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SECTION M

EVALUATION FACTORS FOR AWARD

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M.1. SOLICITATION PROVISIONS

52-217-5 Evaluations of Options. (Jul 1990)

Except when it is determined in accordance with FAR 17.206(b) not to be in the Government’s best interests, the Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. Evaluation of options will not obligate the Government to exercise the option(s).

M.2. BASIS OF EVALUATION

M.2.1. This is a best value source selection conducted in accordance with Federal Acquisition Regulation (FAR) Part 15.3, Source Selection, as supplemented by the Defense Federal Acquisition Regulation Supplement (DFARS). These regulations are available electronically at http://farsite.hill.af.mil. The Government will select the best overall offer, based upon an integrated assessment of technical/management, past performance, and price/cost factors. The Government seeks to award to the Offeror who meets or exceeds the requirements and gives DHA the best value. This may result in an award to a higher rated, higher priced Offeror, where the decision is consistent with the evaluation factors and the Source Selection Authority (SSA) reasonably determines that overall benefit of the non-price factors outweighs the cost difference. In making the trade-off between the non-price factors and the price factor, the SSA will base the source selection decision on an integrated assessment of proposals against all source selection criteria in the solicitation (described below).

M.2.1.1. Should an offeror be determined to have submitted best-value proposals for both the East and West Regions, the Offeror will be awarded the East Region contract, provided at least one other acceptable offer has been submitted for the West Region contract.

M.2.2. Unrealistic Proposals. The Government may reject any proposal that is evaluated to be unrealistic in terms of program commitments, contract terms and conditions such that the proposal is deemed to reflect an inherent lack of competence or failure to comprehend the complexity and risks of the program.

M.2.3. Evaluation Approach. The Government will evaluate the extent to which the proposal exhibits a clear understanding of the work requirements and the means required to fulfill the requirements. The Government will also evaluate the extent to which the proposal demonstrates an ability to meet or exceed the requirements defined in the Request for Proposal (RFP) and the quality of service which is likely to result from implementation of an Offeror’s proposed methods.

M.3. EVALUATION FACTORS. The Government will evaluate each proposal against the following factors and subfactors.

http://farsite.hill.af.mil./

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Factor 1-Technical/Management

Subfactor 1-Network Management Subfactor 2-Referral Management Subfactor 3-Medical Management Subfactor 4- Customer Service Subfactor 5-Claims Processing Subfactor 6-Program Planning and Control Subfactor 7-Transition Management

Factor 2-Past Performance

Factor 3-Price/Cost

Factor 4-Small Business Participation Factor

M.4. EVALUATION FACTOR RELATIVE IMPORTANCE

Factor 1, Technical/Management and Factor 2, Past Performance, are equal in importance, and individually, are more important than Factor 3, Price/Cost. Of the Technical/Management subfactors, Subfactor 6 is the most important. Subfactor 7 is less important than Subfactor 6 but more important than Subfactors 1 through 5 individually. Subfactors 1 through 5 are weighted equally.

Factor 4 will be evaluated on an acceptable/non-acceptable basis. Offers rated “non-acceptable” are not eligible for award. The remaining non-price evaluation factors (Technical/Management and Past Performance) when combined, are significantly more important than Factor 3, Price/Cost.

M.5. EVALUATION OF FACTOR 1, TECHNICAL/MANAGEMENT FUNCTIONS

The Government will determine a Technical Rating (Table M.5.1.) and a Proposal Risk Rating (Table M.6.2.) for each of the subfactors. Each proposal for the Technical/Management factor will be evaluated to determine how well it satisfies the Government’s requirements for the subfactors stated herein. Failure to address any of the specified subfactor requirements may result in an Offeror being ineligible for award.

M.5.1. Technical Rating

M.5.1.1. For each of the subfactors of the Technical/Management factor, the Government will evaluate the quality of the Offeror’s technical solution for meeting the Government’s requirement and assign a Technical Rating (Table M.5.1.). The color rating depicts how well the Offeror’s proposal meets the subfactor requirements. Subfactor ratings shall not be rolled up into an overall color rating for the Technical/Management factor.

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M.5.1.2. A “strength” is an aspect of an Offeror's proposal that has merit or exceeds specified performance or capability requirements in a way that will be advantageous to the Government during contract performance. Multiple strengths may be assigned to a subfactor; however, if the Government deems an aspect of the proposal to be a strength, that strength will be credited to only one subfactor. . The Government will have the sole discretion in determining which subfactor the strength best fits. Strengths will not be assessed for criteria which are evaluated on an acceptable/non-acceptable basis. A “deficiency” is a material failure of a proposal to meet a Government requirement or a combination of significant weaknesses in a proposal that increases the risk of unsuccessful contract performance to an unacceptable level. A “weakness” means a flaw in the proposal that increases the risk of unsuccessful contract performance. A “significant weakness” in the proposal is a flaw that appreciably increases the risk of unsuccessful contract performance.

TABLE M.5.1. – TECHNICAL RATINGS

Color Rating Description

Blue Outstanding Proposal meets requirements and indicates an exceptional approach and understanding of the requirements. The proposal contains multiple strengths and no deficiencies.

Purple Good Proposal meets requirements and indicates a thorough approach and understanding of the requirements. Proposal contains at least one strength and no deficiencies.

Green Acceptable

Proposal meets requirements and indicates an adequate approach and understanding of the requirements. Proposal has no strengths or deficiencies.

Yellow Marginal Proposal does not clearly meet requirements and has not demonstrated an adequate approach and understanding of the requirements.

Red Unacceptable Proposal does not meet requirements and contains one or more deficiencies and is unawardable.

M.6. TECHNICAL/MANAGEMENT RISK RATING

M.6.1. The Government will evaluate the subfactors of the Technical/Management factor for proposal risk. The Government will assess the degree to which the proposed approach has the potential for disruption of schedule, increased cost, degradation of

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M.6.2. Each of the Technical/Management subfactors will receive one of the risk ratings described in Table M.6.2. Technical/Management Risk Ratings, below. Subfactor ratings shall not be rolled up into an overall risk rating for the Technical/Management factor. The risk evaluation includes, but is not limited to, the proposed approach, method or process of completing tasks, and the demonstrated experience in performing tasks (including experience in performing a proposed approach, method, or process).

TABLE M.6.2. - TECHNICAL/MANAGEMENT RISK RATINGS

Rating Description

Low

Has little potential to cause disruption of schedule, increased cost or degradation of performance. Normal contractor effort and normal Government monitoring will likely be able to overcome any difficulties.

Moderate

Can potentially cause disruption of schedule, increased cost or degradation of performance. Special contractor emphasis and close Government monitoring will likely be able to overcome difficulties.

High

Is likely to cause significant disruption of schedule, increased cost or degradation of performance. Is unlikely to overcome any difficulties even with special contractor emphasis and close Government monitoring

M.7. EVALUATION OF TECHNICAL/MANAGEMENT SUBFACTORS

M.7.1. Subfactor 1 – Network Management.

M.7.1.1. The Government will evaluate the Offeror’s proposal for developing and maintaining an accredited, stable, high-quality provider network that, within access to care standards as defined in 32 CFR 199, supplements services provided by the Military Treatment Facility (MTF). The Government will evaluate whether the Offeror’s network sizing model effectively considers the number of providers required, types of providers required, MTF capacity/capability, and the beneficiary population. The Government will assess whether the Offeror has an effective approach for identifying and mitigating network shortages.

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M.7.1.2. The Offeror’s proposal will be evaluated on how it will respond to changes in MTF capabilities and capacities. This includes the ability to respond to such changes on short notice, how the Offeror will stay informed of potential changes, and how activities will be coordinated with the Regional Director and/or the MTF Commander.

M.7.1.3. The Offeror’s proposal will be evaluated for the Offeror’s approach for directing beneficiaries to providers with demonstrated high quality outcomes while meeting health plan administrative standards (such as electronic claims processing, return of clear and legible consultation reports when requested, appointment availability, and secure communications with patients).

M.7.1.4. The Offeror’s proposal will be evaluated for its approach to facilitate the timely return of network provider consultation reports to the MTFs as required by C.2.1.7.

M.7.1.5. The Offeror’s proposal will be evaluated for its approach for maintaining an accurate network provider directory which complies with contract requirements.

M.7.2. Subfactor 2 – Referral Management.

M.7.2.1. The Offeror’s proposal will be evaluated on the effectiveness of its process for managing referrals between the MTFs and the civilian network. The Government will consider how and when the Offeror’s referral management process directs Military Health System (MHS) beneficiaries to the MTF/civilian sector; how this process will be supported through network management activities; how the Offeror proposes to meet the referral processing requirements in the TRICARE Operations Manual (TOM), Chapter 8, Section 5.

M.7.3. Subfactor 3 – Medical Management.

M.7.3.1. The Government will evaluate the Offeror’s proposed approach for designing, implementing, and maintaining integrated, comprehensive medical management programs for all care received by TRICARE-eligible beneficiaries in the civilian sector and for complementing medical management services available within the MTF. Successful programs will be able to objectively document improvements in outcomes.

M.7.3.2. The Government will evaluate the Offeror’s approach for implementing a Utilization Management program for TRICARE-eligible beneficiaries and how well the program will support the identification, prevention, and reduction or elimination of occurrences of over- or under- utilization.

M.7.3.3. The Government will evaluate the Offeror’s proposal for its case management program for TRICARE-eligible beneficiaries and how well the program will support and manage the healthcare of individuals with high-cost conditions or with specific diseases for which evidenced-based clinical management programs exist.

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M.7.3.4. The Government will evaluate the Offeror’s approach for its proposed chronic care/disease management program for effectiveness in improving the clinical and satisfaction outcomes for all TRICARE-eligible beneficiaries and reducing healthcare costs for the Government.

M.7.3.5. The Government will evaluate the Offeror’s approach to providing a Network Prime beneficiary-centric data warehouse and industry analytic tools, (including predictive analytics) which incorporates a data analysis technique with evidence-based algorithms. The Government will evaluate the Offeror’s proposed methodology for applying data stratification and predictive modeling to produce positive patient outcomes and measurable gains. The Government will evaluate the Offeror’s proposed methodology for providing integrated systems and processes for comprehensively discovering and correcting gaps in care, medical errors, and quality issues for Network Prime beneficiaries. A successful plan will be one that describes systems and processes for standardizing error reduction while maintaining transparency and adhering to evidence-based medicine, and that best enables extraction of actionable data from large databases of information that can improve quality of care and patient perception of care.

M.7.3.6. The Government will evaluate the Offeror’s proposed approach to implement a clinical quality management and patient safety program for all TRICARE-eligible beneficiaries for effectiveness and compliance with TOM Chapter 7, Section 4.

M.7.4. Subfactor 4 - Customer Service.

M.7.4.1. The Government will evaluate the Offeror’s approach to customer service for how well it will provide accurate, comprehensive customer information with knowledgeable, courteous, and responsive staff and its approach for providing customer service via multiple, contemporary avenues of access.

M.7.4.2. The Government will evaluate whether the Offeror presents an effective approach for establishing and maintaining optimal beneficiary, provider, and MTF satisfaction in a manner that meets the contract requirements throughout the period of performance.

M.7.4.3. The Government will evaluate the Offeror’s approach for how well it will identify and respond to beneficiary and provider educational needs consistent with the contract requirements.

M.7.5. Subfactor 5 – Claims Processing.

M.7.5.1. The Offeror’s proposal will be evaluated for the inclusion of a readily adaptable, scalable claims processing system which incorporates industry best practices. Consideration will be given to systems that are configured such that changes are made in a timely and efficient manner with minimal disruption to claims processing activities.

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M.7.5.2. The Offeror’s proposal will be evaluated for sound processes and methods designed to ensure that claims processing timeliness and accuracy standards will be met.

M.7.6. Subfactor 6 – Program Planning and Control

M.7.6.1. The Government will evaluate the extent to which the Offeror’s proposal demonstrates an effective management approach for establishing and maintaining, throughout the life of the contract, qualified, experienced key personnel, in the following areas.

• Establishing/Maintaining Networks

• Referral Management

• Medical Management

• Enrollments

• Customer Service

• Claims Processing

• Management

The Government will consider the extent to which this approach will ensure that, where essential for successful contract performance, these personnel will be experienced and knowledgeable in integrating the purchased care system with the direct care system. The Government will not evaluate individual personnel, but will evaluate the Offeror’s approach described above.

M.7.6.2. The Offeror’s Quality Management/Quality Improvement Program Plan will be evaluated to determine if an effective internal quality management/quality improvement program is being offered. The Offeror’s approach to communicating problems and resolutions identified as part of the Quality Management/Quality Improvement Program Plan will be evaluated for timeliness, adequacy and appropriate use of communication medium (e.g. email, telephone, face-to-face meeting).

M.7.7. Subfactor 7- Transition Management

M.7.7.1 The proposal will be evaluated for an effective Integrated Master Schedule and Integrated Master Plan (IMP/IMS) which meets or exceeds the Government transition requirements.

M.8. EVALUATION OF FACTOR 2, PAST PERFORMANCE

M.8.1. The Government will evaluate past performance information, provided in accordance with Section L and other sources, to determine how well an Offeror has performed in the past on recent relevant work. With respect to contracts identified in L.7.4 and L.7.5 and/or discussed

HT9402-15-R-0002 Page M-8 of M-12 Amendment 000008 in the narrative, the Government will only consider relevant past performance information for ongoing contracts and contracts concluded within the last three years from the date of RFP release. The Government will consider the entire period of performance of the contract to include any transition-in and phase-out periods. The past performance evaluation will result in an assessment of the Offeror’s probability of meeting the solicitation requirements. One performance confidence assessment rating will be assigned for each Offeror.

M.8.2. When assessing the Offeror’s performance confidence, the Government will use the Offeror’s past performance proposal, past performance questionnaires, and additional information the Government obtains from the Offeror’s clients listed in the proposal. The Government may also use relevant past performance information from other customers known to the Government, Past Performance Information Retrieval System (PPIRS), Contractor Performance Assessment Reporting System (CPARS), Federal Awardee Performance and Integrity Information System (FAPIIS), Electronic Subcontract Reporting System (eSRS), and other sources of useful and relevant information including the Government’s own internal records.

M.8.3. Relevancy

M.8.3.1. The Government will evaluate past performance deemed relevant in terms of scope and the magnitude of effort and complexities as it relates to the requirements for this solicitation. Assessment of relevancy will be based on those functions the Contractor or subcontractor will be performing on this solicitation. For example, the relevancy of scope will only be assessed on claims processing services if that is the only function the subcontractor will be providing. Past performance history deemed “Not Relevant” will not be considered when determining the performance confidence rating.

M.8.3.2. The Government will assign one of the following relevancy ratings to each contract provided by the Offeror as specified in table M.8.3.2.

TABLE M.8.3.2. PAST PERFORMANCE RELEVANCY RATINGS

Degree Description

VERY RELEVANT (VR)

Past/present performance effort involved essentially the same scope and magnitude of effort and complexities this solicitation requires.

RELEVANT (R)

Past/present performance effort involved similar scope and magnitude of effort and complexities this solicitation requires.

SOMEWHAT RELEVANT

(SR)

Past/present performance effort involved some of the scope and magnitude of effort and complexities this solicitation requires.

NOT RELEVANT (NR) Past/present performance effort involved little or none of the scope and magnitude of effort and complexities this

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M.8.4. Quality

M.8.4.1. Once a relevancy rating has been determined, the Government will review all available information to determine the quality of performance for each of the contracts. If an individual contract has been assessed as not relevant, no performance review will be conducted. The Government will identify any positive and/or negative findings noted during the review

M.8.4.2. In assessing quality of performance, the Government will consider the Offeror’s past performance in compliance with clause FAR 52.219-8, Utilization of Small Business Concerns;

clause FAR 52.219-9, Small Business Subcontracting Plan, or any deviations thereof, including all subcontracting goals.

M.8.5. Performance Confidence Assessment

M.8.5.1. The Government will assigness a performance confidence assessment rating relative to the Offeror’s ability to successfully perform the requirements of this solicitation.

M.8.5.2. Each Offeror will be assigned one of the performance confidence ratings below as specified in table M.8.5.2.

TABLE M.8.5.2. - PERFORMANCE CONFIDENCE ASSESSMENTS

Rating

Description

SUBSTANTIAL

CONFIDENCE

Based on the Offeror’s performance record, the Government has a high expectation that the Offeror will successfully perform the required effort.

SATISFACTORY

CONFIDENCE

Based on the Offeror's performance record, the Government has a reasonable expectation that the Offeror will successfully perform the required effort.

LIMITED

CONFIDENCE

Based on the Offeror’s performance record, the Government has a low expectation that the Offeror will successfully perform the required effort.

NO CONFIDENCE

Based on the Offeror‘s performance record, the Government has no expectation that the Offeror will be able to successfully perform the required effort.

UNKNOWN

CONFIDENCE

No performance record is available or the Offeror’s performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned.

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M.8.5.3. If an Offeror has no past performance relevant to this solicitation, the Government will assess an “Unknown Confidence” (neutral) performance confidence rating and the Government may not evaluate the Offeror’s past performance favorably or unfavorably (see FAR 15.305 (a)(2)(iv)).

M.8.5.4. If an Offeror with no relevant past performance submits relevant past performance information from a predecessor company, a parent organization or consortium member, this information will be considered in rendering a performance confidence level rating. This rating will be based on the amount of past performance, its relevance to providing the services required by this solicitation, and the amount of involvement the parent organization or consortium member will have in the daily operations of the Offeror.

M.8.5.5. When an Offeror submits past performance information on its key personnel as stated in Section L, Instructions, Conditions, and Notices to Offerors, paragraphs L.7.11., the Government will evaluate the key personnel information to determine to what extent, if any, it will affect the performance confidence rating. In evaluating key personnel past performance, the Government will consider the key person’s role in the company, the nature and quality of the services delivered, and the relevant amount of past performance the key person had related to providing the service required by this solicitation.

M.8.5.6. Regardless of whether the past performance data relates to a parent organization, consortium member, or an employee or group of employees, the Government may still render a performance confidence level of Unknown Confidence (Neutral) if an Offeror does not have adequate, convincing and relevant past performance information.

M.9. EVALUATION OF FACTOR 3, PRICE/COST

M.9.1. Each Offeror’s Price/Cost proposal will be evaluated based upon the Government’s calculated total price. Evaluation of options shall not obligate the Government to exercise such options.

M.9.2. Total Evaluated Price (TEP). For the purpose of determining the contract Best Value, the Government will use the “Total Evaluated Price” for each Offeror. The TEP will be the sum of the extended amounts of the priced CLINs, base and all five option periods, in Section B for CLIN 0001 Transition-In, CLIN X001 Underwritten Healthcare Cost, CLIN X002 Underwritten Healthcare Cost Fixed Fee, SLIN X003AA and SLIN X003AB Per Member Per Month (PMPM), CLIN X005 Service Assist Teams, CLINs 9001/9002 Transition-Out (estimated cost and fixed fee), and the calculated amount for the extension of services per M.9.5. CLIN X004 Incentive Pool will be excluded from the TEP.

M.9.3. The Offeror’s compensation plan for professional employees shall be evaluated on an acceptable or nonacceptable basis.

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M.9.4. Cost Realism Analysis:

M.9.4.1. CLIN X001Underwritten Healthcare Costs/CLIN X002 Underwriting Fixed Fee:

The Government has provided the reimbursable cost estimates for underwritten healthcare costs. The application of the Offeror’s guaranteed network provider discounts will be the only adjustments to the CLINs X001. The Government will make the adjustments to all offers according to the Price Evaluation Template, tab entitled Healthcare Cost & Discount. The Offeror’s proposed underwriting fixed fee will not be subject to a most probable cost evaluation. It will be included as proposed in the Total Evaluated Price.

M.9.4.2. CLINs 9001 Transition-Out, Estimated Cost/CLIN 9002 Transition-Out, Fixed Fee The Government will perform a cost realism analysis/most probable cost evaluation, in accordance with FAR 15.404-1(d), on the Offeror’s proposed CLIN 9001Transition-Out, estimated cost. The Offeror’s proposed fixed fee will not be subject to a most probable cost evaluation. It will be included as proposed in the Total Evaluated Price.

M.9.5. Extension of Services: In the calculation of TEP, the Government will add 50% of the total proposed price for Option Period 5 for the possible 6 month extension of services under FAR 52.217-8, Option to Extend Services. This fifty percent will be added to all Option Period 5 CLINS considered in the TEP (see M.9.2), with the exclusion of Transition-Out.

M.9.6. Reasonableness. The Government will evaluate the Offeror’s TEP for reasonableness.

Line items will also be reviewed for unbalanced pricing.

M.9.7. Defense Contracting Audit Agency (DCAA). DCAA and/or the Defense Health Agency (DHA) will conduct a review of Offerors’ and/or subcontractors’ healthcare or claims processing cost accounting systems in order to determine if an Offeror’s accounting system is adequate for award of a cost reimbursement type contract in accordance with the FAR part 9.104.

M.10. EVALUATION OF FACTOR 4, SMALL BUSINESS PARTICIPATION

M.10.1. The Government will evaluate the subcontracting plan and participation of small businesses on an acceptable/non-acceptable basis. Acceptable – Proposal clearly meets the minimum requirements of the solicitation (Strengths are not assessed for this evaluation).

Unacceptable – Proposal does not clearly meet the minimum requirements of the solicitation.

The Contracting Officer (CO) will review the subcontracting plan submitted under Volume I for the submission requirements identified under FAR 19.702, Statutory requirements; FAR 19.704, Subcontracting plan requirements; FAR 52.219-8 Utilization of Small Business Concerns, FAR 52.219-9 Small Business Subcontracting Plan (DEVIATION 2013-O0014), and DFARS 252.219-7003, Small Business Subcontracting Plan (DoD Contracts). The CO will assess the 11 elements of the plan described in FAR 19.704.

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M.10.2. The Government will assess how the Offeror’s proposed subcontracting goals compare with the following subcontracting goals. If the Offeror does not propose the subcontracting goals below, the Government will assess how well the Offeror describes how and why their proposed goals are set at levels that are realistic and that the parties can reasonably expect. The Government will assess the extent the Offeror identifies businesses in the Plan and demonstrated good faith efforts or plans to meet the below goals using small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business (which includes historically black colleges and minority institutions in its goal), and women-owned small business subcontractors to the maximum practicable. The Subcontracting goals are as follows:

• Small Business Subcontracting: 7%

• Women-Owned Small Businesses (WOSB): 2%

• Small Disadvantaged Businesses (SDB): 3%

• Veteran-Owned Small Business (VOSB): 2%

• Service-Disabled Veteran-Owned Small Businesses (SDVOSB): 1%

• Historically Underutilized Business Zone (HUBZone) SBs: 1%

M.11. Financial Viability: As part of the CO’s responsibility determination (FAR 9.1), the CO will evaluate the Offeror’s financial viability to ensure the Offeror has adequate financial resources to perform the prospective contract or demonstrates an ability to obtain adequate financial resources. If an Offeror fails to submit the required financial information, the CO may make a determination the Offeror is not responsible and thus ineligible for award.