31_Attachment_J-21_DRAFT_QASP.doc

Attachment J-21 Draft Quality Assurance Surveillance Plan (QASP)

Quality Assurance Surveillance Plan

TRICARE Quality Monitoring Contract (TQMC) Contract Number: HT9402-15-D-XXXX Contract Description: This contract provides for services and materials to support the management of clinical quality in the Military Health System (MHS). The activities focus on the continuous assessment, analysis and reporting on the quality of direct and purchased healthcare provided in the MHS.

The purpose of the TQMC is to assist the Clinical Support Division (CSD) in assessing and improving the quality of care delivered under the TRICARE benefit across the direct and purchased care systems. This contract will assist DHA in decreasing unwarranted variation in the quality of medical care, implementing proven clinical and business practices, and creating an environment for learning and continuous improvement across the MHS. This contract will also support DHA with the management of clinical quality performance measurement to validate the quality of care.

TRICARE quality monitoring is accomplished through a variety of tasks supporting the direct care and purchased care systems. These tasks include external, third-party data collection, analysis and reporting of clinical quality measures, and comparison with national healthcare benchmarks; reviewing, evaluating, and reporting on published clinical care studies, evolving practices, and other data to identify superior quality healthcare services and recommend means to transfer successes; and conducting comprehensive, timely medical peer reviews to ensure medically-appropriate healthcare is provided per 32 CFR 199.

Contractor’s name: (hereafter referred to as the contractor).

1.0 PURPOSE:

1.1 This Quality Assurance Surveillance Plan (QASP) provides a systematic method for the Government to evaluate the contractor’s performance for the stated contract. This QASP explains the following:

· What will be monitored

· How monitoring will take place

· Who will conduct the monitoring

· How monitoring efforts and results will be documented

1.2 The contractor is responsible for implementing and delivering performance that meets contract standards using its Internal Quality Management Plan (CDRL AP020). The QASP provides the structure for the government's surveillance of the contractor's performance to assure that it meets contract standards. It is the Government's responsibility to be objective, fair and consistent in evaluating contractor performance.

1.3 The QASP is not part of the contract nor is it intended to duplicate the contractor's quality control plan. This QASP is a living document. Flexibility in the QASP is required to allow for an increase or decrease in the level of surveillance necessary based on contractor performance.

1.4 The Government may provide a copy of the QASP to the contractor to facilitate open communication. In addition, the QASP should recognize that unforeseen or uncontrollable circumstances might occur that are outside the control of the contractor. The QASP should ensure early identification and resolution of performance issues to minimize impact on mission performance.

1.5 Authority: Authority for issuance of this QASP is provided under Federal Acquisition Regulation (FAR) 46, Quality Assurance; which provides for inspection, acceptance and documentation of the service called for in the contract or order.

2.0 Government Roles and Responsibilities:

The following personnel shall oversee and coordinate surveillance activities:

a. Contracting Officer (CO).The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

Contracting Officer: Margaret Zancanella Organization or Agency: Defense Health Agency/COD-A, Aurora, CO Telephone: (303) 676-3451 Email: Margaret.A.Zancanella.civ@mail.mil

b. Contracting Officer’s Representative (COR).The COR is responsible for the technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COR shall keep a quality assurance file. At the conclusion of the contract or when requested by the CO, the COR shall provide documentation to the CO. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf. The contractor shall refer any changes it deems may affect contract price, terms, or conditions to the CO for action.

Assigned COR: TBD Telephone:

Email:

c. Other Key Government Personnel – Title: Program Manager, Dr. Barry Cohen Telephone:

Email:

3.0 Contractor Representatives:

The following TQMC employees are the contractor’s designated point(s) of contact for contract performance:

a. Program Manager - Telephone:

Email:

b. Task Manager - Telephone:

Email:

c. Other Contractor Personnel -

Title:

Telephone:

Email:

4.0 Performance Standards:

4.1 The performance standards define the level of service required under the contract for the contractor to meet each performance objective in Section C, TQMC Performance Work Statement (PWS). The contract and task orders will specify quality performance metrics and the Acceptable Quality Levels (AQLs) as the standards the Government requires from the contractor’s performance of services. The Government will perform surveillance to determine if the contractor exceeds, meets or does not meet these standards.

4.2 The Government shall compare the contractor’s performance to the minimum Acceptable Quality Levels (AQLs) in the Performance Standards Summary Matrix below.

Table 1, Performance Standards Summary Matrix

QOC cases

5.0 Incentives:

5.1 As defined in the Section H, Special Contract Requirements, paragraph 1.0, Performance Guarantees, the government will assess performance guarantees to the Section C, tasks defined in paragraphs 6.3.3 and 6.5.

6.0 Methods of QA Surveillance:

6.1 Various methods exist to monitor performance. The COR may use the surveillance methods listed below in the administration of this QASP.

6.2 Regardless of the surveillance method, the COR will contact the contractor's designated point of contact when a defect is identified and inform the manager of the specifics of the problem. The COR shall be responsible for monitoring the contractor’s performance in meeting a specific performance standard/AQL.

a. Direct Observation: (Can be performed periodically or through 100% surveillance.)

· Study work products including methodology, IRB approval, Data Use Agreement, Reports, manuscript and educational materials provided to appropriate recipients in a complete and timely manner

· Meeting support for MHS Quality Forum, Risk Management, Clinical Measures Steering Panel, Scientific Advisory Panel, Perinatal Advisory Group, Infection Prevention and Control Panel, and Medical Directors’ Forum completed on time

· On-line educational materials from the studies developed and posted timely

· Behavioral Health Facility surveys complete and well-written with appropriate recommendations for certification, recertification or decertification

· Standard of Care reviews and reconsideration reviews performed by appropriate peer reviewers within prescribed timelines

b. Management Information Systems (MIS): (Evaluates outputs through the use of management information reports. Best used for general surveillance and may need to be supplemented by periodic inspections.) DHA E-Commerce Extranet Performance Assessment Tool

· Study work products including methodology, , Data Use Agreement, Reports, manuscript and educational materials provided to the Scientific Advisory Panel in a complete and timely manner

c. Periodic Inspection: (Uses a comprehensive evaluation of selected outputs. Inspections may be scheduled [Daily, Weekly, Monthly, Quarterly, or annually] or unscheduled, as required.)

· Availability of secure web-based access

· ORYX® Data Submission to Joint Commission meets accreditation requirements

· Annual HEDIS® audit performed by certified auditor in appropriate manner

d. User Survey: (Combines elements of validated user complaints and random sampling. Random survey is conducted to solicit user satisfaction. Appropriate for high quantity activities that have historically been satisfactory. May also generate periodic and 100% inspections.)

· On-line educational materials from the studies develop and post timely.

e. Validated User/Customer Complaints and Compliments: (Relies on the user of the service to identify deficiencies. Complaints are then investigated and validated. Highly applicable to services provided in quantity and where quality is highly subjective.)

· Availability of secure web based access

· ORYX® Data Submission to Joint Commission meets accreditation requirements

f. Progress or status meetings:

· All tasks

g. Analysis of contractor's progress reports: (Evaluate cost, schedule, etc.)

· All tasks

h. Surveillance results may be used as the basis for actions (to include payment deductions) against the contractor: In such cases, the Inspection of Services clause in the Contract becomes the basis for the KO’s actions.

7.0 Ratings:

Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and AQL. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be used:

8.0 DOCUMENTING PERFORMANCE:

a. Acceptable Performance: The Government shall document positive performance as part of its ongoing surveillance.

b. Unacceptable Performance: Unacceptable performance is contractor performance that is less than satisfactory or fails to meet the stated AQLs or other contract requirements. When unacceptable performance occurs, the COR shall notify the contractor in writing unless circumstances necessitate verbal communication. In any case the COR shall document the discussion of unacceptable performance with a courtesy copy to the CO and place it in the COR file.

The COR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The COR will also state how long after receipt the contractor has to present this corrective action plan to the COR. The Government shall review the contractor's corrective action plan to determine acceptability.

The contractor shall acknowledge receipt in writing of the COR’s notification of unacceptable performance. Any COR notifications of unacceptable performance may become a part of the supporting documentation for contract payment deductions, or other actions deemed necessary by the CO.

c. The COR and CO will use all performance documentation to complete the annual contractor’s performance evaluation in the Contractor Performance Assessment Report System (CPARS) per FAR 42.15, Contractor Performance Information.

9.0 Frequency of Measurement:

a. Frequency of Measurement:

During contract/task order performance, the COR shall take periodic measurements, as specified in the AQL column of the Performance Standards Summary Matrix, and shall analyze whether the negotiated frequency of measurement is appropriate for the work being performed.

b. Frequency of Performance Assessment Meetings:

The COR shall meet with the contractor as often as necessary to assess performance. If performance is less than satisfactory, the COR shall meet more frequently until the contractor’s performance is at least satisfactory. The COR shall document all performance assessment meetings, including the topics discussed, action items and their status until closed. The COR shall provide a copy of performance meetings to the CO

Prepared by:

Signature – Contracting Officer’s Representative

Performance Report

1. CONTRACT NUMBER:

2. Prepared by: (Name of COR)

3. Date and time of observation:

4. Observation:

Prepared by:

Signature – Contracting Officer’s Representative

Date

TQMC HT9402-15-R-0005, Section J, Attachment J-21