Sole Source Justification Under Simplified Acquisition Procedures - CAREWare - Redacted.pdf

Sole Source Justification For

Acquisitions Conducted Under Simplified Acquisition Procedures

FAR 13.5

1. AGENCY AND CONTRACTING ACTIVITY: The Agency/Requiring Activity is the U.S.

Department of Health and Human Services (HHS), Health Resources and Services Administration’s (HRSA) Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) Bureau (HAB). The Contracting Activity is HRSA’s Office of Acquisitions Management and Policy (OAMP).

2. DESCRIPTION OF ACTION: The purpose of this action is to award a follow-on, firm-fixed price contract to the incumbent contractor, Jeff Murray’s Programming Shop, Inc. (jProg), on a sole-source basis, for continued support of HAB’s requirement to maintain, support and update the CAREWare software application. The current contract (HHSH250201800002A) supporting the requirement expires on 3/22/2023. The incumbent contractor has provided these services since 2000. The software application named CAREWare is based on intellectual property that jProg developed. jProg owns the source code to CAREWare, is the sole developer and holds the copyright to the software. CAREWare is a free, electronic health and social support services information system for Ryan White HIV/AIDS Program (RWHAP) grant recipients and their providers.

RWHAP, first authorized by the U.S. Congress in 1990, is administered by HAB. The RWHAP uses dynamic and innovative approaches to provide a comprehensive system of care to achieve optimal health outcomes for people living with HIV (PLWH). Funds are distributed to cities, states, and local community-based organizations that provide primary medical care, treatment, and essential support services. A smaller but equally critical portion of resources is used to fund technical assistance, clinical training, and the development of innovative models of care.

CAREWare has evolved into a comprehensive health information system and is now the source of more than half of all the client-level data that HAB receives from recipients and providers of HIV care. CAREWare installations manage HIV clinical and support service data from more than 360,000 client records in 48 states, Washington, DC, Puerto Rico and the U.S. Virgin Islands. In a number of installations, the application is configured as a full real-time network connecting providers of care across entire states and cities.

3. DESCRIPTION OF REQUIRED SERVICES: HAB requires contracted services to support, maintain, and upgrade CAREWare for users throughout 48 states, Washington, DC, Puerto Rico, and the U.S. Virgin Islands. This contract supports CAREWare software application development, modernization and enhancements to meet legislative and programmatic reporting requirements for client demographics and services. The Contractor shall continue to ensure that CAREWare:

5. REASON FOR AUTHORITY CITED: jProg has been the sole CAREWare developer since it was first released in 2000. jProg is the sole owner of the the software code; however, HRSA via contract provides funding for the CAREWare development and help desk services. In the subsequent 22 years, CAREWare has evolved into a comprehensive, flexible, and widely used electronic health information system; more than half of all the RSR and ADR received by the Bureau is generated by CAREWare. Several important features and functions of CAREWare have been paid for by grantee recipients in direct contract with jProg, outside of the main HRSA contract with jProg. While these additional features are integrated into the main software application and made available to all users (not just the grantee who contracted to have the feature built), they are, contractually, the intellectual property of jProg. These features cannot be singled out and removed from the main software application. These features include critical components to import data into CAREWare from various electronic health records, a number of custom field features, an email notification system, and others. Only the services offered by jProg can meet HAB's needs due to their unique, long-term experience, and that firm's copyright to specific features, functions and algorithms in CAREWare. No other organization would be able to meet HRSA's needs due to the unique "ownership" of the underlying software code.

jProg has gained unique experience and specialized expertise with this longstanding software development project for HAB; hiring a new contractor would require extensive “knowledge transfer” and result in unacceptable delays to users throughout the country and impact care delivery to people living with HIV who are served by the RWHAP.

Finally, HAB paid an independent contractor, Customer Value Partners (CVP) Corp, to conduct an independent Return on Investment (ROI) analysis. This work was undertaken in 2020 and concluded that CAREWare has saved the HIV/AIDS Bureau and its recipients a considerable amount over the past 20 years. Specifically, HAB’s 20-year investment of avoided in costs that providers would have incurred procuring comparable software. The projected 20-year ROI was calculated to be , meaning that for every dollar of HAB investment saved the RWHAP . That report concluded: “The continuing wide use of CAREWare speaks to its quality, cost savings, and importance to grants management.”

The historical record of a significant return on investment to HRSA from CAREWare has, in many cases, eliminated the need for many Ryan White providers of HIV care to invest in their own expensive health information systems but instead use those funds to provide direct services and medications for people living with HIV.

6. EFFORTS TO OBTAIN COMPETITION: A Notice of Intent to Sole Source was posted at the System for Award Management (SAM) on February 02, 2023. The posting closed on February 17, 2023, and one response was received. Due to limited information available from the response, the Government followed up with the firm who provided a response on March 06 and 07, 2023 through a phone call and email. The Government considered the response and follow-up information received and determined that a competitive procurement was not appropriate because the firm’s experience and capabilities did not show that the firm could provide a software application with similar functionalities to CAREWare in a short amount of time without causing a disruption in maintaining programmatic data and reporting requirements. In accordance with FAR 5.2, the award will be synopsized on SAM Contract Opportunities, and a redacted Justification and Approval (J&A) will be made publicly available.

7. FAIR AND REASONABLE PRICE DETERMINATION: The Contracting Officer will determine if the total price is fair and reasonable based on a comparison of the proposed prices to historical prices paid and Independent Government Cost Estimates (IGCE).

8. MARKET RESEARCH: CAREWare is now in its third decade of development. Over the last 7 to 10 years, it has been the source of more than half of the annual client-level data that the Bureau receives in its RSR and ADR reports—close to 1,000 agencies-- and has been essential in allowing the agency to monitor the services that it funds for people with HIV. While other software applications do exist that perform some of the same functions as CAREWare, these packages are private, commercial offerings that have significant purchasing, ongoing licensing and technical assistance costs—costs that are simply not borne directly by Ryan White recipients and providers that use CAREWare. The fact that agencies that use CAREWare do not bear these costs ensures that considerable funds are freed up for direct patient care and treatment.

One of the more commonly used commercial software applications in the Ryan White program is called In 2020, the ROI analysis compared the annual cost per provider of an installation of CAREWare vs. Compared to an installation of CAREWare hosted by the recipient, a comparable installation was estimated to be more or even more if CAREWare were hosted by the vendor jProg It is important to note that these estimates are for annual costs only and would also have to be multiplied by the number of agencies.

In short, there are a handful of commercial products in the market that are available to HIV care providers funded by the Ryan White Program, and there is nothing to prevent agencies from electing to use those applications. Examples of the commercial products available are and However, as noted, the initial and ongoing costs to these agencies is often prohibitive, particularly in light of the fact that agencies do have limits on the proportion of their administrative funds that can be used for such purchases, and that in using CAREWare, those funds are now available for direct patient care, as noted above. As previously stated, a recent ROI analysis concluded that over the last 20 years, the development of CAREWare had avoided in costs that providers would have incurred procuring comparable commercially available software.”

The cost, time and burden to replace CAREWare with commercially available alternatives in the marketplace would be considerable to all parties: the HRSA Bureaus/Offices, Ryan White grantees, and providers of HIV care. There would be further costs and time to convert existing data into the other software applications, training in the new systems, and ongoing technical assistance costs. HRSA’s Maternal and Child Health Bureau also uses CAREWare for some of their Healthy Start grantees and is considering expanding its use to all such grantees. This use of CAREWare in another Bureau also provides the Government with additional cost savings.

9. OTHER FACTS: HRSA estimates that selection of a different contractor to manage and develop CAREWare would result in a minimum six to nine-month hiatus in being able to reasonably assume maintenance and development activities. Due to the complexity of the CAREWare software code, a knowledge transfer to a new contractor would be a significant, time-consuming and cannot take place because HRSA does not own the software code.

In addition, changing to a new contractor will affect the ongoing provision of helpdesk support provided by jProg, critical to CAREWare’s success. Additional major modifications to the application’s ability to important data from third parties - a critical initiative of the Office of the National Coordinator for Health Information Technology (ONCHIT), would further be negatively impacted in their development and in the smooth, ongoing support of users, if development were handed over to another vendor.

10. INTERESTED SOURCES: At this time and to date, one source has expressed interest in writing. The one response to the notice of intent to sole source was from an individual who did not provide the specific name of his/her company. The individual provided no documentation of their expertise or proof of their capacity to overtake, manage and develop such a complex computer program. Based on the lack of information provided, the Government determined that the response did not provide sufficient information to justify a competitive procurement.

11. A statement of the actions, if any, the agency may take to remove or overcome any barriers to competition before any subsequent acquisition for the supplies or services required.

The Government intends to host an industry day before any subsequent acquisition of the services is procured The Government also intends to obtain a third-party analysis of alternatives to the utilization of CAREWare. The analysis would consider cost, functionality, capabilities and transition time.

12. CERTIFICATION:

To the best of my knowledge and the information that is available, I certify that this justification is complete and accurate.

John Milberg Technical or Requirement Personnel Date

To the best of my knowledge and the information that is available, I certify that this justification is complete and accurate.

Kwasi Antwi Contracting Officer Date

Based on the foregoing, I hereby concur with this justification and recommend for approval.

Wendy Ponton Advocate for Competition for the Procuring Activity Date