TQMC_Pre-Proposal_Conference_PowerPoint_Presentation.pdf

TRICARE Quality Monitoring Contract (TQMC)

Solicitation HT9402-15-R-0005 Pre-Proposal Conference

June 5, 2015

Defense Health Agency (DHA) 16401 East Centretech Parkway Aurora, Colorado 80011-9066

Pre-Proposal Conference Agenda

• Welcome/Introductions

• Overview of the TQMC Requirement

• Proposal Preparation

• Conclusion

Welcome/Introductions

• Ms. Margaret Zancanella, Contracting Officer, Contract Operations Division, Aurora, Co.

• Ms. Cynthia Turk, Contract Specialist, Contract Operations Division, Aurora, Co.

• Dr. Barry Cohen, Chief, Evidence Based Care, Clinical Support Division, Falls Church, Va.

• Ms. Margaret Class, RN, Chief, Clinical Quality, Clinical Support Division, Falls Church, Va.

TQMC Solicitation HT9402-15-R-0005

Primary Point of Contact:

Ms. Margaret Zancanella Contracting Officer Margaret.A.Zancanella.civ@mail.mil Phone: (303) 676-3451

Secondary Point of Contact:

Ms. Cynthia Turk Contract Specialist cynthia.d.turk.civ@mail.mil Phone: (303) 676-3534

Pre-Proposal Conference

• Thank you for your interest!

• Purpose of the Conference:

• Improve offerors’ understanding of Government requirements

• Allows potential offerors to judge whether or how they can satisfy the

Government’s requirements

• Enhances the Government’s ability to obtain quality supplies and services at reasonable prices, and increase efficiency in proposal preparation, proposal evaluation, negotiation, and contract award.

• Statements made at the conference are informational only.

• Any exchange of information shall be consistent with procurement integrity requirements (see FAR 3.104, Procurement Integrity) and fair opportunity.

• This TQMC acquisition combines two previous requirements for external clinical quality oversight of the Military Health System (MHS) into a single quality oversight contract

• Oversight of clinical quality within the purchased care system

• Oversight of the clinical quality provided within the direct care system at military treatment facilities (MTFs)

• Incumbents: TQMC: KePRO. Direct Care Lockheed Martin.

• New requirements:

• Global Trigger Tool

• Evaluation of the Autism Care Demonstration project

TQMC Program Overview

TQMC Program Overview, cont.

• Purpose: To assist the DHA Clinical Support Division (CSD) in assessing and improving the quality of care delivered under the TRICARE benefit across the direct and purchased care systems.

• Decrease unwarranted variation in the quality of medical care,

• Implement proven clinical and business practices, and

• Create an environment for learning and continuous improvement across the MHS.

• Support DHA with the management of clinical quality performance measurement to validate the quality of care.

• Objectives: Support the MHS mission of greater integration of the direct and purchased care delivery systems.

• Support the MHS’s Quadruple Aim of Readiness, Population Health, Experience of Care, and Control of Per Capita Cost.

• Where specific performance standards are not stated, the contractor shall use healthcare industry best practices and standards.

• Contract Performance Outcomes:

• Timely and accurate independent and impartial evaluation of the healthcare provided to MHS beneficiaries to ensure quality of care, medical utilization and patient safety.

• Timely, comprehensive reviews that are consistent with the TRICARE requirements to ensure that appropriate levels of healthcare are provided for all beneficiaries.

• Measure, evaluate and compare clinical quality performance to national benchmarks to develop recommendations that transfer successes and identify superior quality healthcare services.

• Support MHS initiatives for data transparency.

• Use an effective management approach to provide the necessary services, incorporating healthcare best practices and standards when practicable.

• TRICARE quality monitoring is accomplished through

• External, 3rd 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

• Conducting comprehensive, timely medical peer reviews to ensure medically appropriate healthcare is provided per 32 CFR 199

• Direct Care System:

• 54 inpatient and 397 outpatient MTFs worldwide.

• Oversight of these facilities is provided by each Military Service’s headquarters.

• Scope (See Section C and Section L Exhibit L-6, Historical Workload

Volumes):

• Conducting clinical quality studies

• Collecting, submitting and presenting the National Hospital Quality

Measures (NHQM) data for comparative analysis with healthcare organizations nationwide and to support the accreditation of Department of Defense (DOD) hospitals.

• Collecting, analyzing and displaying MHS clinical quality measures data with nationally comparable benchmarks in support of the MHS Strategic Plan.

• Conducting external reviews of MTF Standard of Care (SOC) cases.

• Purchased Care System:

• Provided worldwide by the following contracts:

• 3 Managed Care Support Contracts, TRICARE Overseas Program, 6

Designated Providers, TRICARE Dental Program and Retiree Dental Program, Pharmacy Program, and TRICARE Dual-eligible Fiscal Intermediary Contract (TDEFIC).

• Scope (See Section C and Section L Exhibit L-6, Historical Workload Volumes):

• Clinical quality studies

• Reviews of medical, surgical and mental health cases to determine the medical necessity and appropriateness of care provided

• Assessing evolving practices, devices, medicines, treatments and procedures

• Approving applications for and certifying behavioral health facilities

Workload common to both direct and purchased care includes, but is not limited to:

• Conducting clinical quality studies

• Accessing, analyzing, and reporting health plan quality data for comparative analysis with national benchmarks

• Conducting monthly, interactive, web-based seminars focused on clinical quality topics that promote knowledge transfer and the sharing of best practices in healthcare quality and safety

• Program Management (Section C, paragraphs 6.1 and 6.2)

• Single point of contact (POC) to oversee the tasks of this contract

• All personnel, to include subcontractors, shall be qualified to perform their assigned responsibilities in terms of credentials, education, training and experience, consistent with healthcare best practices and standards

• Utilize a nationally recognized process for credentialing, and maintain current and accurate records for all healthcare reviewers

TQMC PROGRAM OVERVIEW, cont.

• Program Management (cont’d)

• Program Management Plan (PMP) (CDRL AP030)

• Comprehensive Transition-In Plan (CDRL OT010, Transition-In Plan)

• Medical record access is a critical element for successful execution of requirements

• Remote access to MTFs

• Performance Measurement and Reporting (Section C, paragraphs under

6.3)

• Joint Commission ORYX ® ( Direct Care)

• HEDIS ® ( Direct and Purchased Care)

• National Hospital Quality Measures (Direct and Purchased Care)

• Institute for Healthcare Improvement Global Trigger Tool (Inpatient

Direct Care)

• Related Performance Measurement Requirements

• Annual HEDIS® Compliance Audit of the MHS Population Health Portal for selected HEDIS® measures

• Annual review of newly released ORYX ® measures for applicability to direct care system

• Quarterly submission of MTF ORYX® Core measure data per Joint Commission criteria to support MTF JC accreditation

• Medical Reviews (Section C, paragraph 6.5)

• Medical Necessity Reconsideration Reviews

• Appeals and Hearings Internal and External Reviews

• Transition Assistance Management Program (TAMP) Benefit Extension

Second-Level Reviews

• Standard of Care Reviews

• Quality of Care (QOC) Reviews

• Clinical Quality Studies (Section C, paragraph 6.6.1)

– The goal of the studies is to improve the quality of the healthcare delivered and reduce variation within the MHS

– Specific to direct care, purchased care or the entire MHS

– Data obtained via administrative means utilizing DHA databases and/or medical record abstraction

– Study reports shall be comparable to the quality of performance improvement studies presented in professional medical healthcare literature

New Requirements:

• Global Trigger Tool (Section C, paragraph 6.3.4)

• Developed by the Institute for Healthcare Improvement (IHI) to identify patient harms

• Monthly reporting requirements to inpatient MTFs, Military Services, DHA

• Monthly teleconferences with inpatient MTFs during Option Year 1

• Autism Care Demonstration (ACD) (Section C, paragraph 6.6.2)

• Annual study to assess the quality of Applied Behavior Analysis (ABA) provided to TRICARE beneficiaries with ASD

• Audit claims data and medical records on a statistically valid sample of new and continuously enrolled ACD beneficiaries during each fiscal year

• Questions?

TQMC Proposal Preparation, cont.

• Solicitation HT9402-15-R-0005

• Also known as a request for proposals (RFP).

• Posted on Federal Business Opportunities (fbo.gov.).

• CO will post any amendments on FBO.

• Proposals & Past Performance Questionnaires are due 1200 Noon

(Mountain), June 19, 2015.

• Late proposals will not be considered for award.

• The CO is the official DHA point of contact (POC) for this solicitation.

• The CO assigned Ms Turk, Contract Specialist, to coordinate with offerors for delivery of proposals and receive solicitation questions.

TQMC Proposal Preparation , cont.

• The TQMC solicitation:

• Full and open competition using best-value, tradeoff source selection procedures (FAR 15.3 as supplemented, Section M, paragraph 2.1)

• Award of a single Indefinite Delivery Indefinite Quantity (IDIQ) contract with fixed unit prices

• The period of performance includes:

• A transition-in period, plus five 1-year option periods

• Transition-out will occur concurrently with the last option period exercised

• Per Section L, paragraph 2.1.8 The CO will update the contract to reflect the actual period of performance dates prior to award.

Contract Type: Fixed-price, IDIQ Advisory & Assistance Services (A&AS

FAR 37.2)

• Indefinite delivery FAR 16.5

• Indefinite-quantity FAR 16.504

• Basic IDIQ contract sets forth

• Contract ceiling, minimum and maximum quantities (not to exceed ).

• Delivery parameters

• Pricing

• CO issues individual task orders in accordance with Sections C and G.

• Task order further defines the requirement(s), sets delivery schedules, orders specific quantity(ies), and provides funding

• Terms are more flexible than with options

• Used for requirements with predictable quantity ranges, short lead times

• Read entire Solicitation, including all sections, attachments and background information and any amendments carefully

• Pay special attention to Sections L and M

• Section L contains the Instructions, Conditions, and Notices: Proposal preparation instructions.

• Section M contains the Evaluation Factors: How DHA will evaluate proposals.

• Failure to comply with the RFP instructions could result in the proposal being ineligible for award (Section L, paragraph 2.1.5)

• The solicitation and resulting contract are interpreted as a whole.

• Plain English takes precedence over technical language.

• Offeror is responsible for being familiar with the applicable FAR and

DFARS references and industry best practices and standards.

• It is the offeror's responsibility to ensure its proposal meets the solicitation requirements

• The Contracting Officer will post any subsequent revisions (if any) as amendments to the solicitation on fbo.gov

• Proposal consists of 5 volumes. See Section L, Table 1, Proposal Volumes and Table 2, Proposal Page Limits

• Section L, paragraph 4.5 The proposal shall not reflect a marketing or sales presentation.

• Unnecessarily elaborate proposals beyond those sufficient to present a complete and effective response to this solicitation are not desired.

• The proposal shall illustrate the offeror’s capability and clearly demonstrate the organization and methodology that will satisfy the solicitation requirements.

Organizational Conflicts of Interest (OCI) (FAR 9.5, TQMC Solicitation Section H)

• Section L, paragraph 2.2.3.1 The following companies have an actual or potential organizational conflict of interest, which must be avoided, neutralized, or mitigated: A-Team Solutions, LLC; Architecture, Engineering, Consulting, Operations and Management (AECOM); Axiom Resource Management Inc.; Booz Allen Hamilton (BAH); Cherokee Information Services (CIS) Inc. and its subcontractor, ThinkQ; Ernst and Young; Kennell and Associates Inc.; Compliance Automation Inc.;

Concept Plus, LLC; E.R. Williams Inc.; Information Technology Solutions & Consulting, LLC (ITSC); Intellidyne, LLC; Kforce Government Solutions, Inc. (KGS); Lockheed Martin Services, Inc.; National Government Services, Inc.; SofTec Solutions, Inc.; and Deloitte Consulting, LLP.

• This is not an exhaustive list. Offeror shall use sound business judgment and determine the significance of any OCI.

• Section L, paragraph 2.2.4 states

• Offeror shall represent in writing in its proposal that, to the best of the offeror’s knowledge, there are no relevant facts or circumstances concerning any past, present, or potential contracts or financial interest relating to the work to be performed, which could give rise to an organizational conflict of interest.

• In the event an actual or potential OCI exists, the offeror shall submit a mitigation plan to the CO.

Former DoD officials/employees OCIs

• Section L, paragraph 2.3.1, Offeror shall comply with FAR Part 3, Improper

Business Practices and Personal Conflicts of Interest, and DFARS 203

• Paragraph 2.3.2, Use of Former DOD/DHA Employees and Uniformed Service Members in Proposal Preparation. (See DFARS 252.203-7005 above for provision)

• Each offeror shall use sound business judgment and determine the significance of any conflict of interest

Award without Discussions (Section L, paragraph 2.1.6 )

• DHA intends to evaluate offers and award a contract without discussions with offerors

• The offeror’s initial offer should contain the offeror’s best terms from a price and technical standpoint

• Award will be made on a competitive best value basis using the tradeoff procedures.

• See FAR Clause 52.215-1, Instructions to Offerors

Section M, Evaluation Factors for Award.

• Tradeoff Source Selection Procedures (FAR 15.101-1 as supplemented)

• Allows for a tradeoff between non-cost factors and cost/price

• Allows DHA to accept other than the lowest priced proposal or other than the highest technically rated proposal to achieve a best-value contract award

• Evaluation Factors (in order of importance) (Section M, paragraph 3.2)

• Factor 1, Technical Approach

• Factor 2, Past Performance

• Factor 3, Price

• Factor 4, Small Business Participation

• Section M, paragraph 3.2, Relative Importance of 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.

• Small Business Participation (Factor 4) is the least important.

• The non-price factors (Technical and Past Performance), when combined, are significantly more important than price (FAR 15.101).

Factor 1, Technical Approach (Section M, paragraph 3.3 )

• 4 Subfactors:

• Subfactor 1, Management and Staffing

• Subfactor 2, Performance Measurement and Reporting

• Subfactor 3, Medical Reviews

• Subfactor 4, Quality Improvement Studies and Evolving Practices

• Subfactor 1, Management and Staffing, and Subfactor 2, Performance Measurement and Reporting, are of equal importance and are more important than Subfactors 3 and 4

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

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

• Section L, paragraph 6.1: The offeror shall submit a written technical proposal that demonstrates the offeror’s understanding of the solicitation requirements and provides an effective and efficient technical approach for meeting the solicitation requirements consistent with healthcare best practices and standards.

• 6.1.1 The offeror shall clearly describe its approach and processes for performing the technical requirements of the solicitation. . .

• 6.1.2 The offeror shall provide convincing rationale that addresses how the offeror intends to meet the requirements in sufficient detail so that evaluators can determine if the proposal meets or exceeds the solicitation requirements. If the offeror uses industry best practices or established standards, the offeror shall provide sufficient detail so that the evaluators can validate it as such. Offerors shall assume that the Government has no prior knowledge of its facilities, capabilities or experience.

Factor 1, Technical Approach:

• Technical evaluation in accordance with Section M, paragraph 4.0

EVALUATION OF FACTOR 1, TECHNICAL APPROACH.

• Two Technical Ratings per Technical Subfactor.

• Technical Rating. See Table A. Technical Ratings

• Technical Risk. See Table B. Technical Risk Ratings

Factor 2, Past Performance (Section L, paragraphs under 7.0 and Section M, Paragraphs under 5.0):

• Offeror provides 3 past performance contracts for offeror and each first-tier subcontractor

• Recency: - Within the 3 years prior to June 19, 2015;

• Relevancy: Section L, paragraph 7.2.1.1 and Section M, paragraph 5.3.

and Table C, Past Performance Relevancy Ratings

• Quality: See Section M, paragraph 5.4: Government will use Past

Performance Questionnaires, CPARS reports, and other past performance information to determine quality of the work the offeror performed on past contracts

• Performance Confidence Assessment: See Section M, paragraph 5.5:

Based on the recency, relevancy, and quality, the Government will assess a performance confidence assessment rating relative to the offeror’s ability to successfully perform the requirements of this solicitation

• One performance confidence assessment rating will be assigned for each offeror after evaluating the offeror’s past performance in total.

• The offeror’s Volume III past performance information consists of two sections (Section L, paragraph 7.2):

• Past Performance Narrative (Section L, paragraph 7.2.1 Past

Performance Narrative)

• Past Performance Contract Descriptions (Section L, paragraph 7.2.2

Past Performance Contract Descriptions).

• Small Business subcontracting participation. (Section L, paragraph 7.3)

• Past Performance Questionnaires (PPQs) (Section L, paragraph 7.7)

• Sources of Past Performance Information:

• Provided by the offeror as stated in the solicitation

• Obtained from questionnaires tailored to the circumstances of the acquisition (See Exhibit L-2, Past Performance Questionnaire)

• Obtained from any other sources available to the Government to include, but not limited to, PPIRS, FAPIS, or other databases; interviews with Program Managers, Contracting Officers, and Fee-Determining Officials;

and the Defense Contract Management Agency

• DHA will review past performance information and determine the quality and usefulness as it applies to the performance confidence assessment

Past Performance Questionnaires (PPQs) (Exhibit L-2):

• Use Section L Exhibit L-2 posted as part of the TQMC Solicitation on

FBO

• The offeror or its first-tier subcontractor/teaming partner shall CLEARLY state the offeror’s name under which the proposal is submitted to the Government

• The past performance questionnaire will not be considered if DHA cannot determine whose past performance or the offeror team to which the past performance belongs

• Section L, Paragraph 7.7.2, It is the offeror’s sole responsibility to ensure questionnaires are submitted to the Contract Specialist and Contracting Officer by the date specified in Block 9 of the SF 33.

• DHA encourages offerors to follow-up with POCs to ensure questionnaires are completed and forwarded to DHA by the date specified in the solicitation.

Factor 3, Price (Section L, paragraph 8.0, and Section M, paragraph 6.0

• 8.1 Offeror shall submit fixed unit prices and extended amounts based on the Government-provided estimated quantities in Section B, Supplies or Services and Prices/Costs, and offeror’s completed Price Proposal (See Section L Exhibit L-11 Price Proposal Template).

• The offeror’s completed Section B constitutes its offer to the Government.

• Section L, Exhibit L-6, TQMC Workload Report, shows the volume of the tasks performed for each of the last 3 years.

• Section L, Exhibit L-7, TRICARE Direct Care Studies, shows the volume of the direct care studies performed for fiscal years 2011 to 2013.

• Section B and Section L Exhibit L-11: The estimated quantities are based on historical data and do not constitute the Government’s commitment that these quantities will actually occur over the course of the contract. See FAR 16.5, Indefinite-Delivery Contracts.

• For all CLINs/SLINs, the unit price in whole dollars with no cents multiplied by the estimated quantity for each respective CLIN/SLIN shall equal the extended amount on the SF 33 Section B, Supplies or Services and Prices/Costs, with no rounding.

• A zero dollar figure ($0.00) entered or a line item left blank will be interpreted as the CLIN/SLIN shall be provided at no cost to the Government.

• In the event there is a discrepancy between Volume IV, Price Proposal and the SF 33, Section B, the amounts on the SF 33, Section B, Supplies or Services and Prices/Costs, shall prevail.

• The price proposal shall clearly state the offeror’s proposed total price/total evaluated price (see Section M, paragraph 6.0).

• The price proposal shall state what portion of the total price is estimated to be attributable to the production or development of the DD Forms 1423-1, Contract Data Requirements List, to be delivered to the Government (not to the sale of rights in the data) (See Section L Exhibit L-11 TAB entitled “CDRL Cost Estimate”).

• It also shall include the price totals by CLINs/SLINs and option year. In the calculation of Total Evaluated Price, the Government will multiply the offeror’s proposed price for Option Period 5 by 0.5 for the possible 6 month extension of services under FAR 52.217-8, Option to Extend Services (See Section L Exhibit L-11, TAB entitled “Summary by CLIN, Option Yr”).

• Per Section L, paragraph 8.4 The offeror shall provide the basis for the proposed prices by major cost element, including the rationale and assumptions used for the estimates.

• The offeror shall provide sufficient detail in its price proposal to facilitate the Government’s examination and evaluation of the proposed prices in response to the solicitation.

• The offeror shall identify any judgmental factors applied and the nature of any contingencies included in the proposed prices.

• The estimated price to the Government shall reflect the use of prudent judgment and sound business practices, reflecting the offeror’s accounting policies and practices.

• The offeror shall provide its rationale for CLIN/SLIN price changes between option years and the assumptions used

• The electronic price proposal shall duplicate the hardcopy version and shall be in Microsoft Word and Excel.

• Include formulas, calculations, and worksheet/workbook links used to compute the proposed amounts.

• The formulas, calculations, and links shall not be hidden in order for DHA to verify the accuracy of the data.

• Print image files (for example JPG, PNG, GIF, TIF) or those files/worksheets containing only values are not acceptable.

• The types and formats of the data submitted are left up to the offeror to prepare and present in support of its proposed prices.

• DHA will evaluate in accordance with Section M, paragraph 6.0:

• Total evaluated price (Section M, paragraph 6.1): The sum of all priced Contract Line Item Numbers (CLINs )and Sub-line Item Numbers in Section B, Supplies or Services and Prices/Costs

• Transition-In Base Period plus each of the five 1-year options

• A 0.5 factor is applied to Option Year 5 for possible 6-month extension of services under FAR 52.217-8

• 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

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

• Options.

Factor 4, Small Business Participation (Section L, paragraph 5.5, and Section M, paragraph 7.0)

• Included in Volume I.

• Large businesses: include subcontracting plan in accordance with Section

L, paragraphs 5.5.1, and 5.5.2, and Section J, Attachment J-16, Small Business Subcontracting Plan Template

• Will be evaluated on Acceptable/Unacceptable basis in accordance with Section M, paragraphs 7.1. and 7.2

• Small businesses: comply with Section L, paragraph 5.5.3, Small Business Exception to Subcontracting Plan

• Will be evaluated on Acceptable/Unacceptable basis in accordance with Section M, paragraph 7.2.1

TQMC Proposal Preparation

• DHA strongly encourages offerors to read the DHA’s responses to offerors’ questions

• Offerors shall proceed with their proposal preparation based on the information in the solicitation and amendments, if any.

QUESTIONS?

TQMC

Pre-Proposal Conference

Thank you for attending