TQMC_Section_L_Exhibit_L-5_Solicitation_Cross_Reference_Table.doc
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- Solicitation number
- HT9402-15-R-0005
- Issued by
-
Defense Health Agency
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Section L Exhibit L-5
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SECTION L, Exhibit L-5 Technical Evaluation Cross Reference Table
Exhibit L-5 provides a general cross-reference between solicitation sections and is not intended to be a substitute for the offeror’s reading and complying with the solicitation requirements. Offerors are not required to submit Exhibit L-5 as part of the proposal.
| Section L |
| Section M |
| Section C |
| Subfactor 1, Management and Staffing |
| 4.2. Subfactor 1, Management and Staffing |
| 6.2.1 The offeror shall describe its proposed management approach for establishing and maintaining experienced, qualified personnel with appropriate skill sets, and management positions (including consultants and subcontractors), facilities, systems, and infrastructure to achieve the solicitation requirements, incorporating best business practices when practicable. |
| 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 staff, facilities, systems, and infrastructure to achieve the solicitation requirements, incorporating best business practices when practical. |
| 6.1. Program Management and all its subparagraphs. |
| 6.2.2. The offeror shall describe its ability to manage contract operations to meet the solicitation requirements and integrate all contractor activities. The description shall include flow integration, organizational structure, lines of authority, subcontractor management, and performance monitoring and reporting. The offeror shall also describe its reporting interfaces between the offeror and the Government. The offeror shall include a description of the reporting structure and any sharing of personnel between and among the business entities for any joint venture or other business structure. The offeror shall specify which contract requirements shall be accomplished by each specific subcontractor. |
| 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. |
6.1.1 The contractor shall designate a single manager to oversee the tasks of this contract, supervise staff assigned to the tasks, and ensure that the tasks of the contract are performed efficiently, accurately, on time, and in compliance with the requirements of this document. The manager shall provide the COR with ongoing status updates of the tasks and any issues relating to the contract. The contractor shall establish and maintain sufficient and appropriate management, staff, management support services, resources and facilities necessary to achieve and maintain compliance with the requirements of this contract.
6.2.3. The offeror shall describe its processes and procedures for its Internal Quality Management Program (IQMP), and how it will integrate its IQMP to ensure accuracy and timeliness of services and products delivered.
| 4.2.3. The Government will evaluate whether the offeror has proposed an effective, comprehensive Internal Quality Management Program (IQMP) 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. |
| 6.1.11. Quality Management: The contractor shall establish and continuously operate an Internal Quality Management Program (IQMP) plan covering every aspect of the contractor’s operation to ensure control, accuracy, and timeliness, effective at the start of Option Year 1 and continuing through the life of the contract. |
6.1.11.1 The contractor shall assess its compliance with qualitative and quantitative standards, identify problems, and identify corrective actions planned or to be initiated. The contractor shall submit its IQMP plan 60 days prior to the start of the first option period and shall update the plan annually in collaboration with the COR within 30 days following the start of each option period. The IQMP plan (CDRL AP020, Internal Quality Management Program Plan) will detail all aspects of the contractor's quality program including the major components of the program, quality control activities, quality assurance functions, risk management, organizational responsibilities for quality management, and how identified quality problems will be monitored and resolved.
| 6.2.4. The offeror shall describe its approach for risk management program and processes and how risks will be mitigated to ensure the solicitation requirements are met. |
| 4.2.4. The Government will evaluate the offeror’s risk management program and process approach for completeness and the effectiveness of the proposed mitigation strategies to include transition and operations consistent with healthcare best practices and standards. |
| 6.1.11.1 The contractor shall assess its compliance with qualitative and quantitative standards, identify problems, and identify corrective actions planned or to be initiated. The contractor shall submit its IQMP plan 60 days prior to the start of the first option period and shall update the plan annually in collaboration with the COR within 30 days following the start of each option period. The IQMP plan (CDRL AP020, Internal Quality Management Program Plan) will detail all aspects of the contractor's quality program including the major components of the program, quality control activities, quality assurance functions, risk management, organizational responsibilities for quality management, and how identified quality problems will be monitored and resolved. |
6.2.5 The offeror shall describe its management approach for conducting medical reviews, quality studies, on-site behavioral health facility reviews, and performance measurement and reporting.
| 4.2.5. The Government will evaluate whether the offeror presents an effective management approach for conducting medical reviews, quality studies, on-site behavioral health facility reviews, and performance measurement and reporting consistent with healthcare best practices and standards. |
| 6.1.7 The contractor shall have procedures and policies in place that shall ensure independent and objective reviews consistent with healthcare industry best practices. |
6.2.6. The offeror shall describe its plan and processes to ensure it has an adequate number of licensed, board-certified, actively-practicing physician reviewers in all American Board of Medical Specialties (AMBS) or Bureau of Osteopathic Specialists (BOS) specialties, dentist reviewers in all American Dental Association Recognized Dental Specialty Certifying Board specialties, and non-physician reviewers, to perform the required work. The offeror shall describe its plan to address the potential need for additional sub-specialty reviewers in response to specific DHA requests.
| 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. |
| 6.1.4 The contractor shall obtain the services of actively practicing, board-certified, licensed doctors of medicine and osteopathy and dentists as necessary to perform the services of the contract. These professionals shall review services provided by the various MHS medical and dental specialties and subspecialties, as identified by the American Board of Medical Specialties, the Bureau of Osteopathic Specialists and the National Certifying Boards for Dental Specialties. Active participation means practicing a minimum of 20 hours per week. |
6.1.5 Section J, Attachment J-21, TQMC Specialty Reviewer Types, provides historical information regarding specialty types utilized for reviews under this contract. The list is not all inclusive because DHA may require other types of reviews in the future. As an example, in the most recent contract, the services of a forensic pathologist were required for a review. If a review requires a specialty not previously identified the contractor may request a 30-day extension for the review to secure those specialty provider services.
6.1.6 The contractor shall provide actively practicing non-physician reviewers of all the provider types set forth in 32 CFR 199.6, TRICARE Authorized Providers.
| 6.2.7. The offeror shall describe its processes for ensuring that its staff is appropriately qualified by education, training, and experience. The offeror shall also describe its procedures for ensuring that its employees, consultants and subcontractors are appropriately credentialed, along with its approach for ensuring that they maintain their required qualifications and certifications while performing under this contract. |
| 4.2.7. The Government will evaluate whether the offeror presents an effective approach to ensure that its staff is appropriately qualified by education, training, and experience; credentialed when appropriate; and that staff maintain its required qualifications and certifications while performing under this contract consistent with healthcare best practices and standards. |
| 6.1.2 The contractor shall ensure all personnel, to include subcontractors, are qualified to perform their assigned responsibilities in terms of credentials, education, training and experience. |
6.1.3 The contractor shall utilize a nationally recognized process to document its review and verification of the credentials, and maintain current and accurate records, for all healthcare reviewers under this contract. The contractor shall conduct the credentials verification process when the reviewer is first considered for employment or contract, and at least every 3) years after the individual has assumed reviewer responsibilities. The contractor shall ensure that all credentialed staff maintain the required qualifications and certifications while performing under this contract. Credentialing files shall be available for inspections and audit by the COR upon request.
6.2.8. The offeror shall describe its transition-in approach to be fully operational at the start of option period one.
| 4.2.8. 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. |
| 6.2.1 Transition-In: The incoming contractor will have time critical tasks to perform during the transition that must be accomplished before the contractor can begin providing the required services on the first day of option period one (OP1). The contractor may accomplish some of these tasks concurrently with others. However, there are certain tasks which the contractor must accomplish, and receive government approval before the contractor can proceed. |
6.2.1.1 Transition-In Plan: The TQMC contractor shall submit a comprehensive Transition-In Plan to the Contracting Officer no later than 5 days following contract award (CDRL OT010, Transition-In Plan). The plan shall address all events and milestones that need to occur for each functional area described in this contract to enable the start of services under this contract. The plan will be used to manage, track and evaluate the contractor’s performance during transition. This plan shall clearly describe the contractor’s control policies and procedures in accordance with standard industry practices for project administration, execution and tracking to ensure a seamless transition.
| Subfactor 2, Performance Measurement and Reporting |
| Subfactor 2, Performance Measurement and Reporting |
| 6.3.1. The offeror shall present its approach for ensuring timely, accurate abstraction, collection, analysis, display, reporting and benchmarking of the health plan quality measures and the posting of results. |
| 4.3.1. The Government will evaluate whether the offeror has proposed an effective approach for ensuring timely, 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. |
6.3.1. Health Plan Clinical Quality Measures (Direct and Purchased Care) 6.3.1.1 The MHS Population Health Portal (MHS PHP) contains MHS clinical quality data for outpatient performance measurement. Each month the contractor shall download MHS PHP data and then analyze and report health plan clinical quality measure data for all MTFs and purchased care network providers (CDRL Q010, Health Plan Data Reporting). DHA currently uses selected National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) measures. DHA reserves the right to change its clinical quality measures as necessary to meet DHA’s mission. The contractor shall identify the appropriate national comparable performance/benchmark for each measure, observed trends and opportunities for improvement.
6.3.1.2 The contractor shall post Health Plan Clinical Quality Measures data on the DHA-designated secure web site. DHA CSD shall determine authorized users.
6.3.1.3 In order to support MHS transparency initiatives, the contractor shall post MHS PHP data analysis with display (i.e. statistical process control charts, bar graphs, line charts) by MTF, Service, Region, eMSM, DP and MHS level.
| 6.3.2. The offeror shall present its approach for ensuring timely, accurate abstraction, collection, analysis, display, reporting and benchmarking of the National Hospital Quality Measures and the posting of results. |
| 4.3.2. The Government will evaluate whether the offeror has proposed an effective approach for ensuring timely, 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. |
| 6.3.2. National Hospital Quality Measures (NHQM) and all subparagraphs. |
| 6.3.3. The offeror shall present its approach for ensuring timely, accurate abstraction, collection, analysis, display, reporting and benchmarking of the ORYX® hospital quality measures and the posting of results. The offeror shall also describe how it will meet the requirements for ORYX® data submission to the Joint Commission (JC). |
| 4.3.3. The Government will evaluate whether the offeror has proposed an effective approach for ensuring timely, 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 approach for submission of the ORYX data to the JC. |
| 6.3.3. Joint Commission ORYX® |
Hospital Quality Measures and all subparagraphs.
| 6.3.4. The offeror shall present its approach for ensuring timely, accurate abstraction, collection, analysis, display, and reporting of the data utilizing the Global Trigger Tool as required. |
| 4.3.4. The Government will evaluate whether the offeror has proposed an effective approach for ensuring timely, accurate collection, analysis, display, reporting of the data utilizing the Global Trigger tool as required. |
| 6.3.4. Institute for Healthcare Improvement (IHI) Global Trigger Tool and all subparagraphs. |
6.3.5. The offeror shall describe how it will meet the requirements for completion of the annual HEDIS® Compliance Audit.
| 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. |
| 6.3.1.4. The contractor shall be, or retain the services of, an NCQA-certified vendor to perform an annual HEDIS® Compliance Audit of the MHS Population Health Portal of DHA selected HEDIS® measures (CDRL A010, HEDIS Audit). |
Subfactor 3, Medical Reviews
| 6.4.1. The offeror shall describe its approach for ensuring complete, timely, medical reviews by the appropriate qualified medical professional. |
| 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. |
| 6.5. Medical Reviews and all its subparagraphs. |
| 6.4.2. The offeror shall describe its approach for ensuring that each purchased care medical record reviewed for any reason is assessed for medical necessity and appropriateness of care. |
| 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. |
| 6.5.1. Quality and Utilization Reviews (Purchased Care) and all its subparagraphs. |
Subfactor 4, Quality Improvement Studies and Evolving Practices
| 6.5.1. The offeror shall describe its approach to identifying appropriate study topics and conducting clinical quality improvement studies which will provide specific and actionable recommendations for the Government to consider. |
| 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 which will provide specific and actionable recommendations for the Government to consider consistent with healthcare best practices and standards. |
| 6.6.1. Clinical Quality Improvement Studies (Direct and Purchased Care) and all its subparagraphs. |
6.5.2.
The offeror shall describe its approach to the design, methodology development, and execution of quality improvement studies. The offeror shall also describe how it would approach performing studies impacting both the direct and purchased care systems to evaluate the quality of care provided across the entire MHS as an integrated healthcare system.
4.5.2.
The Government will evaluate the effectiveness of the offeror’s approach to performing quality improvement studies that impact the direct care system, purchased care system, or the entire military healthcare system.
6.6.1. Clinical Quality Improvement Studies (Direct and Purchased Care) and all its subparagraphs.
6.5.3.
The offeror shall describe its approach to conduct a study to assess the quality of Applied Behavior Analysis.
4.5.3.
The Government will evaluate the effectiveness of the offeror’s approach to conducting a study to assess the quality of Applied Behavior Analysis
6.6.2. Autism Care Demonstration (ACD) Study (Purchased Care) and all its subparagraphs.
6.5.4.
The offeror shall fully describe its approach to performing both long and short assessments of evolving practices, devices, medicines, treatments and procedures.
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.
6.7. Assessment of Evolving Practices, Devices, Medicines, Treatments, and Procedures (Direct and Purchased Care) and all its subparagraphs.
TQMC HT9402-15-R-0001, Section L Exhibit L-5
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