more primary care specialties), adolescent medicine, warrior clinics, marine centered medical homes, fleet centered medical homes, flight medicine, submarine centered medical homes and soldier centered medical homes. Military Medical Treatment Facilities (MTFs) include small stand-alone clinics and range up to large medical centers. A large medical center will have multiple PCMH clinics both within the MTF and outside the MTFs (stand-alone clinics in residential/business areas which may or may not be off-base/post, which function to grow the primary care base for the tertiary care medical center.) The clinics are recognized separately unless the MTF is small enough that the patient population and patient management are similar enough organization-wide to merit a “combined clinic.” Clinics which are not under the same roof/on the same medical campus, as discussed above (medical center and satellite clinics) are always recognized separately to reflect possible differences in local operating procedures due to geographic separateness.

12. Are PCMHs of similar size in the number of service offered and the number of physicians, physician assistants, or nurse practitioners?

Government Response: No. PCMHs vary in size of enrollees, type of services offered and primary care manager (PCM) make-up. For example, a large family medicine clinic (PCMH) at a tertiary care medical center supporting an operational military installation may have 8 primary care teams, with each team in the PCMH having 4-6 PCMs, who are physicians, nurse practitioners and physician assistants with a patient population ranging from infants to retirees. Other PCMHs at smaller MTFs may have 1 or more teams but with multiple specialties (typically 1 internist, 1-3 pediatricians and family medicine, including MD, PA and NPs). The military’s Direct Care System is located world-wide. MTF size varies from large academic medical centers to small clinics with 2-3 PCMs, only.

13. Have any of these PCMHs received recognition or certification in the past? Do any have current recognition?

Government Response:. Approximately 335 of our 440 PCMHs have undergone recognition at least once. In the future, they will be required to seek renewal as often as the frequency rules require The PCMHs which have not yet undergone recognition were in the process of transforming into PCMHs; this also includes the newest operational medical homes (Marine, Fleet, Submarine, Soldier, etc.), new ones of which are being created on a weekly basis to support our warfighters.

Also, note that a change has been made to the PWS, Section 1.6.13 Contractor Travel. Changes are highlighted in yellow.

14. How are the PCMHs prepared for the recognition process? Are there any requirements to provide PCMH Standards training and education? Does the Government envision that this type of training PCMH goals and the recognition process and benefits might be required? If so, please clarify the purpose, content, intended audience, media, frequency and duration of the training. Are these hands-on, virtual or web-based training sessions?

Government Response: Training will be required. In our current (expiring) contract, PCMH recognition training was part of the contract and was conducted in person (at MTFs at central locations) as well as virtually through teleconferencing. Training has been and is expected as part of the recognition process and to be conducted in collaboration with the Defense Health Agency (DHA) and the offeror.

Also, note that Section 1.6.13.1 Training has been added to the PWS. Changes are highlighted in yellow.

15. Is there a defined process to be followed if an organization fails to meet the PCMH standards?

Government Response: Yes; the current process is that the DHA and the Service determine in which area the PCMH failed and the recognition information reviewed. If needed, better documentation is provided to “challenge” the failure . If the failure was valid, then the Service begins conducting remediation with the PCMH. When the Service notifies DHA that the PCMH is ready to try to receive recognition again upon successful completion of Service-directed remediation, then the DHA notifies the current vendor and recognition is attempted again. The government expects to review and determine a process to follow if an organization fails to meet PCMH standards with offeror.

16. Is there an incumbent contractor for the requirements requested under this RFP?

Government Response: Yes.

17. Will DHS provide the PCMH and POC information for the entire year at the start of each contract year? If not how and when will the information be provided to the contractor?

Government Response: Yes; DHA will provide the PCMH name, address, POC name, address and contact information via spreadsheet to the offeror at the beginning of the year. Information will also include whether it is a new recognition or a renewal. If a renewal, the information provided will include the level of prior recognition and year and based on the renewal requirements of the offeror. In addition, if additonal PCMHs are approved by the Service to seek recognition AND if there is existing capacity for recognition on the contract, the DHA will provide this information to the offeror

18. Section 5.1. Basic Services. The contractor shall provide the necessary framework, services and materials to support a recognition program aimed at evaluating the MHS PCMH Primary Care Model. The vendor shall be nationally recognized for their ability to evaluate the application of the PCMH care model in the primary care setting. This requirement is to implement a methodology to provide for a single MHS agreement to support the entire MHS enterprise. Please define the phrases single MHS agreement, and the entire MHS.

Government Response:

1. Single MHS Agreement: one contract for all MHS PCMHs based on the number of recogntions and renewals provided in the RFP.

2. Entire MHS: direct care PCMHs (direct care = Army, Navy, Air Force and Marine Corps PCMHs located in military medical treatment facilities (MTFs)).

19. Section 5.2. Evaluation Process. First bullet, Must provide a mechanism that allows the MHS to function under one single agreement . What is the purpose and definition of a mechanism that allows the MHS to function under one single agreement?

Government Response: Currently, there is one master contract, administered by the Defense Health Agency (DHA).

The DHA manages the contract and leads the recognition process for the Uniformed Services (Army, Navy, Air Force and Marine Corps). The PCMHs are recognized under this single contract; all requirements are a sum of all Uniformed Service requirements.

20. Section 5.2. Evaluation Process. Sixth bullet, Must be applicable to direct care and purchased care for the purposes of comparisons and evaluations across the MHS Please define direct care and purchased care in the context of this bullet.

Government Response:

1. Direct care is defined as military Medical Treatment Facilities (MTFs) operated by the Army, Navy, Air Force and Marine Corps.

2. The term “purchased care” is used to connote private sector care or healthcare delivered in the civilian healthcare industry, as large.

21. Section 5.2. Evaluation Process. Second bullet, Must support studies that will test the relationship between the maturity of PCMH and achievement of Quadruple Aim outcomes: readiness, experience of care, population health, and per capita cost.

Please define support studies in the context of this bullet. Is the contractor expected to conduct studies, or provide data, or provide access to data to support studies? Please specify the level and frequency of support.

Government Response: The contractor will not be expected to conduct studies. The only data the contract will be expected to provide is whether the PCMH is recognized and if available, a relative rating scale showing if the PCMH achieved the highest level if the offeror differentiates in level of PCMH recognition. The MHS wishes to use PCMH recognition status to evaluate various performance measures achieved by the PCMH.

22. Section 5.4 Reports. The methodology developed to support the MHS will include a reporting system that will provide enterprise reports to include system trends, with Service and PCMH level breakdown. The Service Points of Contact (POCs) will receive a consolidated Service report on a quarterly basis (Deliverable 3). This report will provide specific Service results to the identified Service Leads. Findings and results for individual MTFs will be forwarded to the DHA PCMH Section POC within 30 days of the completion of the survey. The Primary Care PCMH Section and COR will receive a consolidated enterprise report of findings to date on a quarterly basis.

(Deliverable 4).

Please define enterprise as used in this requirement.

Government Response: Enterprise is defined as “Army, Navy, Air Force and Marine Corps PCMHs seeking recognition”. DHA manages the contract centrally and will need a status list of practices undergoing recognition and where they are in the process; examples are: whether the recognition process is process, when it is recognized and when it is up for renewal, based on offeror requirements for renewal timing.

23. Section 5.5 Website Posting. The findings and results of the evaluation (recognition process), along with any recommendations will be posted to a secure website. The secure site will include the standard reports as described in paragraph 5.4. Military Service leads will have access to their Service PCMH findings and results. Findings and results shall be in a logistical and concise format. The DHA will have access to all information submitted within the established enterprise agreement. (Deliverable 5) Please define the established enterprise agreement as used in this requirement.

Government Response: Established enterprise agreement is defined as the central contract which will be executed when a contract, based on this solicitation, is awarded. The secure website is intended, as needed, to securely transmit any documents which may be needed by the offeror to inform, clarify or conduct the recognition process. .

Supporting information will be uploaded. That said, the offeror is also free to publish any overall results of on their public vendor website if available.

24. Section 5.6 User IDs. The contractor shall provide access and passwords to authorized users, as determined by DHA PCMH. The secure site will include the standard reports as described in paragraph _____.

The paragraph reference at the end of this section is missing. Should it be Section 5.4? Please define the number of IDs for the secure web based access the Government will require.

Government Response: The government will require at least 3 IDs per PCMH to be recognized (minimum as stated in RFP per year to maximum of 3 x 440 total PCMHs); plus 20 each per Service (for headquarters and regional staff); plus 4 at DHA. The paragraph reference should read “…paragraph 5.4 Also, note that a change has been made to the PWS, Section 5.6 User IDs. Change is highlighted in yellow.

25. Section 5.8 PCMH Access. PCMH personnel will have access to their own PCMH specific data and any bench mark data. (Deliverable 7) How many personnel per PCMH will require access to their own specific data?

Government Response: The government will require at least 3 IDs per PCMH to be recognized (minimum as stated in RFP per year to maximum of 3 x 440 total PCMHs); plus 20 each per large Service (Army, Navy Air Force 3 x 20); 10 for Marine Corps (Service IDs are for headquarters and regional staff); plus 5 DHA PCMH staff.

26. Section 5.9 Service Headquarters Personnel Access. Service personnel will have access to their own Service specific PCMH data. (Deliverable 8) How many Service personnel will have access to their own Service specific PCMH data?

Government Response: 20 each per large Service (Army, Navy Air Force 3 x 20); 10 for Marine Corps (Service IDs are for headquarters and regional staff) – 70 total.

27. Section 5.10 Defense Health Agency Patient Centered Medical Home Office Personnel Access. DHA personnel will have access to all data submitted as part of the DHA enterprise. DHA personnel will have the ability to drill down to PCMH data or roll all data up into consolidated reports. (Deliverable 9).

How many Defense Health Agency Patient Centered Medical Home Office Personnel will require access?

Government Response: Five (5) DHA PCMH staff.

28. Section 1.6.13 Contractor Travel: Contractor will be required to travel within the continental United States and within the National Capital Area during the performance of this contract to attend meetings, conferences, and training. The contractor may be required to travel to off-site training locations and to ship training aids to these locations in support of this PWS. Three trips are estimated for each year of the contract. Contractor will be authorized travel expenses consistent with the substantive provisions of the Joint Travel Regulation (JTR) and the limitation of funds specified in this contract. All travel requires Government approval/authorization and notification to the COR.

There is no requirement in the RFP to provide any training to the PCMH or at conferences or other group events.

This section identifies the potential requirement to travel in support of off-site training and to ship the training aids.

Is the government expecting the contractor to present training during the referenced meetings? If so, is there an additional expectation for customized training, speakers and/or materials? Do the PCMHs participating in the recognition survey or any other DHS personnel require any training as part of this contract? Should the unit price in these CLINs include the development of training aids and shipping costs for the training aids? For bidding purposes, what is the anticipated duration of the travel? 1 day, 2 days etc.

Government Response: This reference was in case PCMH Recognition training could be conducted in consolidated MHS meetings. The type of training referenced above is for “in person” training, to be held at centrally located MTFs and arranged by DHA and the Services. Training material (slides on file) will be provided by the vendor as will trainer/faculty (material can be sent electronically). Training aids (PowerPoint projectors, laptops) will be provided by the government at the training locations. The government will provide the venue and also will fund the travel costs of the MHS attendees. The vendor is expected to fund trainer/faculty travel within the terms of the contract.

Anticipated duration of travel is no more than 2 days per training event.

Also, note that a change has been made to the PWS, Section 1.6.13 Contractor Travel. Changes are highlighted in yellow.

29. Technical Exhibit 1 in columns 3 and 5 refer to the performance period. What is the performance period duration?

Government Response: The performance period is each individual 12 month period. In other words, 12 month base period; 12 month Option Period 1; and 12 month Option Period 2, etc.

30. In light of DHA acknowledging on page 31 of the solicitation that there are “..three other agencies (who) offer accreditation or certifications of PCMHs”, can we assume that the specification on page 33 of 59, Section 1.6.5, Place of Performance stating that “The work to be performed under this contract will be performed at the contractor facility”, is not intended to prohibit the validation of MHS PCMH programs through the use of on-site surveys at the PCMH location?

Government Response: “On-site” evaluation is not a requirement of the PWS. It is not prohibited but will not be funded on this contract.

31. In Part 1 Section 1.3 Objectives (page 31 of the solicitation), there are multiple references specifically to a “personal physician” needing to be involved as part of the system structure and process of the PCMH model that will have an external review. In light of Section 1.4 Scope (on page 32) indicating the intent is to “evaluate the (PCMH) program against industry recognized evidence based standards…”, can we assume that the reference to “personal physician” does not exclude the acceptance of either Advanced Practice Nurses or Physician Assistants in the role of primary care clinician as well?

Government Response: That is correct. The MHS uses the term “Primary Care Manager” or PCM. Valid MHS PCMs include primary care physicians, nurse practitioners and physician assistants.

32. The last sentence of Section 1.4 Scope (on page 32) states “This requirement will be added during the first option period of the award”. What is the requirement that is being referred to in this section? If it is “validation of the implementation of medical home concepts” isn’t this expected to start in the base year?

Government Response: The statements “This requirement will be added during the first option period of the award” and “validation of the implementation of medical home concepts will support the MHS in obtaining maximum benefit for this care redesign initiative.” have been removed from the PWS.

SECTION SF 1449 - CONTINUATION SHEET

SOLICITATION/CONTRACT FORM

The required response date/time has changed from 21-Sep-2015 11:30 AM to 23-Sep-2015 01:00 PM.

The following have been modified:

PERFORMANCE WORK STATEMENT

PERFORMANCE WORK STATEMENT

Title: ACCREDITATION / EXTERNAL REVIEW OF THE MHS PATIENT CENTERED MEDICAL HOME

PROGRAM

Requiring Activity Name: Defense Health Agency, Healthcare Operations Directorate, Clinical Support Division

Part 1

General Information

GENERAL: This is a non-personal services contract to provide services and material to contract with an external agency to assess the MHS (Military Health System) Patient-Centered Medical Home (PCMH) program using a structured, nationally recognized methodology. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform recognition of patient-centered medical homes in the Military Health System (MHS) as defined in this Performance Work Statement except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract.

1.2 Background: PCMH is an established model for the provision of primary care that improves continuity of care and enhances access through patient-centered care and effective patient-provider communication.

Consistent with longstanding MHS goals, the PCMH is associated with better outcomes, reduced mortality, fewer hospital admissions for patients with chronic diseases, lower utilization, improved patient compliance with recommended care, and reduced medical spending. One of the core principles of the PCMH is that patients have a consistent relationship with their health care provider who delivers first contact, continuous, and comprehensive care.

The American Academy of Pediatrics (AAP) introduced the medical home concept in 1967, initially referring to a central location for archiving a child’s medical record. In its 2002 policy statement, the AAP expanded the medical home concept to include these operational characteristics: accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care.

Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. PCMH standards facilitate physician practices functioning as medical homes by using systematic, patient-centered and coordinated care management processes. Practices advocate for their patients to support the attainment of optimal, patient-centered outcomes that are defined by a care planning process driven by a compassionate, robust partnership between physicians, primary care providers, patients, and the patient’s family. The optimal model highlights:

Evidence-based medicine and clinical decision-support tools guide decision making;

Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement;

Patients actively participate in decision-making and feedback is sought to ensure patients’ expectations are being met;

Information technology is utilized appropriately to support optimal patient care, performance measurement, patient education, and enhanced communication;

Practices go through a voluntary assessment process by an appropriate non-governmental entity to demonstrate that they have the capabilities to provide patient centered services consistent with the medical home model; and, Patients and families participate in quality improvement activities at the practice level.

PCMH standards and measures have become a MHS leadership priority because they enable the MHS to test an important hypothesis-that the PCMH is a model of primary care that will have a significant positive impact on care provided in the MHS and align with the pursuit of the Quadruple Aim (readiness, experience of care, population health, and per capita cost). Standards allow the MHS to differentiate medical home model from traditional models for primary care; while measures enable the MHS to evaluate the performance of medical homes against other care models. In November 2009, the MHS Medical Home Tiger Team recommended adopting the NCQA PPC-PCMH standards as the MHS baseline and, subsequently, tailoring them to incorporate areas that are unique or are of greater importance to military health (e.g., readiness, medical evaluation boards, resiliency). Since that time, three other agencies offer accreditation or certification of PCMHs.

1.3 Objectives: The external review of the MHS PCMH Programs should assess that the following system structures and processes::

Each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.

The personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.

The personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care.

Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

Quality and safety are hallmarks of the medical home.

Enhanced access to care is available through systems such as open scheduling, expanded hours and new options for communication between patients, their personal physician, and practice staff.

Payment appropriately recognizes the added value provided to patients who have a PCMH.

1.4 Scope: This award provides for services and material to contract with an external agency to assess the MHS Patient-Centered Medical Home (PCMH) program using a structured, nationally recognized methodology. The intent is to evaluate the program against industry recognized evidence based standards that emphasize the use of systematic, patient-centered, coordinated care management processes. Validation of the implementation of medical home concepts will support the MHS in obtaining maximum benefit for this care redesign initiative. This requirement will be added during the first option period of the award.

1.5 Period of Performance: The period of performance shall be for one base period of 12 months and four (12) month options. The period of Performance reads as follows:

Base Period 12 months Option Period I 12 months Option Period II 12 Months Option Period III 12 Months Option IV 12 Months

1.6 General Information

1.6.1 Quality Control The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract. The Quality Control Plan (QCP) shall be delivered within 30 days after the contract award. After acceptance of the QCP, the contractor shall receive the contracting officer’s acceptance in writing of any proposed change to the QCP.

(Deliverable 11).

1.6.2 Quality Assurance: The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s)

1.6.3 Recognized Holidays: The contractor is not required to perform services on Federal holidays.

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Independence Day Christmas Day

1.6.4 Hours of Operation: The contractor is responsible for conducting business, between the hours of 8:00 am – 5:00 pm EST or DST Monday thru Friday except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. For other than firm fixed price contracts, the contractor will not be reimbursed when the government facility is closed for the above reasons. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.6.5 Place of Performance: The work to be performed under this contract will be performed at the contractor facility.

1.6.6 Type of Contract: The government will award a Firm Fixed Price contract.

1.6.7 Security Requirements: NA

1.6.7.1. Physical Security NA

1.6.7.2 Key Control NA

1.6.8 Special Qualifications: NA

1.6.9 Post Award Conference/Periodic Progress Meetings: The Contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The contracting officer, Contracting Officers Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the contracting officer will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced.

Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.6.10: Contracting Officer’s Representative (COR): The (COR) will be identified by separate letter. The COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract:

perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

1.6.11 Key Personnel: The follow personnel are considered key personnel by the government: the contract manager who shall be responsible for the performance of the work. The contract manager who shall be responsible for the performance of the work is considered to be the key personnel by the government. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available between 8:00am to

4:30 pm Eastern Standard Time (EST) or Daylight Savings Time (DST), Monday thru Friday except Federal holidays or when the government facility is closed for administrative reasons.

1.6.12 Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones, and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contractor products or that contractor participation is appropriately disclosed.

1.6.13 Contractor Travel: Contractor will be required to travel within the Continental United States and the National Capital Area during the performance of this contract to participate in meetings and training conferences sponsored by the Government. Three six trips are estimated for each year of the contract to participate in presentations at central locations arranged by the government.

Arrangements for and costs of all travel, transportation, meals, lodging, and incidentals are the responsibility of the Contractor. Travel costs shall be incurred and billed in accordance with FAR Part 31. Costs for these expenses shall be reviewed, certified and approved by the COR. All travel and transportation shall utilize commercial sources and carriers. The Government shall not pay for business class or first-class travel. Lodging and meals shall be reimbursed in accordance with regulations defined in FAR PART 31.

1.6.13.1 Training: A member of the DHA PCMH Program Office will lead training and discussions sessions. The Contractor will provide one participant to brief on how to meet the standards and answer any questions from audience participants. The accepted format of presentations is by PowerPoint electronically or any format accepted by the COR. In addition, the vendor shall already have an existing website that contains reference materials to facilitate recognition and be available for questions.

As a performance based contract, it is up to the vendor to develop effective training modalities/methods.

1.6.14 Other Direct Costs: This category includes travel (outlined in 1.6.13), reproduction, and shipping expenses associated with accreditation activities.

1.6.15 Data Rights: The Government has unlimited rights to all documents/material produced under this contract.

All documents and materials, to include the source codes of any software, produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission from the Contracting Officer. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

1.6.17 Organizational Conflict of Interest: (Technical Exhibit 4) Contractor and subcontractor personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart 9.5. The Contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may effect other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

PART 2

DEFINITIONS & ACRONYMS

2. DEFINITIONS AND ACRONYMS:

2.1. DEFINITIONS:

2.1.1. CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

2.1.2. CONTRACTING OFFICER. A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

2.1.3. CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.4. DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.5. DELIVERABLE. Anything that can be physically delivered, but may include non-manufactured things such as meeting minutes or reports.

2.1.6. KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.7. PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.1.8. QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.9. QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.10. QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.11. SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.1.12. WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

2.1.12. WORK WEEK. Monday through Friday, unless specified otherwise.

2.2. ACRONYMS:

CFR Code of Federal Regulations CONUS Continental United States (excluding Hawaii and Alaska) COR Contracting Officer Representative COTS Commercial-Off-the-Shelf DD254 Department of Defense Contract Security Requirement List DFARS Defense Federal Acquisition Regulation Supplement DMDC Defense Manpower Data Center DoD Department of Defense FAR Federal Acquisition Regulation HIPAA Health Insurance Portability and Accountability Act of 1996 CO Contracting Officer OCI Organizational Conflict of Interest OCONUS Outside Continental United States (includes Alaska and Hawaii) ODC Other Direct Costs PIPO Phase In/Phase Out PHI Protected Health Information PII Personally Identifiable Information POC Point of Contact PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QAP Quality Assurance Program QASP Quality…