JA - Management Consulting Services and Healthca - Redacted.pdf

VA-22-00054941

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 action is for a sole source Firm-Fixed-Price Task Order (TO) to be issued under the Transformation Twenty-One Total Technology Next Generation (T4NG) Contract Number VA118-16-D-1006 with Favor TechConsulting, LLC (FTC), for renewal of MD Clarity Payer Compliance Tool (PCT) software licenses, Huron Healthcare (Huron) Workflow Management Tool (WFT) software licenses and associated technical and support services for the Office of Finance (OF) - Revenue Operations (RO) healthcare revenue business tools.

3. Description of the Supplies or Services: The VA Veterans Health Administration (VHA) OF-RO Program Management Office has a requirement to ensure VA’s RO remains operational. The RO and its seven regionally aligned Consolidated Patient Account Centers (CPACs) rely on the existing workflow management and payer compliance information technology business tools to provide industry modeled automated technologies to sustain and continuously improve revenue cycle activities in support of healthcare revenue collections.

The VA Office of Information & Technology (OIT) Finance Product Line (FPL) supports the VHA OF. The goal within the Enterprise Program Management OF is to create a unified and seamless FPL that can adapt to meet the growing requirements of the OF- RO. The Finance Program is vast in the systems in which it encompasses and requires a diverse development team that can adapt to the nature of the multitude of Finance requirements. FPL strives to consolidate, integrate and streamline the delivery of its products to improve Veterans’ access to care by reducing redundancies and increasing efficiencies. To this end, FPL has established Sub-Product Lines with product teams that are focused on specific strategic themes and requirements of the consolidation effort and require support to develop, test, deploy and operate useful and usable products and solutions employing a Development, Security and Operations methodology and Essential Scaled Agile Framework practices and any VA-approved practice in the future. These product teams work with one another to ensure the continuous delivery and continuous improvement of VA collection rules under 38 CFR

17.106. This results in business value to the VA by ensuring continued compliance and collections from third party payers.

Specifically, under this proposed action VA requires provisioning, continued development/configuration, modeling, change management and sustainment of automated RO, workflow management and payer compliance healthcare revenue business tools. To meet these requirements, the contractor shall provide technical services to include configuration and modification of existing interfaces for the aforementioned business tools with current VA legacy systems and processes. In addition, the contractor shall provide software licenses and software maintenance (updates and bug fixes for the software and models) for the MD Clarity PCT.

Management Consulting Services and Healthcare Revenue Workflow Management and Business Information Technology Tools, VA-22-00054941

Specifically, this will be accomplished by renewing the existing MD Clarity PCT enterprise license which shall be renewed annually as part of this TO. The Contractor shall also provide software licenses, maintenance and support (updates and bug fixes for the software) for the Huron WFT licenses. Specifically, this will be accomplished by renewing the existing Huron Workflow Management enterprise license which shall be renewed as part of this TO. The MD Clarity PCT and the Huron WFT provide a combined software suite for VA’s OF-RO. The MD Clarity PCT provides scenario modeling of approximately one hundred insurance carrier agreements with automatic calculation of expected allowed amounts and provides reports displaying agreements in various views and search capabilities to include adjustment codes, bill type and estimated allowance at the bill, medical center, Veterans Integrated Services Network and CPAC level. The Huron WFT manages data extracted nightly from each instance of Veterans Integrated Service Technology Architecture (VistA) and the VHA Financial Service Center (FSC) Austin, TX, and is imported into the Huron WFT. Using data extracted from VA sources, the Huron WFT generates workflow items for manual review and distribution to staff, provides an electronic mechanism to assist in the prioritization, distribution, tracking and reporting of daily workload and provides users the ability to sort and communicate work items. The Huron WFT applications have four components.

The first enables effective monitoring of the front-end process, including verification of third-party insurance and related authorization or pre-certification activities. The second enables effective third-party claim monitoring, follow-up and account resolution processes. The third includes communication regarding resolution of specific encounters across all areas of the CPAC revenue cycle. The fourth enables effective monitoring, communication and resolution of various first party processes, including claims matching, bankruptcies, repayment plans, aged debt, etc., reducing the potential adverse Veteran first party debt impact.

In addition, the contractor shall provide healthcare revenue business support services required for continued process improvement of the overall revenue program. These process improvements include the following: revenue system training support, payer compliance, workflow optimization and report generation. The contractor shall also provide training, operational maintenance support, insurance carrier modeling, revenue studies, assessments and analysis, additional configuration, additional software development and change management.

The period of performance for this proposed action consists of one, 12-month base period, three 12-month option periods and six Optional Tasks. The base period and option periods shall consist of continuity and maintenance of the current system as well as system training and the development of staffing models and reports. The optional tasks shall include Leadership Mentoring/Training, Policy Analysts – Mentoring/Training, Insurance Carrier Modeling, Revenue Studies, Assessments and Analysis, Change Management Process, Techniques and Controls Services and RO Automation, Workflow Management or PCT Software Development or Configuration.

The total estimated value of the proposed action is , inclusive of all option periods and optional tasks.

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 is FTC, 8075 Leesburg Pike Suite 300, Vienna, VA 22182. No other source, other than FTC, is able to meet the Government’s requirements as documented below.

The original TO was awarded to Liberty Information Technology (IT) on September 30, 2019, as a result of a competitive action under the T4NG Indefinite Delivery Indefinite Quantity (IDIQ) contract. Though this was issued competitively, only one contract holder (Liberty) submitted a competitive Task Execution Plan. At the time, it was confirmed with both MD Clarity and Huron WFT that Liberty was the sole provider for both MD Clarity PCT and Huron WFT. Since that time, Liberty was acquired by Booz Allen Hamilton, Inc. and VA was made aware that both MD Clarity and Huron WFT will solely work with FTC. In April 2022, the VA Contract Specialist reached out to MD Clarity and Huron to inquire if any sources other than FTC could provide these proprietary solutions. Huron responded on April 8, 2022, confirming it currently has an exclusive teaming arrangement with FTC for the services related to the OF-RO following upon the completion of Liberty’s current contract on September 29, 2022, with RO. MD Clarity provided a response on April 18, 2022, confirming that MD Clarity also currently has an exclusive agreement with FTC to deliver the MD Clarity Payer Compliance system and related services to VA following upon the completion of Liberty’s current contract with RO.

Only the teaming arrangement of FTC, Huron and MD Clarity PCT can provide the aforementioned software and services in a manner that will meet the requirements for VA. Huron WFT and the MD Clarity PCT are both proprietary tools that are currently integrated in VA systems and processes. These tools are inseverable as the MD Clarity PCT provides a daily file containing claims remittent information utilized by the Huron WFT. The Huron WFT is configured to VA specific data received from the MD Clarity PCT. The data from MD Clarity PCT creates a process that reduces daily workload for the Account Management Payment Analysis area by up to 40% on a weekly basis. The time savings is a result of flagging claims within the Huron WFT that have been paid according to their contractually expected amount (calculated by MD Clarity software) and do not require manual review prior to closing out a claim. Additionally, the claim payment and contractually expected reimbursement amount data also allows Account Management staff to prioritize claims with the best opportunity for further reimbursement. These tools can only provide the required value to VA as a consolidated suite. FTC IT shall provide these tools, provide overall management of the solution and integration support of this solution with VA systems such as VistA and the Corporate Data Warehouse (CDW). If Huron WFT and the MD Clarity PCT were separated, VA would not be able to meet the basic requirements related to VA RO.

The MD Clarity PCT has configured its system for insurance carrier modeling to provide specific standardized reimbursements for each carrier agreement. This modeling has been developed and implemented over the course of several years. These integrations and configurations are inherent to the software and source code of the MD Clarity PCT.

Use of any other tool would require a complete re-design and re-development effort which includes new integrations to VA systems such as VistA, CDW and new modeling to VA service agreements. If any other software were to be utilized, the payer carrier agreements would have to be remodeled for VA and each insurance carrier, resulting in a duplication of cost estimated at $4,500,000.00 (estimated $45,000 per agreement for the 100 agreements already established). Further, re-establishing these modeled agreements with each insurance carrier is anticipated to take approximately 24 months to correctly model all potential reimbursements. This estimate is based on previous history to establish modeled agreements with 100 insurance carriers. These costs are not anticipated to be recuperated through competition. The MD Clarity PCT, most specifically its databases and source code, is proprietary to MD Clarity and no source other than MD Clarity or its partners can provide or modify this code that is configured and integrated for VA systems and billing processes. VA currently utilizes the Huron WFT that is only configured to work with the MD Clarity PCT. The existing Huron WFT configuration is proprietary to Huron and cannot be re-configured to work with any other software. Use of any software other than MD Clarity PCT would require VA to replace the existing Huron WFT software resulting in delays of 24-36 months of new development, and testing. Following the development and successful testing of the new software, deployment and training would take approximately 12 months to rollout nationwide. These estimates of time are based on time required for both development, testing and deployment efforts on previous acquisitions and efforts of similar size and scope. Due to the criticality of the system, VA would have to first deploy the system to one CPAC. Only after the first deployment is successful, lessons are learned and all issues are resolved could the deployment and training be rolled out nationwide. For these reasons, OIT estimates that for Commercial off the Shelf (COTS) products and a solution of this magnitude to integrate with VA systems it would take approximately 48 months to complete. Additionally, VA estimates that this development and deployment effort would produce duplicated costs of approximately $84,500,000.00 over 48 months to develop, test and deploy a new solution while maintaining the current solution in parallel. These estimated costs are based on previous acquisition history and efforts of similar size and scope. These estimated duplicative costs would not be recovered through competition.

The Huron WFT is also integrated with VistA and integrated and configured to the MD Clarity PCT insurance modeling. These configurations and integrations are inherent in the WFT. Utilizing a tool other than the Huron WFT would require a complete re-design and re-development effort which includes new integrations to be established between the new tool, VistA, FSC and other VA systems. The new tool would need to be configured to VA specific data provided from the MD Clarity tool, and the new tool would have to be configured to VA revenue processes. VA will procure an annual license as only Huron or a Huron partner has access to the proprietary Huron source code for the purposes of maintaining the software and modification/configuration of the software.

Access to this code is needed to ensure all the services provided are properly configured.

The Huron WFT and the MD Clarity PCT represents proprietary solutions that are integrated with VA data, legacy systems, VA agreements, business processes and have been customized to scope only those insurances billable by VA. The Huron WFT and the MD Clarity PCT also assists with scoping authorizations unique to VA such as service-connection or other special authority such as agent orange or military sexual trauma. The tools support specialty billing processes unique to VA such as care provided in the community and prosthetic devices. The first-party portion of the Huron workflow tool was built and implemented specifically for VA to assist with the first-party claims matching process. The Veteran Services tool has been expanded to include numerous work drivers across the Veteran Services unit to ensure efficient and timely processing of refunds, account issue resolution and overall improved customer service to Veterans. These integrations, configurations and payer compliance models are built into the proprietary software of the MD Clarity PCT and WFTs and cannot be migrated to any other solution. If a different solution were proposed, these integrations, models and configurations would need to be completely rebuilt. This would result in additional delivery delays and duplicated costs that would not be recovered through competition.

During the time required to rebuild these customizations, VA would be unable to efficiently and effectively receive reimbursement, assign work or effectively do any type of workforce planning. Further, there is no value in VA adapting a newly built system as it is anticipated that these services will be absorbed by the Electronic Health Record Modernization Program.

VA’s current TO with Liberty IT is set to expire on September 29, 2022. These services provide standardized RO and analysis. Without these services, VA OF RO staff (primary) will not be able to utilize MD Clarity PCT and Huron WFT in the performance of all revenue cycle and revenue collections, resulting in significant manual processing.

Other staff (secondary) who also utilize the products for tracking and reporting will not be able to augment the execution of work, which would then require manual processing to fulfill revenue requirements. Loss of this system will result in decreased collections, higher labor costs and decreased Veteran satisfaction. Revenue collections represent over $4 Billion annually and these funds are used to support health care services to Veterans. Loss of the ability to efficiently process revenue would result in decreased funding and healthcare services for Veterans. Therefore, based on the exclusive partnership that both MD Clarity and Huron WFT have with FTC going forward, FTC is the sole company that would be able to meet the requirements for this effort as there is no way to support any of the requirements of the effort without the ability to support and utilize both MD Clarity and Huron WFT.

6. Efforts to Obtain Competition: Market research was conducted, details of which are in section 8 of this justification. This effort did not yield any additional sources that can meet the Government's requirements. In accordance with FAR 16.505(a)(4)(iii)(A)(1), this justification will be provided with the solicitation to all appropriate T4NG Prime

Contract holders. Furthermore, in accordance with FAR 5.301, 16.505(b)(2)(ii)(D), and 16.505(a)(4)(iii), the award notice for this action will be synopsized on the Federal Business Opportunities website and this justification will be made publicly available within 14 days of award.

7. Actions to Increase Competition: The Government will continue to conduct market research to ascertain if there are changes in the marketplace that would enable future actions to be competed.

8. Market Research: Market research was posted via a draft Performance Work Statement issued under Request for Information (RFI) number 36C10B22Q0316 to SAM.gov on May 17, 2022. This RFI sought sources for VA’s requirements or potential other commercial solutions that could meet VA’s needs. The RFI yielded three responses from DK Shin Laboratories, Team RV Global Solutions Inc. with a teaming partner Tetra Tech Inc. and FTC. All of the capability statements were reviewed and only FTC was determined to be capable of performing the effort. Of the responses received, only FTC has an exclusive agreement with both MD Clarity and Huron. Only through FTC can VA obtain the required Huron WFT and the MD Clarity Payer Compliance system and related services. DK Shin Laboratories did not provide a technical approach or specific details requested in the RFI. All that was provided was a brief statement and a link to its website. RV Global Solutions did not provide its relationship to the Original Software Developers or any other potential software providers nor its ability to provide required maintenance and licenses. The only relevant information provided was an example of building capabilities on the cloud. However, the vendor did not detail its experience with migrating customer facing Cloud Hosted environments in a scalable agile framework. On August 4, 2022, DK Shin Laboratories and RV Global Solutions were both notified that their solutions could not be determined capable due to the lack of information provided in both submissions. No further responses have been received to date.

Additional Market research was performed in July 2022. Specifically, VA technical experts conducted web-based market research by reviewing similar COTS products to determine if other brands could meet VA’s functional requirements. Specifically, VA technical experts reviewed alternative software solutions including those from Experian Health, Thrive and SSI Healthcare Revenue Cycle Solutions. After review, VA technical experts concluded that while other manufacturers produce COTS products that have software services similar to what Huron WFT and MD Clarity provide, no alternative software can avoid the duplication of cost and time as outlined in Section 5 of this justification. Specifically, any alternative software would need to be configured to accommodate VA systems. VA has specific requirements, such as Authority to Operate, and alternative software would need to be configured to integrate with unique VA systems such as VistA and CDW, along with legislative requirements, regulatory mandates, over 100 insurance modeling agreements and unique VA processes which would necessitate a development, testing, deployment, training and deployment effort estimated to take approximately 48 months to fully complete.

Additional Market Research was conducted in April 2022 by contacting the software providers MD Clarity and Huron, to inquire if any sources other than FTC could provide these proprietary solutions. Huron responded on April 8, 2022, confirming it has an exclusive teaming arrangement with FTC for the services related to the Office of Finance – RO. MD Clarity provided a response on April 18, 2022, confirming that MD Clarity also has an exclusive agreement with FTC to deliver the MD Clarity Payer Compliance system and related services to VA. The confirmation emails from Huron and MD Clarity have been placed in the Electronic Contract Management System (eCMS) Briefcase. Based on this market research, VA has determined only FTC can meet all of the requirements necessary for continued support of these proprietary solutions.

9. Other Facts: None

Concurrence

In my role as Head of the Contracting Activity, based on the foregoing justification, I hereby approve the acquisition of a sole source, Firm-Fixed-Price TO to be issued under the T4NG Contract Number VA118-16-D-1006 with FTC, for technical services, support services and software from FTC for OF-RO healthcare revenue business tools 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.

Approval

In my role as Agency Senior Procurement Executive, based on the foregoing justification, I hereby approve the acquisition of a sole source, Firm-Fixed-Price TO to be issued under the T4NG Contract Number VA118-16-D-1006 with FTC, for technical services, support services and software from FTC for OF-RO healthcare revenue business tools on an other than fair opportunity basis pursuant to the authority cited in paragraph 4 above, subject to availability of funds, and provided that the property and services herein described have otherwise been authorized for acquisition.