Justification COVID-19 AMS Support.pdf

JUSTIFICATION AND APPROVAL (J&A)

for

FAR Subpart 6.3 Other Than Full and Open Competition

COVID-19 UNUSUAL AND COMPELLING

IMMEDIATE ACTION REQUIRED

Justification and Approval for Other than Full and Open Competition, Unusual and Compelling Urgency, FAR 6.302-2

J&A Tracking No.

l. Contracting Activity: This Justification and Approval (J&A) is being prepared for the DHA Managed Care Contracting Division (MC-CD).

2. Description of Action: DHA’s Analytics and Evaluation Division (AED) (J-5) has a requirement for COVID-19 Modeling and Simulation Services. The modeling and simulation services will include event monitoring, data modeling and the development of a data science factory, provide support for the early identification of harm indicators for improved tracking and modeling of COVID-19 progression and patient identification. A new one year, firm-fixed price contract will be awarded to Ernst and Young, LLC due to its prior and existing work and proprietary software which enables it to meet the urgent need by beginning performance immediately. This action is unusual and compelling, and any delay would cause serious injury to the Government. The Government projects award in September 2020. The approximate value of this requirement is dollars and fiscal year 2020 Operations and Maintenance (O&M) COVID-19 funds will be used as a funding appropriation.

3. Description of Supplies/Services: In order to meet the current needs for evaluating the impacts of COVID-19 on Service Members and other beneficiaries of Defense Health Program (DHP) funded health care, DHA needs additional analytical tools and support to manage the types and volumes of queries. Furthermore, DHA needs to have these tools and support provided as an immediate assist.

To accomplish these objectives, the contractor will be asked to provide tools, resources, and expertise to assist with the following three (3) projects:

Event Monitoring Data Modeling Data Science Factory.

a. Event Monitoring: This project will focus on conducting analyses to assess the implications of COVID-19 and the availability of commercial health resources for Service Members and beneficiaries, with a focus on those Service Members and beneficiaries who might be remotely located from Military Treatment Facilities. This project will also serve as a model for longer term event modeling capabilities for DHA.

b. Data Modeling: This project will provide support for the early identification of harm indicators for improved tracking and modeling of COVID-19 progression and patient identification using: 1) NLP to identify key markers embedded in unstructured data for

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(b)(4) within existing DHA data repositories; 2) pattern recognition across four (4) COVID models; and

3) simulation models (e.g. causal loops). This project will specifically deploy resources to DHA with the requisite skills for immediate integration.

c. Data Science Factory: This project will create a “data science factory” platform within a cloud environment making MHS data readily available for various modeling and simulation scenarios, and providing more stability, flexibility and capacity to support the various analytic needs of the DHA. The factory will be an easily accessible virtual development environment that includes industry leading analytic tools in a collaborative workspace that allows rapid dissemination of results. This project will use an agile development and co- design process to develop the platform. Furthermore, the project will include training to optimize use of the platform by the end users.

The period of performance and estimated value for this action are listed below:

Description Estimated Price

Period of Performance: Sept 30, 2020 – Sept 29, 2021

Total Estimated Price

4. Statutory and Regulatory Authority Permitting Other Than Full and Open Competition (see FAR 6.302), or the Specification of the Statutory and Regulatory Provision Providing Exception to 8(a) Program Competitive Requirements (see FAR 19.805-1): 10 U.S.C. 2304(c)(2), as implemented by FAR 6.302-2, Unusual and Compelling Urgency.

5. Rationale Justifying Use of the Statutory Authority Cited: As described at FAR 6.302-2, when the agency's need for the services is of such an unusual and compelling urgency that the Government would be seriously injured unless the agency is permitted to limit the number of sources from which it solicits bids or proposals, full and open competition need not be provided for.

On March 13, 2020, the President of the United States made an emergency declaration related to the COVID-19 pandemic under the authority of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. 5121-5207 (the "Stafford Act"). The President’s declaration highlights the urgency and need to expedite the execution of contract actions in support of the response to the COVID-19 pandemic. The subject contract is directly related to DHA’s response to the pandemic.

Per DHA AI 3000.01, the J5 Analytics and Evaluation Division (AED) provides a centralized, shared, service across the Defense Health Agency (DHA). Per DHA Terms of Reference, AED’s mutually exclusive function is Data Management, Analytics, and Measures and Reporting. Per DHA AI-8900.01, AED is also responsible for management of all Surveys across the MHS. Per UPR001221, AED is authorized to align resources and manpower associated with Data Management, Analytics, and Measures and Reporting for headquarters, the markets, and the MTFs. AED works with all government agencies who are modeling COVID-19 and with all of the component Analytic and Evaluation Directors. AED is the prime COVID-19 modeler for the DHA.

a. Background & Context of Award

AED links the science of the epidemiological compartment model, to the causal loops to the discrete

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(b)(4) simulation of process to design information systems that provide decision support for the operational and clinical domains for the MHS. The operational tempo for requests for information and action require a 24/7 operations to meet the timing of product requirements. Due to the unknowns of the COVID-19 response and the complexity of the MHS data systems, AED relies on contracts to supplement our response to RFIs and RFAs which includes the continual upgrading of products towards more automation. The COVID-19 response is tactical, so real time data is needed.

During the COVID-19 response, there was a need to move all of our information systems to the AWS cloud. Many systems were rendered inoperable at this time. For example, HEDIS Measures which take 8 weeks to refresh were late. We had to design a process that would get these measures refreshed in 70% less time. The Electronic Health Record Modernization and MHS Transition was not completed at the time of the COVID-19 response. Therefore, Legacy and Future Systems had to be managed dichotomously to aggregate information. Collaboration between DOD, HA, DHA, AF, Army, and Navy increased the complexity of aggregation. Complexity increases system risk, level of effort, and system size. Our system size has increased based on requirements, interfaces, operational scenarios, and algorithms. The level of effort increased based on requirements understanding, architecture understanding, level of service requirements, migration complexity, number and diversity of installations and platforms, number of recursive levels in the design of these systems, documentation, and technology risk. Furthermore, team application factors were considered such as stakeholder cohesion, personnel/team capability, personnel experience and continuity, process capability, multi-site coordination and tool support. Due to this complexity, systems engineering is leveraged to organize the work.

Currently, pockets of data are managed in silos which makes aggregation of data more complex. Because of the silos, initial work load of 13276 reports has increased to 400,000 data pulls, 1000 measures, EUCOM, AF stand-alone sites, and support of QPP projects around the MHS. The average lead time of ADHOC requests can reach an average of 41 days, whereas, the refresh of automated requests can be refreshed within 8 days. These overall level of effort for these products has improved by 72%. The number of automated reports has increased by 27% of our product line.

The onset of COVID-19 created a significant need for more real time data, aggregation of data, data management between legacy systems and new systems to answer a range of questions well beyond our capacity prior to COVID-19. COVIID-19 request scope and complexity pushed AED well beyond those capabilities doubling our level of effort.

Because of the rapid onset of COVID-19, multiple contracts were deployed to provide augmented support, system discovery, system interface, and system development. Rapid requirements evolved around beds, labs, plasma, models, vaccine, operations, etc. Systems had to be developed in pieces, integrated, and matured with flexibility, timeliness, and quality. Currently, we are using a 50% confidence factor for effort;

however, depending on the risk may adjust to 100% due to the seriousness of the COVID-19 pandemic.

This increase in the volume and types of questions being asked was responded to through the use of several contractors under then-existing contracts and contracts issued specifically for the response to COVID.

Three separate contracts provided: lab support to the COVID-19 Pentagon Task Force (performed by McKinsey under a sole source award made against a VA contract); modeling and identifying hot spots (provided by McKinsey, awarded under a sole source award, contract expires December 2020); market operations and analysis (currently being performed by E&Y as a subcontractor on a contract ending in October 2020). Under these contracts, the following types of COVID related data are collected:

(1) Bed Systems - Example: MTF teams plan bed capacity expansion based on HPCON Status, PPE and Staff availability. The goal of this system is to plan for future bed capacities. This data is then integrated with the private sector to see capacities by hospital, quality level, ventilators, specialty care available, etc.

(2) Lab Systems - Example of Data Sets: PPE, Staff, Machine Types, Batch Sizes, Variable Schedules, etc.

(3) Plasma Systems - Examples of Data Sets: Donor Centers, Staff, PPE, Acquisition, etc.

(4) Vaccine Systems - Example: Comorbidities, High Risk Patients, COVID-19 Registry, Policy Changes, etc,

(5) Model Systems - Example: R value, Hot Spots, Hurricanes, Loss of Facility Usage, Expanding Capabilities, forecasting impacts of events such as evacuation and sheltering in anticipation of fires and hurricanes (such events impacts the ability to maintain social distancing and causes air quality degradation from smoke from wildfires, possibly further complicate respiratory symptoms of COVID-19 positive patients), modeling "return-to-normal" COVID-19 forecasts, etc.

(6) Operations systems - Example: Costs, Appointments, Startup, Triage, Mobilization, AAR, Enduring Capabilities, Measurement, etc.

Although the initial “putting out fires” rush of the COVID pandemic is over, there is still a significant need for data and data types that have not yet been answered yet, as well as just to manage the day-to-day operations. Moreover, the existing COVID data is housed in over 60 dashboards, none of which provide a “whole picture” to decision makers. The integration of these dashboards have created COVID-19 Multivariate Model which provides system information on bed, lab, plasma, vaccine, model and operations and combines with environmental and control factors in order to provide leadership with the necessary daily monitoring of COVID-19 for all RFA’s/RFIs (see picture above).

b. Urgent & Compelling Nature of Awarded Work

The subject J&A is for 1) Event Monitoring 2) Data modeling and 3) a Data Science Factory related to COVID-19. The objective of this effort is to provide facts, insights, and implications on the COVID-19 situation to inform decision-making that could have significant impact on the healthcare of patients and providers over the next 18-24 months.

The first two tasks will require E&Y to continue supporting AED in fielding data requests and will expand to additional types of questions. It will also take on the work load of the imminently expiring contracts. The third requirement is new, and for the systems development of the Data Science Factory tasker E&Y will, in addition to building additional dashboards, consolidate the 60+ existing dashboards into a DHA-owned deliverable to be housed within a DHA platform and will allow a “whole picture” response and provided higher level functionalities.

The COVID-19 Dashboard on CarePoint uses the Risk Analysis Framework to provide assistance to the MHS in identifying and locating both low and high-risk areas in the system.

The Dashboard includes information to facilitate MTF planning and projections for peak hospitalizations, peak ICU and peak ventilator use. It also includes population risk data for MTFs as well as a risk heat map, a map of beds and capacity, an MHS enterprise view of inpatient capability, and other resources such as staffed beds, COVID-19 beds, number of ventilators for planning and staying ahead of the demand signal.

J-5 staff personnel are working to link fully with the services so they can accurately build a process from the model to, for example, move PPE. This requirement will help fill in the data gaps and ensure we can predict the demand for Lab, logistics and patient flow.

MTFs can use the model from the dashboard to identify alternatives and mitigate anticipated shortages, and then request needed supplies through the Defense Medical Logistics Standard Support (DMLSS).

The Data Science Factory is a new requirement and is not within scope of an available contract. The other two tasks are currently being performed by

The provision of these services and the deliverable are integral to DHA Leadership’s ability to make informed decisions as to how to respond to COVID. They cannot be allowed to lapse.

This is not an instance of a failure to plan. The COVID pandemic was sudden and unpredictable, and, although six months have passed since the start, the time was largely spent in responding to immediate demands. This time period did not provide employee bandwidth to forecast 6 months into the future.

Moreover, even under normal circumstances, and even assuming it could have been anticipated in March that COVID needs would still be a consideration in September and beyond, it is not adequate time to anticipate, prepare, execute, onboard and stand-up a new contractor to perform this work (a new contractor would have to establish a data sharing agreement and potentially grant security clearances prior to even beginning to perform meaningfully).

Further, the COVID-19 Pandemic is still here and is generating even more questions that require immediate responses. This has resulted in the creation of the referenced 60+ dashboards which are no longer manageable and must be consolidated under the Data Science Factory tasker so that as medical decisions and plans are made to prepare for a potential COVID surge this fall and winter. These decisions can be made on the most up-to-date and holistic data picture possible, using industry leading analytic tools in a collaborative workspace that allows rapid dissemination of results and remote access to information using

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Any delay to the performance of this work will result in serious injury to the Government as accurate, timely, and holistic data and forecasting and modeling tools provided to DHA’s leadership underpins decisions which an impact on the health of communities and service members, and the ability of the DHA to meet its mandate for military readiness, and it has a public responsibility to help prevent further spread of COVID-19. They are also required to comply with DoD guidance to implement plans to ensure compliance with directed force health protection measures throughout the area of operations in order to prevent an outbreak of COVID-19 within U.S. personnel (service members, civilians, contractors, and dependents) or confine it to as small a population as possible.

Every day that passes, confirmed COVID-19 cases in the United States and around the world spike as we enter the “fall surge” and flu season. It is imperative that these services are obtained as quickly as possible to assist DHA leadership in making health decisions to protect military readiness, service members and their beneficiaries, and. the public health system. Therefore, in order to comply and put protective measures in place and provide COVID-19 related preparation and care based on up to date information, DHA has an unusual and compelling urgent need for support in developing and executing its COVID-19 modeling and simulation strategy.

6. Efforts to Obtain Competition: In accordance with FAR 5.202(a)(2), this action will not be synopsized. The extremely limited time-frame to execute a contract precluded any form of competition, and solicitation to E&Y was the only practical approach under the circumstances, as discussed in the Rationale Justifying Use of the Statutory Authority Cited and Market Research sections. The need for a COVID-19 modeling and simulation services is immediate and discrete.

The requirement is being established with a one year period of performance; it authorize only the minimum amount of time and funding necessary to establish and execute the DoD's COVID-19 strategy, without committing the Government beyond what is minimally necessary. Should additional requirements for this need arise in the future, competition will be sought.

6. Determination that Anticipated Cost to the Government will be Fair and Reasonable:

The Contracting Officer will evaluate the contractor’s proposal, determine the proposed amount and mix of labor are appropriate, and verify the proposed rates are reasonable by conducting price analysis in accordance with the methods identified at FAR 15.404-1

7. Market Research: On January 31, 2020, the United States Department of Health and Human Services Secretary Alex M. Azar II declared a public health emergency (PHE) for the United States to aid the nation's health care community in responding to COVID-19. On 13 March 2020, the President of the United States of America declared COVID-19 an emergency IAW 42 U.S.C. 5122 (the Robert T.

Stafford Disaster Relief and Emergency Assistance Act) which allows for Special Emergency Procurement Authority IAW 41 U.S.C.1903.

The Program Office Team conducted market research on 21 September 2020. Market research was expedited due to the unusual and compelling nature of this emergency procurement. Through the market research, the J-5 Program Management Division and Analytics and Evaluation jointly identified Ernst and Young as the provider capable of meeting the requirement utilizing its proprietary tools within the urgent time frames required due to its existing work within the DHA. No other vendor was identified as providing all the services within the immediate time frame needed to circumvent the injury described in the Rationale Justifying Use of the Statutory Authority Cited section above and mitigating cost injury described below.

When conducting the market research, available vendors were considered those who could perform within the unusual and compelling urgency of these services. This urgent nature does not allow any time to onboard a new contractor unfamiliar with the unique challenges facing the DoD and DHA. Moreover, the amount of time it would take to compete a contract, establish a contract, establish a data sharing agreement, potentially grant security clearances, and begin performing meaningfully is beyond the timeframe required to perform the services now. Therefore, only current contractors with data sharing agreements and security clearances were considered. The nature of the work to be performed was also considered, and (or one like it) which is being utilized to perform part of the tasks under this contract, was considered integral to the ability to performance under the time frames necessary.

Ernst and Young (E&Y) is already on boarded and is currently performing a subset of the requirement, and it has existing work with other COVID-19 strategies with the DHA. It has an existing data sharing agreement with DHA, E&Y personnel already have security clearances, and E&Y is poised to continue the work it is doing within AED and expand into the new requirement.

Further, the Data Modeling and Event Monitoring currently being performed by E&Y--and eventually as part of the Data Science Lab--uses E&Y's proprietary tool. The tool is located within E&Ys Microsoft Azure Cloud infrastructure. To the Government’s knowledge, this is the only tool of its kind in the industry, and no other vendor currently has the capabilities of EY’s proprietary tool. The tool contains the most current data from and other commercial health care purchased data to conduct the necessary analyses. The combination of the current ingested commercial datasets with DHA Direct Care and Purchased Care data within the tool allows for leadership to assess COVID-19 progression and associated impacts on the commercial, Market, and MTF environments specific to supply/demand, quality, safety, and access dynamics.

8. As stated, no other vendor was identified as having a similar tool. Another vendor would have to either partner with E&Y to continue the use of the tool, license the tool from E&Y, or attempt to perform the work on its own through discrete tools or the creation of an tool. This would result in financial injury and time delay to the Government. The Government would have to pay unnecessary, duplicative costs to re-create work E&Y has already done which is not conducive to a new vendor’s systems, pay increased costs related to licensing fees, pay increased costs related to the new vendor’s inefficiencies or development costs a different vendor’s own proprietary tool. The unnecessary time-delay associated with creating a partnership or license agreement (assuming E&Y would agree), create a new tool, or attempt to accomplish the tasks without an tool.

Other Facts: Procurement History. There is limited known active or historical contracts for these services due to the recent outbreak of COVID-19. DHA will take appropriate action in accordance with FAR 5.404-1(a) to ensure the contract price is fair and reasonable.

9. Interested Sources: Based on the urgent requirement and the time frame to meet the immediate needs, Ernst & Young was the only source solicited. As discussed in the market research, the Government does not anticipated other interested sources capable of performing the needs within the time frame required.

10. Actions to overcome barriers: The need for a COVID-19 Modeling and Simulation service’s immediate and discrete. Should additional requirements for this need arise in the future, competition will

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11. Technical and Requirements Representative: I certify that the supporting data under my cognizance which are included in the justification are accurate and complete to the best of my knowledge and belief.

Program Management Branch

12. Fair and Reasonable Cost Determination: An Independent Government Estimate has been created on the basis of market research and labor cost categories for similar actions has been completed. A comparison of the proposed prices to historical prices paid by the Government for similar contract actions and in comparison to the most-preferred customer rates Ernst & Young have developed for work directly related to COVID-19 was made. A final analysis of the price was conducted during the technical evaluations after proposal submission which indicated Ernst &Young offered a rate which reflects a discounts to its Professional Services Schedule (PSS) rates negotiated with the General Services Administration under schedule, GS-

00F-290CA.

Contracting Officer

13. Legal Review:

I have reviewed this justification and have found it to be legally sufficient.

Office of General Counsel

APPROVAL:

14. Contracting Officer Certification: I certify that this justification is accurate and complete to the best of my knowledge and belief.

Contracting Officer

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15. Competition Advocate: Based on the foregoing justification, I hereby approve the procurement of COVID-19 Modeling and Simulating Services for the estimated amount of on an other than full and open competition basis pursuant to the authority of 10 U.S.C.2304(c) (2) Unusual and Compelling Urgency, subject to availability of funds, and provided that the services or property herein described have otherwise been authorized for acquisition.

Competition Advocate (J-4)

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