P00025 - Legacy Telehealth Supplemental JA - OCC Eqip and Services - Fully Executed - SPE Approved.pdf

DEPARTMENT OF VETERANS AFFAIRS

Office of Procurement, Acquisition and Logistics (OPAL)

Strategic Acquisition Center (SAC) 10300 Spotsylvania Ave, Suite 400

Fredericksburg, VA 22408

JUSTIFICATION AND APPROVAL

FOR OTHER THAN FULL AND OPEN COMPETITION

(1) Contracting Activity:

This Justification and Approval (J&A) for Other Than Full and Open Competition is executed by the Strategic Acquisition Center (SAC), on behalf of the Department of Veterans Affairs (VA), Veterans Health Administration (VHA) Digital Health Office (DHO) Office of Connected Care (OCC).

(2) Description of Action:

The proposed action is a modification and extension of the current sole source contract for 36C10G21D0016 – Equipment and Services Support Transition Contract. In order to continue supporting the transition effort, an extension is needed for the existing sole source procurement with Iron Bow Technologies, LLC 2121 Cooperative Way STE 500 Herndon, Virginia 20171-5346. This contract will otherwise expire on September 29, 2024. An extension is necessary to avoid a gap in service for critical and essential connected care technology equipment and services. The SAC continues to work toward competitive follow-on procurements, which contemplate multiple awards and greater opportunities for Service-Disabled Veteran-Owned Small Businesses (SDVOSBs), Veteran-Owned Small Businesses (VOSBs), and/or other Small Businesses (SBs).

The contract extension will be for a six-month base and two, three-month option periods. The issuance of each delivery and task order will not exceed 12-months beyond its date of issuance, will specify its own period of performance, and may go beyond the end date of the base contract to be inclusive of option periods exercised, if any.

(3) Description of Supplies or Services:

This requirement is to provide continued support for VA's existing network for connected care to include all products and integrated program support services as already conducted under contract 36C10G21D0016. The connected care technology network is an exceptionally complex, major VA system that supports a myriad of clinical disciplines and procedures across the VA enterprise. VA’s network comprises of highly specialized equipment, including more than 9,500 videoconferencing codec devices, 115,000 iPads issued to patients, 16,000 iPads issued to providers, and more than 288,000 peripheral devices such as stethoscopes, cameras, etc., at more than 171 VA medical centers and 1,113 VA clinics. In FY23, over 2.4 million Veterans received at least some VA healthcare through over 11.6 million telehealth encounters.

Strategic Acquisition Center (SAC)

The estimated value of this action, inclusive of options, is $200,000,000.00 which will change the overall contract ceiling value to $1,160,637,210.00.

(4) Statutory Authority Permitting Other Than Full and Open Competition:

The statutory authority permitting other than full and open competition is 41 U.S.C. 3304 (a)(1), as implemented by the Federal Acquisition Regulation (FAR) Subpart 6.302-1 entitled, "Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements".

(5) Rationale Justifying Use of Cited Statutory Authority:

Background:

VA continues to work to implement the decision to break telehealth requirements into three (3) smaller, separate, and distinct contract vehicles.

These requirements are defined below:

a) Program Support Integration (PSI) - a single-award IDIQ responsible for program and project management functions required by OCC, including program integration and program support; project, release, and implementation management; communications and training.

b) Connected Care Integrated Network (CCIN) - a single-award IDIQ responsible for technical support services required by OCC, including product ordering, inventory, and asset management; help desk support;

connected care technology software and mobile medical application design, development, enhancement, and remediation, and infrastructure and architecture support.

c) Connected Care Product Catalog (CCPC) – a catalog of multiple BPAs that provide necessary hardware, software, licenses, subscriptions, warranties, and maintenance necessary to operate, maintain, and enhance the overall connected care technology network.

Current Status:

VA is less than 60 days from the expiration of the current contract, 36C10G21D0016, and only one of the three contracts, CCIN, is in place for continued support beyond September 29, 2024. CCIN was successfully awarded on January 1, 2024. All CCIN-eligible work will not be executed through any future orders through the current contract. Rather, all such services will be executed only from the CCIN contract.

VA requires another extension to the current contract due to the following status of

Strategic Acquisition Center (SAC) two (2) of the three (3) recompetes:

a) Given a previous award and then various protests in 2023, PSI was re-awarded on February 28, 2024. Another Government Accountability Office (GAO) protest was filed on March 13, 2024. On April 2, 2024, GAO dismissed the protest on account of VA’s decision to take corrective action.

PSI past performance and technical re-evaluations were completed by May 29, 2024. A new best-value trade-off is currently being conducted. A new award is expected late August 2024.

b) CCPC was posted to Contract Opportunities on July 7, 2023, for a minimum of 30 days, with a previously anticipated award of March 2024; however, this solicitation resulted in the receipt of unfavorable quotes that did not meet the needs of the Government and thus, was cancelled on May 16, 2024. An RFI was immediately posted with a close date of June 14, 2024, and the Government received eight (8) responses: three (3) SDVOSB’s, one (1) SDVOSB/WOSB, one (1) Small Business, and three (3) Large Businesses. VA still needs to develop a new strategy based on feedback received and conduct planning to determine a new way forward. A virtual industry day is being developed, and the intent is to host it in August 2024;

this will assist in finalizing the acquisition strategy.

VA continues to work toward the award of PSI and CCPC, but in the meantime, requires the services and products these planned contracts are expected to provide.

If VA was required to compete rather than extend the existing sole-source contract during this time, it would result in unacceptable delays, lack of knowledge transfer, disruption in services, and substantial duplication of costs, including an increase in award cost caused by a new contractor start-up process, which is discussed below.

PSI Protest Results, CCPC Cancellation, and Impact to Telehealth Recompete:

The PSI protest activity introduced progressive delays in the start of the programmatic component of the support to OCC. PSI needed to be awarded timely and free of protests, as this portion would ensure support for program and project management functions required by OCC, including program integration; project, release, and implementation management; communications; and training to set up success for the remaining recompetes. Since PSI has a delayed award, this extension is increasingly becoming mandatory as these programmatic elements need to be supported by the existing vehicle.

The cancellation of CCPC was unexpected and now has an unknown award date, anticipated for FY25. The delay has now impacted the ability to procure products beyond the current contract end date and has caused the Government to revisit the Market Research phase. This will assist in developing a new acquisition strategy which will involve restructuring the solicitation to be substantially different than the

Strategic Acquisition Center (SAC) cancelled solicitation. Given the need to restart the entire acquisition of CCPC, the Government’s need for the extension of this existing vehicle is at a critical point where loss of the ability to procure these products beyond the current end date would be detrimental to the Government.

Due to the current status of PSI and CCPC, failure to extend the existing contract would affect the connected care technology network in the following ways:

Lack of Knowledge Transfer:

In the absence of an extension, OCC would not have a contract vehicle in place for an appropriate integrated program support transition period before the end of the current contract period of performance. Due to corrective action following the protest dismissal, PSI's current projected award date is late August 2024. Although the two previous protests were dismissed through corrective action, another protest would continue to build on the substantial delay in PSI work beginning.

Due to the scale and complexity of this requirement, the incumbent contractor is the only source who currently has the resources, knowledge, and expertise to permit uninterrupted continuity of program support operations. Currently, PSI provides for up to an estimated 6-months transition period, once awarded, to allow for adequate knowledge transfer from the current contractor to a new contractor.

Disruption in Services:

VA must continue to have a contractual vehicle in place to procure connected care technology equipment, software licenses, and subscriptions, and provide integrated program support services through product management. In-depth knowledge of the connected care system is required to allow for continuity of operations and provide the insight that ensures the highest standards of performance, which is critical to facilitating the delivery of timely and safe healthcare for Veterans.

Without regular integrated program support for production systems that is provided in the to-be-awarded PSI contract, errors and downtime could follow. OCC would lose help with oversight and validation of products prior to deployment. Disruption could extend to virtually all aspects of the OCC Program to include analytics, Virtual Health Resource Centers, implementation, communications, and training which could hinder OCC from fulfilling its mission.

Although the recently awarded CCIN contract provides for product development, program/product management activities will be included in the to-be-awarded PSI contract. Program/Product management provides the overarching consolidated view among all developers, technical PM’s and VA business owners, providing a consolidated and coordinated view of a particular development effort. In short, Strategic Acquisition Center (SAC) program/product management helps prevent software failures. So, with only the award of CCIN, the legacy contract must continue to provide these services until the PSI contract is awarded. Due to the status of PSI, VA risks the possibility that applications or updates could be deployed with flaws. Examples are included below:

a) Image Viewing Solution (IVS) and Stroke Code are used to treat acute stroke cases in VA Emergency Departments. Disruption of these capabilities could result in negative patient outcomes – increased inpatient stays, harm to patients, increased rehab costs, increased nursing home costs, and potentially death, resulting in lawsuits when families discover VA terminated its remote support for emergency stroke treatment.

b) Annie – Text message reminder capability through the Annie application could fail. Veterans would not receive reminders for procedure preparation, potentially resulting in wasted appointment slots for procedures and delays in providing care to patients who could not receive timely procedures. Additionally, all other forms of self-management provided through Annie would cease to function, including reminders for taking medications, smoking cessation, and caregiver support messages.

c) RX Refill – Prescription refill capability disruption could lead to thousands of prescription refills not being processed correctly through the current mobile app, leading to increased Veteran frustration, increased visits and phone calls to VA pharmacies, delays or shipment failures of medications, and overall poor customer service to Veterans.

d) Patient-Generated Health Data – Data collection could be disrupted, resulting in the loss of tens of millions of new data points that could be used for healthcare monitoring and direct patient care.

Provided that the local contracting offices are the predominate component of orders placed on this contract vehicle, a disruption in service will also have detrimental effects on these VA contracting activities as this is a decentralized vehicle and field contract ordering accounts for 88.46% by volume and 11.54% by value of all orders. If this extension is not approved, this will force field offices to procure their own telehealth products that will be more costly and less effective to acquire through multiple, disparate contracts and would cause a high-risk, logistical burden for OCC due to potential mismanagement of licenses, data plans, and Help Desk support. Additionally, there is a high risk that the field could procure equipment incompatible with the existing connected care technology network and unsupported by the OCC Help Desk. This would further compromise access to care and potentially impact patient safety through improper use of equipment that does not function based on the policies, training, and procedures upon which the connected care technology network is based.

Strategic Acquisition Center (SAC)

Additionally, based on the unknown projected award date for CCPC, the Government could not procure telehealth equipment critical to maintaining the connected care technology network. This equipment includes annual licensing for critical platforms such as Pexip, which underpins the VA Video Connect (VVC) platform; maintenance agreements for equipment such as teleretinal imaging cameras; and the ability to provide or replace iPads for rural or elderly Veterans that require VA loaned tablets to access VA’s connected care services. The absence of an extension would cripple VA’s ability to provide care to Veterans through connected care. This risk to patient safety, patient care, delays in meeting program requirements, and the costs incurred by the Government would be incalculable.

Duplication of Cost to the Government:

Failure to extend the contract would result in substantial duplication of costs to the Government that are not expected to be recovered through competition. For example, loss of the products that will eventually be provided through the CCPC contract, particularly the Pexip video conferencing platform, would render VA’s video telehealth platform VVC inoperable, disrupting care to Veterans who use it for approximately 181,000 appointments a week, which would have a dramatic negative impact on their access to healthcare. This impact would be even greater in rural areas where telehealth is especially important because VA clinics are not easily accessible; the absence of telehealth in rural areas would require Veterans to physically travel long distances to VA locations or receive care in the community, which results in increased costs to the Government for reimbursements both in Veterans’ travel fees and private care providers and their facilities. This would create an incredible burden on the VA healthcare system as well as a significant increase in healthcare costs.

Using Corporate Data Warehouse (CDW) data from October 2022 through September 2023, a total of 5,795,347 VVC appointments for mental healthcare have been provided to Veterans. The cost increase to conduct these appointments through Community Care is outlined below. The estimates are based on usage and cost data from October 2022 through September 2023 the CDW and represent a ‘best guess’ about where Veterans would seek care if VVC were not available:

A conservative estimate is that 25% of the Veterans who would lose access to VVC would seek mental healthcare in the community at an average cost of $454.43 per mental healthcare visit. Using CDW data referenced above and multiplying by 25% to calculate the projected number of appointments, this would incur a cost of $658,394,997.91 to the VA (1,448,837 projected appointments x $454.43 average community care visit cost = $658,394,997.91 incurred cost). If the same visits were conducted via VVC, the cost to VA would be $358,051,087.81 (1,448,837 projected appointments x $247.13 VVC visit cost = $358,051,087.81 incurred cost). Should VVC become inoperable, this would result in a net increase in cost to VA of

Strategic Acquisition Center (SAC)

$300,343,910.10 ($658,394,997.91 community care cost - $358,051,087.81 VVC cost = $300,343,910.10 net increase).

In addition to the total net cost increase to VA of paying for mental healthcare in the community, VVC has also saved the VA approximately $1,338,725,933.85 in transportation costs for eligible Veterans that would be reimbursed for travel to a VA or community care appointment since VVC’s inception in FY15 to FY23. The inoperability of VVC mental health visits is just one portion of overall VVC costs and an even smaller fraction of the overall OCC program; impacts of a disruption in connected care services would be much more widespread.

Summary:

As explained above, failure to extend the existing contract while re-procurement efforts are still ongoing could interrupt services and have a deleterious effect on the health and well-being of Veterans who access VA healthcare through connected care services nationwide.

In order to provide continuity of services until the PSI and CCPC contracts are awarded, VA requires the extension of the contract with Iron Bow Technologies.

Until re-procurement is complete, this is the only contract enterprise-wide that currently meets the need of Connected Care Telehealth under one contract vehicle. The digital health technology network requires multiple clinical disciplines and procedures as well as equipment, items, components, online health platforms, web and mobile medical applications, software, and infrastructure platforms that must be integrated through interfaces and enhancements to OCC digital health technologies. OCC requires all digital services, applications, platforms, architecture, and equipment to integrate effectively so that all components work together seamlessly to ensure VA’s digital health technology system provides safe, effective, and quality medical and critical care. Only Iron Bow Technologies can provide the continued services without any disruptions.

(6) Description of Efforts to Solicit Offers from as Many Sources as Practicable:

Due to the nature of this requirement and the plan to award competitively in the near future PSI and CCPC, further efforts to solicit the current effort were not made as such effort would not be practicable for the reasons outlined in paragraph 5 above.

The proposed action will be synopsized on the Contract Opportunities via SAM.gov page in accordance with FAR 5.201. Any proposals that are received through this Notice of Intent shall be evaluated.

Strategic Acquisition Center (SAC)

(7) Fair and Reasonable Price Determination:

As this is a supplemental modification to the base contract, the Government does not anticipate significant price increases as pricing was negotiated on various line items in May 2024. If there are increases to the Master Price List (MPL), the increase would only affect the MPL and not the overall contract ceiling value. For all MPL increases, the Government will evaluate those prices to determine fair and reasonableness in accordance with FAR 15.404. This determination will be based on a comparison of current contract pricing, an Independent Government Cost Estimate, and other information as made available. Based on historical prices for this requirement, the Contracting Officer anticipates the updated MPL cost will be fair and reasonable. Furthermore, a proposal analysis in accordance with FAR

15.404 will be accomplished at the Task/Delivery Order level.

(8) Market Research:

With the opportunity to establish a new procurement approach and the exponential growth due to the COVID-19 pandemic, extensive market research was conducted prior to this current action. A series of RFIs were issued to industry, resulting in the current recompete strategy, which is expected to improve long-term competition while increasing small business participation.

Although this market research supports competition as a long-term strategy, a short-term sole-source award is necessary to avoid a gap in service. Obtaining competition for the short-term sole source is not possible without a tremendous risk of mission failure and its impact on Veterans.

There was no additional market research conducted for this modification since the Government is currently procuring two competitive recompetes at present time.

Iron Bow Technologies, LLC has successfully supported VA in similar efforts and has been determined to be a responsible source with respect to performance. In addition, the Federal Awardee Performance and Integrity Information System (FAPIIS) was reviewed and FAPIIS shows no reports for Iron Bow Technologies, LLC that would indicate defective pricing, instances of contractor fault or recipient not-qualified, terminations for cause, default, material failure to comply, or non-responsibility of the contractor.

The NAICS code for this effort is 334111 Electronic Computer Manufacturing.

These are commercial products. The most applicable Product Service Code is 6515

– Medical and Surgical Instruments, Equipment, and Supplies.

Strategic Acquisition Center (SAC)

(9) Other Facts:

Transition-in and transition-out time is required in order to properly transition from a single contractor to multiple contractors without a disruption in services. Once the protest is resolved, PSI currently requires up to an estimated 6-months of transition time from the incumbent. CCPC has an unknown strategy at this time and planning is underway to develop a new acquisition strategy.

With the unknown strategy for CCPC and no operational Product Catalog, if the current contract were to expire, VA would be unable to replace or repair any malfunctioning or end-of-life equipment on the contract that are not covered under Original Equipment Manufacturer (OEM) warranties. This would leave VA Medical Centers in possession of inoperable equipment with no recourse for repair or replacement and introduce significant delays in the ability to provide telehealth care. Currently, field contracting activities are expected procure from the CCIN and transition contract; thus, requiring the need to ensure this extension is approved given the volume of orders processed from the field, especially during 4th Quarter.

CCPC is planned as decentralized as well, but given the status of CCPC, these products are still able to be procured through the transition contract. Furthermore, PSI is a centralized contract. This does not allow for the field to procure products and services, but is integral to CCIN as both contractors have tasks which mandate they work together under certain tasks for the life of the contract.

In order to allow for adequate ramp-up time for each contractor and to not allow disruption to the field offices, extending the current contract is essential to ensuring the success of OCC and VA.

(10) Sources Expressing Interest:

Iron Bow Technologies, LLC, 2121 Cooperative Way STE 500 Herndon, Virginia 20171-5346

(11) Actions to Remove Barriers to Future Competition:

Currently, OCC and the SAC are procuring two competitive contract vehicles for OCC's connected care technology network: PSI and CCPC. One recompete, CCIN, has already been awarded. As noted, these requirements were previously procured under one contract vehicle with a single awardee for more than ten years. Today, this contract works seamlessly through one contractor and requires extensive integration between several functional areas that support VA connected care. Due to the COVID-19 pandemic, expansive growth of the program occurred and as a result, VA revisited opportunities to restructure the existing contract and determined the original requirement could be separated into smaller separate contract vehicles to provide more opportunities for competition. Market research was conducted as

Strategic Acquisition Center (SAC) detailed in section 8 of this document. As elaborated upon above, the findings resulted in the following recompete strategies and restructuring of the single contract (36C10G21D0016) into three separate procurements:

a. PSI was solicited as a single-award indefinite-delivery contract set aside for

Service-Disabled Veteran-Owned Small Businesses (SDVOSB) providing for full and open competition – Pending award following Protest Corrective Action.

b. CCIN was solicited as a single-award indefinite-delivery contract vehicle providing for full and open competition – Awarded on January 1, 2024.

c. CCPC has been canceled and is being re-strategized at this time.

Overall, these separate strategies are intended to remove barriers to future competition and increase the utilization of small businesses.

Strategic Acquisition Center (SAC) 10300 Spotsylvania Ave, Suite 400

Fredericksburg, VA 22408

(12) Evidence that any supporting data that is the responsibility of technical or requirements personnel (e.g., verifying the Government’s minimum needs or requirements or other rationale for an exception to fair opportunity) and which form a basis for the justification have been certified as complete and accurate by the technical or requirements personnel.

I certify that the supporting data under my cognizance, which are included in this justification, are accurate and complete to the best of my knowledge and belief.

Signature:

Kevin Galpin, MD Acting Chief Officer Office of Connected Care

(13) Contracting officer certification that the justification is accurate and complete to the best of the contracting officer ’s knowledge and belief.

I certify that this justification is accurate and complete to the best of my knowledge and belief.

Signature:

William Milline Division Chief, Contracting Officer Acquisition Services 5-A Strategic Acquisition Center

Concurrence

Based on the foregoing justification, I hereby approve this acquisition on an “other than full and open competition” basis pursuant to the statutory authority cited in paragraph four above, subject to availability of funds, and provided that the property and services herein described have otherwise been authorized for acquisition.

Signature:

Christopher D. Parker Head Contracting Activity Strategic Acquisition Center and National Acquisition Center

Kevin Galpin, MD

WILLIAM

MILLINE

Digitally signed by

WILLIAM MILLINE

Date: 2024.08.13 23:46:44 -04'00'

CHRISTOPHER

PARKER

Digitally signed by

CHRISTOPHER PARKER

Date: 2024.08.16 16:23:40 -04'00'

Strategic Acquisition Center (SAC)

Approval

Based on the foregoing justification, I hereby approve this acquisition on an “other than full and open competition” basis pursuant to the statutory authority cited in paragraph four above, subject to availability of funds, and provided that the property and services herein described have otherwise been authorized for acquisition. As this action exceeds $75M, the certification below required by FAR 6.304 serves as approval.

Signature:

Angela Billups, Ph.D.

Executive Director Office of Acquisitions and Logistics, and Senior Procurement Executive

ANGELA BILLUPS

Digitally signed by ANGELA

BILLUPS

Date: 2024.09.05 16:52:51 -04'00'