Notice_of_Intent_to_Sole_Source_-_HHS_ASPE_CHCD_1.pdf

Notice of Intent to Sole Source

HHS ASPE

Commercial Healthcare Claims Data

Agency Contact Information:

U.S. Department of the Interior (DOI), Interior Business Center (IBC), Acquisition Services Directorate (AQD), 381 Elden Street, Suite 4000, Herndon, VA 20170 Contracting Officer: Russell Pfeiffer - russell_pfeiffer@ibc.doi.gov

Proposed Action:

The Government intends to negotiate, on a sole source basis, a firm-fixed-price (FFP) acquisition with Merative US, L.P. (Merative) for Commercial Healthcare Claims Data (CHCD). This non-competitive action is being issued by the Acquisition Services Directorate on the behalf of the U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation

(ASPE).

Place of Performance:

Contractor Facilities.

Description of Requirement:

The objective of this acquisition is to acquire commercial healthcare claims data. These data are necessary to understand health care spending and utilization of health services, particularly as it relates to large employer-provided insurance and Medicaid managed care (Transformed Medicaid Statistical Information System (T-MSIS) currently does not have cost data). Access to such data, as well as technical assistance to analyze these data, is important to understand the service utilization and expenditures patterns surrounding issues of importance to the Secretary and the Department (e.g., to track the opioid epidemic, health care cost persistence, and the healthcare experiences of vulnerable populations).

This effort involves the following tasks:

TASK 1.1: Private Health Insurance Claims Databases: The Contractor shall license to ASPE ten years of the most current private insurance claims data for a 12-month period beginning September 29, 2022.

The claims shall come from geographically diverse private insurers. There shall not be limits on the number of ASPE staff who will have access to the data.

TASK 2.1: Medicaid Claims Databases: The Contractor shall license to ASPE ten years of the most current Medicaid claims data for a 12-month period beginning September 29, 2022. The claims shall come from geographically diverse Medicaid programs. There shall not be limits on the number of ASPE staff who will have access to the data.

TASK 3.1: Online Analytic Tool to Analyze Health Insurance Claims Data: The Contractor shall license to ASPE for 12 months an online analytic tool that will support the rapid analysis of the private insurance and Medicaid claims data by 10 ASPE staff members. The analytic tool shall enable a user without programming expertise to generate descriptive statistics from the claims data (e.g., what are the average payments for treatment? what is the average length of stay of a person hospitalized for a certain condition?). The analytic tool shall also facilitate the creation of analytic data files from the claims data (e.g., creation of variables, limiting of the data set to specified sub-populations).

TASK 4.1: Analytic Support for ASPE analysis of Health Insurance Claims Data: The contractor shall provide ASPE staff with technical support in using the insurance claims data (answer questions about variables in the data, assist with the online analytic tool programming), and the analytic tools. In addition, the Contractor shall respond to emails and phone calls from ASPE staff requesting technical assistance in using the databases and the online analytic tool.

Optional Task 5.1: Annual Data Files: In this task, the contractor shall provide five sets of files based on the most recent commercial claims data that contains proprietary information to which ASPE researchers would otherwise not have access, but which can be summarized in an aggregate fashion. These files shall include:

1. Plan Generosity File: this file should include the plan benefits generosity information and plan type including the estimated actuarial value (AV) of the plan and necessary information to link to the enrollee-level file and the Per-Member-Per-Month (PMPM) files described below (i.e., geographic codes and associated enrollment in order to compute enrollment-weighted AV at various geographic codes). The actuarial value (AV) is defined as the ratio of total paid plan costs to total allowed plan costs. Paid plan costs are medical plan expenses that are paid by health insurance companies, while allowed plan costs are the total costs (plan payments and patient liabilities) paid to the providers. The plan benefits generosity information includes total costs (medical and drug), patient liability amounts (cost-sharing by provider settings or plan type).

2. Payment Rate Analytic Files: These files should use the provider’s county and core-based statistical area (CBSA) codes and include:

• A summary of payments among non-capitated plans for outpatient and non-facility inpatient services, geography, physician specialty (STDPROV), place of service (STDPLAC) and procedure code (PROC1).

• A summary of payments among non-capitated plans only for inpatient facility services, geography, physician specialty (STDPROV) and DRG. The STDPROV was derived based on identifying the provider type for the hospital provider reflected on the claim. When there were multiples, the provider type selected was the one with the largest payment value when all line items for that provider type were summed. Where none was found, the STDPROV value should be set to 999 so they may be evaluated to determine how best to handle them for ASPE analyses.

3. County/Sex/Age Group Level File: This file should contain one record for every unique combination of these three variables. It also should contain summary counts of all enrollees whether or not they had any claims (ENROLL), enrollment months (ENRMON) and total payments across all file types (SUM_PAID), and include a separate STATE and CBSA or county variables. Enrollees without any claims should also be included (payments would count as zero for these enrollees – the contractor shall make sure to identify and distinguish Payments=0 vs. Payments=missing as ASPE doesn’t want to assign missing the value of 0).

4. Per Member Per Month (PMPM) Files should be computed based on all enrollees whether or not they had any claims and include:

• Per member counts by: county, core-based statistical area (CBSA), Hospital Service Area (HSA), and Hospital Referral Region (HRR).

• Monthly usage summaries by enrollee (PMPM). These files should be tagged with core-based statistical area (CBSA) and State/County. Non-CBSA areas are coded with the state FIPS code (FIPS refers to U.S. Federal Information Processing Standard Publication) followed by three 9s (e.g., non-CBSA Wyoming is coded as '56999').

5. Drug Pricing Analytical data files: data files, by payer category and site of service files shall include:

• Prescription drugs by National Drug Code (NDC). Drug establishments are required to provide FDA with a current list of all drugs manufactured, prepared, propagated, compounded or processed for sale in the U.S. at their facilities. Drugs are identified and reported using a unique, three-segment number called the National Drug Code (NDC) which serves as the FDA’s identifier for drugs. FDA publishes the listed NDC numbers in the NDC Directory which is updated daily.

• Part B drugs by Healthcare Common Procedure Coding System (HCPCS) codes: all Average Sales Price (ASP)-paid Medicare Part B physician-administered drugs, and all ASP-paid Medicare Part B physician-administered drugs (with identifiers for single source drugs, drugs not paid separately under Medicare in hospital outpatient departments). The Healthcare Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs. The Average Sales Price (ASP) system was enacted in 2005 as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and generally reflects the average price of a drug’s sales to all purchasers in the United States, including commercial payers. The ASP is calculated for each Healthcare Common Procedure Coding System (HCPCS) code included in Part B coverage.

Response Information:

This action is being processed in accordance with FAR 13.5. No other organization besides Merative (formerly IBM Watson Health) is known to provide a database that includes all of the required elements.

However, interested parties may identify their interest and capabilities regarding this requirement by submitting a capabilities statement by the date specified herein.

A one-year base period and four (4) one-year option periods are anticipated for this effort. The Government will consider all capabilities statements received by 10:00 A.M. ET, Tuesday, July 5, 2022.

Please be advised that it is the offeror’s responsibility to ensure the Government receives your submission on or before the specified due date. Submissions shall be sent electronically to Russell Pfeiffer, Contracting Officer at russell_pfeiffer@ibc.doi.gov. Submissions shall not exceed ten (10) pages. Paper copies will not be accepted. Late responses will only be accepted if they contain extraordinary value to the Government. Submissions should be in a Microsoft Office compatible format (i.e., Microsoft Word, PowerPoint, Excel, etc.) or Adobe Acrobat and not contain text smaller than 11-point font. The maximum file size of the submission shall not exceed 8 MB. Tables, graphs, etc. will count against the total page count. Font size smaller than 11 may be used to label tables and graphs, but may not be smaller than 8-point font. All data received in response to this Special Notice that are marked or designated as corporate or proprietary information will be fully protected from release outside the Evaluation Panel.

Proprietary information and trade secrets, if any, must be clearly marked on all materials. All information received that is marked Proprietary will be handled accordingly. Please be advised that all submissions become Government property and will not be returned. All Government and contractor personnel reviewing responses will have signed non-disclosure agreements and understand their responsibility for proper use and protection from unauthorized disclosure of proprietary information as described in 41 USC

423. The Government shall not be held liable for any damages incurred if proprietary information is not properly identified. Responders are advised that the Government will not reimburse for any information or administrative costs incurred in response to this Special Notice; all costs associated with responding to this Special Notice will be solely at the interested parties' expense. This is NOT a request for competitive quotes. A determination by the Government not to compete this proposed action based upon responses to this announcement is solely within the discretion of the Government. Information received is solely for the purpose of determining whether to conduct a competitive acquisition. The Government reserves the right to issue a Request for Quote (RFQ) as a result of this announcement. Please be advised that this announcement may constitute the only notice that will be posted for this acquisition, based on the review of any responses to this notice. Marketing brochures and/or generic company literature will not be considered. Not addressing all the requested information may result in the Government determining the responder is not capable of performing the scope of work required.