J-and-A-Other-Than-Full-and-Open-Updated.pdf

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Patient Activation Measure FY2024
Solicitation number
APP240432
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About this file

This document is a Justification and Approval (J&A) for Other Than Full and Open Competition for a federal contract to continue using the Patient Activation Measure (PAM) tool for the Center for Medicare and Medicaid Innovation's (CMMI) Kidney Care Choices (KCC) Model.

The justification explains that the PAM tool is a proprietary measure owned by Phreesia (dba Insignia Health) and is the only tool that can meet CMMI's needs to collect quality performance data for the KCC Model. Discontinuing the PAM tool would cause unacceptable delays and compromise data collection and reporting for the ongoing model. The total estimated value of the proposed 1-year contract, including options, is $18,517,500. CMS conducted market research but determined there are no other sources capable of meeting the government's requirements. A notice will be posted to confirm there are no other qualified sources. If no other sources are identified, the contract will be awarded to Insignia Health on a sole source basis.

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JUSTIFICATION AND APPROVAL

FOR OTHER THAN FULL AND OPEN COMPETITION

Completion Instructions: The Department of Health and Human Services (HHS) has established a standard template for the preparation of a J&A for Other Than Full and Open Competition. If this is an 8(a) set-aside, please note this form is not required unless the acquisition is valued (including all options) at greater than $22 million. This template is NOT applicable for actions using simplified acquisition procedures (FAR Part 13), Federal Supply Schedule orders (FAR 8.4) or task or delivery orders subject to fair opportunity (FAR 16.505).

Tailor all aspects of this template to the individual acquisition. Consult FAR Subpart 6.3 for guidance. An addendum may be added in case additional space is needed.

When this document is printed, the blue italic instructions are automatically deleted on the printed version.

Acquisition Title:

Agency:

Acquisition Year (FY):

Author and Title:

2. Description of Action:

Nature: New Requirement Follow-on Requirement

Modification to Existing Purchase Order/Contract Number:

Pricing: Firm-Fixed Price Time & Materials Cost

Other:

Funds: OMA Other Funds:

Name of Proposed Contractor(s):

Street Address:

City, State, Zip:

3. Description of Services or Supplies:

Basis for Approval (FAR 6.303-1(d)): Individual Basis Class Basis

The total estimated value of the proposed action, including all options is $

As applicable, briefly describe the services or supplies required to meet the agency's needs, including make & model number where appropriate. Include quantities of supplies or period of performance for services. Provide information for any options included. If the action is a modification to an existing contract, distinguish clearly between the work covered by the original contract and the work to be obtained by the proposed modification.

https://www.acquisition.gov/far/part-8#FAR_Subpart_8_4 https://www.acquisition.gov/far/part-13 https://www.acquisition.gov/far/part-16#FAR_16_505 https://www.acquisition.gov/far/part-6#FAR_Subpart_6_3 https://www.acquisition.gov/far/part-6#FAR_6_303_1

4. Authority and Rationale: Identify the statutory authority, FAR title and FAR citation permitting other than full and open competition. It may be one of the following most commonly used citations by the operating divisions of the Department of Health and Human Services (HHS), but other exceptions may apply per FAR Subpart 6.3.

Actions other than simplified acquisition procedures (select only one and provide an explanation):

FAR 6.302-1: Only one responsible source and no other supplies or services will satisfy agency requirements, 41 U.S.C.

3304(a)(1)

Explain why the intended contractor is the only responsible source who can provide the required supplies or s ervices.

Discuss the unique capabilities, expertise, etc. that support the lack of competition/why no other type of supplies or servic es will satisfy agency requirements. Explain factors/unique qualifications such as proprietary data or exclusive licensing rights, if applicable. When competition is limited to items particular to one manufacturer, this justification must explain why the particular brand name, product, or feature is essential to the Government's requirements, and that market research indicates other companies' similar products, or products lacking the particular feature, do not meet, or cannot be modified to meet the agency's needs in accordance with FAR 11.105. If in connection with a follow-on contract for continued development or production of highly specialized equipment, detail the substantial duplication of cost or unacceptable delays.

FAR 6.302-2: Unusual and compelling urgency, 41 U.S.C. 3304(a)(2)

If unusual and compelling urgency is the basis for the justification, explain the chronological events leading up to the requirement and explain why time constraints cannot permit even a limited competition. Describe the detrimental effects/ serious injury to the mission of the requiring activity or to the government, financial or otherwise, that will result if this justification is not approved. Describe impact of required delivery/performance date. Describe the detrimental effects/ serious injury to the mission of the requiring activity or to the government, financial or otherwise, that will result if this justification is not approved and the product or service cannot be provided by the intended sole source contractor. Failure to plan for expiring funds is not a valid reason for citing this exception. May not exceed one year, including all options, unless the head of the agency determines that exceptional circumstances apply.

FAR 6.302-5: Authorized or Required by Statute, 41 U.S.C. 3304(a)(5)

Provide a citation to the statutory authorization and a brief description of its content, or identify the specified source or other agency.

Other (See FAR Subpart 6.3 for additional authority)

Provide the authority and citation to the applicable section of FAR 6.3.

Provide a full explanation to justify use of the exception.

5. Agency Actions to Take or Remove Barriers That Led to Other Than Full and Open Competition (If applicable):

Describe the actions, if any, the agency may take to remove or overcome any barriers that led to the restricted consideration prior to any subsequent acquisition for the supplies of services is made. If no such actions have been taken, explain why.

https://www.acquisition.gov/far/part-6#FAR_6_302_1 https://www.acquisition.gov/far/part-6#FAR_Subpart_6_3 https://www.acquisition.gov/far/part-11#FAR_11_105 https://www.acquisition.gov/far/part-6#FAR_6_302_2 https://www.acquisition.gov/far/part-6#FAR_6_302_5

6. Bridge Contracts:

For contract extensions or bridge contracts when a competitive follow-on is in the process of being developed, summarize history of current contract and explain the reasons for any delays in the acquisition. Include discussion of the milestones f or the follow-on action; the milestones should be as efficient as possible. Discuss why it would be neither cost effective nor realistic to expect another contractor to perform during the brief interim period; include issues such as start -up costs, phase-in, transfer of GFP, recruitment and staffing, etc. If the action is because of a protest, provide a brief discussion of the protest including the date the protest was filed and the basis of the protest. Explain that the action will provide the minimum quant ity or performance period.

7. Actions to Increase Competition:

Describe efforts made to compete the action, including whether a notice was or will be publicized as required by FAR Subpart

5.2 or which exception under FAR 5.202 applies. If a notice was publicized, discuss the number of written responses to the synopsis and the results of the assessment of the written responses. List sources, if any, that expressed, in writing, an interest in the acquisition. Provide rationale if interested sources were rejected. If applicable, state that no other sources have expressed interest, but all offers received shall be considered. Describe what actions will be taken to increase competition before subsequent acquisition of the supplies or services is required. You may state that an action is a one-time requirement, but if a similar requirement arises, every effort will be made to compete it to the maximum extent possible. If action is sole source because of proprietary data or licensing rights and there will be a continuing need for the requirement, there must be evidence that advanced planning has been initiated to overcome the barriers to competition, or there should be documentation to support an analysis that replacement costs/licensing purchase costs outweigh the benefits of competition. If the action is a contract extension or bridge, explain actions to compete the follow-on. If action is an urgent new requirement and a competitive follow-on is anticipated, explain that efforts are underway to facilitate a full and open competition.

8. Market Research:

Describe the extent of the market research conducted to identify all qualified sources and the results thereof. “Market Research” is defined as those attempts you made to ascertain whether other qualified sources exist, and can include contact with knowledgeable experts regarding similar or duplicate requirements, contact with industry, results of a sources sought synopsis, or draft solicitations. Research of the marketplace may consist of written, electronic (i.e. email) telephonic, or world wide web inquiries. Lack of advanced planning is not an acceptable reason for the lack of market research, but true urgency may necessitate abbreviated market research that is limited to readily available historical and commercial information. If ac tion is a contract extension or bridge contract, describe the market research efforts underway or completed for the follow-on. See FAR 10.002(b)(2).

9. Procurement History:

Purchase order or contract number:

Was action competed? Yes No

If action was not competed, state the cited authority, summarize rationale, and describe the actions that were supposed to be taken to increase competition and the results thereof:

https://www.acquisition.gov/far/part-5#FAR_Subpart_5_2 https://www.acquisition.gov/far/part-5#FAR_Subpart_5_2 https://www.acquisition.gov/far/part-5#FAR_5_202 https://www.acquisition.gov/far/part-10#FAR_10_002

10.Additional Information to support the justification:

If applicable, explain why technical packages or specifications to facilitate competition were not developed or available;

describe actions taken to remedy the situation.

11. Technical / Requirements Certification: By my signature below, I certify that the supporting data included in this

J&A is accurate and complete.

Program Manager

Name:

Position Title:

Email address:

Phone:

Program Manager Supervisor (or one level above Program Manager)

Name:

Position Title:

Email address:

Signature:

Date:

12. Fair and Reasonable Price/Cost Determination: As Contracting Officer, by my signature below, I hereby determine that the anticipated price/cost to the Government for this contract action will be fair and reasonable based on history information and price analyses comparing the IGCE to the Contractor's proposal..

Provide the basis for this determination, e.g., describe techniques to be used to determine fair and reasonable price

(FAR Subpart 15.402), such as price analysis, cost analysis, cost realism. Per FAR Subpart 15.403-4(a)(1), the threshold for obtaining cost or pricing data is $750,000.

Name: Phone:

Signature: Date:

13. Contracting Officer's Approval (Required for proposed contract not to exceed $700,000 (value calculated including all options)): I hereby certify that this justification is accurate and complete to the best of my knowledge. I approve this justification subject to availability of funds, and provided that the services and supplies herein described have otherwise been authorized for acquisition.

Name: Phone:

Signature: Date:

https://www.acquisition.gov/far/part-15#FAR_15_402 https://www.acquisition.gov/far/part-15#FAR_15_402 https://www.acquisition.gov/far/part-15#FAR_15_403_4 W1C5 Cross-Out

14. Legal Review:

All J&As greater than $68 million must have a legal review from the General Law Division of the Office of the General Counsel prior to sending it to the Department.

15. OPDIV Competition Advocate Approval (Required for proposed contract over $700,000 but not exceeding $13.5 million (value calculated including all options)):

I have reviewed this justification and find that it adequately supports other than full and open competition.

Name:

Phone:

Signature:

Date:

All J&As greater than $68 million must have a review from the Office of Small & Disadvantaged Business Utilization (OSDBU) prior to sending it to the Department. The OSDBU at their discretion may review any J&A.

16. Office of Small and Disadvantaged Business Utilization Review: (Required for contracts exceeding $68 million (value calculated including all options)):

Concur:

Non-Concur:

17. OPDIV HCA Approval (Required for proposed contract over $13.5 million but not exceeding $68 million (value calculated including all options)):

18. Department Competition Advocate (Required for contracts exceeding $68 million (value calculated including all options)):

Concur:

Non-Concur:

(The below approval paragraph is required if the cumulative contract value, including all options, exceeds $68 million.)

19. HHS Senior Procurement Executive (SPE) Approval:

Based on the foregoing justification, I hereby approve other than full and open competition for the above stated procurement, subject to the availability of funds, and provided that the services herein described have otherwise been authorized for acquisition.

State supplies/services being procured:

State the full statutory authority and FAR cite and title, consistent with paragraph 4, e.g. 41 U.S.C. 3304:

Modificationto Existing Purchase OrderContract Number:
Other:
Other Funds:
Name: Susannah Bernheim
Position Title: Project Officer
Email address: Susannah.Bernheim@cms.hhs.gov
Phone: (443) 425-6361
Name_2: Eliot Z. Fishman
Position Title_2: Manager
Email address_2: Eliot.Fishman@cms.hhs.gov
Date:
Phone_2: (410) 786-0520
Date_2:
Phone_3:
Date_3:
Name_3:
Phone_4:
Date_4:
Name_4:
Phone_5:
Date_5:
Name_5: Douglas Bergevin, Deputy Director, OAGM or Derrick Heard, Director, OAGM
Phone_6: Douglas Bergevin, (443) 909-0131 and Derrick Heard, (410) 786-2545
Date_6:
Name_6:
Phone_7:
Date_7:
Name_7:
Phone_8:
Date_8:
Text51: Continuation of the Implementation of a Patient Activation Measure (PAM) for CMMI Alternative Payment Measures (APMs) FY2024
Text52: August Nemec, Contracting Officer Representative and Eddie Woodard, Contract Specialist
Text53: FY2024
Dropdown54: [CMS]
Check Box55: Yes
Check Box56: Off
Check Box57: Off
Check Box58: Yes
Check Box59: Off
Check Box60: Off
Check Box61: Off
Check Box62: Off
Text63: Phreesia (dba Insignia Health)
Text64: 1521Concord Pike, Suite 301,PMB 221
Text65: Wilmington, DE 19803
Check Box66: Yes
Check Box67: Off
Text68: $18,517,500
Text69: Congress enacted the Patient Protection and Affordable Care Act (Pub. L. 111-148) on March 23, 2010. Following the enactment of Pub. L. 111-148, the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152) (enacted on March 30, 2010), amended certain provisions of Pub. L. 111-148. These public laws are collectively known as the Affordable Care Act (ACA).

The intent of the ACA is to transform the healthcare system by increasing access to care and reforming the delivery system by improving quality and lowering the cost of care. Section 1115A of the Social Security Act, as amended by section 3021 of the Affordable Care Act, authorizes CMMI to test new health care payment and service delivery models that have the potential to lower Medicare, Medicaid, and CHIP (Children’s Health Insurance Program) spending while maintaining or improving the quality of beneficiaries’ care (42 U.S.C. 1315a).

Based on this authority, CMMI is continuing and implementing a portfolio of Alternative Payment Models (APM’s) aimed at achieving better health care, improved population health, and lower cost through improvements in care. CMMI is responsible for the design, implementation, and monitoring of a portfolio of APMs aimed at achieving better health care, improved population health, and lower cost through improvements in care across the United States. Although the J&A is being completed because of the need for this company’s proprietary data, this requirement aligns with FAR Part 37 Service Contracting.

Text70:

The requirement can only be satisfied by one responsible source pursuant to FAR 6.302-1(a)(2)(ii). The continued use of the PAM tool is required by the KCC Model Team to ensure uniform quality measurement results through the end of the model. Discontinuation of the PAM almost 3 years into the model’s lifecycle would cause unacceptable delays in fulfilling the model’s requirements. Data collection, quality measurement, and reporting for the model would be compromised.

Text71:
Check Box72: Yes
Check Box73: Off
Check Box74: Off
Check Box75: Off
Text76:
Text77:
Text78:
Text79: CMS believes there will be a continuing need for the requirement, and therefore advanced planning has taken place to ensure an initiation to overcome the barriers to competition. CMS has structured the contract with option periods. CMS will evaluate the continuation of the contract after each option period and decide if competition exists in the marketplace. This will give the government the ability to solicit competition for the requirement if there are other organizations that have developed owning a license for a PRO-PM during the period of performance for this contract.
Text80: N/A
Text81: The program team (CMMI’s Quality Innovation Council) has SMEs from each group at CMMI who have expertise in quality measures and many of these SMEs work on model teams. This group has a thorough understanding of the measure required to support and fulfill CMS’ need and conducted market research to identify vendors capable of meeting the need. This effort included discussions with measure experts, searches of measure databases, and discussions with other CMS components. Additionally, other CMMI model teams performed market research by contacting provider sites currently using a patient activation measure. All of the sites contacted were using the PAM created by Insignia Health. The outcome from this outreach involved a discussion of the capabilities, pros/cons, and customer reviews of the tool. This led to the decision that PAM was the only measure capable of supporting CMMI’s operations as a means for monitoring and reporting quality performance results on APMs.

A FedBizOpps notice will be publicized as required by FAR Subpart 5.2.

Check Box82: Off
Check Box83: Yes
Text84: CMMI conducted market research and concluded that only one source is available and therefore is unable to increase competition. This proprietary measure is currently used by the KCC model as a quality performance indicator to assess whether model participants can improve the quality of care by improving their patient’s ability to self-manage their health. Discontinuation of the PAM almost 3 years into KCC’s lifecycle would cause unacceptable delays in fulfilling the model’s requirements. Data collection, quality measurement, and reporting for the model would be compromised.

As a result, this Justification for Other than Full and Open Competition will be posted on FBO for at least 30 days to confirm that there are no other sources able to meet this requirement. If because of the posting, new information is received and that other sources are available, the requirement will be re-evaluated for competition.

CMMI has explored different channels to increase the level of competition. Currently, there are no supplies or licenses that would meet the Government needs that have already been purchased through the Enterprise License Agreements or excess government property. In addition, this requirement does not fit within any existing Government contracts, or General Services Administration (GSA) Federal Supply Schedules. Furthermore, there aren’t any CMS contract vehicles, or another agency contract, that could serve as a potential alternative to creating a new contract. Also during Market Research it had been determined that Phreesia has no Government contract vehicles that could be utilized at this time..

Text85: 75FCMC19C0025
Text86: The requirement can only be satisfied by one responsible source pursuant to FAR 6.302-1(a)(2)(ii). The continued use of the PAM tool is required by the KCC Model Team to ensure uniform quality measurement results through the end of the model. Discontinuation of the PAM almost 3 years into the model’s lifecycle would cause unacceptable delays in fulfilling the model’s requirements. Data collection, quality measurement, and reporting for the model would be compromised.

CMMI has explored different channels to increase the level of competition. Currently, there are no supplies or licenses that would meet the Government needs that have already been purchased through the Enterprise License Agreements or excess government property. In addition, this requirement does not fit within any existing Government contracts, or General Services Administration (GSA) Federal Supply Schedules. Furthermore, there aren’t any CMS contract vehicles, or another agency contract, that could serve as a potential alternative to creating a new contract.

Text87: The PAM is a unique proprietary measure owned by Phreesia that can be utilized for any patient population making it a useful tool for CMMI’s diverse models. The PAM is a tested and fully developed tool currently used with positive results in the KCC Model. The KCC Model has been utilizing the PAM since the model began on January 1, 2022. The current end date for the KCC model is December 31,2026. The continued use of the PAM tool is required by the KCC Model Team to ensure uniform quality measurement results through the end of the model. Discontinuation of the PAM almost 3 years into the model’s lifecycle would cause unacceptable delays in fulfilling the model’s requirements. Data collection, quality measurement, and reporting for the model would be compromised.
2024-06-05T11:33:06-0400
Eliot Z. Fishman -S
Text89: John Cruse
Text90:
2024-06-05T15:32:55-0400
John Cruse -S
2024-06-05T15:33:48-0400
John Cruse -S
Text93:
Check Box96: Off
Check Box97: Off
Check Box98: Off
Check Box99: Off
2024-06-10T12:26:22-0400
Douglas D. Bergevin -S
Text102:
Text103:
Text105: By my signature below, after review of the relevant documents, I have determined that the order subject to this Justification represents the best value for the Government as set forth in FAR 6.303-2(b)(7) and constitutes a fair and reasonable price.

Text1: $18,517,500

File details come from the government source that posted it. Updated .