OACT-393-2019-0022_HCCI_SOW.docx

June 13, 2019

STATEMENT OF WORK

I. SCOPE

Private health insurance claims data, as well as data for Medicare beneficiaries covered by Medicare Advantage (MA) plans, are needed to support the development and analysis of projected health spending, the evaluation of the accuracy of historical health spending estimates, and the development of estimates of private health spending by age and gender and by state. It is vital for the National Health Statistics Group (NHSG) to be able to gain knowledge and insight into health care spending trends of the privately insured and those enrolled in MA. The Health Care Cost Institute (HCCI) possesses a unique claims database that would allow for testing of a hypothesis to gain insight into the private health insurance and MA populations, which cannot be tested without these data.

A. Background

In the historical National Health Expenditure Accounts (NHEA), estimates of private spending for health care are calculated as a residual. As such, the accuracy of these estimates is largely dependent upon the accuracy of estimates of total health spending and publically financed health expenditures. This limits the use of NHEA data for testing hypotheses of private health insurance trends. HCCI possesses a unique data set that includes claims data from three (3) of the largest national health insurance companies, Aetna, Humana, and UnitedHealthcare. Gaining access to this claims database would allow the NHSG to learn more about the privately insured population. Additionally, utilization data on the part of MA enrollees are needed to more fully understand the drivers of spending for the Medicare program.

B. Purpose

The purpose of this contract is to enable the NHSG to test approved hypotheses that will allow for the NHSG to gain greater insight into privately insured health spending trends and trends associated with MA enrollees.

C. Technical Considerations (Ranking in order of importance)

1. The vendor currently has a data collection system in place that produces a sufficiently large private health insurance claims database that allows for the evaluation and comparison of nationally representative estimates of private health insurance spending and fulfills the requirements listed in section II of this Statement of Work.

2. The vendor has data from numerous private health insurance plans.

3. The vendor currently has a system in place for ensuring the statistical reliability and consistency of the database.

4. The vendor has an ongoing quality assurance program that tests the accuracy of the data system.

II. REQUIREMENTS

Independently and not as an agent of the Government, the Contractor shall furnish all the necessary accesses to data as required in this Statement of Work.

A. Requirements/Tasks to be Performed.

These task orders are contingent upon having agreed to a hypothesis for the NHSG to test, as well as a master license agreement.

1. Grant access to HCCI database for users for the hypothesis testing.

2. Provide access to the expanded data set, which includes all years of data

3. Provide training for CMS users to be able to access the HCCI data through a data enclave.

4. Provide up to 30 hours of standard support.

5. Upload approved data sets to the CMS researcher’s workspace in the HCCI data enclave

B. Report Requirements

The Contractor shall provide access to the private claims database for 2 concurrent NHSG users. NHSG will be able to access the data through the HCCI data enclave.

The contractor will provide reasonably detailed and comprehensive support and materials (such as a data dictionary or glossary of terms/data variables) to NHSG including answering questions related to the database and providing adequate documentation that details the methods used to construct the database and the layout of the data and files.

See separate document for a complete listing of “Items to be Furnished and Deliverable Schedule”.

C. Period of Performance

The period of performance for this purchase is one year from gaining access, or until the completion of the research project, whichever is first.

D. Government Property

None.

E. Personnel Requirements

None.

III. QUALITY ASSURANCE

The Project Officer will review data described in section II.B. of this SOW and provide comment(s) to the Contractor.

IV. APPENDICES:

Section 508 Compliance:

The deliverables shall comply with the ICT Accessibility Requirements Statement per the Revised Section 508 of the Rehabilitation Act.

Electronic Content Technical Criteria:

• E205.1 General - Electronic content shall comply with E205.

Functional Performance Criteria:

•301.1 Scope - The requirements of Chapter 3 shall apply to ICT where required by 508 Chapter 2 (Scoping Requirements), 255 Chapter 2 (Scoping Requirements), and where otherwise referenced in any other chapter of the Revised 508 Standards or Revised 255 Guidelines.

•302.1 Without Vision - Where a visual mode of operation is provided, ICT shall provide at least one mode of operation that does not require user vision.

•302.2 With Limited Vision - Where a visual mode of operation is provided, ICT shall provide at least one mode of operation that enables users to make use of limited vision.

•302.3 Without Perception of Color - Where a visual mode of operation is provided, ICT shall provide at least one visual mode of operation that does not require user perception of color.

•302.4 Without Hearing - Where an audible mode of operation is provided, ICT shall provide at least one mode of operation that does not require user hearing.

•302.5 With Limited Hearing - Where an audible mode of operation is provided, ICT shall provide at least one mode of operation that enables users to make use of limited hearing.

•302.6 Without Speech - Where speech is used for input, control, or operation, ICT shall provide at least one mode of operation that does not require user speech.

•302.7 With Limited Manipulation - Where a manual mode of operation is provided, ICT shall provide at least one mode of operation that does not require fine motor control or simultaneous manual operations.

•302.8 With Limited Reach and Strength - Where a manual mode of operation is provided, ICT shall provide at least one mode of operation that is operable with limited reach and limited strength.

•302.9 With Limited Language, Cognitive, and Learning Abilities - ICT shall provide features making its use by individuals with limited cognitive, language, and learning abilities simpler and easier.

V. REFERENCES

Please see website for additional information and background on the estimates in the National Health Expenditure Accounts (NHEA):

Definitions, Sources, and Methods document: http://www.cms.hhs.gov/NationalHealthExpendData/downloads/dsm-07.pdf

Additional references:

http://www.cms.hhs.gov/NationalHealthExpendData/01_Overview.asp#TopOfPage

Attachment J-

ITEMS TO BE FURNISHED AND DELIVERABLE SCHEDULE

The Contractor shall submit all required reports and deliverables in accordance with the following schedule. Reports and/or deliverables submitted under this contract shall be in accordance with the Statement of Work entitled

ITEM # DESCRIPTION QTY/RECIPIENT DELIVERY

Example: (Do NOT list what is to be in each report in this section. Descriptions of content and format for reports are contained in the SOW under Reporting Requirements.)

*Access will be granted within 45 days of the completion of the purchase order. Training is for new CMS users, or current users if there are changes to the enclave.

Recipient Addresses:

Joseph Benson Project Officer Centers for Medicare and Medicaid Services Office of the Actuary, N3-02-02 7500 Security Blvd.

Baltimore, MD 21244-1850