48_Section_M_05-19-15.docx

SECTION M, EVALUATION FACTORS FOR AWARD

1.0 FAR 52.217-5 EVALUATION 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 options(s).

(End of Provision)

2.0 BASIS OF EVALUATION:

2.1 This is a full and open competitive source selection, using the best value tradeoff process, in accordance with Federal Acquisition Regulation (FAR) 15.3, Source Selection, as supplemented by the Defense FAR Supplement (DFARS).

2.1.1 This source selection process allows for a tradeoff between non-price factors and price and allows the Government to accept other than the lowest priced proposal or other than the highest technically rated proposal to achieve a best-value contract award. The Government will select the best overall offer, based upon an integrated assessment of technical/management, past performance, and price 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 tradeoff 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).

2.2 Evaluation Approach: The Government will evaluate the extent to which the proposal exhibits a clear understanding of the TRICARE Quality Monitoring Contract (TQMC) requirements and a sound approach to fulfill the solicitation requirements. The Government will also evaluate the extent to which the proposal demonstrates an ability to meet or exceed the solicitation requirements and the quality of service expected to result from implementation of an offeror’s proposed methods.

3.0 EVALUATION FACTORS AND RELATIVE VALUES:

3.1 Evaluation Factors: The Government shall evaluate each proposal against the following factors and subfactors.

- Factor 1, Technical Approach:

- Factor 2, Past Performance

- Factor 3, Price; and

- Factor 4, Small Business Participation

3.2 Relative Importance of Factors: Of the four factors, Factor 1, Technical Approach, is the most important factor. Factor 2, Past Performance, is less important than Factor 1, but more important than Factors 3. The non-price factors (Technical and Past Performance), when combined, are significantly more important than price (FAR 15.101). Small Business Participation (Factor 4) is the least important.

3.3 Of the four subfactors under Technical Approach, the following is stated in descending order of importance:

3.3.1 Subfactor 1, Management and Staffing, and Subfactor 2, Performance Measurement and Reporting, are equal in importance and are more important than Subfactors 3 and 4.

3.3.2 Subfactor 3, Medical Reviews, is less important than Subfactors 1 and 2 but more important than Subfactor 4.

3.3.3 Subfactor 4, Quality Improvement Studies and Evolving Practices, is the least important Subfactor.

4.0 EVALUATION OF FACTOR 1, TECHNICAL APPROACH:

4.1 The Government will evaluate Subfactors 1-4 to determine a technical rating and a technical risk rating for each subfactor. Each technical proposal will be evaluated separately and will be evaluated solely on its own merits. The Government will consider the technical rating and technical risk rating in determining the best value to the Government. The Government will evaluate each proposal to determine how well an offeror’s proposed approach meets or exceeds the Government’s requirements. When an offeror proposes to exceed a solicitation requirement, the Government will consider whether exceeding the requirement is advantageous to the Government. The Government reserves the sole right to determine whether exceeding a requirement is advantageous to the Government.

4.1.1 Technical Rating: The Government will assign a technical rating to each Subfactor 1-4. The technical rating reflects the degree to which the offeror’s proposed approach meets, or does not meet, the minimum performance or capability requirements based on the evaluation criteria. In evaluating the offeror’s proposal, the Government will review the offeror’s compliance with the requirements to determine if the offeror demonstrated it understands the solicitation requirements and whether the offeror demonstrates a sound approach to accomplish the solicitation requirements consistent with best practices and standards. No award will be made to any offeror who receives an Unacceptable (red) technical rating in any subfactor. Subfactor ratings shall not be rolled up into an overall technical rating for Factor 1, Technical Approach. The following definitions will apply when assigning technical ratings to Subfactors 1 through 4:

4.1.1.1 A strength is an aspect of an offeror’s proposal that has merit or exceeds specified performance or capability requirements in a way that the Government determines will be advantageous to the Government during contract performance.

4.1.1.2 A weakness is a flaw in the proposal that increases the risk of unsuccessful contract performance. See FAR 15.001.

4.1.1.3 A significant weakness is a flaw in the proposal that appreciably increases the risk of unsuccessful contract performance.

4.1.1.4 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 and is un-awardable. See FAR 15.001.

4.1.1.4 The Government will use the technical ratings below to rate Subfactors 1-4.

Table A. Technical Ratings

4.1.2 Technical Risk: In addition to the technical evaluation, the Government will evaluate each Subfactor 1-4 for technical risk. The Government will assess the level of risk based on the degree to which the offeror’s proposed technical approach may cause the potential for disruption of schedule, increased costs, degradation of performance, the need for increased Government oversight, or the likelihood of unsuccessful contract performance. The technical risk evaluation includes, but is not limited to, the proposed approach, method, or process of completing tasks and the processes in performing tasks (including processes in performing its proposed approach, method or process). The Government will assign one of the technical risk ratings below to Subfactors 1-4. Any proposal subfactor rated High for technical risk is unacceptable and is un-awardable.

Table B. Technical Risk Ratings

4.2 Subfactor 1, Management and Staffing:

4.2.1 The Government will evaluate whether the offeror’s proposal demonstrates an effective management approach for establishing and maintaining experienced, qualified personnel with appropriate skill sets, and management positions (includes all professionals providing services under the contract), facilities, systems, and infrastructure to achieve the solicitation requirements consistent with healthcare best practices and standards.

4.2.2 The Government will evaluate whether the offeror’s proposal demonstrates an effective management approach to contract operations that meet the solicitation requirements. Specifically, the Government will evaluate whether the offeror’s approach is effective through its integration, organizational structure, lines of authority, subcontractor management, and performance monitoring and reporting (to include reporting interfaces between the offeror and the Government, structure, and sharing of personnel between and among the business entities. The Government will evaluate the management effectiveness of any contract requirements that will be accomplished by each specific subcontractor.

4.2.3 The Government will evaluate whether the offeror has proposed an effective, comprehensive Internal Quality Management Program (IQMP) Plan that will ensure the accuracy and timeliness of services and products delivered. The Government will evaluate the offeror’s proposed approach for quality management/quality improvement to determine whether the approach will ensure the solicitation requirements are met consistent with healthcare best practices and standards.

4.2.4 Risk Management: The Government will evaluate the offeror’s risk management program and processes for completeness and the effectiveness of the proposed mitigation strategies to include transition and operations consistent with healthcare best practices and standards.

4.2.5 The Government will evaluate whether the offeror presents an effective management approach for conducting medical reviews, quality studies, onsite behavioral health facility reviews, and performance measurement and reporting consistent with healthcare best practices and standards.

4.2.6 The Government will evaluate whether the offeror presents an effective approach to ensure it can obtain an adequate number of appropriately licensed and certified medical reviewers to perform all of the required work.

4.2.7 The Government will evaluate whether the offeror presents an effective approach to ensure that all personnel are appropriately qualified by education, training, and experience; credentialed when appropriate; and personnel maintain required qualifications and certifications while performing under this contract consistent with healthcare best practices and standards.

4.2.8 Transition-In: The Government will evaluate whether the offeror has proposed a reasonable transition–in approach to be fully operational at the start of Option Year 1 .

4.2.9 The Government will evaluate the Program Management Plan (PMP) (CDRL AP030) and the Transition-In Plan (CDRL 0T010) to determine if the offeror’s proposal provides for an effective program management and transition-in approach which meet solicitation requirements and consistent with program management best practices and standards.

4.3 Subfactor 2, Performance Measurement and Reporting:

4.3.1 The Government will evaluate whether the offeror has proposed an effective approach for ensuring timely and accurate collection, analysis, display, reporting and benchmarking of the health plan quality measures, and the posting of results consistent with healthcare best practices and standards.

4.3.2 The Government will evaluate whether the offeror has proposed an effective approach for ensuring timely, cost effective, and accurate collection, analysis, display, reporting and benchmarking of the National Hospital Quality Measures, and the posting of results consistent with healthcare best practices and standards.

4.3.3 The Government will evaluate whether the offeror has proposed an effective approach for ensuring timely, cost effective, and accurate collection, analysis, display, reporting and benchmarking of the ORYX® hospital quality measures and the posting of results consistent with healthcare best practices and standards. The Government will also evaluate the offeror’s approach for submission of the ORYX data to the JC.

4.3.4 The Government will evaluate whether the offeror has proposed an effective approach for ensuring timely, cost effective, accurate collection, analysis, display, reporting of the data utilizing the Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT) to meet the solicitation requirements consistent with healthcare best practices and standards.

4.3.5 The Government will evaluate whether the offeror has proposed an effective approach to meet the requirements for completion of the annual National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) measures Compliance Audit.

4.4 Subfactor 3, Medical Reviews:

4.4.1 The Government will evaluate the effectiveness of the offeror’s approach for ensuring complete, timely, medical reviews by the appropriate qualified medical professional consistent with healthcare best practices and standards.

4.4.2 The Government will evaluate the effectiveness of the offeror’s approach for ensuring that each purchased care medical record reviewed for any reason is assessed for medical necessity and appropriateness of care.

4.5 Subfactor 4, Quality Improvement Studies and Evolving Practices:

4.5.1 The Government will evaluate whether the offeror’s proposal demonstrates an effective approach for identifying appropriate study topics and conducting clinical quality improvement studies consistent with healthcare best practices and standards which will provide specific and actionable recommendations for the Government to consider.

4.5.2 The Government will evaluate the effectiveness of the offeror’s approach for performing clinical quality improvement studies that impact the direct care system, purchased care system, or the entire military healthcare system to achieve the contract requirements consistent with healthcare best practices and standards.

4.5.3 The Government will evaluate the effectiveness of the offeror’s approach for conducting a study to assess the quality of Applied Behavior Analysis.

4.5.4 The Government will evaluate the effectiveness of the offeror’s approach to the performance of both long and short assessments of evolving practices, devices, medicines, treatments and procedures to achieve the contract requirements consistent with healthcare best practices and standards.

5.0 EVALUATION OF FACTOR 2, PAST PERFORMANCE:

5.1 The past performance evaluation results in an assessment of the offeror’s probability of meeting the solicitation requirements. The past performance evaluation considers each offeror's demonstrated recent and relevant record of performance in providing service/support that meets the contract’s requirements. The Government will evaluate past performance information submitted by the offeror, and any other past performance information that the Government has independently obtained. One performance confidence assessment rating will be assigned for each offeror after evaluating the offeror’s past performance.

5.2 Recency: The Government will only consider past performance if it is recent. The Government will only consider past performance information for relevant ongoing contracts and relevant contracts concluded within the last three years as defined in Section L, paragraph 7.1.2. The Government may consider the entire period of performance of the contract submitted for past performance to include any transition-in and phase-out periods.

5.3 Relevancy: Relevancy is a measure of the extent of similarity of the services/support effort, complexity, dollar value, contract type, degree of subcontracting/teaming, and other comparable attributes of an offeror’s past performance to the TQMC solicitation requirements. Past performance that is more relevant is a stronger predictor of future success and will have more influence on the past performance confidence assessment than past performance that is less relevant when compared to the TQMC solicitation. Relevancy is also a measure of the likelihood that the past performance is an indicator of future performance.

5.3.1 The Government will evaluate the scope and magnitude of each of the offeror’s past performance effort based on the similarity and complexity of the work compared to the solicitation requirements. The Government will evaluate past performance to determine relevancy of each of the offeror’s past performance effort in terms of scope and the magnitude of effort and complexities as it relates to the requirements for this solicitation. The government will assess relevancy based on those functions which are similar to those the contractor or subcontractor will perform on this solicitation. Past performance history deemed “Not Relevant” will not be considered when determining the performance confidence assessment rating.

5.3.2 The Government will assign one of the following relevancy ratings to each past performance contract provided by the offeror.

Table C. Past Performance Relevancy Ratings

5.4 Quality: Once the Government determines a contract’s relevancy rating is “Somewhat Relevant” or higher, the Government will review all available information to determine the quality of performance for the contract. The Government will review Contractor Performance Assessment Reporting System (CPARS) report(s), Past Performance Questionnaires (PPQs) (Section L Exhibit L-2) from clients, and other information addressing the quality of the work the offeror performed those past contracts.

5.4.1 If the Government identifies any negative findings to which the offeror has not had the opportunity to respond, the Government will notify the offeror of the findings and allow the offeror to comment on these negative findings. If the Government determines an individual contract is “Not Relevant,” the Government will not conduct a quality review for that contract.

5.4.1.1 The table below gives the Quality ratings which the Government will assign to each offeror’s past performance contracts:

Table D. Past Performance Quality Ratings

5.4.2 In assessing quality of performance, the Government will also consider the offeror’s past performance in compliance with FAR clause 52.219-8, Utilization of Small Business Concerns; clause FAR 52.219-9, Small Business Subcontracting Plan, including all subcontracting goals; and any contract monetary targets for Small Disadvantaged Business Participation Program.

5.5 Performance Confidence Assessment: Based on the Government’s determinations of recency, relevancy, and quality, the Government will then determine one performance confidence assessment rating relative to the ability of the prime offeror and the proposed first-tier subcontractors to successfully perform the requirements of this solicitation. When assessing the offeror’s performance confidence assessment rating, 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, consumer protection organizations, Past Performance Information Retrieval System (PPIRS), Federal Awardee Performance and Integrity Information System (FAPIIS), Electronic Subcontract Reporting System (eSRS), System for Award Management (SAM), and other sources of useful and relevant information including the Government’s own internal records. The Government will not consider any past performance history deemed “Not Relevant” when determining the performance confidence assessment rating.

5.5.1 If an offeror has no past performance relevant to the TQMC 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)).

5.5.1.1 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.

5.5.1.2 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.

5.5.1.3 If information about consortium members, or predecessor companies is not available, the Government may use relevant past performance information of subcontractors with a significant functional role in performing the contract. If the subcontractor(s) does not have relevant past performance information, the Government will assess an Unknown Confidence rating.

5.5.2 The Government will assign one of the performance confidence ratings below to the offeror’s past performance proposal.

Table E. Performance Confidence Assessments

6.0 EVALUATION OF FACTOR 3, PRICE:

6.1 Total Evaluated Price: The total evaluated price is the sum of all priced CLINs/SLINs in Section B, Supplies or Services and Prices/Costs, for the Transition-In Base Period and each of the Option Years 1-5, including the 0.5 factor applied to Option Period 5 for the possible 6-month extension of services under FAR 52.217-8, Option to Extend Services.

6.2 Reasonableness: The Government will use the proposal analysis techniques discussed in FAR 15.404-1 in determining reasonableness. Price analysis will be the primary technique used in the Government’s price evaluation.

6.3 Unbalanced Pricing: The Government will evaluate each offeror’s price proposal for unbalanced pricing per FAR 15.404-1(g).

6.4 Evaluation of Options: In accordance with FAR 52.217-5, Evaluation of Options; and FAR 52.217-8, Option to Extend Services, the price evaluation is inclusive of the evaluation of options required for any extension of services resulting from the Government’s unilateral right to exercise FAR 52.217-8. The Government may choose to exercise the Extension of Services at the end of any performance period (base or option periods), utilizing the rates of that performance period.

7.0 EVALUATION OF FACTOR 4, SMALL BUSINESS PARTICIPATION:

7.1 Other than Small Business (Large Business) Offerors: The Government will evaluate the subcontracting plan and participation of small businesses on an Acceptable/Unacceptable basis.

a. Acceptable – Proposal clearly meets the minimum Small Business requirements of the solicitation (Strengths are not assessed for this evaluation).

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

7.1.1 Other than Small Businesses (Large businesses): The Government will review the offeror’s subcontracting plan submitted under Volume I for the submission requirements identified under FAR 19.704, Subcontracting plan requirements; and DFARS 252.219-7003, Small Business Subcontracting Plan (DoD Contracts). The Government will determine whether the offeror’s subcontracting plan addresses the 11 elements of the plan described in FAR 19.704.

7.2 The Government will assess how the offeror’s proposed subcontracting goals compare to the subcontracting goals stated below. If the offeror did not propose the subcontracting goals below, the Government will determine if the offeror demonstrated its good faith efforts to maximize small business participation and evidence of its commitment to implement the proposed small business participation goals below.

7.2.1 Small Business: If the offeror identified itself as a small business, the Government will evaluate the small business offeror as Acceptable if the Government can verify the offeror’s small business status against the offeror’s representations and certifications and the acceptability of any proposed teaming arrangement. If the government determines the offeror is NOT a small business based on the NAICS size standard, the government will rate the offeror Unacceptable for Factor 4.

(END OF SECTION)

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