Ask_Me_Anything_Questions_Amendment_04_20190731.pdf

HT9402‐19‐S‐C001

“Ask Me Anything” Questions and Responses

REVISED 20190731 ‐ Amendment 04 № Question Response

1 Please provide detail on the “identified capability gaps” DHA is currently aware of for these beneficiaries.

The FY18 NDAA 731 Patient Navigator Program has identified the current capability gaps.

2 The last paragraph states the “Applicant shall use their legal name and not a shortened version that could be confused with a parent company or other corporation” and goes on to say “The applicant shall clearly distinguish information in its solution that it attributes to itself (the applicant) its parent company, affiliate or subsidiary.”

Does this requirement also apply to any information submitted for past performance?

Yes – Past Performance should be limited to prime contractor or named partner

3 The due date for the Phase 1 solution file is listed as July 26th. The list of required submissions included in this section, see to include the “Pitch Day Slide Deck”. However, in the “Solution Evaluation” section, it is unclear as to whether the Pitch Deck should be included with the initial Phase 1 solution submission, or whether it will be submitted some other time prior to the Pitch Day event on or about the week of 5 August. (“All applicants shall submit Pitch Day slides…”) Can DHA please clarify when the Pitch Deck slides are due?

Slide deck is due July 26th along with Phase 1 solution

4 The instructions contained in this requirement state, “but need not include a high level of detail.” However, in Phase 1 Evaluation, ELEMENT 1 the requirement states, “shall address all objectives in the SOO in a manner that allows evaluators to fully understand the approach and intended outcomes, but does not require a high degree of detail.” Additionally, Phase 2 Negotiation & Award, ELEMENT 1 states, “Complete Performance Work Statement (PWS).” Please clarify your evaluation criteria to allow applicants to better understand the level of detail that is sufficient to permit evaluators to “fully understand.”

Remove “, but does not require a high degree of detail”

5 Please define which “payment” DHA means when it says “value‐based incentive structure linking payment…” Does this mean the payment to the contractor awarded this contract, the payment made to the provider who is treating the beneficiary, or both?

Payment to the 731 Patient Navigator Contractor.

The 731 Patient Navigator contract will not alter the Managed Care contract in any way.

6 Regarding cost savings, does this mean the cost of: the beneficiary treatment in the purchase care system or the treatment in the direct care system or the combined cost of care.

Cost of care overall.

7 Please describe how the contractor will be provided the cost of care information needed to determine cost savings.

Solution should identify what information is needed – Government will work with vendor and any sources to obtain the necessary data

8 Please describe how beneficiary satisfaction will be measured, including how often and how these results will be reported to the contractor.

Part of solution

9 Please describe how health outcome data will be provided to the contractor. Solution should identify what information is needed – Government will work with vendor and any sources to obtain the necessary data

10 Are applicants permitted to present a live demonstration of their solution during pitch day?

If it falls within the time, technological, and personnel limitations. 15 slide deck, 3 person, 30min+10 for the Government to ask questions, no internet access, Government computer

11 Will DHA publish a transcript of this session? No 12 After identification of successful offer, how soon thereafter will funding be available?

FY20 funding is planned for this requirement.

13 What is the competitive range DHA has developed from their IGCE? N/A 14 How much time will the DHA allot for the pitch deck presentation? 30 min + 10 for questions 15 Please provide a description of the room and facilities to be provided by DHA for the Pitch Deck live presentation. What equipment (laptop, LCD projector, Wi‐Fi/hotspot, etc.) will the presenters be expected to provide?

Government will pull up slides submitted with phase 1 solution. No internet or additional access to slides.

16 What is the anticipated audience for the live pitch? Will the audience include technical, clinical, healthcare administration, executive, contracts or other representatives?

Yes. You can assume that the attendees will have at least cursorily reviewed solutions. These attendees will not be introduced or identified to the presenters.

17 Please provide a list of planned questions to the presenters prior to presentation day?

No

18 In order to preserve a fair and consistent evaluation of the pitch day presentations, will DHA consider an agenda that allots separate time for presentation and Q&A/interviews of presenters

30 min for presentation + ~10 for government questions

19 Please provide the DHA’s expectation on the make‐up of the pitch team – is there a limit to the number of people who may attend?

3 people per team maximum

20 Please provide the evaluation criteria that will be used to assess the pitch deck and presentation.

The pitch deck is part of the Phase 1 evaluation and presentation merely clarifies the solution presented. There are no separate evaluation criteria

21 What topics or aspects of the solution may not be discussed within the Pitch deck – i.e., typically price information is restricted from oral presentations

There are no limitations on the presentation topic. All elements of solution may be presented.

22 Because of the need to plan travel to San Antonio for the pitch team, will DHA please consider providing at least 2 weeks’ notice of pitch date/time/location?

August 6, with overflow on 7th depending on number of solutions received. Time slots will be assigned as soon as possible following 26 July.

Please make it clear if your firm is electing to present on pitch day or not.

23 Given the focus on new technologies and innovative solutions, how will the “technical merits” of the proposed solution be assessed?

Please see Evaluation factors.

24 If Past Performance information is not included in CPARS/PPIRS will a neutral rating be applied?

Relevant PP info will be evaluated, including other sources. Neutral rating is a Pass

25 How will Past Performance information be gathered (CPARS/PPIRS)? Past Performance will be gathered from references submitted with solution and the Government reserves the right to obtain relevant Past Performance from any source.

26 Will DHA provide the contractor with quality, safety and cost information for the direct care system to facilitate beneficiary decision making? If so, in what format and how often is this information updated?

Solutions should clearly identify any information their solution is contingent upon. Especially information expected to be provided from the current managed care contractors via the Government.

27 Please confirm the Right of First Refusal (ROFR) process will not apply to those participating in this pilot. If a beneficiary chooses to receive care in the purchased care system but the MTF’s ROFR process recaptures the care into the direct care system, this could negatively impact beneficiary experience and could harm the experience of care under this pilot.

Please review the TRICARE select benefit structure.

28 How will DHA provide contact information for all beneficiaries upon contract award?

Contact information is held in DEERS.

29 It is possible that the Navigator could identify a non‐network provider who could deliver higher quality health care services at lower costs to TRICARE Select beneficiaries. Under the Navigator contract, is the contractor required to only consider network providers?

Please review the TRICARE select benefit structure.

Non‐network providers are accessible for TRICARE select beneficiaries but may be at a higher cost

30 Does the “cost of available health care services” include beneficiary out‐of‐ pocket costs or only the costs incurred by DHA for the care?

All health care costs.

31 To enable applicants to develop fair and consistent pricing under this full and open competition, please provide detailed demographic data on TRICARE Select beneficiaries to include:

Population by zip Gender Age Number of beneficiaries with $100k in annual claims (by zip code) Number of beneficiaries with complex medical conditions (by zip code) Percentage of beneficiaries also eligible for VA healthcare Percentage of beneficiaries covered by other health insurance

Data will be uploaded to FBO.gov ASAP

32 Section 2.0 states, “The Secretary of Defense is required to submit a report containing an evaluation of the effectiveness of the pilot program to the

DHA is responsible for the report to Congress.

The Patient Navigator contractor is responsible committees on Armed Services of the House Representatives and the Senate not later than January 1, 2021.” Section 3.0 states, “The period of performance includes (a) a base period for the transition‐in period from contract award to full pilot performance as proposed by the vendor, (b) with three one‐year option period for pilot performance, and (c) one transition‐ out and final report period.”

Please confirm clarify the discrepancy between the period of performance and the required report to Congress.

for providing the information identified in the SOO. The Congressional report is due Jan 1, 2021 IAW NDAA 731. The performance period includes potential options that may run concurrently with managed care contracts

Please provide potential applicants with the same data DHA previously provided to the Managed Care Support Contractors (MCSC) bidders in the prior MCSC competition, to include detailed claim level data over the last three‐year period for all TRICARE Select beneficiaries. This information is critical to allow applicants to be able to proposed shared savings models and incentives/payments.

A data file will be uploaded to FBO.gov asap.

34 Please provide the frequency and detailed data fields of the information that will be provided to the contractor to allow the baseline analysis and analysis of implementation of OBJECTIVES 1 – 5.

Solutions should clearly identify any information their solution is contingent upon.

35 Are current or potential Managed Care Support Contractors (MCSCs) permitted to Prime on this contract? If so, how will DHA protect the integrity of the fair and open competition for T5 given any potential MCSC performing work under this contract would have access to additional information regarding the insights developed under this pilot program?

Applicants are asked to identify, mitigate, avoid any actual or potential OCI’s.

The patient navigator contractor is not anticipated to be involved in development of T5 or future contracts requirements.

36 As listed in Section 5.0 Constraints, service provider are required to “adhere to or work under” the “TRICARE Program Manuals 2015. Additionally, the “Contractor will comply with the Personally Identifiable Information, Protected Health Information, and Federal Information Requirements (NoA – Attachment 2).

In the instance of conflicts between those two documents, which takes precedence?

The applicant shall bring any conflicts it identifies to the Contracting Officer’s attention.

37 52.219‐9 is included in the provisions, but a Small Business Plan is not listed as an element of the Solution Submission section of the NoA. Is a Small Business Subcontracting Plan required with the submission or prior to award?

SB Plan and other conditions/requirements will be addressed in Phase 2 depending on the solution proposed.

38 No Wage Determination accompanied the NoA. Please confirm it is acceptable to claim exemption IAW FLSA (29 C.F.R. Part 541) as personnel contemplated to perform services under this NoA are considered exempt as bona fide executive, administrative and professional employees.

Wage determination or exemptions are based on the solution proposed.

39 Should bidders assume a transition‐in timeframe of less than 3 months? Is that adequate to roll‐out a nationwide program in partnership with the MCSCs?

The solution submitted should include a transition‐in timeframe necessary to complement the proposed approach.

40 How does DHA intend to address duplication of services included in the T2017 contract (see paragraph C.2.4.5. of Contract HT9402‐16‐C‐0001 for example)?

The Patient Navigator program is not case management or disease management. It is not clinical in nature.

41 When does the DHA plan to provide current MCSCs with change orders to implement the Navigator program?

Depending on the proposed solution, any coordination or changes to the MCSC’s will be addressed.

42 What level of effort does the DHA estimate will be required for the current MCSCs to implement the Navigator program?

There is potential for coordination and interface with current MCSCs to include involvement with case management and disease management programs.

43 Does the DHA see a conflict in the planned Fixed Price Incentive Contract type per FAR 16.204 in establishing shared savings or incentives based on health care cost savings vs. establishing the final contract price by a formula based on the relationship of final negotiated total cost to total target cost for this specific contract?

The price and incentive structure are to be proposed by the applicant.

Commercial contracts are prohibited from using cost

44 Are all aspects of the program offering required to be “available on demand” per Objective 4?

Solutions will be evaluated based on how well they meet SOO. Remove “on demand” from Objective 4.

45 Can you further clarify “coordination of multiple specialties”? For example if a beneficiary saw their PCM and got a lab done that could be seen as two/multiple specialties involved in care

PCM is not a specialist. Specialty = neurologist, gastroenterologist, nephrologist, etc.

46 Given the short reporting window, what metrics will the DHA use to determine whether the program is a success within less than 12 months of implementation?

The Government will consider the metrics proposed by the applicants in the proposed solution.

47 How will the Government complete the initial report to Congress by the Secretary of Defense no later than Jan 1, 2021 with less than one year of program data to show health improvements?

The report is a Congressional requirement.

48 With a significant overlap in the identified population being identified by MCSC for care management programs, how will the Government actually measure results? What type of attribution model will be used to assign credit for a reduction in key utilization measures to Navigator vs. Care management programs?

The Government will consider the metrics proposed by the applicants in the proposed solution.

49 What variables will the DHA study to evaluate the Navigator program, and how will the evaluation assure that these variables are isolated from the influence of other clinical activities occurring outside of the Navigator program?

The Government will consider the metrics proposed by the applicants in the proposed solution.

50 What data sources will the DHA require current MCSCs to expose to the entity awarded with the Navigator contract?

Depending on the proposed solution, any coordination with the MCSC’s will be addressed.

Solutions should clearly identify any information their solution is contingent upon.

51 What information will the Government provide to the Navigator contractor to support assistance to beneficiaries in making "informed decisions regarding the quality, safety, and cost of available health care services"?

We are asking the offerors to include this, they should know the resources/how to find this information

52 TRICARE contracts typically require non‐commercial solutions, but Navigator calls for a commercial solution. Why is this?

This is considered commercial services.

53 Will TRICARE Select beneficiaries who meet the requirements for participation in this pilot be allowed to opt‐out?

This is not a mandatory program as currently envisioned.

54 Will TRICARE Select beneficiaries who do not meet the annual cost or complex medical conditions be eligible to utilize these services if requested?

Complex medical conditions as defined in NoA

55 Since FAR Clause 52.222‐41, Service Contract Labor Standards, is included in Attachment 3 under FAR Clause 52.212‐5, should FAR Clause 52.222‐43, Fair Labor Standards Act and Service Contract Labor Standards – Price Adjustment (Multiple Year and Option Contracts) also be checked and included in order to allow the contractor the opportunity for an equitable adjustment in the event of wage determination updates?

Wage determination or exemptions are based on the solution proposed.

56 When will funds be made available for this acquisition? See Question/Response #12 57 For assessing health outcomes and patient experience, how will the DHA differentiate between those related to services already provided under the T‐ 2017 Contracts and those introduced by the awardee of the Pilot Program?

Solutions should clearly identify any information their solution is contingent upon.

58 Pursuant to FAR 9.502(c), does DHA anticipate that the nature of the work under the current NOA would create an actual or potential conflict of interest on the next acquisition for TRICARE Managed Care Support services (T‐5)?

See Question/Response #35

59 Section 731 of the NDAA provides for DHA to “carry out a pilot program to provide a health care assistance service” for certain covered beneficiaries.

For purposes of assisting potential offerors to evaluate any potential OCIs (see FAR 9.505‐2, 9.505‐3), will DHA please confirm that any contract award under the current NOA statement of work does not involve evaluating the current performance of the MCSCs or providing any material that will lead directly to a work statement for the next TRICARE support contracts?

See Question/Response #35

60 What specific financial, health and patient satisfaction outcomes are you interested in measuring with this program? Are there any outcomes that are particularly important to you?

Quality, safety, cost, improving health outcomes and overall satisfaction of the beneficiaries IAW SOO and FY18 NDAA 731

61 What are the particular unique factors to this population that you would like us to know? What are your challenges?

TRICARE Select beneficiaries with complex medical conditions as defined in FY18 NDAA 731 and the SOO

62 Will you be willing and able to provide personal contact information including telephone numbers and emails?

See Question/Response #28

63 What would success look like to you with this program? A solution that reduces costs, and improves health outcomes and patient experience and satisfaction for covered beneficiaries with complex medical conditions or high cost claimant status.

64 How many current members have complex medical conditions (2 or more medical conditions requiring the coordination of multiple specialties for at least 12 months and/or a spend of > 100K?

The current estimate is 72,000 beneficiaries nationwide.

65 Do you have a list of specific conditions you would like included? What behavioral health diagnoses would be included?

All condition that meet the criteria as defined

66 What would information sharing/sharing of clinical data look like? Would we be able to obtain any of this data from your providers or from your system?

Solutions should clearly identify any information their solution is contingent upon.

67 What are the behavioral health needs of this population? All condition that meet the criteria as defined 68 Are you open to digital outreach in addition to telephonic outreach? All innovative approaches will be taken into consideration 69 What telemedicine options exist within your system today? Criteria available in the TRICARE Manuals 70 What are the demographics of this population? (0‐64 years old) Including percent living in a metro area vs rural?

TRICARE Select beneficiaries are geographically dispersed throughout the US.

71 What percentage currently use the MHS (Military Health System) vs private system? Is there an ideal percentage one direction or another?

There is not an ideal percentage, TRICARE Select beneficiaries utilize MHS less frequently than other TRICARE beneficiaries.

72 What do you define as “low value care and services” vs “high value care and services”?

As it relates to quality, safety and cost of care.

73 Are BH, Vision, Dental and RX carved into the health plans or are they separate carriers?

All but BH are separate carriers

74 Are there any restrictions on receiving member PHI data like claims and authorization data from the carriers?

Solutions should clearly identify any information their solution is contingent upon. It is possible that a contract modification to the MCSC contract and/or MOU will need to be developed

75 Are there any restrictions on member outreach or communication including type of outreach like email, home mail, telephone phone calls, or electronic messaging?

No

76 Would member contact information be shared with the vendor where available including email address, phone numbers, and home address?

See Question/Response #28

77 What data would the vendor receive for this population? Would we receive membership, eligibility, claims and UM feeds on a regular basis?

Solutions should clearly identify any information their solution is contingent upon.

78 Regarding beneficiaries with complex medical conditions, as that population will change throughout the year and year over year, is there a method for us to receive new members that fall under scope on a regular basis as changes happen?

Solutions should clearly identify any information their solution is contingent upon.

79 Are there any specific technical requirements that we should be aware of to serve this population?

See SOO Constraints

80 Are there any limitations on outreach and types of outreach that can be performed?

Solutions should reflect an innovative approach.

81 Are there any additional partner programs that the vendor will need to integrate with?

See SOO Constraints

82 Is an NDA required to be signed by each vendor workforce member assigned to support the program?

Yes

83 Term indicates a transition‐in, then three 1‐year periods, and then a transition‐out. What are the anticipated lengths of time for the transition periods and are the three 1‐year periods optional?

The transition in/out period will depend on the selected solution. Any Options will be exercised at the discretion of the Government. See SOO Paragraph 3.0

84 Other than mandatory terms, if selected for Phase 2, will there be an opportunity to negotiate key terms in the contract?

During the solution feedback session all elements are available for negotiation and award. See NoA Phase 2 Negotiation and Award.

85 Can the Government provide the funding estimate for this program so that bidders can properly scope the scale of this program?

Since funds are not yet available, how can an offer be determined to be within available funds?

See Question/Response #64, #12 and #31.

86 Since the Government is asking for a guaranteed positive return on investment, how is it possible that an offer would exceed available funds?

This depends on the solution proposed.

87 There appears to be no evaluation criteria that will measure the positive return on investment. Please clarify.

See NoA Phase 1 Evaluation Element 2

88 Will the cost of amending the MCSCs’ contracts be considered in the evaluation of price to the extent required by the PWS?

No – this a separate standalone contract.

90 Will DHA provide claims and encounter data, to include pharmacy data, for Select members?

OR will the regional contractors such as Humana Government Business (HGB) and Health Net Federal Services, LLC (HNFS) provide us with an authorization and claims file for the impacted Select beneficiaries? If so, how often will we receive it (e.g., daily, weekly)?

Solutions should clearly identify any information their solution is contingent upon.

91 1. Describe the scope of “real‐time data exchange.”

2.Is the DHA suggesting the contractor should have full access to MCSC systems? What data, specifically, does the DHA envision would be exchanged?

Depending on the proposed solution, any coordination or changes to the MCSC’s will be addressed.

92 In order for all bidders to be on equal footing, please provide historical claims and beneficiary volume data associated with the population impacted by this pilot.

Data will be uploaded to FBO.gov ASAP

93 Is the Government seeking 24/7 phone‐based Navigator services? The Government is seeking innovative solutions or potential new capabilities.

“The scope of the program is implementation a nation‐wide Pilot Program to provide TRICARE Select beneficiaries with complex medical conditions (complex medical conditions is defined as two or more medical conditions requiring the coordination of multiple specialties for at least 12 months ) or high cost claimant status ($100K/year or above).”

Is it the Government's intent that members with two or more medical conditions without a significant cost will still be engaged in the program?

Yes – if there are medical conditions requiring coordination with multiple specialties for at least 12 months.

94 Is the high cost claimant status ($100k/year or above) based upon total charges submitted or total dollars paid out?

The Government assumes that these are billed charges.

95 Can a beneficiary become eligible for the Patient Navigator Pilot Program at any time during a year once they reach the $100k/year mark?

Yes

96 The health.mil site identifies 1.94 million TRICARE Standard and Extra beneficiaries and 379,000 TRICARE Reserve Select beneficiaries.

Are the TRICARE Standard and Extra part of the Select population or is there another number for TRICARE Select?

There are approximately 1.6M TRICARE Select beneficiaries throughout CONUS

97 Will bidders be automatically excluded from consideration if during refinement discussions any increases to work scope, as requested by the Government, causes an increase to the price submitted in phase 1?

Discussions are not anticipated

98 Will the Government be notifying the Contractor of its intent to exercise Option Period 1 prior to reporting to the SASC and HASC?

Notification to exercise of the Option will be made IAW FAR 52.217‐9 and will depend on the individual solution selected.

99 Please clarify if the Contractor’s deliverable to support the January 1, 2021 briefing to the Senate and House Armed Services Committees denotes the end of the Contractor’s Base Period?

Base period will be for transition‐in services. Pilot Performance will take place on option periods (in the Government’s discretion) following transition‐in. See SOO paragraph 3.0

100 FAR 52.219‐9, Small Business Subcontracting Plan (Aug 2018) (15 U.S.C. 637 (d)(4)). (Class Deviation 2018‐O0018), requires the offeror to submit a Small Business Subcontracting Plan upon the Contracting Officer’s request. In reviewing the Solution Submission requirements, it does not appear a Small Business Subcontracting Plan is required as part of the submission on July 26, 2019. Please confirm that the Small Business Subcontracting Plan:

(1) Is not due at the time of Solution Submission.

(2) Will only be required by the successful offeror upon award.

See Question/Response #37

101 Can the Government please define what it means by unlimited access and rights to the data used to develop the value‐based pricing structure? While providing data to support the pricing structure proposed and data that allows for measurement of success is understood, VB pricing methods and models may be proprietary and competition sensitive. Is the Government suggesting that a contractor will give up rights to its methods and models?

Depends on the solution submitted

102 Does the Government intend for the awardee to provide an irrevocable, perpetual, paid‐up, royalty‐free license (i.e., at no extra charge to the Government) to support contractors and the successor contractor to access and use commercial software tools under a supplier agreement upon the termination or expiration of this contract?

Depends on the solution submitted

103 Can the government please include a list of all the attendees who announced themselves on the AMA call?

A list of attendees that identified themselves will be posted on FBO.

104 Will vendors submitting solutions be notified by Friday, August 2, 2019 of their invitation to Pitch Day?

Yes, all vendors submitting solutions will receive invitations to Pitch Day (August 6 or 7) on Friday, August 2, 2019.

105 We came up with a different estimate for the number of eligible beneficiaries from the government working estimate provided. What should we do?

There may be differences between estimates derived from the dataset provided and the Government estimate provided (See Q64).

Interested vendors are instructed to let their own estimates govern when developing their solution.