K7293 WSMA Sole Source Justification Questions.pdf

Department of Enterprise Services – C&P Page 1 of 8 June 2024

Sole Source CONTRACT Filing Justification Template

Use the following justification template for preparing to file sole source contracts in the Sole Source Contracts Database (SSCD). Once completed, copy and paste the answers into the corresponding SSCD question and answer fields. You will also need to include a copy of this completed form in the documents you post to your agency website and in WEBS.

What is a sole source contract?

"Sole source" means a contractor providing goods or services of such a unique nature or sole availability that the contractor is clearly and justifiably the only practicable source to provide the goods or services. (RCW 39.26.010)

Unique qualifications or services are those which are highly specialized or one-of-a-kind.

Other factors which may be considered include past performance, cost-effectiveness (learning curve), and/or follow-up nature of the required goods and/or services. Past performance alone does not provide adequate justification for a sole source contract. Time constraints may be considered as a contributing factor in a sole source justification, however will not be on its own a sufficient justification.

Why is a sole source justification required?

The State of Washington, by policy and law, believes competition is the best strategy to obtain the best value for the goods and services it purchases, and to ensure that all interested vendors have a fair and transparent opportunity to sell goods and services to the state.

A sole source contract does not benefit from competition. Thus the state, through RCW 39.26.010, has determined it is important to evaluate whether the conditions, costs and risks related to the proposal of a sole source contract truly outweigh forgoing the benefits of a competitive contract.

Providing compelling answers to the following questions will facilitate DES’ evaluation.

https://sscd.des.wa.gov/Logon/Logon.aspx?ReturnUrl=%2f https://sscd.des.wa.gov/Logon/Logon.aspx?ReturnUrl=%2f https://pr-webs-customer.des.wa.gov/

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Specific Problem or Need

• What is the business need or problem that requires this contract?

Approximately one in five adults have chronic pain1. While prescription opioids can be valuable to manage chronic pain, the Center for Disease Control (CDC) found a direct link between opioid prescribing practices, and the current opioid crises of widespread addiction and overdose.2 In addition to devastating families and communities and straining state systems, opioid-related overdoses are the leading cause of accidental death in adults under age 45 and have lowered the average life expectancy in the U.S.3

Improving opioid prescribing practices in Washington is central to addressing the State’s opioid crisis and saving lives. If approved, this contract will implement one of the strategies in the State Opioid and Overdose Response Plan4 (SOORP) to encourage safe opioid prescribing practices through the Better Prescribing, Better Treatment (BPBT) program5.

BPBT is a peer-to-peer, clinician-driven quality improvement program that promotes safe, appropriate prescribing to curb opioid misuse and overdose.6 BPBT is a component of the State Opioid and Response Plan (SOORP) and the Health Care Authority (HCA) is required by law7 to execute the SOORP, including the strategy that identifies the Washington State Medical Association (WSMA) for this work (Goal 1, Strategy 3) 8.

1 National Institutes of Health, NIH study finds high rates of persistent chronic pain among U.S. adults, 05/16/2023;

https://www.nih.gov/news-events/news-releases/nih-study-finds-high-rates-persistent-chronic-pain-among-us-adults 2 Centers for Disease Control, Recommendations and Reports, CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016, 03/18/2016; https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm 3 Mayo Clinic, The role of healthcare professionals in opioid addiction prevention, 01/17/2024;

https://www.mayoclinic.org/medical-professionals/trauma/news/the-role-of-healthcare-professionals-in-opioid-addiction-prevention/mac-20561321 4 Washington State, 2021-2022 WA State Opioid and Overdose Response Plan;

https://www.hca.wa.gov/assets/program/WashingtonStateOpioidandOverdoseResponsePlan-final-2021.pdf 5 Washington State Medical Association, Better Prescribing, Better Treatment, Program Overview:

https://wsma.org/wsma/resources/better-prescribing-better-treatment/program-overview.aspx?hkey=42729990- 0749-4850-b50a-a23a37590234&WebsiteKey=c182ff6d-1438-4899-abc5-614681b54927 6 ibid 7 RCW 43.70.770 State opioid response plan; https://app.leg.wa.gov/rcw/default.aspx?cite=43.70.770 8 Washington State, 2021-2022 WA State Opioid and Overdose Response Plan, Goal 1: Prevent opioid misuse, Strategy 3: Increase the use of the Prescription Monitoring Program (PMP) to encourage safe prescribing practices, page 13; https://www.hca.wa.gov/assets/program/WashingtonStateOpioidandOverdoseResponsePlan-final- 2021.pdf https://www.hca.wa.gov/assets/program/WashingtonStateOpioidandOverdoseResponsePlan-final-2021.pdf https://wsma.org/wsma/resources/better-prescribing-better-treatment/program-overview.aspx?hkey=42729990-0749-4850-b50a-a23a37590234&WebsiteKey=c182ff6d-1438-4899-abc5-614681b54927 https://app.leg.wa.gov/rcw/default.aspx?cite=43.70.770 https://www.hca.wa.gov/assets/program/WashingtonStateOpioidandOverdoseResponsePlan-final-2021.pdf

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Sole Source Criteria

• Describe the unique features, qualifications, abilities or expertise of the contractor proposed for this sole source contract.

WSMA is one of four BPBT collaboration members, which also include the Washington State Department of Health (DOH), HCA, and the Washington State Hospital Association (WSHA).

WSMA is tasked in the SOORP as a co-lead organization to perform the work described in the proposed contract9.

WSMA is the largest and oldest physician professional association in the State, representing physicians, residents, medical students, and physician assistants for more than 125 years.

This contract will contain obligations for the vendor to provide candid, confidential feedback and technical assistance to opioid prescribers to improve their opioid prescribing practices.

The prescriber participation is voluntary. For this work to be effective, it is essential that the prescribers trust and can share their sensitive performance-related information with the vendor. It is also essential that the maximum number of prescribers volunteer to participate, so the vendor must effectively reach non-participating prescribers and persuade them to sign-up for BPBT.

WSMA’s position as a founding partner in the BPBT collaborative, its ongoing coordination with the other founding members of the BPBT collaborative, and its unique position as the largest and oldest physician professional association in the State makes WSMA the only contractor capable of performing the work described in the proposed contract.

• What kind of market research did the agency conduct to conclude that alternative sources were inappropriate or unavailable? Provide a narrative description of the agency’s due diligence in determining the basis for the sole source contract, including methods used by the agency to conduct a review of available sources. Use DES’ Market Research Template if assistance is needed.

In 2016 the Washington State Interagency Opioid Working Plan10 (WSIOWP) members initially performed market research as they developed their recommended strategies for the creation of the SOORP. The WSIOWP formed in 2016 as a result of Executive Order 16-09 which directed that “state agencies . . . work with local public health, Tribal governments, and other partners across the state, to implement the state opioid response plan [.]”11

9 ibid 10 2016 Washington State Interagency Opioid Working Plan; https://stopoverdose.org/stateresponseplan.pdf 11 Executive Order 16-09 Addressing the Opioid Use Public Health Crisis;

https://governor.wa.gov/sites/default/files/exe_order/eo_16-09.pdf https://www.hca.wa.gov/assets/program/WashingtonStateOpioidandOverdoseResponsePlan-final-2021.pdf https://stopoverdose.org/stateresponseplan.pdf https://governor.wa.gov/sites/default/files/exe_order/eo_16-09.pdf

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WSIOWP included state agency leaders, medical directors, research scientists, and participating organizations who reviewed all possibilities as they developed recommendations. The executive sponsors (i.e., DOH, Department of Social and Health Services, Department of Labor and Industries, HCA and University of Washington) recommended WSMA to the SOORP. The executive sponsors are subject matter experts in responding to the state opioid crises.

HCA is not privy to the detailed market research conducted by WSIOWP and the executive sponsors, but HCA can assert that this large and diverse decision-making body carefully considered each strategy and identified partner, including the work in this contract with WSMA, before memorializing it in the SOORP.

• As part of the market research requirements, include a list of statewide contracts reviewed and/or businesses contacted, date of contact, method of contact (telephone, mail, e-mail, other), and documentation demonstrating an explanation of why those businesses could not or would not, under any circumstances, perform the contract; or an explanation of why the agency has determined that no businesses other than the prospective contractor can perform the contract.

HCA reviewed the statewide contracts list and did not find any contractors capable of providing opioid prescribing recommendations to medical professionals at a statewide level.

Terms below were searched in the statewide contracts database:

“Medical” “Prescribing”

“Professional” “Treatment”

“Opioid(s)”

• Per the Supplier Diversity Policy, DES-090-06: was this purchase included in the agency’s forecasted needs report?

No.

• Describe what targeted industry outreach was completed to locate small and/or veteran-owned businesses to meet the agency’s need?

HCA did not conduct targeted outreach because HCA does not have authority to independently change how the BPBT is administered or the SOORP strategy that identifies WSMA and BPBT for this work. RCW 43.70.770 requires HCA to partner with DOH to execute the SOORP, in collaboration with the agencies and organizations identified in the SOORP.

https://app.leg.wa.gov/RCW/default.aspx?cite=43.70.770

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• What considerations were given to unbundling the goods and/or services in this contract, which would provide opportunities for Washington small, diverse, and/or veteran-owned businesses. Provide a summary of your agency’s unbundling analysis for this contract.

In considering unbundling, HCA determined that this was not an available option because:

HCA does not have authority to independently change how the BPBT is administered or the SOORP strategy that identifies WSMA and BPBT for this work; this contract is unique and highly-specialized since the BPBT is a collaboration between the participating state agencies and private organizations who are members of the BPBT; HCA is only one member of the

BPBT. ]

• Provide a detailed and compelling description that includes quantification of the costs and risks mitigated by contracting with this contractor (i.e. learning curve, follow-up nature).

There are several risks and potential costs associated with not awarding this contract to WSMA.

i. There are no other entities with the unique position, qualifications, expertise, and access to provide BPBT training to thousands of opioid prescribers across the State. Without awarding this contract HCA and the SOORP sub-committee would not be able to provide individual feedback to opioid prescribers across the State, in a variety of care settings.

Without targeted feedback at the individual prescriber level, some prescribers may remain unaware of risks associated with their opioid prescribing practices and would be unable to implement individualized technical assistance and lower risk prescribing methods gained through the BPBT for opioid use disorders and chronic opioid therapy. If this contract is not awarded to WSMA, it is foreseeable that there could be an increase in Washington residents at risk of Opioid Use Disorder (OUD) and overdose.

ii. The SOORP sub-committee selected BPBT in part for its ability to reduce the opioid-related economic burden in WA State. A 2021 CDC report found the estimated economic costs (including: healthcare, criminal justice, lost productivity, reduction in quality of life, and life lost) associated with Opioid Use Disorder and fatal opioid overdose in Washington State in 2017 was $23,611,600,00012 or $3,18813 per capita. Therefore the expertise WSMA will provide opioid prescribers through this contract may reduce the economic costs in the state by reducing the number of individuals adversely affected by opioids.

12 Luo F, Li M, Florence C. State-Level Economic Costs of Opioid Use Disorder and Fatal Opioid Overdose — United States, 2017. MMWR Morb Mortal Wkly Rep 2021;70:541–546.

DOI: http://dx.doi.org/10.15585/mmwr.mm7015a1 13 ibid http://dx.doi.org/10.15585/mmwr.mm7015a1

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• Is the agency proposing this sole source contract because of special circumstances such as confidential investigations, copyright restrictions, etc.? If so, please describe.

Yes. This vendor is identified for this work in SOORP, Goal 1, Strategy 1.3.1, Increase the use of the Prescription Monitoring Program (PMP) to encourage safe prescribing practices. HCA does not have authority to modify the SOORP. Additionally, RCW 43.70.770 requires HCA to “coordinat[e] the statewide response to the opioid epidemic and execut[e] the state opioid response plan.” (the SOORP)

• Is the agency proposing this sole source contract because of unavoidable, critical time delays or issues that prevented the agency from completing this acquisition using a competitive process? If so, please describe. For example, if time constraints are applicable, identify when the agency was on notice of the need for the goods and/or service, the entity that imposed the constraints, explain the authority of that entity to impose them, and provide the timelines within which work must be accomplished.

No.

• What are the consequences of not having this sole source filing approved? Describe in detail the impact to the agency and to services it provides if this sole source filing is not approved.

If DES does not approve this filing, HCA will not fulfill its obligation in RCW 43.70.770 to execute the SOORP Goal 1, Strategy 1.3.1, Increase the use of the Prescription Monitoring Program (PMP) to encourage safe prescribing practices, and few prescribers will receive the crucial feedback, training and technical assistance to mitigate the opioid crisis, and save lives.

Sole Source Posting

• Sole Source Posting on Agency Website - Provide the date in which the sole source posting, the draft contract, and a copy of the Sole Source Contract Justification Template were published on your agency’s website.

- If failed to post, please explain why.

The information for this is not available at time of posting.

https://app.leg.wa.gov/RCW/default.aspx?cite=43.70.770 https://app.leg.wa.gov/rcw/default.aspx?cite=43.70.770

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• Provide the date in which the sole source posting, the draft contract, and a copy of the Sole Source Contract Justification Template were published in WEBS.

- If failed to post, please explain why.

September 17, 2024

• Were responses received to the sole source posting in WEBS?

- If one or more responses are received, list name of entities responding and explain how the agency concluded the contract is appropriate for sole source award.

This information is not available at the time of posting.

Reasonableness of Cost

• Since competition was not used as the means for procurement, how did the agency conclude that the costs, fees, or rates negotiated are fair and reasonable? Please make a comparison with comparable contracts, use the results of a market survey, or employ some other appropriate means calculated to make such a determination.

HCA compared this contract with contracts for other training and technical assistance programs that target OUD providers. This contract is similar in cost with contracts for technical assistance related to Opioids/Substance Use Disorder with other agencies, academic institutions and professional organizations.

Examples of comparable contracts are:

• HCA interagency agreement K6375-0-6 (Value of $679,500 over a 2-year period.)

Contractor developed a non-individualized training and educational plan for health care providers to reduce inappropriate opioid prescribing practices.

• HCA interagency agreement K7133 (Value of $1,500,000 over a 2-year period)

Contractor developed a training and workforce development plan for SUD, mental health and cooccurring disorder providers.

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• HCA Contract K7582 resulting from RFP #2023HCA14. (Value $500,000 over a one-year period.)

Contractor facilitated and promoted a SUD/mental health wellness and recovery culture, to support underrepresented and underserved communities, skill training, events and conferences.