RFI_Questions_to_Industry_Integrator_VCC.pdf

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DEPARTMENT OF VETERANS AFFAIRS

Veterans Health Administration

Office of Veterans Community Care

REQUEST FOR INFORMATION

Questions to Industry

Health Systems Technology Integrator in Support of the Veterans Accountable Care Operating Model

RFI No.: 36C10G26Q0087 NAICS: [TO BE CONFIRMED] Responses due: October 2, 2026, 12:00 PM Eastern

Submit to: Gary T. Basile (gary.basile@va.gov)

THIS IS A REQUEST FOR INFORMATION ONLY — NOT A SOLICITATION

mailto:gary.basile@va.gov

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Table of Contents Table of Contents

1.0 Purpose and Disclaimer

2.0 Background

3.0 Response Instructions

4.0 Section A — Respondent Information

5.0 Section B — End-to-End Testing

Test strategy and method

Test staffing and organization

Defects in production

6.0 Section C — Multi-Payer and Federal Systems Experience

Multiple health plans and administrators

Federal systems integration

7.0 Section D — Training and Capability Transfer

8.0 Section E — Benefits Eligibility Across Multiple Systems

9.0 Section F — Bulk Data Exchange and FHIR Standards

10.0 Section G — Onboarding Third-Party Vendor Technical Environments

11.0 Section H — Feedback on the Acquisition Approach

12.0 Response Summary Matrix

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1.0 Purpose and Disclaimer

The Department of Veterans Affairs (VA), Veterans Health Administration (VHA), Office of Veterans Community Care (VCC) is conducting market research regarding the potential acquisition of a Health Systems Technology Integrator to support the establishment of an accountable care operating model for community care.

This Request for Information (RFI) is issued solely for information and planning purposes in accordance with RFO 15.101(c). It does not constitute a Request for Proposal, an Invitation for Bid, or a commitment by the Government to issue a solicitation or ultimately award a contract.

Responses to this RFI are voluntary. The Government will not pay for any information provided and will not reimburse any cost incurred in responding. Responses will not be returned. Submission of a response does not confer any advantage or disadvantage in any subsequent competition, and failure to respond does not preclude participation.

Respondents shall clearly mark any information they consider proprietary. Information not so marked may be used by the Government without restriction in developing the acquisition strategy. Respondents are cautioned that a subsequent solicitation may incorporate concepts described in RFI responses.

The Government may, at its discretion, conduct one-on-one sessions with respondents, hold an industry day, or issue a draft Statement of Objectives for comment. Participation in any such activity will be offered on a non-exclusive basis.

2.0 Background

VHA is establishing the Office of Veterans Community Care and transitioning community care toward a value-based, accountable care operating model. Approximately 40 percent of VA care is delivered through community providers.

The environment is characterized by three concurrent transitions that the Integrator must operate within rather than around:

• Dual EHR operations. VA is deploying the Federal EHR (Oracle Health) while continuing to operate VistA at the majority of facilities, with full deployment extending into the early 2030s. A separate dental EHR may also be in operation. Dual-EHR coexistence is a sustained state, not a transition window.

• Community Care Network restructuring. Community care administration is consolidating from five regions to two under a long-duration IDIQ structure, with third-party administrators (TPAs) responsible for network management, customer service, quality and performance reporting, and claims processing and payment.

• Financial systems modernization. VA is migrating to the Integrated Financial and Acquisition Management System (iFAMS) in waves, with VHA in a later wave.

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Current VCC capabilities — eligibility determination, referral management, care coordination, scheduling, claims processing, quality reporting, and provider payment — are supported by loosely coupled applications with limited shared data, redundant data entry, and constrained analytic capability.

Please reference the attached Statement of Objectives (SOO):

(Draft_SOO_Health_Systems_Technology_Integrator_VCC) and reference Section 5.0 for program objectives.

3.0 Response Instructions

Responses shall be submitted electronically to the point of contact identified on the cover page no later than the date and time stated. Respondents are asked to observe the following:

Item Instruction

Format Microsoft Word or searchable PDF, 8.5 x 11, minimum 11-point font, one-inch margins.

Length Section 4.0 (company information): no page limit, use the provided form. Sections 5.0 through 11.0: 50 pages maximum in total.

Structure Respond using the question numbering in this RFI (A-1, B-1, and so on). Respondents need not answer every question; identify any question not answered.

Evidence Cite specific engagements by client type, scale, duration, and outcome. Where a question asks for a figure, provide the figure and state its basis.

Marketing material Do not submit general capability brochures or boilerplate. Material not responsive to a numbered question will not be reviewed.

Proprietary data Mark proprietary content at the paragraph level, not by blanket cover-page legend.

Questions Questions regarding this RFI shall be submitted in writing to the point of contact by October 2, 2026.

A note on how the Government intends to read these responses: the questions below are drafted to elicit specific, verifiable practice rather than stated capability. A response describing what an organization is able to do, without reference to where it has done it, will be of limited value to the Government’s planning.

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4.0 Section A — Respondent Information

A-1 Company name, UEI, CAGE code, address, and point of contact.

A-2 Suggested NAICS and associated business size, and any socioeconomic classifications held (small business, SDVOSB, VOSB, 8(a), HUBZone, WOSB).

A-3 Contract vehicles held that could support this requirement, including GSA MAS, GWACs, and VA-specific vehicles such as T4NG2. Identify the vehicle, contract number, and applicable SIN or functional area.

A-4 Approximate annual revenue in health information technology integration services, and the portion derived from federal health work.

A-5 Whether the respondent would pursue this effort as a prime, as a subcontractor, or as part of a team. If as a team, identify the anticipated division of scope.

A-6 Any affiliation, teaming arrangement, subcontract, or financial interest involving: a Community Care Network TPA or an offeror for a CCN task order; the Federal EHR vendor or its affiliates; any entity performing claims adjudication, utilization management, or network administration for VA; or any entity whose performance would be measured by capabilities delivered under this effort.

5.0 Section B — End-to-End Testing

The Government is particularly interested in how respondents validate transactions that cross organizational boundaries and systems the respondent does not control.

Test strategy and method B-1 Describe your test strategy for a multi-system integration spanning two concurrently operating

EHRs, one or more external payer administrators, and a federal financial system of record.

Identify test levels, environments, and entry and exit criteria for each.

B-2 How do you test a transaction that crosses organizational boundaries — for example, a referral issued in a VA system, authorized by a TPA, delivered by a community provider, documented externally, and paid through a federal general ledger? Who stands up the counterparty environments, and how do you validate behavior you cannot instrument?

B-3 Describe your approach to constructing test data when production PHI is unavailable. Address synthetic generation of FHIR resources, X12 transaction sets, and eligibility scenarios, and how you establish that synthetic data is representative rather than merely well-formed.

B-4 How do you conduct regression testing when one of the integrated systems changes on a release cadence controlled by its vendor rather than by you or the customer? What is your regression cycle time and automated coverage?

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B-5 Describe how you prove financial correctness. Specifically, how do you validate that a computed payment amount is right — not merely that the calculation executed? Address parallel runs, independent recomputation, and reconciliation to an independently maintained ledger.

B-6 What volumes have you performance-tested to in a claims or encounter processing context? State transactions per period, data volumes, and the environment in which testing occurred.

B-7 Describe your approach to testing artificial intelligence and machine learning components, including validation, subgroup performance testing, and how you test the rollback path.

B-8 How do you conduct testing in an environment subject to FedRAMP and VA security controls, where continuous deployment tooling and access to production-like data may be constrained? What have you found workable, and what have you found impractical?

Test staffing and organization B-9 Describe your test organization: roles, the ratio of test personnel to development personnel, and whether test staff report independently of delivery leadership.

B-10 For an effort of this scope, what test staffing would you anticipate by phase, and what proportion would be onshore, US persons, and able to meet federal background investigation requirements?

B-11 How do you staff clinical and financial subject matter validation — that is, personnel who can judge whether a result is correct in domain terms rather than merely conformant?

B-12 Would you accept an independent verification and validation authority engaged directly by the Government? Describe how you have worked alongside one, and any conflict you see with your own delivery accountability.

Defects in production B-13 Describe your process when a defect is discovered after go-live in a system that moves money.

Address detection, containment, reprocessing, restatement of prior results, and notification.

B-14 Provide an example of a significant post-deployment defect on a prior engagement, its root cause, and what you changed in your testing practice as a result.

6.0 Section C — Multi-Payer and Federal Systems Experience

Multiple health plans and administrators C-1 Describe engagements in which you integrated two or more health plans or third-party administrators operating under differing data standards, benefit configurations, and provider networks. State scale, duration, and outcome.

C-2 How did you reconcile differences in benefit configuration, network definition, and provider identity across plans so that utilization and cost could be analyzed on a common basis?

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C-3 Where you have received claims and encounter data from multiple administrators, how did you establish that the data was complete? Describe the completeness controls you applied and what they detected.

C-4 Describe your experience with coordination of benefits across payers, including where a beneficiary held coverage from a public program and a commercial plan simultaneously.

C-5 What have you found to be the most persistent source of disagreement between a plan’s reported figures and independently derived figures, and how did you resolve it?

Federal systems integration C-6 Identify federal agencies for which you have performed health data or financial systems integration.

For each, state the systems involved, the security posture, and the period of performance.

C-7 Describe your experience integrating with federal financial systems, including CGI Momentum, and reconciling program transactions to a federal general ledger at obligation, accrual, and disbursement.

C-8 Describe your experience achieving and sustaining an Authority to Operate in a federal health environment. State the planned and actual duration to initial ATO, and what accounted for any difference.

C-9 Describe an engagement in which the Government retained architectural decision authority and your role was to advise and implement. How did that division of authority work in practice, and what did you need from the Government to make it work?

C-10 Describe a federal health integration engagement that did not go well. State what happened, your assessment of the cause, and what you would do differently. The Government regards a candid answer here as more informative than a list of successes.

C-11 What portion of the scope described in Section 2.0 would you expect to self-perform, and what would you expect to subcontract?

C-12 Describe your experience with data subject to statutory protections beyond HIPAA — in particular 38 U.S.C. § 7332, 42 CFR Part 2, or comparable regimes — and how you segmented such data within an integration and analytics environment.

7.0 Section D — Training and Capability Transfer

The Government intends to retain the ability to operate, understand, and modify its own accountable care infrastructure. Training is treated here as capability transfer, not as course delivery.

D-1 Describe your approach to training three distinct audiences: informatics and data staff who will maintain the semantic layer and measure logic; technical operations staff who will run the platform; and business and management users who will interpret and act on the outputs.

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D-2 How do you train government staff to independently maintain a canonical data model, terminology mappings, and measure specifications after your departure? Cite a client that successfully assumed that maintenance, and state how long the transfer took.

D-3 How do you measure that capability transfer actually occurred, as distinct from training having been delivered? Describe competency assessment, certification, or supervised-practice methods you use.

D-4 Describe how you would train management users to interpret risk-adjusted quality and cost measures, including the misinterpretations you most commonly encounter and how you address them.

D-5 What is your approach to training executive and clinical leadership on the appropriate use and limits of AI-derived outputs, including where a model output should not be relied upon?

D-6 Describe your delivery model for a geographically dispersed enterprise of approximately 170 medical centers and more than 1,000 outpatient sites, including the mix of virtual, on-site, and train-the-trainer approaches.

D-7 Who owns curriculum maintenance as the underlying systems change, and how is that funded in your typical commercial construct?

D-8 What training staffing and level of effort would you anticipate for an effort of this scope, by audience and by phase?

D-9 Describe how training content is delivered to the customer in a form the customer can maintain and reuse without further license or contractor involvement.

8.0 Section E — Benefits Eligibility Across Multiple Systems

E-1 Describe your strategy for producing a single authoritative eligibility determination where source systems hold conflicting or incomplete data about the same individual.

E-2 How do you handle eligibility rules that change by statute or policy, including changes with retroactive effect? Address rules engine design, rule versioning, effective dating, and retroactive recomputation of prior determinations.

E-3 Can a determination be reconstructed and explained after the fact — stating which rule version, which source data, and which values produced the outcome? Describe how, and whether that explanation is available to a caseworker, to the beneficiary, and to an appeals authority.

E-4 How does your approach depend on identity resolution? Describe how an ambiguous or unresolved identity is handled in an eligibility decision, and what you do rather than guessing.

E-5 Where you have automated eligibility determination, what proportion completed without human intervention, what was the observed error rate, and how was that error rate measured?

E-6 Describe your approach to routing exceptions for human adjudication, including how the threshold for routing is set and adjusted over time.

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E-7 How do you address eligibility where an individual holds coverage under other programs — for example Medicare, TRICARE, or commercial insurance — and where that coverage affects the determination or the payment consequence?

E-8 Describe how you would approach eligibility determination that must operate consistently across multiple distinct programs with different statutory bases and different administering systems.

E-9 What is your position on the use of machine learning in eligibility determination, and where would you decline to use it?

9.0 Section F — Bulk Data Exchange and FHIR Standards

F-1 Describe your production experience implementing FHIR Bulk Data Access (the $export operation), including system-level, patient-level, and group-level export. State the FHIR version and implementation guide version.

F-2 State the largest bulk export you have implemented in production: number of patients, number of resources, total volume, and elapsed export duration.

F-3 How do you obtain bulk data from systems that do not natively support FHIR bulk export? Address extraction from VistA specifically, and how you would render such an extract conformant rather than merely converted.

F-4 Describe your approach to the relationship between bulk historical load and ongoing incremental exchange, including how you reconcile the two and detect divergence.

F-5 How do you validate conformance to US Core and USCDI? Identify the tooling used, including Inferno, Touchstone, or equivalent, and describe what your conformance testing has actually caught.

F-6 How do you ingest bulk non-FHIR sources — X12 transaction sets, flat files, proprietary extracts — into the same canonical representation as FHIR-sourced data, and how do you preserve provenance across both paths?

F-7 Describe how de-identification, minimization, and statutory filtering — including 38 U.S.C. § 7332 protections — are applied to a bulk export. At what point in the pipeline is the filter applied, and how is it verified?

F-8 What operational impact does a large bulk export impose on a production EHR, and how do you manage throttling, scheduling, and contention with clinical use?

F-9 How do you handle bulk export failure and restart at scale — partial completion, deduplication on retry, and confirmation that the receiving system holds what the sending system sent?

F-10 Where have you found the FHIR standard insufficient for a payer or accountable care use case, and what did you do?

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10.0 Section G — Onboarding Third-Party Vendor Technical Environments The Government anticipates connecting new third-party technical environments over the life of this effort, including administrators, exchange partners, and specialty vendors.

G-1 Describe your standard playbook for onboarding a new third-party vendor environment: sequence, artifacts produced, decision points, and typical elapsed duration from initiation to production exchange.

G-2 What staffing does a single vendor onboarding require, by role and level of effort? How does that staffing scale when three or more vendors are onboarded concurrently?

G-3 How do you reduce onboarding effort over successive vendors? Address reusable connectors, a published conformance specification, a partner sandbox, and self-service certification.

G-4 Describe how you handle a vendor whose technical capability falls below the required standard.

What remediation do you offer, and at what point do you recommend that the customer decline the connection?

G-5 What are the security and authorization consequences of connecting a new external environment, and who performs the assessment? Describe how you have handled this within a federal ATO boundary.

G-6 What interface control documentation do you produce, and is it maintained as a living artifact owned by the customer?

G-7 How do you test a new vendor connection end to end before production exchange, and what constitutes your go/no-go criteria?

G-8 What would VA need to provide — in access, environments, decision authority, and staff — for vendor onboarding to proceed at the pace you would propose? Be specific about the dependencies most likely to delay you.

G-9 Describe how you onboard a vendor whose data must flow into measurement and payment, where an error would have financial consequence. What additional controls apply?

11.0 Section H — Feedback on the Acquisition Approach

The Government values candid feedback on the acquisition construct itself. Responses to this section will inform the structure of any subsequent solicitation.

H-1 Is the scope described in Section 2.0 appropriately sized for a single award, or would the Government be better served by dividing it? If divided, along what lines, and how would the Government manage the resulting integration seams?

H-2 The Government is considering an integrator model in which VA retains architectural decision authority and ownership of the data model, mappings, and measure logic, and the contractor advises and implements. Comment on the feasibility of that model and on what it requires from the Government to succeed.

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H-3 What contract type or mix of types would you recommend, and why? Where in this scope is outcome-based or firm-fixed pricing workable, and where is it not?

H-4 Comment on the relative importance the Government has assigned to financial systems and payment integration, EHR and multi-source clinical integration, security and ATO, AI governance, data rights and transition-out, management approach, and technical demonstration. Would you weight these differently?

H-5 The Government is considering a technical demonstration using Government-furnished synthetic data against defined end-to-end scenarios. Would you participate? What environment, data, and lead time would you require, and what duration is realistic?

H-6 What Government-furnished information is essential for you to price this work with confidence?

What would you assume, and how would you price that assumption, if it were not provided?

H-7 What period of performance and phasing would you recommend, and what would you sequence first?

H-8 What opportunities do you see for small business participation, and in what portions of the scope?

H-9 What is the single greatest risk to this effort that the Government has not addressed in this RFI?

12.0 Response Summary Matrix

Respondents are asked to complete the following as the first page of their response.

Section Subject Questions Answered Page Reference

A Respondent information A-1 through A-6

B End-to-end testing B-1 through B-14

C Multi-payer and federal systems experience C-1 through C-12

D Training and capability transfer D-1 through D-9

E Benefits eligibility across multiple systems E-1 through E-9

F Bulk data exchange and FHIR standards F-1 through F-10

G Onboarding third-party vendor environments G-1 through G-9

H Feedback on the acquisition approach H-1 through H-10