TQMC QA.pdf

Question RFP/Manual

Location Subsection/Citation Subject Question Government Response

1 General What is the anticipated Date of Award? Award is anticipated in the first quarter of FY23 2 General What date (on or about) is contract award? Award is anticipated in the first quarter of FY23 3 General What date (on or about) does the Base Period start? Base period is anticipated in the first quarter of FY23 4 General How many MTFs are not accessible remotely? 0

5 General How many GFEs are issued on the current contract and how many are anticipated to be issued for the Transition-In and OY1?

Approximately 30-35 GFE computers.

6 General Proposal Extension Request

Given the complexity of the solicitation and the important role this requirement plays in ensuring TRICARE beneficiaries receive high quality healthcare, please extend the proposal response time to provide 10 additional business days.

Solicitation due date has been extended via Amendments 0002 & 0003

7 General Proposal Extension Request

Would the Government consider an extension of 10 business days for submission of all RFP response materials?

Solicitation due date has been extended via Amendments 0002 & 0003

8 SF33

Proposal Extension Request

Due to the timing in regards to receiving answers back from the Government pertaining to questions received and the complexity of the solicitation requirements, we kindly request a 30-Day Extension and request the response due date of August 22, 2022.

Solicitation due date has been extended via Amendments 0002 & 0003

9 SF33 Sec 9 Proposal Extension Request

In order to allow sufficient time for the government to respond to questions, can the RFP due date be extended two weeks?

Solicitation due date has been extended via Amendments 0002 & 0003

Amendment-

SF 30

Section 11

Proposal Extension Request

Please extend the deadline for proposals by 30 calendar days to allow offerors to consider the CDRLs and address them in their proposals, given the below.

The Solicitation originally included references to Contract Data Requirements List (CDRL) such as in Section C.2.2, Acronyms and in Schedule B. But the solicitation did not include any detail regarding the specific requirements listed therein.

The CDRLs were not provided until June 28, 2022, which is less than 30 days before the deadline for submission of proposals.

Agencies must provide offerors with both sufficient information and sufficient time to address and price the agency’s requirements in their proposals. See:

▪ ASRC Fed. Data Network Techs., LLC, B-418085.4, May 5, 2020, 2020 CPD ¶ 164 (in sustaining a protest challenging the terms of a solicitation that did not provide information regarding the level of effort associated with certain requirements, confirming that “a contracting agency must provide offerors with sufficient detail in a solicitation to enable them to compete intelligently and on a relatively equal basis”)

▪ FAR 5.203(b) (requiring agencies to “establish a solicitation response time that will afford potential offerors a reasonable opportunity to respond”)

▪ MCR Fed., LLC, B-416654.2, Dec. 18, 2018, 2018 CPD 335 (response times must be “calculated to provide the firm with a fair opportunity to improve its proposal, or to maximize the agency's ability to obtain the best value”).

CDRLs were added 1 week after initial posting. Solicitation due date has been extended via Amendment 00002 and further extended via Amendment 00003

11 Section B 1.2 Is the contract ceiling of $75,000,000 inclusive of the 6-month option? Yes.

12 Section B 2 Supplies or Services, 1002AA

“National Hospital Quality Measures Data Collection Tools and Data Management (MTF with Essentris) FFP per Inpatient MTF per quarter. 192 EA”

What does the count of 192 represent?

This estimate assumes 48 inpatient MTFs providing pulling data over 4 quarters: this estimate is abstractions per quarter per MTF. The count of 192 is an estimate only, based on historical data. Actual quantities will be provided at the task order level and may vary from the estimate.

13 Section B 3 Supplies or Services, 1003AB

For pricing purposes, please clarify if/how many the 95,000 chart abstractions per year are be expected to decrease in favor of eCQM submission – and in which Option Year the decrease would start?

Please note that quantity of 95,000 chart abstractions is an estimate only.

Actual quantities will be provided at the task order level and may vary from the estimate.

Expectation is that chart abstractions will decrease but the Government is not currently able to predict because of transition of Services and Genesis roll-out. Once all MTFs can transmit ECQMs that are consistent with abstracted data, chart abstraction will eventually be phased out over

Location Subsection/Citation Subject Question Government Response

14 Section B 3 Attachment J-13 Supplies or Services, 1003AA and Attachment J-13

“Joint Commission ORYX® Data Collection Tools, Data Management and Data File Submission (For MTFs with Essentris) FFP per MTF per quarterly submission - 120 EA”

Please clarify the discrepancy between the 50 inpatient facilities (two of which appear to be transitioning to ambulatory care only) listed in Attachment J-13 and the implied 40 MTFS requiring data file submission each quarter over the life of the contract.

With a TJC minimum of three measures per MTF, the specification of 120 quarterly data file submissions, or 480 per year per Schedule B as cited above implies a consistent 40 MTFs (with Essentris) requiring ORYX® data file submission each quarter over the life of the contract.

48 MTFs are in transition to GENESIS so numbers are estimated. Please also note that the quantity is provided to offerors as an estimate;

however, actual quantities will be provided at the task order level and may vary from the estimate.

15 Section B 7 Supplies or Services, 1012, QoC Reviews

Please clarify to what this line item is in reference in Section C.

Section C, 5.5.1, last bullet item, references SoC/QoC reviews but otherwise there is no reference to QoC reviews as a separate task.

Section C, 5.5.5 cites Standard of Care (SOC) reviews of the direct care system, which are reflected in 1011. Section C, Section 5.5.2.2.1 and line item 1008 reference Quality and Utilization Reviews of private care, which is a different task.

QOC reviews are referenced in Section C 5.5.2.2.1

16 Section B 7 Supplies or Services, Ad Hoc Reviews

Please provide the number of units for the task per Section C, 5.5.6, Ad Hoc Medical Record Review and corresponding to CDRL R070.

In the event that Ad Hoc Medical Record Review is required, a separate CLIN will be added.

17 Section B 7 Supplies or Services, Autism Study

1014 indicates that the Annual Autism Care Demonstration Study is reimbursed at a fixed price per chart.

Please clarify if “price per chart” also includes the required analysis of claims data and report production (in addition to chart review).

Yes, this is a FFP CLIN per chart and should include the total price for all required information, to include the required analysis of claims data and report production.

18 Section B 7 Supplies or Services, 1031AA, 1031AB, Clinical Quality Studies

For these items, if a proposed study is of high complexity with numerous sub-topics identified for investigation, how will any additionally needed hours be handled?

Will they be broken down into smaller (subtopic) studies that do not exceed the hour limits? Or will additional hours be billed at the same hourly rate?

The hours provided in Section B are estimates only. In the event that a task order is awarded for these services, the total number of hours will be provided at that time.

19 Section B 7

Supplies or Services, 1013AC, 1013AD, Clinical Quality Improvement Abstraction Study

“Clinical Quality Improvement Abstraction Study (Fewer than 2,000 Records) (PWS Section 5 paragraph 5.6.1) Fixed price per chart. 2000 EA”

For pricing purposes, please provide historical data on the average number of charts abstracted for each study in this category.

Historical data is included in Section L, Exhibit L-5 TQMC Workload 2018-2020

Please note that quantity of 2,000 is an estimate only. Actual quantities will be provided at the task order level and may vary from the estimate.

20 Section B 18 Supplies or Services, 3004AH Leapfrog Health System Analyst

Please clarify why contractors must price for this specific analyst compared with providing the required analyst meeting solicitation requirements in the ways best suited for the contractor’s Best Value offeror– just as the contractor is pricing for all other solicitation requirements across labor categories?

We note that other analysts are required for the work in Section C, 5.1.2.1 for other clinical measures, including TJC and CMS, but there are no specific CLINs for those analysts.

This requirement has been changed. Please see amendment 00003.

21 Section B 18 Supplies or Services, 3004AJ, Leapfrog Administrative Assistant

Please clarify why contractors must price for this specific administrative assistant compared with providing required staffing to meet solicitation requirements in the ways best suited for the contractor's Best Value offeror – just as the contractor is pricing for all other solicitation requirements across labor categories?

This requirement has been changed. Please see amendment 00003.

22 Section B 43 Supplies or Services, 1.1., Min Guarantee

Please confirm the minimum guarantee is in addition to Transition-In payments.

In accordance with Section B, 1.0, the minimum guarantee will be satisfied under the first issued task order. The first task order will be issued for transition in services.

Location Subsection/Citation Subject Question Government Response

23 Section C 1.6.1 (C5) Transition

“Full performance start date is 5 months after the effective date of the contract award. Transition-in performance will occur during the first 5 months after the effective date of the contract award.”

Please clarify the difference between “effective date” of contract award cited here and “date of contract award” cited numerous times elsewhere throughout the solicitation and CDRL attachments, including

CDRL T010.

Contract award is the effective date of contract award.

24 Section C 1.6.1 (C5) Transition Should all dates of contract award be interpreted as “effective date” of contract award if the two dates differ?

Solicitation has been amended to clarify. See response to Question 23.

25 Section C 1.6.1.1 (C5) Can the Government provide a plug amount for Transition-In services so that the incumbent doesn't have a competitive advantage?

No.

26 Section C 1.7.1 (C5) Administrative Specifications

For place of performance, may employees, subcontractors, and peer reviewers work from home? Yes

27 Section C 1.7.3 (C5) Administrative Specifications

According to the solicitation, “The contractor is responsible for conducting business Monday through Friday between 8:00 a.m. to 6:00 p.m. Eastern Time (ET), except Federal holidays.”

Which specific items must be accomplished between 8:00 a.m. to 6:00 p.m. ET, except Federal holidays, that cannot be accomplished at other times outside of these parameters (e.g., can remote abstraction be performed outside of these timeframes)?

Please refer to Section C, 1.7.3

28 Section C 1.8 (C6) Please provide historical information regarding which MTFs were unable to provide remote access to the incumbent contractor.

No data available to provide. Please see response to Question 4.

29 Section C 1.8.1.1 (C6) Contractor Travel

This requirement states travel may be needed for Quality Improvement studies; does the DHA anticipate travel related to any other tasks, e.g., medical reviews or ORYX abstractions? If initiation of remote access is unable to be obtained, does DHA allow the submission of medical records in PDF format through a secure portal?

Travel is not currently anticipated for quality improvement studies, medical reviews or abstractions. Alternative submission of medical records will be discussed and reviewed by the COR or designee as needed. If at a later date it is determined that travel is required, it will be billed against CLIN X020 and will not exceed $10,000. Please also refer to 1.8, 1.8.3 for additional details on how travel costs will be reimbursed.

30 Section C 1.8.2 (C6 and G6) Contractor Travel, G.5.6, Travel and Meeting Attendance

For travel within the United States, for pricing purposes, please provide:

▪ How many meetings per year are anticipated requiring travel?

▪ How many personnel will be required per trip, on average?

▪ What type of personnel will be required per trip, on average?

Travel is not anticipated except for Leapfrog specific training - refer to

5.3.5.5.2.2. If at a later date it is determined that travel is required, it will be billed against CLIN X020 and will not exceed $10,000. Please also refer to 1.8, 1.8.3 for additional details on how travel costs will be reimbursed. For on-site support as needed for conference logistics needed during annual Quality conferences, please refer to 5.8.2.3.

Location Subsection/Citation Subject Question Government Response

31 Section C 1.14.1 (C10) Post Award Conference

“The contractor agrees to attend any post award conference. These meetings shall be at no additional cost to the government…”

If this is required in person, please specify where this conference will be held.

The post award conference will be held virtually.

32 Section C 1.14.1 (C10) Post Award Conference

“The contractor agrees to attend any post award conference. These meetings shall be at no additional cost to the government…”

Shall contractors then include the cost as part of Transition-In? How otherwise should contractors capture this cost so that it does not become an unallowable cost?

The post award conference will be held virtually.

33 Section C

1.14.1 (C10, C24, C44)

Section 1.14.1; Section 5.2; Section 5.8.2, Post Award Conference, Transition In/Out Meetings, Meeting Support

Regarding meetings:

▪ Which meetings are mandated on-site?

▪ How many meetings will be mandated on- site/year?

▪ When meetings are on-site, where on-site are they to be held?

Mandated on-site meetings are not anticipated at this time. If at a later date it is determined that travel is required, it will be billed against CLIN X020 and will not exceed $10,000. Please also refer to 1.8, 1.8.3 for additional details on how travel costs will be reimbursed.

34 Section C

3.4 (C17-C18)

4.4 (C19)

Clarification regarding government provided computers

Section C3.4 indicates that the Government will provide government computers for “all program managers, all contractors supporting SOC External Reviews, and the contractors providing Meeting Support, at a minimum”. However, section C4.4 notes that “the contractor shall have the equipment needed for all personnel providing support to meeting support, program management, and external reviews…” – please confirm which personnel will be provided computers by the government; whether software such as the TRICARE DRG Grouper software will be used on government computers, contractor computers, or both; and whether computers will be provided for all external reviews or only SOC reviews.

The Government will provide GFE computers for use in performance under this contract for all program managers, all contractors supporting SOC External Reviews, and the contractors providing Meeting Support, at a minimum. Please refer to Section C, PART 3

3.0 GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND

SERVICES & response to Question 5 above.

35 Section C 4 (PDF 48/211)

1.6 – Period of Performance

Section 1.6 references a Base Period of 5 months while section 1.6.1 references a 5 month transition that is not listed on the PoP table in section 1.6. Will the Government please clarify if the references to Base Period and Transition-in are being used interchangeably throughout the solicitation

Yes, the base period is the transition in period.

36 Section C 6 (PDF: 50/211)

1.7.4 – Emergency Services

As the solicitation mentions the potential need for "occasional" emergency services will these services be specifically requested at the Task Order level, so that the "occasional" emergency services can be accurately priced?

In the event of "occasional" emergency services, it will be requested at the task order level.

37 Section C C17-18 (PDF: 61-211) 3.4 – Equipment Does the government plan to provide any equipment for contractors performing reviews other than SOC or for meeting support? Does the government plan on providing any equipment for abstraction work that may support reviews?

The Government will provide computers for use in performance under this contract for all program managers, all contractors supporting SOC External Reviews, and the contractors providing Meeting Support, at a minimum. Please refer to Section C, PART 3

3.0 GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND

SERVICES. Please see responses to Questions 5 & 34 above.

38 Section C 5.2 Transition is not addressed in Exhibit L-12 however L.6.1.8 and L.6.1.9 in Subfactor 1 request transition-in approach and plan. Should the offeror address this Section C requirement for transition in and transition out?

Exhibit L-12 is provided as a guide only, and is not intended to be a substitute for the offeror's reading and complying with the solicitation requirements.

Location Subsection/Citation Subject Question Government Response

39 Section C 5.2.1.1

The contractor shall complete transition-in activities required to assume full responsibilities for the contract requirements. The contractor will have time-critical tasks to perform during the transition-in prior to the first day of Option Period 1. 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. Which tasks need government approval?

Examples include, but are not limited to: approval for CAC cards, access to systems, etc. Refer to Section C, 5.2 and CDRL 0T010.

40 Section C 5.2.1.4 (C24) Transition-In Does the new contractor inherit the outgoing contractor’s tools used for the ongoing surveillance data abstraction being performed (i.e., the data from one contractor to the next, from one year to the next, are abstracted using the same tools)?

The incumbent has developed proprietary medical review system and data abstraction tools that will not be provided; however, the HRM tracking tool and tools being used that are non proprietary will be provided to offerors.

41 Section C 5.2.2 (C24) Transition-Out For pricing purposes, please provide the timeframe (number of months) for Transition-Out activities.

The transition out time is contingent on the offeror's performance of all the transition out task, and it depends on the contractor's plan that will be submitted under OT020 for the COR's review. Generally, this takes about 2-6 months; however, CLIN 6022, Transition-out, is not based on time, but rather full performance of the transition out activities.

42 Section C 5.3 What are the DHA approved quality and performance analytic tools for visualization and analyses?

Examples include but are not limited to: Excel, Word, PPT, Tableau, statistical software and packages such as SPSS, SAS, etc. However, offerors may propose additional tools but must ensure legal and privacy considerations, and full compliance with Section 508 standards for accessibility.

43 Section C 5.3 Can you share the system architecture view of all the legacy and new EHR systems from which quality and performance data must be extracted?

Essentris EHR used is the legacy system, and the Cerner Millenium Record (MHS Genesis) is the new EHR system used for abstraction of inpatient measures.

44 Section C 5.3 For sites that switched to MHS GENESIS and are no longer using Essentris, is the data still accessible on local servers and for how long?

Data will be archived for access; however, it is unknown for how long.

Specific technical questions can be further addressed by SMEs when awarded, during transition in.

45 Section C 5.3 Will we have access to the raw data using SQL/CCL queries generated by contractor queries or will these be provided via the EMR Vendor? If generated by the contractor, is there a specific query generator tool that is required?

It is unlikely that contractors will have access to raw data using SQL/CCL queries.

46 Section C 5.3 What measures have been “previously” submitted to and by what methods?

Refer to CDRL A020; Government reserves the right to change the number of measures audited each year. Currently, the measures include cervical cancer screening, breast cancer screening, colorectal cancer screening, diabetes management, well child care, treatment for bronchitis and bronchiolitis, treatment for upper respiratory infection, testing for pharyngitis, mental health follow-up, antidepressant medication treatment, and imaging for low back pain. DHA may add additional or delete existing HEDIS® measures for validation at a future time. CMS Timely and Effective Care Measures for MTFs is submitted via csv file

47 Section C 5.3 What EMR access is granted to the contractor in order to validate the data? Does this include non-prod domain to test and validate data being pulled without effecting the live domain?

Appropriate access will be given that enables abstraction and verification of measure results

48 Section C 5.3 Can the government please provide a complete listing of the federal IT systems in which the contractor will access?

Systems include, but are not limited to: MHS PHP, MHS Management, Analysis and Reporting Tool (M2), MHS Data Repository (MDR), MHS Genesis, Armed Forces Health Longitudinal Technology Application (AHLTA). Specific details will be provided during transition-in with functional SMEs.

49 Section C 5.3.1 (C25) HEDIS Audit How many units of reporting (sets of HEDIS measure rates ) will be audited?

Refer to CDRL A020; Govt reserves the right to change the number of measures audited each year. Currently, the measures include cervical cancer screening, breast cancer screening, colorectal cancer screening, diabetes management, well child care, treatment for bronchitis and bronchiolitis, treatment for upper respiratory infection, testing for pharyngitis, mental health follow-up, antidepressant medication treatment, and imaging for low back pain. DHA may add additional or delete existing HEDIS® measures for validation at a future time.

Location Subsection/Citation Subject Question Government Response

50 Section C 5.3.1 (C25) HEDIS Audit Are the measures produced/calculated by a NCQA-certified measure vendor?

Measures are produced and calculated by the MHS; reviewed by certified NCQA auditor

51 Section C 5.3.1 (C25) HEDIS Audit Is the purchased care under the scope of the HEDIS audit? Private sector care data is included in HEDIS audit.

52 Section C 5.3.1 (C25) HEDIS Audit Is there any medical record review data collection used to report the HEDIS measures or is only administrative data (i.e. claims/encounters, pharmacy claims and other vendor claims) used?

Administrative data is used primarily; Some forms of supplemental data are also used. Medical record review data collection is not used.

53 Section C 5.3.1 (C25) HEDIS Audit Is supplemental data (i.e. EHR feeds, immunization registry data, etc.) used as a source for reporting the HEDIS measures?

Administrative data is used primarily; Some forms of supplemental data are also used. Medical record review data collection is not used.

54 Section C 5.3.1 (C25) Please confirm whether there is or is not any analysis of HEDIS data and the contractor is not required to purchase HEDIS data.

MHS provides HEDIS data results

55 Section C 5.3.1 (C29) (C25) PWS 5.3.1.3 mentions the NCQA-certified vendor will provide education and consultation for 6 hours per quarter. Can the Government clarify what type of consultation services are requested?

General HEDIS methodology training and best practices for improving beneficiary health and healthcare evidenced in measures scores.

56 Section C 5.3.1 (C29) (C25) For the HEDIS audit component, is the DHA/MHS data that is audited for compliance with NCQA HEDIS technical specifications submitted directly to NCQA via NCQA’s Interactive Data Submission System (IDSS), or is the audited data used for internal QI purposes only?

HEDIS auditor reviews MHS data and processes for compliance; MHS directly interacts with NCQA or automated source code review (ASCR).

The MHS does not submit to NCQA via IDSS.

57 Section C 5.3.1 (C29) (C25) If data is submitted to NCQA via the IDSS, how many submission entities are there? MHS does not submit to NCQA via IDSS for health plan accreditation.

58 Section C 5.3.1 (C29) (C25) If data is not submitted to NCQA via the IDSS, does DHA/MHS have an license agreement or permission from NCQA for the use of the specifications and follow the allowable adjustments?

Yes. MHS purchases the technical specifications for licensed agreements. MHS has license agreement with NCQA for Automated Source Code Review (ASCR).

59 Section C 5.3.1 (C29) (C25)

Our understanding is that the HEDIS measures to be audited include cervical cancer screening, breast cancer screening, colorectal cancer screening, diabetes management, well child care, treatment for bronchitis and bronchiolitis, treatment for upper respiratory infection, testing for pharyngitis, mental health follow-up, antidepressant medication treatment, and imaging for low back pain. In reviewing this list, we would like to further clarify if the “diabetes management” measure (formerly known as the Comprehensive Diabetes Care measure) would be the updated, individual diabetes measures for eye exam, HbA1c testing and control, and blood pressure control. For mental health follow-up, would that be the Follow-up After Hospitalization for Mental Illness (FUH) measure?

MHS currently uses Comprehensive Diabetes Care (CDC) measure, HbA1c testing and control. MHS does not currently measure diabetes eye exam or blood pressure control for CDC.

60 Section C 5.3.1 (C29) (C25) Does DHA/MHS require a face-to-face HEDIS audit, or is a virtual audit visit acceptable?

Virtual is acceptable. However, if at a later date it is determined that in an in person HEDIS audit and travel is required, it will be billed against CLIN X020 and will not exceed $10,000. Please also refer to 1.8, 1.8.3 for additional details on how travel costs will be reimbursed.

61 Section C 5.3.1 (C29) (C25) Does DHA/MHS use a software vendor that is certified through NCQA to generate its HEDIS measure rates?

Measures are produced and calculated by the MHS and reviewed by certified NCQA auditor

62 Section C 5.3.1 Page 69 of 211 HEDIS Audit

The scope of work under 5.3.1.1 states that the contractor shall perform an annual HEDIS® Compliance Audit of the MHS systems and processes utilized to calculate the DHA selected HEDIS® measures to validate compliance with NCQA technical specifications (CDRL A020, Annual HEDIS® Compliance Audit). Please confirm whether DHA will require only one NCQA submission of HEDIS rates to be validated each year from data in the MHS systems.

Yes, once per year.

63 Section C 5.3.1 Page 69 of 211 HEDIS Audit

The scope of work under 5.3.1.1 states that the contractor shall perform an annual HEDIS® Compliance Audit of the MHS systems and processes utilized to calculate the DHA selected HEDIS® measures to validate compliance with NCQA technical specifications (CDRL A020, Annual HEDIS® Compliance Audit). Please confirm whether DHA will calculate and report rates using only administrative/claims data from the MTF systems.

Administrative data is used primarily; Some forms of supplemental data are also used. Medical record review data collection is not used.

64 Section C 5.3.1 Page 69 of 211 HEDIS Audit

The scope of work under 5.3.1.1 states that the contractor shall perform an annual HEDIS® Compliance Audit of the MHS systems and processes utilized to calculate the DHA selected HEDIS® measures to validate compliance with NCQA technical specifications (CDRL A020, Annual HEDIS® Compliance Audit). Please confirm whether DHA will calculate and report rates using any additional supplemental data files from other MCSC or other health systems.

Some forms of supplemental data are also used, including but not limited to: private sector care claims data. Medical record review data collection is not used.

Location Subsection/Citation Subject Question Government Response

65 Section C 5.3.1 Page 69 of 211 HEDIS Audit

The RFP states that Tricare Health Plan uses private sector contractors via Managed Care Support Contracts (MCSCs) to administer the Tricare Health plan. The scope of work under 5.3.1.1 states that the contractor shall perform an annual HEDIS® Compliance Audit of the MHS systems and processes utilized to calculate the DHA selected HEDIS® measures to validate compliance with NCQA technical specifications (CDRL A020, Annual HEDIS® Compliance Audit). Please confirm whether DHA will require one set of rates to be validated and submitted to NCQA or whether the HEDIS Compliance audit will include validation of rate submissions from the individual MCSCs as well.

If yes, How many separate rate submissions will require audit each year?

DHA will require one set of rates to be validated each year.

66 Section C 5.3.1 (C25) HEDIS Audit What HEDIS measures will be reported? Please refer to A020 for current measures

67 Section C 5.3.1 (C25) HEDIS Audit Does DHS submit HEDIS to NCQA?

DHA does not submit HEDIS measures results for accreditation to NCQA. HEDIS measures results are audited by a certified NCQA auditor.

68 Section C 5.3.1.3 (C25) HEDIS Audit “The NCQA-certified vendor shall provide education to all DHA staff….”

Will the required education be provided virtually or in-person?

Virtual is preferred. However, if at a later date it is determined that travel is required, it will be billed against CLIN X020 and will not exceed $10,000. Please also refer to 1.8, 1.8.3 for additional details on how travel costs will be reimbursed.

69 Section C 5.3.1.3 (C25) A potential HEDIS auditor has stated licensed HEDIS auditors cannot provide HEDIS education to the client as it is a conflict of interest and they could lose their license. Assuming this is true, can the contractor provide the HEDIS education indicated at 5.3.1.3?

Please refer to Section C, 5.3.1.2.

70 Section C 5.3.1.3 (C25) CMS Hospital/Care Compare Quality Measures

“The contractor shall obtain remote access to MTF electronic medical records to conduct data abstraction. DoD is in the process of transitioning from Essentris to MH GENESIS as the electronic health record.”

What IT /technological considerations and thus, pricing impacts, should bidders expect related to this Measure task when the medical records systems transition fully from Essentris to GENESIS?

Transition is occurring now through 2025. Impact is expected but additional detailed information about IT/technological considerations is unknown at this time.

Section C, Section G, Section L, Section M

C.5.3.2 G.6.6.2 (G6) L.6.2.1 (L13) M.5.2.1 (M4)

Sections G, L, and M all mention "National Hospital Quality Measures," which is outdated terminology. Section G references Section C paragraphs 5.3.2, 5.3.3. Neither section C 5.3.2 nor 5.3.3 mentions/lists "National Hospital Quality Measures ." Can we assume the Sections G, L, and M references should be to CMS Hospital/Care Compare Quality Measures (Section C 5.3.2) and TJC ORYX quality measures (Section C 5.3.3)?

"National Hospital Quality Measures" is verbiage still found on common web links. Yes, this is CMS Hospital/Care Compare Quality Measures.

72 Section C 5.3.2 (C25) CMS Hospital/Care Compare Quality Measures

Please provide sample redacted records from Essentris.

Sample redacted records have been included as a Section L Exhibit, please see amendment 0003.

73 Section C 5.3.2 (C25) CMS Hospital/Care Compare Quality Measures

Please provide sample redacted records from GENESIS.

Sample redacted records have been included as a Section L Exhibit, please see amendment 0003.

74 Section C 5.3.2 (C25) CMS Hospital/Care Compare Quality Measures

Via what file format and platform are the MTF-specific patient-level data created from measure data collection and analysis currently available to authorized users?

If this question refers to Care Compare results presentations, the contractor should use Care Compare, healthdata.gov, or other current platforms to obtain Care Compare quality measure results. If this question refers to data submission to CMS, csv is current file format.

75 Section C 5.3.2 (C25-C26)) CMS Hospital/Care Compare Quality Measures

For pricing purposes, how many inpatient charts are to be abstracted each quarter for Hospital Compare reporting?

48 inpatient MTFs are providing data over 4 quarters: estimate is 192 abstractions per quarter per MTF.

The count of 192 is an estimate only, based on historical data. Actual quantities will be provided at the task order level and may vary from the estimate.

Location Subsection/Citation Subject Question Government Response

76 Section C 5.3.2.1.2 The contractor shall provide the data collection tools and data management for CMS. Timely and Effective Care Measures for MTFs with Essentris. What does “the data collection tools and data management” mean? Do we develop those tools? Maintain the tools? Purchase the tools?

Contractor needs to have/supply the systems & programs necessary to collect and store the data for CMS T&E measures.

77 Section C 5.3.2.1.3 (C25)

The solicitation states “For MTFs with Essentris, the contractor shall ensure the MTF-specific patient level data created from measure data collection and analysis are available to authorized users as determined by Medical Affairs Clinical Quality Management Branch. There will be approximately 100 users authorized to access this CMS Timely and Effective Care measures data. As MTFs transition to MHS GENESIS, patient level data for the CMS Timely and Effective Care measures are available within the quality reports of the new DoD electronic health record.” Do the 100 authorized users need to have concurrent access to the information?

Contractor will anticipate 100 unique authorized users need to have concurrent access to all EHR information.

78 Section C

5.3.2.2 (C26) 5.3.2.2.1 5.3.2.2.2 5.3.2.2.2.1 5.3.2.2.2.2 5.3.2.2.3 5.3.2.2.3.1

Detailed Quarterly comparative analysis of ALL national CMS Care Compare measures for direct care and private sector care even if direct care data is not available. Performance and comparative data will be sliced across geo markets and include SPC/graphic displays.

1. Please confirm “all” Care Compare measures include eCQM’s and Hybrid Risk Adjusted Readmission and Mortality Rates which CMS plans to introduce within duration of future option years of this contract

2. SPC charts require a minimum number of quarters as data points. How many quarters of historical data does the DHA expect for the SPC charts and will the quarterly updates be “rolling” additions?

1. Yes, all.

2. CMS data is based on rolling years; quarterly updates will also be rolling additions.

79 Section C 5.3.3 (C26) TJC ORYX Hospital Quality Measures (Direct Care)

The TJC DDSP has been inactive since September 2021. Is there a backlog of measure data that the new contractor would be responsible for submitting?

The DDSP will open on 5 August 2022. A backlog may occur; however, TJC has not announced the data submission schedule so it is unknown at this time. Once a submission schedule is known, a backlog can then be characterized.

80 Section C 5.3.3 (C26) TJC ORYX Hospital Quality Measures (Direct Care)

Do both Essentris and MHS GENESIS have the capability of creating QRDA I category files for submission to TJC?

Essentris, no. MHS GENESIS, yes. The MHS currently has a waiver for submission of eCQMs to TJC for all facilities using Essentris, and Cerner facilitates eCQM for the facilities using MHS GENESIS.

81 Section C 5.3.3 (C26) TJC ORYX® Hospital Quality Measures

Please provide a list of all ORYX measures currently being utilized by MTFs, plus a list of what measures are expected to be used during the life of the contract.

TJC decides on measures yearly. Therefore, the Government is unable to predict what measures will be selected over the contract's life.

82 Section C 5.3.3 (C26) TJC ORYX® Hospital Quality Measures

What are DHA’s plans to replace chart-abstracted measures with eCQMs? How should contractor’s price for this?

This is a FFP contract -- it is incumbent upon the contractor to determine pricing methodology.

Once all MTFs can transmit eCQMs that are consistent with abstracted data, chart abstraction will eventually be phased out over time. However, this is dependent upon TJC being able to ensure data is comparable to chart abstracted data. In addition, there may be a need for chart abstraction for special studies.

Location Subsection/Citation Subject Question Government Response

83 Section C

5.3.3 (C26) Schedule B

1003AB

TJC ORYX® Hospital Quality Measures

Do the requirements under 5.3.3 and quantity under 1003AB for 95,000 EA mean that all eCQMs will be concurrently validated by chart abstraction?

The measures are validated through a Cerner algorithm. The abstractor validates Chart Abstracted measures, and if data can't be found, the information is forwarded back to the MTF for resolution.

Please note that quantity of 95,000 chart abstractions is an estimate only.

Actual quantities will be provided at the task order level and may vary from the estimate.

84 Section C 5.3.3 (C26) TJC ORYX® Hospital Quality Measures

Is there any record abstraction and data submission required for MTFs using Cerner’s MHS Genesis

EHR?

Yes.

85 Section C 5.3.3 (C26-C27) TJC ORYX® Hospital Quality Measures

What formats will the contractor be expected to support when accessing records and other data remotely?

For MTFs with MHS GENESIS, the contractor shall submit the MTFs’ ORYX® chart-abstracted measure data via The Joint Commission’s Direct Data Submission Platform (DDSP) or other designated Joint Commission Platform according to Joint Commission criteria (CDRL Q060, ORYX® Data Submission) to support MTF TJC accreditation.

86 Section C 5.3.3 (C27) TJC ORYX® Hospital Quality Measures

“For MTFs with Essentris, the contractor shall submit the MTFs’ ORYX® chart abstracted measure data via The Joint Commission’s Direct Data Submission Platform (DDSP) or other designated Joint Commission Platform…”

For pricing purposes, how many MTFs are anticipated to be still using Essentris at time of contract award and therefore will use the other designated TJC platform?

It is estimated that 48 MTFs will use the Genesis platform to submit data.

All OCONUS MTFs will remain on Essentris for the rest of 2022, with a transition to MHS Genesis starting sometime in 2023. No date for OCONUS MTF Transition.

87 Section C 5.3.3 (C27) TJC ORYX® Hospital Quality Measures

What method of submission is proposed or specified for MTFs using the GENESIS EHR?

For MTFs with MHS GENESIS, the contractor shall submit the MTFs’ ORYX® chart-abstracted measure data via The Joint Commission’s Direct Data Submission Platform (DDSP) or other designated Joint Commission Platform according to Joint Commission criteria (CDRL Q060, ORYX® Data Submission) to support MTF TJC accreditation.

Location Subsection/Citation Subject Question Government Response

88 Section C 5.3.3 (C26-C28) TJC ORYX® Hospital Quality Measures

“Not later than 90 days after TJC’s release of a new or revised ORYX® Measure (eCQM and chart abstracted)…

Which MTFs submit eCQMs to TJC? Please list by name or DMSID for pricing purposes.

The current list includes the following: Brooke Army Medical Center Bassett Army Community Hospital Naval Hospital Beaufort Naval Hospital Bremerton USA MEDDAC Korea (Brian Allgood) Naval Medical Center Camp Lejeune Naval Medical Center Camp Pendleton 96th MDG (Eglin AFB) 673d Medical Group (JBER) Fort Belvoir Community Hospital Martin Army Community Hospital William Beaumont Army Medical Center Womack Army Medical Center Blanchfield Army Community Hospital Evans Army Community Hospital Eisenhower Army Medical Center Darnall Army Medical Center Weed Army Community Hospital Bayne Jones Army Community Hospital Irwin Army Community Hospital Winn Army Community Hospital General Leonard Wood Army Community Hospital US Naval Hospital, Guam US Naval Hospital Guantanamo Bay Naval Hospital Jacksonville 81st MDG (Keesler AFB) Keller Army Community Hospital 48th MDG (RAF Lakenheath) Landstuhl Regional Medical Center Madigan Army Medical Center 35th Medical Group - Misawa AB, Japan US Naval Hospital- Naples, Italy 99th Medical Group (Nellis AFB) US Naval Hospital - Okinawa, Japan 51st Medical Group (Osan Korea) Naval Medical Center Portsmouth US Naval Hospital Rota Spain Naval Medical Center San Diego US Naval Hospital Sigonella 60th Medical Group David Grant Medical Center Tripler Army Medical Center Naval Hospital Twenty-nine Palms Walter Reed Military Medical Center 88th Medical Group, Wright Patterson Medical Center US Naval Hospital - Yokosuka, Japan 374th Medical Group (PACAF)

89 Section C 5.3.3 (C26-C28) TJC ORYX® Hospital Quality Measures

Please list by name or DMSID which MTFs DHA expects to be participating in ORYX® data submission in Option Years 1 through 5 for pricing purposes.

The current list is provided below; however, it is subject to change:

Brooke Army Medical Center Bassett Army Community Hospital Naval Hospital Beaufort Naval Hospital Bremerton USA MEDDAC Korea (Brian Allgood) Naval Medical Center Camp Lejeune Naval Medical Center Camp Pendleton 96th MDG (Eglin AFB) 673d Medical Group (JBER) Fort Belvoir Community Hospital Martin Army Community Hospital William Beaumont Army Medical Center Womack Army Medical Center Blanchfield Army Community Hospital Evans Army Community Hospital Eisenhower Army Medical Center Darnall Army Medical Center Weed Army Community Hospital Bayne Jones Army Community Hospital Irwin Army Community Hospital Winn Army Community Hospital General Leonard Wood Army Community Hospital US Naval Hospital, Guam US Naval Hospital Guantanamo Bay Naval Hospital Jacksonville 81st MDG (Keesler AFB) Keller Army Community Hospital 48th MDG (RAF Lakenheath) Landstuhl Regional Medical Center Madigan Army Medical Center 35th Medical Group - Misawa AB, Japan US Naval Hospital- Naples, Italy 99th Medical Group (Nellis AFB) US Naval Hospital - Okinawa, Japan 51st Medical Group (Osan Korea) Naval Medical Center Portsmouth US Naval Hospital Rota Spain Naval Medical Center San Diego US Naval Hospital Sigonella 60th Medical Group David Grant Medical Center Tripler Army Medical Center Naval Hospital Twenty-nine Palms Walter Reed Military Medical Center 88th Medical Group, Wright Patterson Medical Center US Naval Hospital - Yokosuka, Japan 374th Medical Group (PACAF)

90 Section C 5.3.3.5.1 (C28)

TJC spec review of new and revised eCQM’s and Chart abstracted measures.

Measure applicability to the populations served by MTF’s based on specifications and patient volumes in previous year and assessment of availability of required data elements

1. We assume eCQM’s refer only to Cerner Genesis MTF’s. Will the contractor have access to the Cerner QRDA 1 eCQM data files for this analysis.

2. Will Cerner Genesis chart abstraction data be available for volume analysis of chart abstracted measures?

1. Essentris cannot produce ECQM data. MTFs that have transitioned to MHS Genesis can submit ECQM data. 2. Yes

Location Subsection/Citation Subject Question Government Response

91 Section C 5.3.3.6 (C28)

Oryx measure performance rates and “available” TJC comparative benchmarks

1. TJC does not have eCQM benchmark data. Would DHA be open to other sources of eCQM benchmark data?

TJC is currently benchmarking ECQM data against chart abstracted data.

Using other sources of comparison data would be very confusing.

92 Section C

5.3.3.7 (C28) 5.3.3.7.1

Annual eCQM and CQM selection coordination and guidance

1. Will this be for both Essentris and Cerner Genesis facilities?

2. Is the measure selection tool electronic files or web based?

1. Essentris cannot produce ECQM data. MTFs that have transitioned to MHS Genesis can submit ECQM data. 2. Paper Copy

93 Section C 5.3.4 (C27) TJC ORYX Hospital Quality Measures (Direct Care)

Can the DHA provide the number of MTFs that are currently using the Essentris platform and the number of MTFs transitioned to/utilizing the MHS GENESIS platform

It is estimated that 48 MTFs will use the Genesis platform to submit data.

All OCONUS MTFs will remain on Essentris for the rest of 2022, with a transition to MHS Genesis starting sometime in 2023. No date for OCONUS MTF Transition.

94 Section C 5.3.4 (C28) Clinical Quality Measurement Result Accuracy Validation

5.3.4.1 states the contractor shall validate the quality of the "administrative data" by comparing the measure result derived from administrative data to medical record abstracted data. How would "administrative data" be defined?

Administrative data are collected for billing purposes, e.g., diagnostic or procedure codes.

95 Section C 5.3.5 (C28) Clinical Quality Measurement Result Accuracy Validation

Will there be a CLIN added for 5.3.4 work tasks? Yes. Please see SLIN X003AC via amendment 00003

96 Section C 5.3.4 (C28) Clinical Quality Measurement Result Accuracy Validation

Does the DHA anticipate all measure results being validated, including the ORYX measures reported to

TJC?

Yes. All measure results will be validated by means within the contractor's scope and control. Electronic quality ORYX measures are validated through vendor algorithm. The abstractor validates Chart Abstracted measures, and if data can't be found, the information is forwarded back to the MTF for resolution.

97 Section C 5.3.4 (C28)

When validating the quality of the administrative data with the measure result of the medical record abstracted data, are there particular requests for which measures to validate? PWS 5.3.4.1. mentions existing quality measures methodologies such as HEDIS, risk adjusted mortality, post-partum hemorrhage rate, and Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ PSIs).

The methodologies listed in the solicitation are examples of existing quality measure methodologies; however, the data collection file shall reflect the existing quality measures related specifically to the Government selected validations and will vary based on the specific validation.

98 Section C 5.3.4 (C28 of C76) Can the government verify where cost for Clinical Quality Measurement Result Accuracy Validation should be factored in the Pricing Template?

It is at the contractors discretion to account for these costs within its proposal pricing.

99 Section C 5.3.4.1 (C29) Does the contractor have access to the administrative and claims data? Yes.

Location Subsection/Citation Subject Question Government Response

100 Section C 5.3.4.1.1 (C28-C29) Clinical Quality Measurement Result Accuracy Validation

“The contractor shall develop and manage chart abstraction data collection file for the selected measures.”

For pricing purposes, how many measures per year will be selected for validation?

Please refer to Section L, Exhibit L-5 TQMC Workload 2018-2020 for historic numbers.

101 Section C 5.3.4.1.1 (C28-C29) Clinical Quality Measurement Result Accuracy Validation

“The contractor shall develop and manage chart abstraction data collection file for the selected measures.”

To develop a sampling plan that meets 80% confidence level, please provide the historical error rate.

Historical error rate is plus or minus 5%. Across MTFs this may vary by measure.

102 Section C 5.3.4.1.1 (C28-C29) Clinical Quality Measurement Result Accuracy Validation

For pricing purposes, what is the anticipated average time needed per chart abstraction? It is incumbent upon the contractor to determine this information.

103 Section C 5.3.4.1.1 (C29)

Validation of HEDIS, Risk adjusted mortality, post-partum hemorrhage and AHRQ PSI’s Admin data measures using EHR abstraction

1. Will the existing measures database(s) be available and accessible to harvest patient populations by measure to generate the data abstraction patient files. Will it be possible to segment these patient data by EHR (Genesis and Essentris) for abstraction?

2. Will detailed measure specifications be provided for any DoD developed or modified measures or national measures without publicly available specifications

3. Please confirm all measures validated in this task use administrative only data sources and will exclude Hybrid HEDIS measures.

4. Please provide some guidance on the volumes and complexity of abstractions for the measure data validation

1.The government will provide the chart or record numbers for chart abstraction.

2. Yes, Government will provide information needed

3. The MHS uses administrative data sources including limited patient provided non-standard supplemental data such as a proof of colorectal cancer screening.

4. Please see SLIN X003AC as added via Amendment 00003. Please note these are estimates only; actual quantities will be provided at the task order level.

104 Section C 5.3.4.1.1 (C29) What are the "selected measures"? How many measures and will the number and measures change over the course of the contract?

Refer to A020, and Section C, paragraph 5.3.1.1. It is unknown at this time whether the measures will change over the course of the contract.

105 Section C 5.3.4.1.1 (C29) Is the confidence level calculated across all MTFs, will each MTF have a confidence level? Is it at the measure level?

Historical error rate is plus or minus 5% generally; however, across MTFs this may vary by measure. The government will compute the sample size and provide that information to the contractor. The information on the confidence level is provided informationally to make contractors aware of the of balance cost and adequate sample size.

106 Section C 5.3.4.1.1.2 (C29) RE: "until MHS GENESIS is fully deployed. "Once MHS GENESIS is fully deployed, will the task change in any way other than only abstracting from MHS GENESIS?

Ta…