OPM35-15-RFI-0001.pdf

Request for Information

Plan Performance Assessment

Federal Employees Health Benefits Program

Developed by

U.S. OFFICE OF PERSONNEL MANAGEMENT

HEALTHCARE AND INSURANCE

FEDERAL EMPLOYEE INSURANCE OPERATIONS

Point of Contact Information

Edward M. DeHarde, Contracting Officer

U.S. Office of Personnel Management

Healthcare and Insurance, Federal Employees Insurance Operations

1900 E Street NW, Washington DC 20415, Room 3400I

Table of Contents Responses

Response Submission

Instructions

Questions

Proposed Timetable

RFI Contact

Key Information

Background

Request for Information Objectives

Objective

Requirements and Requested Information

Requirements

Appendix A: Applicable IT Policies and Standards

Security and Privacy

Enterprise Architecture and Capital Planning and Investment Control

Records Management and Acceptable Use

Accessibility and Assistive Technology

HEALTHCARE AND INSURANCE

Federal Employee Insurance Operations

The U.S. Office of Personnel Management (OPM) is releasing this Request for Information

(RFI) with the intent of soliciting information from well-qualified vendors who are capable of providing high-quality systems and services to support the Federal Employees Health Benefits

(FEHB) Program Plan Performance Assessment. The RFI is seeking information on available options to integrate data derived from Healthcare Effectiveness Data and Information Set

(HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), and potentially other measures endorsed by the National Quality Forum, as well as to provide analytic and business infrastructure for the FEHB Plan Performance Assessment.

Responses

Responses should include detailed information about your experience in providing the services discussed in this RFI. Specific examples from your current and past client base are especially helpful. As this is not a Request for Proposals (RFP), partial responses will be accepted.

In addition to the requested information within this document, please include the following information with your response:

1. Name and address of your firm.

2. Two points of contact, including: name, title, phone, fax and email address.

3. Ownership of the firm, indicating whether it is a: large, small, small disadvantaged, 8(a), women-owned, HUBZone, and/or Veteran-owned business.

4. Number of years in business.

5. Up to three current or past (within 5 years) performance references of similar programs or projects. Include the size and type of the contract, if your company was the prime contractor, and a description of services provided.

6. Experience in HEDIS or CAHPS and whether you have a commercial (including commercially available off-the-shelf with modifications) or non-developmental system that could meet the needs as described in this RFI.

7. Specify what types of additional information you would need in order to provide a thorough response to an RFP.

8. Estimation of how much time you would need to prepare a response to an RFP.

9. Estimation of how much time you would need from the date of award to be ready to start.

Interested small businesses are encouraged to respond to this notice and vendors are encouraged to provide evidence that they can comply with FAR 52.219.14 (“Limitations of

Subcontracting”).

This is not an RFP. Proposals are not requested at this time and will not be considered or accepted. Do not include any pricing information with your response. A determination on how, or if, to proceed with this requirement will be based in part upon responses to this RFI and will be solely within the discretion of the government and based on its needs and requirements. You do not have to respond to this RFI in order to respond to any future RFP.

The government may request to meet one-on-one with selected respondents to this RFI for a more in-depth capabilities presentation. OPM anticipates scheduling one-on-one capabilities presentations with firms responding to this RFI within 30 days after the RFI’s due date.

Your response to this RFI is voluntary. The information gathered from this RFI will be used to improve and enhance our understanding of the industry’s current capabilities and practices and will potentially help us craft an RFP. Please note that OPM often receives requests under the

Freedom of Information Act to publicly disclose information it receives from industry. If you consider anything you provide us to be confidential, proprietary or otherwise protected from public disclosure, you must clearly identify and mark it as such.

We recommend that firms planning to respond to this RFI register their email addresses on the

Federal Business Opportunities (FedBizOpps or FBO) website at http://www.fbo.gov to receive notices of any changes as they are uploaded to the website, or information on a future RFP.

Response Submission

Instructions

Your response should be direct and concise. Please adhere to the format guidelines outlined below. Submissions shall be no more than 25 pages in length, excluding the cover page, table of contents and past performance.

Formatting should include printing on 8.5” x 11” paper, 1” margins, and 12 pt. font.

All responses must be included in the table of contents with the appropriate page number referenced.

Responses must include a restatement of the request (number and text) with the response immediately following.

Appendices and other supplemental information provided with your response must be clearly identified.

Prospective respondents should mail or deliver five (5) hard copies of the RFI to the point of contact listed in this RFI.

Please also send your submission electronically in Microsoft Word file format to

Edward.DeHarde@opm.gov. Reference the RFI number in the subject line. Please note that http://www.fbo.gov/ mailto:Edward.DeHarde@opm.gov excessively large documents and/or numerous attachments may not be deliverable through the

OPM email system.

Questions

Prospective respondents may submit questions in writing via email to the RFI contact by the date and time indicated in the timeline. We will provide all questions and answers to all prospective respondents by the date and time indicated in the timeline. We will not accept telephone inquiries.

Proposed Timetable

The timeline is provided below for informational purposes. OPM reserves the right to change the dates. Every effort will be made to notify prospective respondents of changes to the proposed timeline.

Activity Date/Time (All Times in Eastern Time)

OPM releases RFI September 23, 2015

Prospective Respondents’ questions (in writing) due October 2, 2015 – 3:00 p.m.

OPM distributes answers to prospective respondents’ questions October 14, 2015

RFI Responses due October 21, 2015 – 3:00 p.m.

RFI Contact

Edward M. DeHarde, Contracting Officer

U.S. Office of Personnel Management

Healthcare and Insurance, Federal Employees Insurance Operations

1900 E Street NW, Washington DC 20415, Room 3400I

Prospective respondents may contact only the RFI contact. All correspondence and questions must be submitted in writing via email to the RFI contact in accordance with the timeline set forth in this RFI; other OPM personnel are not authorized to discuss this RFI with prospective respondents.

Key Information

Background

With the publication of its Final Rule on Plan Performance Assessment in the Federal Register on June 30, the Federal Employees Health Benefits (FEHB) Program has moved to value based payment across its $48B health insurance portfolio. The new FEHB Plan Performance

Assessment methodology, described in an OPM letter to insurance carriers, is designed to hold the 97 FEHB program carriers accountable for delivering quality health care to all 8.2 million federal employees, retirees, and family members. Beginning in 2016, FEHB will tie profits to plan performance on 19 measures of clinical quality, customer satisfaction, and resource use selected from HEDIS and the Consumer Assessment of Healthcare Providers and Systems

(CAHPS).

FEHB carriers typically collect each measure for at least 2 years before it is included in the performance formula. Scoring is performed against nationwide commercial benchmarks matched for product type, allowing all FEHB plans the opportunity to succeed. The methodology uses a continuous scoring system, allowing carriers to earn credit for incremental achievement on each measure, and includes a gradual transition from the existing system, which assesses performance based on contract compliance. Additional credit for year over year improvement is anticipated as a new feature in 2017.

Request for Information Objectives

Objective

The U.S. Office of Personnel Management (OPM) is charged with administration of the Federal

Employees Health Benefits Program, as authorized by Title V, Section 89, and implementing regulations. Under contracts with OPM, health insurance issuers offer FEHB plans to federal employees and annuitants.

Beginning in 2016, OPM’s evaluation of each FEHB plan’s performance will include measures that reflect clinical quality, customer satisfaction, and resource use. Measures are largely drawn from HEDIS and CAHPS, though may include other NQF endorsed or industry standard measures over time. OPM seeks a vendor to support:

aggregation of data streams reflecting each plan’s results data quality evaluation, including validation and trend analyses, and compliance with written instructions on how to sample the data reporting capabilities http://www.gpo.gov/fdsys/pkg/FR-2015-06-30/pdf/2015-15988.pdf https://www.opm.gov/healthcare-insurance/healthcare/carriers/2015/2015-10.pdf development of nationwide benchmarks for any measures not already benchmarked through the Quality Compass system

Details of OPM’s Plan Performance Assessment methodology appear at https://www.opm.gov/healthcare-insurance/healthcare/carriers/2015/2015-10.pdf.

In most cases, the data will be transmitted to OPM’s data aggregation vendor by each plan’s

HEDIS/CAHPS contractor or the National Committee for Quality Assurance. OPM does not receive claims or encounter data from FEHB plans for purposes of calculating quality measures.

Plans typically engage a HEDIS vendor and/or auditor to assist with the analysis of their claims and medical records data in order to generate valid metric results. In similar fashion, plans engage a CAHPS vendor to generate a qualifying sample and perform the survey. Plans may maintain their current business relationships under this new system, and OPM’s vendor must be capable of working with these business partners to accomplish program goals.

Currently, OPM aggregates CAHPS data with the assistance of a vendor, receives HEDIS results directly through NCQA, and contracts with NCQA for Quality Compass benchmarks. In the event that an FEHB plan independently selects and separately contracts with OPM’s data aggregation vendor as their HEDIS or CAHPS contractor, claims data may be available to assist with benchmarking, interim analysis, or trend analysis.

We seek vendor(s) that are experienced with both HEDIS and CAHPS, or vendor(s) that can offer subcontracted partners with this expertise. The ideal vendor(s) would have access to an established database to allow the generation of benchmarks for National Quality Forum endorsed measures that are not tracked via Quality Compass, along with sufficient experience with HEDIS and CAHPS trends to flag data anomalies. OPM is interested in obtaining information on existing tools for performing this work and receiving suggestions and solutions for novel approaches. OPM may pursue one or more contracts to accomplish these tasks.

Requirements and Requested Information

In each of the below sections, we describe our anticipated requirements and the requested information for a response to this RFI. The requested information will help us better clarify requirements in the future.

Requirements

We are interested in receiving information about your HEDIS/CAHPS analysis, data aggregation, and benchmarking capabilities. For all responses, please indicate if the listed capability is within your core scope or provided by business partners. If you would develop new partnerships to perform this work, please so indicate.

1. Discuss your experience with collecting, reporting, auditing, or analyzing

a. HEDIS data

b. CAHPS data

c. Other healthcare measures (endorsed by NQF or used by states/CMS)

2. Provide the number and size of the clients for whom you provide services related to quality measurement and reporting, and the type of reporting.

3. Can you accept HEDIS/CAHPS data files from other vendors?

4. Can you accept claims/electronic clinical files for primary measure analysis?

5. Detail the methodologies, criteria, and technology you employ to detect and correct anomalous data.

6. Detail the methodologies, criteria, and technology you employ to perform trend analysis and compile reports.

7. Discuss the extent and nature of health care claims databases or other databases available to you that could inform OPM’s benchmarking.

8. Do you currently generate benchmarks for other clients? To the extent you can discuss, please provide examples.

9. In addition to required reports, can clients obtain access to a data portal or other functionality for interim analysis?

10. Discuss your ability to generate standard reports and ad hoc reports using any of the collected data elements for deeper analysis. Discuss how your system accomplishes these reporting needs.

11. Discuss your ability to generate customized reports or special inquiries.

12. Review your ability to identify best practices that result in high level performance on quality measures.

13. Highlight any efforts you have undertaken to develop new or alternative methods for analyzing health care quality and satisfaction data.

Appendix A: Applicable IT Policies and Standards

Security and Privacy

Federal Privacy Rule for Personal Health Information – Health Insurance Portability and

Accountability Act of 1996 (HIPAA)

The Federal Information Security Management Act (FISMA) of 2002

Section 208 of the E-Government Act of 2002 (Public Law 107-347)

The Privacy Act of 1974, Public Law 93-579, December 31, 1974, (5 U.S.C. 552a)

Office of Management and Budget (OMB) Memorandum “Protection of Sensitive

Agency Information” (OMB M-06-16)

The Federal Enterprise Architecture Security and Privacy Profile

National Institute of Standards and Technology (NIST) Special Publication 800-18, “Guide for Developing Security Plans for Information Technology Systems”

Federal Information Processing Standards (FIPS) Publication 197 regarding encryption standards

OPM – Information Security and Privacy Policy (OPM Policy 2011)

OPM – Information Security and Privacy Policy addendum (OPM Policy 2013)

OPM IT Security Policy and Procedures (OPM Policy 2011)

OPM Incident Response and Reporting Guide (OPM Policy 2009)

OPM Policy for Responding to Breaches of Personally Identifiable Information (PII)

Enterprise Architecture and Capital Planning and Investment Control

IT Enterprise Architecture

IT Baseline Management Policy (OPM Policy 2011)

OPM Policy on Information Technology (IT) Procurement, 2009

System Development Life Cycle (SDLC)

OPM Financial Management Manual, 2013

Records Management and Acceptable Use

The Paperwork Reduction Act of 1995, as amended (44 U.S.C. 3501)

Office of Management and Budget Circular No. A-130 “Management of Federal

Information Resources”

Web Publishing Policy, 2006

OPM Policy for Computer User Responsibilities (OPM Policy 2009)

OPM Policy – Email Management Annual Notice, 2014

OPM Records Management Handbook, 2003

OPM Rules of Behavior

Accessibility and Assistive Technology

Section 508 of the Rehabilitation Act (29 U.S.C. 794d), as amended by the Workforce

Investment Act of 1998 (P.L. 105-220)

Section 255 of the Telecommunications Act of 1996

Section 508 Standards for Electronic and Information Technology

OPM Information Technology Accessibility – Section 508