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TQMC Draft Solicitation Questions & DHA Responses Offerors shall not use the responses to potential offerors’ questions as a substitute for reading and complying with the solicitation requirements posted on fbo.gov on May 19, 2015. The offeror is solely responsible for reading the solicitation and any amendments issued and submitting a proposal in compliance with all terms and conditions. Please note that references in the “Solicitation Section & Paragraph Citation” column reflect the Sections and paragraphs in DRAFT Solicitation whereas the Section and paragraph references in the “DHA Response” column cite the Solicitation Sections and paragraphs as of May 19, 2015.
| TQMC Draft Solicitation |
| HT9402-15-R-0005 |
| No: |
| Solicitation Section & Paragraph Citation |
| Question/Comment |
| DHA Response |
| 1 |
| Section C, 1.0 General, 1.1 Scope, paragraph 1.1.3 |
| Is it DHA’s intention to compare the overall delivery process between the Direct Care and Purchased care systems to evaluate the clinical and financial outcomes yielded by each system? |
| No. See Solicitation Section C, paragraphs 1.1.3 and 1.5. |
The objectives of this contract are two fold: To support the MHS mission of greater integration of the direct and purchased care delivery systems, and to support the MHS’s Quadruple Aim of Rediness, Population Health, Experience of Care, and control Per Capita Cost.
| 2 |
| Section C, 1.0 General, 1.1 Scope, paragraph 1.1.3 |
| How much of these tasks are automated and what is the strategic road map (3-5 years out) for automation to broaden the scope of the data collection, improve the timeliness of the data to ensure the medically appropriate care is provisioned to beneficiaries? Are any predictive models utilized to identify waste or fraudulent occurrences? What percentage of data collection and comparison is automated? |
| DHA does not currently use predictive models, and there is minimal automated data collection. DHA anticipates the direct care system will move towards a new electronic health record that should improve the scope and ease of data collection. The DHA plans to implement e-measures to collect ORYX® data in the next few years. Purchased care data will continue to be derived from claims data stored in systems such as M2 and the MHS Population Health Portal. |
| 3 |
| Section C, 1.0 General, 1.2 Direct Care |
| How much of this task is automated, is it currently a paper based medical record review? Are these records sent/faxed to a central location? Are there alerts that would flag records with incomplete or missing data? Are any predictive models utilized to identify waste or fraudulent occurrences? |
| Direct care inpatient electronic medical records (known as Essentris) can be accessed either remotely, onsite, or via hard copy printouts. Purchased care medical records must be requested from the purchased care contractors, but may be submitted to the TQMC in an electronic or hard copy format. These processes are not automated. There are currently no flags to denote incomplete or missing data, and no predictive modeling is utilized. See Solicitation Section C, paragraph 4.0. |
| 4 |
| Section C, 1.0 General, 1.2 Direct Care, |
paragraph 1.2.1
| Is it DHA’s desire to have data collected for the clinical studies done at the same time as the ORYX® measures or will this be a separate abstraction? The ability to combine these activities will provide efficiency and cost savings with the process. |
| While DHA desires data collection efficiencies, it may not always be possible to combine chart abstractions for clinical studies with ORYX® measure abstraction depending upon the timing of the two events. |
| 5 |
| Section C, 1.0 General, 1.2 Direct Care, |
paragraph 1.2.1
| Will it be permissible to use all data available to us on the direct care side including the ORYX®, medical record, administrative (claims) and patient/provider interview or survey data? Having the ability to view and review all forms of information on the healthcare delivery system will allow us the ability to provide DHA the most informative and actionable study results. |
| Data utilized for the performance of a clinical quality study will be dependent upon the purpose and design of the quality improvement study. Administrative data, chart abstractions, and survey data may all be sources utilized in the performance of a study. |
| 6 |
| Section C, 1.0 General, 1.3 Purchase Care |
| How much of this task is automated, is it currently a paper based medical record review? Are these records sent/faxed to a central location? Are there alerts that would flag records with incomplete or missing data? |
| The TQMC contractor will request purchased care medical records from the purchased care contractors. This is currently not an automated process. The purchased care contractors may send medical records in hard copy or in an electronic format to the TQMC, as described in TOM Chapter 7, Section 3. There are no alerts that would flag a record for missing or incomplete data. Solicitation Section C, paragraph 6.5.1, was revised to clarify this process. |
| 7 |
| Section C, 1.0 General, 1.3 Purchase Care, |
paragraph 1.3.1
| Will it be permissible to use all data available to us on the purchased care side including the medical record, administrative (claims) and patient/provider interview or survey data? |
| Data utilized for the performance of a clinical quality study will be dependent upon the purpose and design of the quality improvement study. Administrative data, chart abstractions, and survey data may all be sources utilized in the performance of a study. |
| 8 |
| Section C, 1.0 General, 1.4 MHS Care, paragraph 1.4.1 |
| Are these studies conducted utilizing automated research and artificial intelligence to identify trends in care or new/emerging benchmarks? |
| These clinical quality studies may involve care that is performed in both the direct and purchased care systems or either the direct or purchased care system in isolation. For example, they may involve transitions of care as beneficiaries move between the two systems to receive care for a particular condition. There is no automated research or artificial intelligence involved. |
| 9 |
| Section C, 1.0 General, 1.4 MHS Care, paragraph 1.4.3 |
| Would learning or seminar data be available via mobile devices for just in time use or implementation models available for organizations to leverage or customize? |
| See Solicitation Section C, paragraphs 6.8.1, and 6.8.3. The seminars will not be further customized by organizations and will be the property of DoD. In addition, see CDRL M070, Knowledge Development, provided with the solicitation. |
| 10 |
| Section C, 1.0 General, 1.5 Objectives |
| When DHA mentions integration as a goal, do you intend that to mean that you seek to ensure excellence on both the direct care and purchased care through consistent and efficient delivery systems? Or does integration refer to consistency and efficiency of the quality management oversight? |
| For purposes of the TQMC, the intention of the term “integration” is consistency and efficiency of the DHA quality management oversight. |
| 11 |
| Section C, 1.0 General, 1.5 Objectives, |
paragraph 1.5.2.1
1. Are the data captured from MTF and purchased care structured identically?
2. How current are the data that are made available?
3. What time lag is there from data capture to reporting?
4. Are all data captured and collected electronically (e.g. structured data fields)?
1) Administrative data from the direct and purchased care systems are structured in a similar manner and can be obtained from similar data sources such as M2 and the MHS Population Health Portal.
2) Purchased care data are subject to a claims data lag which could be anywhere from several weeks to several months in duration. Direct care data can likewise be subject to a lag dependent upon the length of time it takes for inpatient records to be coded and closed; this lag can also be several weeks to several months.
3) Time lag in both direct and purchased care from capture to reporting could be weeks to months.
4) All data are captured and collected electronically with the exception of ORYX® data which are abstracted from direct care medical records and submitted electronically to the Joint Commission.
| 12 |
| Section C, 1.0 General, 1.5 Objectives, |
paragraph 1.5.2.1 Is there any artificial intelligence leveraged now or conceived to be used in the future to review data to lower the cost of reviews while improving the volume of medical records reviewed. We are not advocating the replacement of peer reviews but only to accelerate the review process and provide a higher volume of reviews with greater insight to anomalies. This change would allow MHS to meet its mission of overall integration and expansion of readiness, population health and improved experience of care at lower costs.
Is there an expectation that the current core measures will be revised to be most effective given the data analysis options that are available now, and the new capabilities that are being developed? (big data, incorporation of unstructured data, use of predictive capabilities, etc.)
DOD is not currently using, nor planning to use, any artificial intelligence to review medical record data.
Core measures may be revised in the future depending upon direction from MHS leadership or external organizations such as the Joint Commission.
| 13 |
| Section C, 1.0 General, 1.5 Objectives, |
paragraph 1.5.2.3
| Please confirm which benchmarks DHA contemplates using when implementing existing national quality measures. |
| Examples of national benchmarks currently used are National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data Information Set (HEDIS®) benchmarks and the Joint Commission (JC) ORYX® benchmarks. |
| 14 |
| Section C, 6.0 Technical Requirements, 6.1 Program Management, paragraph 6.1.13 |
| Please provide an estimate of the number of face-to-face meetings required per year. |
| There are currently no scheduled meetings requiring contract attendance during 2015. See Solicitation Section G, paragraph 5.6, Section H, paragraph 8.0, and Section J, Attachment J-6. |
| 15 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, Unstructured Data |
| Is unstructured data used in any capacity? |
| The generic term “unstructured data” is not specified in Solicitation Section C. However, if the question is referencing the term “unstructured data” as defined as “a generic label for describing data that is not contained in a database or some other type of data structure”, then the following are examples of its use based upon this definition: Unstructured data are created from the collection of ORYX® measure data and submission, and from performance of the Global Trigger Tool (GTT) evaluations. In both instances, medical records must be abstracted, and data elements collected for analysis and reporting. Those data elements are, by the above definition, unstructured data. |
| 16 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, Unstructured Data |
| What are the future plans for unstructured data? |
| There are no plans to change the current processes for the collection of ORYX® data or the GTT findings. ORYX® data collection and submission processes are dictated by the JC, and the GTT processes are defined by the Institute for Healthcare Improvement (IHI). |
| 17 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, Unstructured Data |
| Is the unstructured data in the patient chart currently collected with the data for analysis? |
| See responses to questions 15 and 16. |
| 18 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, Predictive Capabilities |
| What predictive capabilities are employed in the clinical quality measures? |
| See response to question 2. |
| 19 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, Predictive Capabilities |
| Is the implementation of predictive capabilities in the 3-5 year plan for quality measures or other data interpretation opportunities? |
| See response to question 2. |
| 20 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, Predictive Capabilities |
| Is there a plan to develop abilities to predict the expected clinical outcomes or performance against peer organization based on non-standard criteria or data not used today? |
| No |
| 21 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, Predictive Capabilities |
| Is there any ability to identify criteria that should be incorporated in the rating mechanisms but is not today? E.g. identification of previously unidentified data that has statistically significant impact on outcomes that could be gathered through advanced Business Intelligence (BI) capabilities. |
| DOD continuously re-evaluates the quality measures tracked in both the direct and purchased care and may add or remove measures depending upon their relevancy and importance to the organization. Business Intelligence capabilities are not currently utilized in this contract. |
| 22 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.1 Health Plan Clinical Quality Measures (Direct and Purchased Care), paragraph 6.3.1.1 |
1. Please provide an estimate of the length of time from patient encounter until the data are available.
2. Please indicate whether historical data are available to calculate trends. We recommend the ability to use at least 2 years of data for modeling and up to 7 years of data for trending purposes
1) For the direct care system, data entered into the electronic medical record is sent to M2 where it is processed and stored. Once processed, it takes approximately one month to appear in the MHS population health portal. For Purchased care, once a TED record is sent to M2 for processing, it also takes approximately one month for the data to be available in the MHS-PHP. Processing time in M2 is variable, from weeks to months.
2) Historical data is available from DoD data sources for at least the past three years for most measures, and depending upon the data element, often longer.
| 23 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.1 Health Plan Clinical Quality Measures (Direct and Purchased Care), paragraph 6.3.1.1 |
| Please confirm: Who is doing the monthly reports now and are there samples available? |
| Monthly data collection and quarterly reporting is currently performed by Lockheed Martin, the current MHS-Clinical Quality Management (CQM) contractor. A sample is not provided; however, see CDRL Q010, Health Plan Data Report of the solicitation |
| 24 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.1 Health Plan Clinical Quality Measures (Direct and Purchased Care), paragraph 6.3.1.1 |
| Is the monthly calculation of health plan clinical quality measures a new requirement or something that has been done in the past by MHS PHP staff? |
| The MHS-CQM contractor currently downloads Health Plan Quality measure data from the MHS-PHP monthly, and reports performance quarterly |
| 25 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.1 Health Plan Clinical Quality Measures (Direct and Purchased Care), paragraph 6.3.1.1 |
| We suggest that the NCQA would consider it an OCI for one vendor to perform both the metric calculations and conduct the audit of those collected measures. We suggest DHA consider separating those two processes if the intent of the RFP includes both the calculation of the health plan clinical quality measures require and an audit of the programming code used to calculate these measures. |
| The annual audit of the MHS-PHP must be performed by a NCQA certified vendor. The audit requires review of the source code and data utilized by the Government, (not work performed by a contractor), to calculate measure performance. |
| 26 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.1 Health Plan Clinical Quality Measures (Direct and Purchased Care), paragraph 6.3.1.1 |
| The NCQA Means and Percentiles are now issued with a license that governs their use and we are prepared to secure that license. If these same means and percentiles are to be used in the required benchmarking, will DHA secure the appropriate agreement with NCQA for their use or will the contractor be required to obtain such an agreement? |
| The DHA currently purchases the benchmarks from NCQA each year and provides the quality contractor with the benchmarks to utilize in displaying the MHS comparisons. The expectation is for this to continue under the new TQMC contract. |
| 27 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.1 Health Plan Clinical Quality Measures (Direct and Purchased Care), paragraph 6.3.1.1 |
| DHA describes the use of “select NCQA HEDIS® measures.” Can DHA provide an approximate number of HEDIS® measures that are to be analyzed by the contractor? |
| DHA currently monitors 13 HEDIS® measures for the direct and purchased care systems in the following categories (identified in CDRL Q010 provided in the solicitation): cancer screening, diabetes care, asthma care, well childcare, and mental health follow-up. As a result of the recent Secretary of Defense review of Quality, Safety and Access, the DHA is looking at potentially adding additional HEDIS® measures, but no decision has been made to date as to how many (if any) or which measures to add. |
| 28 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.1 Health Plan Clinical Quality Measures (Direct and Purchased Care), paragraph 6.3.1.1 |
| DHA reserves the right to change its quality measures as needed. Can DHA describe how often these measures have change historically? |
| NCQA has historically retired measures, altered technical specifications, and added new measures over time. The DHA, like all other health plans, must follow NCQA measure guidance and technical specifications. Most recently, NCQA retired measures for LDL screening and modified technical specifications for cervical cancer screening. Joint Commission also modifies ORYX® measures in a similar manner. Contract modifications will be made when changes occur to the measures currently identified in the respective CDRL (See CDRLs Q010, Health Plan Data Reporting; Q020, ORYX® Data Reporting; and Q030-ORYX® Data Submission). |
| 29 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.1 Health Plan Clinical Quality Measures (Direct and Purchased Care), paragraph 6.3.1.2 |
| Can DHA describe some of your data requirements? For example will you be looking for trending analysis? For each reporting region, would you want to see trends over a number of reporting periods? If there are various summary reports, would an executive level summary dashboard be deployed? |
| DHA would expect the TQMC to display data trends in the most appropriate manner. Examples include the use of statistical process control charts, bar graphs, and line charts. Trend data might be most meaningfully displayed over a period of 1, 2 or more years, by quarter or other appropriate interval, depending upon the measure and intent of the graphical display. The data from this contract may be posted to an existing Government executive dashboard; the contractor would not be expected to provide its own executive level dashboard. |
| 30 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.1 Health Plan Clinical Quality Measures (Direct and Purchased Care), paragraph 6.3.1.3 |
| Performing both audit and production functions for monthly reports will streamline DHA processes and provide efficiencies this requirement. Please clarify: Do the monthly performance reports for the MTF and MCSCs have to be audited, produced or both? |
| The performance reports are not formally audited, but DHA expects the TQMC contractor to accurately download, analyze and report data for both direct and purchased care. The COR will review the contractor’s processes and performance. |
| 31 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.2 National Hospital Quality Measures (NHQM) (Direct and Purchased Care), paragraph 6.3.2.1.1 |
| 1. Please advise if DHA’s goals are to compare the National Hospital Quality Measures (NHQM) data from military facilities to private (PPS) facilities, MTFs to other MTFs, PPS to other PPS, and/or MTFs to PPS? |
2. Should the analysis of PPS facilities be restricted to care provided only to military beneficiaries or to all patients seen within that facility?
1) The goal is to enable TRICARE beneficiaries to identify which facilities are network providers, and to review the CMS Hospital Compare data for network provider performance. It is also to enable beneficiaries to compare MTF performance for like-measures against both network and non-network providers in their geographical area.
2) Data for civilian (aka PPS) facilities is not stratified by TRICARE vs. non-TRICARE beneficiaries. The CMS Hospital Compare lists data for all patients cared for in a facility, to include those who are TRICARE eligible.
| 32 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.2 National Hospital Quality Measures (NHQM) (Direct and Purchased Care), paragraph 6.3.2.1.1 |
| How can additional methods/technologies to further automate (in addition to current analysis) the analysis of Quality measures provide additional insights into captured quality data? |
| DHA is currently working with CMS to post its data for comparable Hospital Compare measures on the CMS Hospital Compare website (https://data.medicare.gov/data/hospital-compare). This will provide standardized data reporting for direct and purchased care in a single public site. See Solicitation Section C, paragraph 6.3.2.1.1. |
| 33 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.2 National Hospital Quality Measures (NHQM) (Direct and Purchased Care), paragraph 6.3.2.1.2 |
| CMS hospital quality data is based on data that is one quarter to six months old. How should the contractor account for this lag time when comparing MTF data to PPS hospital data? What is the lag, if any, for data from MTFs? |
| The time lag for MTF ORYX® data collection is 4 months after the close of the quarter. The time lag for CMS to post Hospital Compare data is approximately 9 months. The contractor must align the timing of these data collection periods to ensure comparability of the two data sets. |
| 34 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.2 National Hospital Quality Measures (NHQM) (Direct and Purchased Care), paragraph 6.3.2.1.3 |
| Can DHA provide an estimate of the number of charts that will require to be extracted for the purposes of the Hospital Compare Timely and Effective Care comparisons? |
| This data abstraction occurs at the time of the scheduled chart review for ORYX® data (See Solicitation Section C, paragraph 6.1.13 for frequency). Therefore, the number of charts abstracted may vary based upon the ORYX® measures that are selected for submission to the JC by each MTF. For 2014 ORYX® quarterly chart abstractions, the mean was 23,148 charts, with a median of 22,572 per quarter. The number of charts abstracted for Hospital Compare will be the same as that abstracted for ORYX®. |
| 35 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.2 National Hospital Quality Measures (NHQM) (Direct and Purchased Care), paragraph 6.3.2.1.6 |
| Is there an established set of “Timely and Effective Care” measures or will these be defined by the contractor? |
See Solicitation Section C, paragraph 6.3.2.1. The CMS Hospital Compare establishes these measures.
| 36 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.3 Joint Commission ORYX® Hospital Quality Measures (Direct and Purchased Care), paragraph 6.3.3.1 |
| Please clarify: Will all 12 CORE measures be abstracted each quarter or only a select number of measures abstracted per quarter? |
| The contractor will abstract all 14 CORE measures at each MTF, regardless of which measures the MTF chooses to submit to the Joint Commission (see Section C, paragraphs 6.3.3.1, which reflects the correct number of CORE measures, and 6.3.3.6). |
| 37 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.3 Joint Commission ORYX® Hospital Quality Measures (Direct and Purchased Care), paragraph 6.3.3.5 |
| Which entities should be included in the calculation of national performance rates? |
| The national performance rate is calculated by the Joint Commission for ORYX® and published for comparison purposes. See Solicitation Section C, paragraph 6.3.3.5.. |
| 38 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.3 Joint Commission ORYX® Hospital Quality Measures (Direct and Purchased Care), paragraph 6.3.3.7 |
| How are selection decisions made from the ORYX® core measures to assist in the transition to new core measure sets? Would there be benefit in analysis or core measures to drive the evolution of new core measures as opposed to following their implementation? |
| The Joint Commission creates and publishes new core measures for hospitals to utilize on a mandatory or elective basis. For the elective measures, the TQMC contractor will assist MTFs to determine the applicability of the measure to their facility, and in transitioning the MTF to any new core measures selected for use. Each MTF is ultimately responsible for selecting which core measures will be submitted to the JC. |
| 39 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.3 Joint Commission ORYX® Hospital Quality Measures (Direct and Purchased Care), paragraph 6.3.3.7 |
| In the monthly teleconference with the MTFs, would there be a benefit to providing MTFs with insight to the causes of adverse events, triggers and categories in the monthly calls, or in a separate report? BI capabilities would allow deeper analysis that could identify root causes that are not currently addressed but could drive significant positive impact. |
| See Solicitation Section C, paragraph 6.3.4.4, regarding the GTT. The TQMC will develop and provide each inpatient MTF with a monthly report of identified triggers and identified harms by trigger and category. This contract requirement does not include the identification of root causes due to the brief amount of time allotted for the review of each chart. The results of this will be discussed with each inpatient MTF on the monthly telephone call referenced in paragraph 6.3.4.6. This should provide each MTF with insights into the causes for adverse events, and the reports will categorize triggers. |
| 40 |
| Section C, 6.0 Technical Requirements, 6.3 Performance Measurement and Reporting, 6.3.4 Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT) (Direct Care) |
| We recognize the benefits of the GTT model utilizing “triggers” to identify AEs. We have successfully presented this tool/trained/abstracted/reported outcomes for the DHA PC population and support its use with DC providers. |
| Noted. |
| 41 |
| Section C, 6.0 Technical Requirements, 6.5 Medical Reviews, 6.5.1 Quality and Utilization Reviews (Purchased Care), paragraph 6.5.1.1 |
| Describe your current review methods for each of the categories of reviews? What analytical models are currently in place to gain insights from the captured data? What methods are deployed to evaluate the results and current methods deployed? What considerations are currently in place to enhance the generally accepted standards? |
| The DHA reviews the TQMC report of its findings to identify any trends in the purchased care system that might require corrective action. All data analysis is performed by the Government, and not by the Contractor. |
| 42 |
| Section C, 6.0 Technical Requirements, 6.5 Medical Reviews, 6.5.1 Quality and Utilization Reviews (Purchased Care), paragraph 6.5.1.3 |
| Can you describe some of your current methods and technologies for identifying potential cases of fraud? IBM has significant assets that are deployed (for example in the banking and insurance industry) to detect fraud and proactive capabilities to prevent fraud. IBM would be pleased to discuss opportunities in fraud detection and prevention. Predictive capabilities can also provide a significant advantage in identifying the factors that indicate fraudulent behavior, to enhance the methods used to find potential situations for analysis. |
| The DHA does not prescribe any specific fraud detection methodologies for potential offerors to use but notes the 32 CFR 199.5 requirement for the TQMC contractor to report potential cases of fraud and abuse. |
| 43 |
| Section C, 6.0 Technical Requirements, 6.5 Medical Reviews, 6.5.1 Quality and Utilization Reviews (Purchased Care), paragraph 6.5.1.5 |
| Please provide more information on anticipated sample size and available data to conduct these screens. |
| Solicitation Section L Exhibit L-6 provides historical information on workload volumes from 2012-2014. Also, see response to question 41. |
| 44 |
| Section C, 6.0 Technical Requirements, 6.5 Medical Reviews, 6.5.1 Quality and Utilization Reviews (Purchased Care), paragraph 6.5.1.6 |
| IBM has developed Watson technologies that can perform some automated peer reviews. These reviews can then be brought to the attention of a board certified licensed physician who can then review the results of the automated review process. Further manual reviews can be performed as needed. Can DHA describe how an automated tool developed to assist in the quality reviews of cases can be integrated within your current processes? |
| DHA will not prescribe how potential offerors propose to perform peer reviews other than it must meet all of the requirements listed in Solicitation Section C, paragraph 6.5.1.6. |
| 45 |
| Section C, 6.0 Technical Requirements, 6.6 Quality Improvement Studies, 6.6.1 Clinical Quality Improvement Studies (Direct and Purchased Care) |
| DHA describes the use of data from administrative means and/or medical record abstraction; can DHA provide an estimate of the proportion of records anticipated to require abstraction? |
The general rule of thumb is that a clinical study requiring chart abstraction will require a statistically valid sample of charts, based upon the denominator of patients eligible for inclusion in the study. A clinical quality study that is not clearly amenable to solely using administrative data will require chart abstraction. DHA cannot anticipate the proportion of records that will require abstraction. However, Solicitation Section L Exhibit L-6 does contain historical information on workload volumes from 2012-2014.
| 46 |
| Section C, 6.0 Technical Requirements, 6.6 Quality Improvement Studies, 6.6.1 Clinical Quality Improvement Studies (Direct and Purchased Care), paragraph 6.6.1 |
| Does DHA anticipate that the studies will be focused on hospitals and facilities (both purchased care and direct care) or also on ambulatory care? |
Historically, purchased care quality improvement studies have been performed using only inpatient records due to the difficulty in obtaining ambulatory records. Should access to outpatient records in purchased care improve, these studies may be considered in the future. Both inpatient and outpatient records can be readily obtained for the performance of direct care studies.
| 47 |
| Section C, 6.0 Technical Requirements, 6.6 Quality Improvement Studies, 6.6.1 Clinical Quality Improvement Studies (Direct and Purchased Care), paragraph 6.6.1.3 |
| What does DHA envision for the size and scope of the two studies per year? |
| The size and scope of the studies will depend on the subject matter selected for the quality improvement studies. |
| 48 |
| Section C, 6.0 Technical Requirements, 6.6 Quality Improvement Studies, 6.6.1 Clinical Quality Improvement Studies (Direct and Purchased Care), paragraph 6.6.1.3 |
| What mechanism will DHA use to determine which of the proposed study topics will be selected? |
| The DHA will utilize established committees of subject matter experts in clinical quality from both the direct and purchased care sectors to determine the study topics. |
| 49 |
| Section C, 6.0 Technical Requirements, 6.6 Quality Improvement Studies, 6.6.1 Clinical Quality Improvement Studies (Direct and Purchased Care), paragraph 6.6.1.8 |
| Combining both the PC and DC population for studies will provide a more robust sample size and outcomes to promote clinical opportunities. The RFP suggests data collection should be done on-site at the MTF in order to conduct the focus study abstractions. Please confirm the preferred methodology is on-site for all MTF records requested vs. the ability to request/receive electronically or hard copy. KEPRO supports electronic record submission (cost efficient) and has the ability to request/receive records electronically or hard copy. |
| See Solicitation Section C, paragraph 6.6.1.7. |
The intent of this paragraph is that remote access to medical records in the direct care system should be utilized whenever possible and practicable. If remote access is not possible, on-site abstraction at the MTF will be required by the TQMC staff. MTF staff will not replicate records for submission to the TQMC, nor perform any record abstraction for the TQMC. Purchased care records must be requested from the PC contractors and may be sent to the TQMC either in hard copy or electronic format.
| 50 |
| Section C, 6.0 Technical Requirements, 6.6 Quality Improvement Studies, 6.6.2 Autism Care Demonstration (ACD) Study (Purchased Care) |
| What does DHA envision for the size of the annual Autism Care Demonstration study? |
| The study will be performed on a statistically valid sample of all autism spectrum disorder patients receiving ABA services as described in Solicitation Section C, paragraph 6.6.2. The TQMC will be required to calculate the sample size based on the total volume of eligible beneficiaries at the time of the study; the current volume of beneficiaries receiving ABA therapy is estimated to be around 10,000. |
| 51 |
| Section C, 6.0 Technical Requirements, 6.6 Quality Improvement Studies, 6.6.2 Autism Care Demonstration (ACD) Study (Purchased Care), paragraph 6.6.2.1 |
| Please clarify: “we are to be assessing the quality of care provided to TRICARE Beneficiaries by Board Certified Behavior Analysts (BCBA’s), Certified Board Assistant Behavior Analysts (BCaBA’s) and Behavior Technicians” in accordance to TOM Chapter 18 Section 18 – 6.0 ABA Provider Requirements: 6.0 explicitly outlines the requirements for each of these positions. Under this provision will we be required to assess the ABA provider’s credentials to ensure compliance? |
| TOM Ch. 18, Section 18, paragraph 6.0, does define the requirements for each type of ABA provider. However, the purpose of this contract requirement is not to assess credentials compliance. |
| 52 |
| Section C, 6.0 Technical Requirements, 6.6 Quality Improvement Studies, 6.6.2 Autism Care Demonstration (ACD) Study (Purchased Care), paragraph 6.6.2.1 |
| What is the estimated number of records to be audited for the Autism study? |
| The study will be performed on a statistically valid sample of all autism spectrum disorder patients receiving ABA services as described. The TQMC will be required to calculate the sample size based on the total volume of eligible beneficiaries at the time of the study. The current estimated volume of beneficiaries receiving ABA therapy is approximately 10,000. |
| 53 |
| Section C, 6.0 Technical Requirements, 6.6 Quality Improvement Studies, 6.6.2 Autism Care Demonstration (ACD) Study (Purchased Care), paragraph 6.6.2.2.2 |
| Will DHA provide direct access to the medical records needed for this task (ABA initial assessments and re-assessments and ABA treatment plans/treatment plan updates) or will the contractor work with third parties to obtain the records? |
| The TQMC must request records via the appropriate purchased care contractor for review. See Solicitation Section C paragraph 6.5.1. |
| 54 |
| Section C, 6.0 Technical Requirements, 6.8 Quality Communications |
| For the purpose of planning and budgeting, please confirm the number of purchased care contractors. The draft RFP reports the number of direct care facilities, however, not the number for purchased care. |
| See Solicitation Section C, paragraph 1.1.1. The purchased care system provides care through private sector contractors, including the three managed care support contractors (MCSCs), six Designated Providers (DP) under the Uniformed Services Family Health Plan (USFHP), the TRICARE Overseas Program (TOP) contractor, the TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC), TRICARE Dental Program (TDP), TRICARE Retiree Dental Program (TRDP) and the TRICARE pharmacy program (TPharm)”. |
The number of facilities for purchased care is not available. An overview of the TRICARE program, including purchased care contractors for the TRICARE health plans, can be viewed at the site http://tricare.mil.
| 55 |
| Section C, 6.0 Technical Requirements, 6.8 Quality Communications, paragraph 6.8.1. |
| Experience demonstrates that providing national webinars is an excellent method to reach providers. Offering programs to all DHA providers, both DC and PC, will reach an extended audience. To maximize this requirement, please confirm: Are only the monthly webinars for purchased care contractors (6.8.1) or are they for all of the Quality Communications activities? It is only for 6.8.1 that the draft RFP explicitly states that purchased care contractors are to be included. |
| See Solicitation Section C, paragraph 6.8.3 which refers to both the direct and purchased care systems. Purchased and direct care providers will have full access to the public portions of the web site. Purchased care contractors will have access to select portions of the secure web site at the discretion of DHA. |
| 56 |
| Section C, 6.0 Technical Requirements, 6.8 Quality Communications, paragraph 6.8.1 |
| IBM technology is changing the way healthcare is delivered to children around the globe. Our award winning solution enables doctors with the tools necessary to share expertise interactively around the globe. IBM can bring that technology to DHA as a way of sharing best practices in healthcare quality and safety. |
| DHA will not prescribe how potential offerors meet the requirements of this contract. |
| 57 |
| Section C, 6.0 Technical Requirements, 6.8 Quality Communications, paragraph 6.8.3 |
| Please confirm: Is the intent that the contractor improve an existing web site or develop and maintain a new web site? |
| See Solicitation Section C, paragraph 6.8.3 and subparagraphs.. |
| 58 |
| Section C, 6.0 Technical Requirements, 6.8 Quality Communications, paragraph 6.8.3 |
| Can DHA share your current vision for enabling mobile technologies that may enhance the ROI of the web site? |
| DHA will not prescribe to any potential offeror how to meet the requirements of this contract. |
| 59 |
| Section C, 6.0 Technical Requirements, 6.8 Quality Communications, paragraph 6.8.3 |
| Mobile technologies are a disruptive force in the healthcare industry. Can you describe your current mobile use of the MHS web site? |
| There is currently no specific mobile access to the MHS-CQM website. |
| 60 |
| Section C, 6.0 Technical Requirements, 6.8 Quality Communications, paragraph 6.8.3 |
| Can you share any of your plans/insights into how mobile technologies can be deployed in the field as your auditors and reviewers perform their job functions as member hospitals and facilities? |
| DHA currently strongly encourages remote access for direct care record abstraction using encrypted laptop computers. There are currently no “smart phone apps” or similar technology employed in the DHA quality contracts. |
| 61 |
| Section C, 6.0 Technical Requirements, 6.8 Quality Communications, paragraph 6.8.3 |
| Who currently maintains the MHS Clinical Quality Management Web Site? |
| This site is currently maintained by the MHS-CQM incumbent contractor Lockheed Martin. |
| 62 |
| Section C, 6.0 Technical Requirements, 6.8 Quality Communications, paragraph 6.8.3 |
| Where is the Clinical Quality Management Web Site hosted? |
| It will be hosted by the Government. |
| 63 |
| Section C, 6.0 Technical Requirements, 6.8 Quality Communications, paragraph 6.8.3 |
| Will ownership of the domain www.mhs.cqm.info, web site code, content, and any related databases be transferred from the outgoing to the incoming contractor? |
| The responsibility of the website will transfer. See Solicitation Section C, paragraph 6.2.1.3. |
| 64 |
| Section C, 10.0 Travel, paragraph 10.2 |
| “The goal is to abstract the data remotely however this is an evolving capability. The contractor will visit approximately 60 % of the inpatient MTFs one time per quarter and will visit 25% of the MTFs three times per quarter.” Is the travel still mandated even if the facilities are capable of remote abstraction? |
| No. See Solicitation Section C, paragraph 6.1.13; and Section H, paragraph 8.0. |
| 65 |
| Section H, Special Contract Requirements, |
1.0 Penalties, paragraph 1.3
| Will the reduction be on just the invoiced task order related to the ORYX® submission? Or does it apply to the entire contractor invoice? |
| See Solicitation Section G, paragraph 5.0, and Section H, paragraph 1.0. |
| 66 |
| Section H, Special Contract Requirements, |
1.0 Penalties, paragraph 1.3
| Has this penalty been paid in the past 3 years? |
| No. |
| 67 |
| Section H, Special Contract Requirements, |
1.0 Penalties, paragraph 1.3.1 and 1.3.2
The penalties specified under Section H, paragraphs 1.3.1 and 1.3.2 are onerous; will DHA eliminate these in the final RFP?
Noted. DHA will not eliminate the performance guarantees specified in Section H. ORYX data submissions and case reviews are critical processes that must occur within the prescribed timelines.
| 68 |
| Section H, Special Contract Requirements, |
2.10 HIPAA Business Associate Provisions
| The references throughout Section H, paragraph 2.10 need to be corrected to reflect the correct numbering; the section refers to itself as Section H paragraph 2.8 instead of paragraph 2.10. |
| See Solicitation Section H. |
| 69 |
| Section H, Special Contract Requirements, 2.13 Individual Notification Provisions |
| Section H, paragraph 2.13.6 refers to “breach response procedures set forth below” yet Section H ends without detailing any procedures. Please clarify what breach response procedures must be followed. |
| See Solicitation Section H. |
| 70 |
| Section L, Instructions, Conditions, and Notices to Offerors, 2.0 General Instructions, paragraph 2.1.10 |
| What is the amended period of performance on this contract? |
| See Solicitation Sections B and F. The contracting officer will update the contract periods of performance prior to award. |
| 71 |
| Section L, Instructions, Conditions, and Notices to Offerors, 7.0 Volume III, Past Performance Information (Factor 2, Past Performance), paragraph 7.1.1 |
| There does not appear to be any publically available information on the current direct care contract that will be combined with purchased care under this contract. So that all potential offerors may have equivalent information, please provide the direct care incumbent contract for bidders’ review. |
| The contracts for both the current TQMC and CQM are protected from release under FAR 2.101 & 3.104. In its commitment to ensuring fair opportunity for all offerors, DHA has incorporated the CQM and the TQMC requirements in the solicitation. Historical information is included in Section L Exhibits L-6 and L-7. |
| 72 |
| Each offeror shall comply with the solicitation requirements and submit a clear, concise proposal that includes sufficient detail for the Government’s effective evaluation and validation of offeror’s stated claims. |
(Page 3, Section L, 2.1.2) Since this is anticipated to be an IDIQ contract, will there be multiple awardees? And, if there are multiple awardees, will the proposal process include an IDIQ proposal and a task order proposal?
The contracting officer anticipates awarding a single indefinite delivery/indefinite quantity (IDIQ) contract with fixed-unit prices to the responsive, responsible offeror whose proposal represents the best overall value to the Government. The two contracts were combined into a single requirement to decrease unwarranted variation in quality monitoring while improving MHS data collection and trending across the continuum of care consistent with the DHA Quadruple Aim
| 73 |
| 4.0 GOVERNMENT FURNISHED EQUIPMENT (GFE) AND INFORMATION (GFI): |
5.0 CONTRACTOR FURNISHED ITEMS:
(Pages 4-5, Section C, 4.0 and 5.0)
| It’s unclear what specifically would be required from an infrastructure standpoint in order to perform the work. Specifically, does the contractor utilize its own corporate network or will all work containing sensitive information, remain on the DOD network utilizing GFE equipment? |
| Yes. See Solicitation Section C, paragraphs 4.0 and 5.0. |
| 74 |
| The contractor shall ensure that all employees, consultants, and subcontractors supporting the TQMC sign the DHA Non-Disclosure/Non-Use Agreement, (CDRL: R080) before performing any work. The contractor shall also ensure that all staff understand and adhere to the terms of the non-disclosure statement, protecting all Health Insurance Portability and Accountability Act (HIPAA), Protected Health Information (PHI), Personally Identifiable Information (PII), and procurement sensitive information of the Government and the proprietary information of other contractors (see Section H, paragraph 2.). |
(Page 4-5, Section C, 5.2)
| There’s a mention of Section H, paragraph 2 regarding security protections, but we are unable to locate this section even within the DOD manuals. |
| See Solicitation Section H, paragraph 2.0, General Requirements Overview--Personally Identifiable Information (PII), Protected Health Information (PHI) and Federal Information Laws; and Section I, DFARS Clause 252.204-7012, and DFARS Clause 252.239-7001. |
See Solicitation Section C, paragraph 2.0.
| 75 |
| Procedures for ensuring on time abstraction and submission of the Joint Commission (JC) ORYX®® data |
(Page 7, Section C, 6.1.12, last bullet) Will the contractor be required to collect both Core measures and eMeasures for JC ORYX® submission?
AMI - Acute Myocardial Infarction SCIP - Surgical Care Improvement Project OP – Hospital Outpatient CAC – Children’s Asthma Care HBIPS - Hospital-Based Inpatient Psychiatric Services STK – Stroke VTE - Venous Thromboembolism PC – Perinatal Care ED – Emergency Department IMM – Immunization SUB – Substance Use TOB – Tobacco Treatment eAMI – Acute Myocardial Infarction eCAC – Children’s Asthma Care eED – Emergency Department ePC – Perinatal Care eSCIP – Surgical Care Improvement Project eSTK – Stroke eVTE – Venous Thromboembolism DHA does not currently have the capability to transmit ORYX® e-measures but reserves the right to add this capability in the future. All Core measures collected by DHA will continue to utilize manual abstraction.
| 76 |
| Transfer website content and all active files….. detailing status of record. |
(Page 8, Section C, 6.2.1.4) Will the contractor be required to create a website, or maintain an existing website?
Also, can you define “record?”
See response to question 57.
See Solicitation Section C, paragraph 6.2.2.4; and Section H, paragraph 2.4.
| 77 |
| There are additional NHQM data that are not currently in the DHA-designated database for inpatient MTFs. Therefore, the contractor shall conduct chart abstraction of inpatient MTF medical records to obtain data for any remaining Hospital Compare ‘Timely and Effective Care’ measures…. (Page 10, Section C, 6.3.2.1.3) |
| Is the data abstraction tool to collect the additional data already created, or will the contractor be required to develop the tool? |
| DHA is not aware of any electronic tool or software to collect/log this information. DHA will not prescribe how potential offerors propose to manage and perform the task beyond the stated requirements in the Solicitation. |
| 78 |
| The contractor shall provide all analyses to the COR and other authorized recipients via a secure website. |
(Page 10, Section C, 6.3.2.1.5) Will the contractor be required to create a website, or maintain an existing website?
And how many authorized recipients are there?
See response to question 57. The number of authorized recipients is not available.
| 79 |
| The contractor shall use the ORYX®® methodology to identify the applicable patient population for each core measure and define the appropriate data collection process. |
(Page 11, Section C, 6.3.3.2)
| What is meant by “the appropriate data collection process?” |
| Per Section C paragraph 6.3.3.2 ORYX® data collection specifications are defined by the JC for each measure. |
| 80 |
| The contractor shall provide a monthly report of GTT data for each military Service and NCR Medical Directorate (MD) as well as for the direct care system (all Services and NCR-MD). |
(Page 12, Section C, 6.3.4.5)
| How many users will need access to this data? |
| MTF level reports will be sent to the patient safety manager at each inpatient MTF. Military Service reports will be sent to each Military Service (to include National Capital Region (NCR) Medical Directorate patient safety manager. A DHA level report will be sent to the DHA patient safety manager. |
| 81 |
| The contractor shall maintain a current listing of available mental health facilities (Section J, Attachment J-11, |
(Page 12-13, Section C, 6.4)
| There’s a mention of Attachment J-11, but we are unable to locate this section even within the DOD manuals. |
| See Solicitation Section J, Attachment J-11 |
| 82 |
| The contractor shall perform the following types of medical reviews: Medical Necessity (Reconsideration) Appeal Case Reconsiderations (both Internal and External –see Attachment J-6 Part 1, Description of Internal and External Reviews), (Page 13, Section C, 6.5) |
| There’s a mention of Attachment J-6 Part 1, but we are unable to locate this section even within the DOD manuals. |
| See Solicitation Section J, Attachment J-6. |
| 83 |
| 30 days prior to the start of each option year, the contractor shall obtain the TRICARE DRG Grouper software…. |
(Page 14, Section C, 6.5.1.7) Should the contractor include in its pricing any costs associated with the purchase of this software?
See Solicitation Section L, FAR Clause 52.216-1, and paragraph 8.0; and Section B CLIN Descriptions. The contract will be fixed price. See FAR 16.202. The cost for the TRICARE DRG Grouper software is related to CLINs X008, Quality and Utilization Reviews.
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Defense Health Agency