JA_CCDSO Extension for Approval-S.doc_Redacted.pdf

Community Care DevSecOps Support Extension

Control Number VA-23-00048524

JUSTIFICATION

FOR AN EXCEPTION TO FAIR OPPORTUNITY

1. Contracting Activity: Department of Veterans Affairs (VA)

Office of Procurement, Acquisition, and Logistics Technology Acquisition Center 23 Christopher Way Eatontown, NJ 07724

2. Description of Action: The proposed sole source action is for a modification to the hybrid Firm-Fixed-Price (FFP) and Time-and-Materials (T&M) Task Order (TO) 36C10B21N10280019 issued under Transformation Twenty-One Total Technology Next Generation (T4NG) Contract VA118-16-D-1028 with Veterans EZ Info Inc. (VetsEZ), 1901 1st Avenue, Suite 192, San Diego, CA 92101. The purpose of this modification is to extend the period of performance of Option Period Two for six months and incorporate three additional one-month option periods for the continuation of Community Care DevSecOps Support.

3. Description of the Supplies or Services: The scope of the Community Care DevSecOps (CC DSO) Support TO is to provide the Community Care Product Line (CCPL) enhancements and maintenance of critical Community Care (CC) products. The current TO provides shippable product, operations support, and security compliance for the CCPL, including Integrated Billing and Accounts Receivable (IBAR), Consult Toolbox (CTB), Enterprise Precision Scanning and Indexing Automation (EPSI), Standard Episodes of Care (SEOC), Referral Documentation (REFDOC), and Delivery Operations Claims Management Platform (DOCMP) product lines. Services consist of development, testing, integration, architecture, refactoring, release planning, security expertise, and operations and maintenance support throughout the product lifecycle.

Additionally, critical support is provided to the entire CCPL through cross-functional resources that focus on release train engineering, security compliance, architectural engineering, and technical analysis. VA requires continued services to ensure key system capabilities are delivered and sustained, providing clinicians and Veterans uninterrupted support for critical CC systems. The proposed action will provide for continuity of the critical support to be maintained until a new TO is awarded. No additional hardware or software will be procured as a result of this action.

As way of background, TO 36C10B21N10280019 was competitively awarded to VetsEZ on February 24, 2021. The Base period of performance was March 1, 2021 – February 28, 2022, with two 12-month Option Periods and one 60-day optional task for transition support for a total TO value of $74,839,459.97. A modification (P00002) was issued on February 28, 2022, to descope six months from Option Period Two in order to reallocate ceiling from the T&M Contract Line Item Numbers (CLINs) in Option Period Two to the T&M CLINs in Option Period One. The modification was necessary to accommodate a surge of support requirements for the CCPL, resulting in the overall period of performance being reduced to August 31, 2023, with the total TO value being decreased to $71,145,387.17. The proposed modification is to reinstate the original period of performance for Option Period Two through February 29, 2024 and incorporate three additional one-month option periods for continued support through May 31, 2024, if needed, to provide a seamless transition. The total estimated value of the proposed action is $ . However, there is unused ceiling in the amount of $ that will be reallocated to Option Period Two, resulting in the total TO value increase of $ .

4. Statutory Authority: The statutory authority permitting an exception to fair opportunity is Section 41 U.S.C. 4106(c)(2) as implemented by the Federal Acquisition Regulation (FAR) 16.505(b)(2)(i)(B), entitled “Only one awardee is capable of providing the supplies or services required at the level of quality required because the supplies or services ordered are unique or highly specialized.”

5. Rationale Supporting Use of Authority Cited Above: The proposed source for this action is VetsEZ, 1901 1st Avenue, Suite 192, San Diego, California, 92101. VetsEZ was awarded the CC DSO Support TO on February 24, 2021, on a competitive basis under Service-Disabled Veteran-Owned Small Business (SDVOSB) set-aside procedures on the T4NG contract vehicle. The work performed by VetsEZ under this TO provides development services, post deployment support and sustainment support services for critical CC systems that facilitate the care of Veterans. VetsEZ releases system updates, as frequently as weekly, to provide critical defect resolution and new capabilities due to rapidly changing business needs and priorities for critical system features, to ensure the systems can meet the demands of our nation’s Veterans. The required expertise provided by VetsEZ, coupled with the flexibility of the current hybrid TO, allows the CCPL to effectively meet the fluctuating delivery demands of legislative mandates including: Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act; American Rescue Plan (ARP) Act; Megabus Act; Digital Accountability and Transparency Act (DATA Act); Social Security Number Reduction (SSNR) Act; Cleland-Dole Act; Comprehensive Prevention, Access to Care, and Treatment (COMPACT) Act; and Promise to Address Comprehensive Toxics (PACT) Act. Extending the duration of this TO will provide uninterrupted delivery of sustainment and enhancements of vital CC products and ensure adequate time for proper transition to a follow-on contract, currently in the planning stages.

Originally, the plan was to transition the CCPL to another TO, 36C10B21N10150057 for Health Services DSO (HS DSO), when the CC DSO Support TO expired, however, due to the extensive delays and program interruptions associated with transition efforts of two product lines, Provider Profile Management System and Enterprise Program Reporting System, that were moved to the HS DSO TO, which initiated in June 2022 and completed in February 2023, the CCPL identified the need to extend the CC DSO TO in March 2023 in order to sustain critical systems while alternate follow-on support strategies were sought. The delays were due to product line variables such as product realignment within Health Services and Community specifically between 2022 and 2023 including internal staffing issues, highlighting the need for further analysis to determine the most efficient strategy for transition of the remaining CC products with minimal interruption. Additionally, the Tier 4 Position Sensitivity and Background Investigation

Requirements of the CC DSO TO are not readily available under other DSO contracts.

The HS DSO task order only currently supports Tier 2 and 3 level support of which the current products EPSI and DOCMP require Tier 4 support and resulted in inaccessibility to transition these services. On June 8, 2023, CC leadership provided approval to proceed with a follow-on TO for the CCPL and preparation of the acquisition package is underway. Continuous services through May 2024 ensures vital support remains intact with adequate risk mitigation for successful transition of critical CC systems.

The CCPL has to mitigate complex delivery and transition risks, requiring continued support of the current VetsEZ team. Based on contracts for similar Health DevSecOps services, new vendors require a minimum of six to nine months to fully transition and provide development and sustainment services at levels consistent with prior vendor services to meet demanding community care requirements. The post-COVID-19 National Crisis continues to create additional complexity during this time as qualified resources are in high demand with limited availability. The clinical and IT environment of the post-COVID-19 pandemic and OIT’s DevSecOps migration, both compounds and exacerbates the known risks of transition. The CCPL is made up of a myriad of unique products integrated with numerous upstream and downstream systems built to stringent clinical specifications. Although the technology employed is common to industry, what is uncommon is the technical competency to understand hundreds of complex workflows and data variations that are inherent to CC requirements that can only be learned through clinical collaboration. To obtain the spatial and relational knowledge to develop technologies that safely meets clinical specifications requires clinical staff to orientate technologists to CC clinical workflows. With clinical staff already overburdened to focus on critical Veteran care, knowledge transfer will be impeded significantly, and this additional complexity would further delay a new vendor in being able to understand the clinical aspects of the technical workflows and provide support at the level the current environment requires. Given these additional complexities it is estimated that a vendor, other than VetsEZ, would require up to nine months to onboard resources and develop sound knowledge of complex workflows to capably fulfill CC requirements. The current vendor has a unique understanding and experience of the clinical aspects of the technical workflows that could take another vendor up to nine months to obtain comparable knowledge. Specific product line details are provided below to further depict the unique qualifications and specialized capabilities VetsEZ provides to meet the requirements of the CCPL.

The IBAR product is a Veterans Health Information Systems and Technology Architecture (VistA) package that ensures accuracy of Veteran First Party copayments and maximization of revenue collections. These packages enable VA to track the billing and collections of charges billed to Veterans who received medical care from VA and non-VA providers. VistA, unlike modern software platforms, has a tightly coupled software architecture which makes modifications complicated without keen knowledge of not only Massachusetts General Hospital Utility Multi-Programming System (MUMPS) programming but also extensive knowledge of its business domain Revenue Operations (RO). If modifications are made without extensive software and business knowledge, quality releases are at higher unacceptable risks as they will impact millions of Veterans and operational income for the VA.

The VetsEZ team minimizes the aforementioned risks by possessing the specialized IBAR MUMPS programming experience and business domain knowledge not readily available in the marketplace today. The current team possesses more than 50 years of VistA experience, with 33 of those years specialized in IBAR software and business processes. Additionally, the current team has established collaborative relationships with VA VistA developers that allow them to assist with Integrated Billing's Internal Change Requests, serve as Subject Matter Experts, and assist with critical and time sensitive system issues that impact VistA-Integrated Billing (IB) and VistA- Accounts Receivable (AR). Leveraging this specialized expertise, the team was instrumental in designing and developing new functionality within the IB package for Urgent Care, Repayment Plans, Mental Health, Cleland-Dole, and the implementation of Copayments and Rate types within AR. Since performance began on this TO (March 2021), the VetsEZ team has released 14 IBAR patches to meet legislative mandates set forth by the MISSION Act, ARP Act, Megabus Act, DATA Act, and SSNR Act, plus 22 additional patches to fulfill RO requirements. Product Increment (PI) 13 (4/1/23-6/30/23) includes development work for the newest legislative mandate, the Cleland-Dole Act, with a release date of June 28, 2023, followed by additional increments required to mature the product. Furthermore, PI 13 includes development work for the DATA Act- Non-Medical Debt Treasury Cross-Servicing, the COMPACT Act-Automation of copayment cancellations, Megabus Act- Automation of copayment cancellations, three SSNR Act patches in testing, and four RO patches. Planning for development work beyond June 2023 will build upon the expertise honed to date requiring further elaboration, development, testing, and ultimately the release of over 40 SSNR patches, other legislative patches, and RO requirements. Historically, the team manages the development cycle of over 15 patches at a time, providing the ability to release at least one patch per month. When transition is required, it is estimated to take at least six months due to the difficulty of recruiting experienced VistA IB and AR developers, onboarding, and the extensive knowledge transfer that would need to occur to attempt to maintain the team’s current release cadence. It is unlikely that any releases would occur during transition, thus leading to unmet legislative mandates and Congressional inquiries by Veterans. The Cleland-Dole Act still requires the development, testing, and release of 4 patches due in March 2024. Considering the estimated timeframes associated with transitioning to another contractor, such a transition would be detrimental to the business stakeholders, Veterans, and VA.

Clinical Integration consists of products that support the management of clinical care in the community such as Consult Toolbox (CTB), Enterprise Precision Scanning and Indexing Automation (EPSI) and Standardized Episodes of Care (SEOC). Due to the upcoming platform integrations scheduled for completion in January 2024, with dependent increments through June 2024 required to mature the products, changing vendors at this time would disrupt workflows, lead to decreased efficiency, and increased costs, as detailed below. Retaining the current VetsEZ team ensures seamless system integration and maintenance of system security to meet critical project demands. Upcoming platform integrations (e.g., Hyperscience, PEGA, WellHive) require specialized expertise to minimize the disruption of current workflow, to prevent delays and reduced efficiency. The VetsEZ team retains this expertise and knowledge of Clinical Integration, including the historical context, business requirements, and end-user needs. Adapting to a new platform required to modernize the capabilities is complex and time-consuming, requiring integration with existing systems and processes, significant investment in terms of time, effort, and resources, all of which the current vendor provides. Their historical knowledge and experience in building and maturing the CTB, EPSI, and SEOC systems are invaluable assets for successful integration. The VetsEZ team possesses expertise in both the legacy tool and the enhanced CTB, having worked closely with the business during its development.

Additionally, with the EPSI product re-aligned within the Clinical Integration sub-portfolio in May 2021, the unique experience gained is imperative to achieve the required platform integration. Further, the VetsEZ team has accumulated the historical knowledge and expertise that is required to support ongoing development and maintenance of these critical clinical systems to meet legislative mandates. Adapting to a new platform is complex and time-consuming, requiring integration with existing systems and processes, significant investment in terms of time, effort, and resources.

VetsEZ is the only vendor capable of meeting the timely needs of the CCPL to ensure successful platform integrations. A new vendor brought in at this stage of the product development lifecycle would require rework of the initial designs resulting in duplicative costs and delays of product enhancements impacting legislative mandate compliance.

Rework required may consist of a minimum of two planning increments for CTB, EPSI and SEOC, in addition, DOCMP would require an estimate of three planning increments, spanning over a 6-month timeline, estimated at $2.4M.

DOCMP is a suite of claims processing components that assists with quicker processing, adjudication of claims, and report creation. The goal is to take on-premise products and migrate them to a cloud environment. Initial products identified to be migrated are the Document and Process Enable Repositories (DAPER), Operations Decision Management (ODM), MoveIT, and Health Administration Center (HAC) Data Warehouse. DAPER is a high visibility product that deals with Veteran eligibility.

Disruption of services would result in significant delays affecting several dependent products, including CP&E decommissioning, resulting in delayed modernization directly impacting Veteran eligibility by changing a manual process that currently takes 60 days into an automated process which will achieve a 30-day benchmark. Concerns related to this product have been briefed at the Chief Information Officer and Congressional levels. DAPER is a document imaging/workflow/data interchange designed to operate within and across multiple lines of business under the CCPL. It is a legacy product with locally developed code therefore limited experienced resources are available. Storage, latency, and congestion challenges plague the on-premise environment. The current CCPL architecture has identified a DAPER solution leveraging the existing VetsEZ team and their initiated PEGA platform replacement underway, utilizing the experienced development and implementation team mid-way through the replacement of DAPER. Continuity of services is imperative to the success of the solution with Phase I implementation scheduled for August 2023 and Phase II scheduled in February

2024. Specialized knowledge of the environment, only available through the VetsEZ team, will provide an expeditious migration to the PEGA platform dictated by VA leadership.

As described above, due to the technical complexities of the CCPL systems, extensive dependencies of incremental releases, and criticality of seamless support for systems that facilitate the care of Veterans, the successful transition to another vendor would require six to nine months which is essential for completion of PI iterations which would require between two and three PIs and release of enhancements. While transition to a new vendor may be necessary as this TO eventually expires, VA will have to maintain and sustain the current CCPL systems in order to fulfill its commitment to the care of Veterans while a follow-on TO is pursued. Extensive efforts are involved with acclimating to the CCPL environment. A new team would require up to three planning increments to onboard qualified resources, learn the systems’ architecture, and get acquainted with the stakeholders in order to perform at a similar level of expertise. The proposed extension will ensure critical support is provided during this time while the follow-on TO is executed. Any delay to receive care, particularly in acute cases, is a risk to a Veteran’s wellbeing and longevity. Only VetsEZ can meet the current requirements of VA. Procuring alternative support efforts at this time would result in substantial duplication of time and cost to the Government that is not expected to be recovered in competition.

6. Efforts to Obtain Competition: Market research was conducted, details of which are in the market research section of this document. This effort did not yield any additional sources that can meet the Government’s requirements. There is no competition anticipated for this acquisition. In accordance with FAR 5.301 and 16.505(b)(2)(ii)(D), the award notice for this action will be synopsized on the Contracting Opportunities website, SAM.gov and the justification will be made publicly available within 14 days of award.

7. Actions to Increase Competition: The Government anticipates competing future requirements prior to the expiration of the extended TO. The acquisition request for a new TO is planned for submission in first quarter of fiscal year (FY) 2024 for CC DSO requirements to award the follow-on before the end of FY24.

8. Market Research: Market Research was performed as part of an assessment of needs in March and April 2023 by researching various Contractors’ capabilities under T4NG and performing an analysis of CCPL products that transitioned to an alternate vehicle in FY23. VA technical experts reviewed potential vendors including Booz Allen Hamilton, King Street Technology Partners, and Science Applications International Corporation, and existing vehicles to leverage under T4NG but found that the vendors lacked the specialized MUMPS experience which is not readily available in the current marketplace. Additionally, the Tier 4 Position Sensitivity and Background Investigation Requirements of the CC DSO TO are not readily available under other DSO contracts.

While sources were found that could meet some of VA’s general capabilities, such sources would require six to nine months to meet all of VA’s requirements in a seamless manner. This was discovered during transition of two products to a similar Health DSO vehicle which resulted in nine months of efforts before a full team was implemented and capable to deliver on CCPL requirements. Additionally, VetsEZ has been instrumental in establishing Essential Scaled Agile Framework and DSO processes within the CCPL, they possess the technical expertise of complex workflows and data variations unique to CC requirements and the specialized expertise to the development services in order to continue to provide critical access to healthcare for our nation’s Veterans. As a result, based on the market research described, VA has determined that only VetsEZ can meet all of VA’s requirements.

9. Other Facts: None

Approval

In my role as procuring activity Advocate for Competition, based on the foregoing justification, I hereby approve the acquisition of a FFP and T&M modification to be issued under the T4NG Contract VA118-16-D-1028 TO 36C10B21N10280019 for CC DSO, on an other than fair opportunity basis pursuant to the authority cited in Section 4 above, subject to availability of funds, and provided that the property and services herein described have otherwise been authorized for acquisition.

Date: 7/27/2023 Signature:

Advocate for Competition Technology Acquisition Center Office of Procurement, Acquisition, and Logistics