Past Performance Questionnaire Worksheet RFP xx.docx
DOCX document 34 KB Posted
- Attached to
- TELEHEALTH SERVICES-PLENTYWOOD, MT
- Solicitation number
- 36C25926Q0065
About this file
This document is a Past Performance Questionnaire Worksheet for a Community Based Outpatient Clinic (CBOC) contract with the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 19. The questionnaire seeks detailed information about a contractor's previous performance, including geographic service location, contract dates, per member per month (PMPM) service costs, clinical quality performance measures, patient experience survey outcomes, provider vacancy rates, transition planning, and facility design capabilities.
The worksheet requires comprehensive documentation across 14 key areas, with a focus on healthcare service delivery for Veterans primarily in Montana counties including Daniels, Lincoln, Richland, Roosevelt, Sheridan, and Silver Bow. Specific areas of inquiry include provider coverage plans, quality improvement initiatives, credentialing details, space design guidelines, and contact information for performance verification. The document is directly linked to Solicitation Number 36C25926Q0065 for Telehealth Services in Plentywood, MT, and is designed to assess a potential contractor's ability to effectively manage and deliver community-based healthcare services to Veterans.
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Text version
D.6 Past Performance Questionnaire Worksheet – RFP xx
1. The legal name of entity with whom the Contractor held the contract.
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2. Contract Number(s)
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3. Overall, how has the contractor performed services required for the Community Based Outpatient Clinic, met the requirements of the Performance Work Statement (PWS) and detail how did they effectively achieve the performance objectives of the referenced Quality, management, experience and staffing, transition plan, start-up plan, and geographic location requirements.
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4. In what geographic location the contractor performed these services.
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5. What are the dates during which the contractor performed the contract.
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6. What is the annual size of the per member per month (PMPM) for the CBOC services.
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7. What is the clinical quality performance measure outcomes, combined and by individual CBOC. Provide two examples of related quality improvement initiatives.
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8. What is the Survey of Healthcare Experience of Patients (SHEP) domain outcomes, combined and by individual CBOC. Provide examples of related quality improvement initiatives.
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9. What were the vacancy rates, combined and by individual CBOC.
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10. What was the plan for provider coverage for leave, unscheduled access, and vacancies with list of currently VA credentialed providers available for coverage.
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11. What was the transition plan with emphasis on minimizing time from contract award to provision of patient care.
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12. What was the floor plan that demonstrates knowledge of current PACT space design guidelines and did it allow for expansion over life of the contract.
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13. What was the plan for provider coverage for planned leave, unscheduled leave, and vacancies with list of currently VA credentialed providers available for coverage.
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14. The name, phone number, and email address of a person at the entity with whom the Offeror held this contract who can verify the information the Offeror provides in the narrative description for this contract.
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File details come from the government source that posted it. Updated .