Source Sought PSC331110.pdf

Federal Occupational Health (FOH) – Systems Integrator Services

Sources Sought Notice (SSN)

General Information

Contract Opportunity Type: Sources Sought Notice Opportunity Title: Systems Integrator Services All Dates/Times are: EASTERN STANDARD TIME Responses are due by: August 30, 2024, 8:00 am EST

1. Purpose

This is a Sources Sought notice (SSN). This is NOT a solicitation for proposals, proposal abstracts, or quotations. The purpose of this notice is to obtain information regarding the availability and capability of all qualified sources to perform a potential requirement.

2. Description

Federal Occupational Health (FOH) is a component of the Program Support Center (PSC) that is part of the U.S. Department of Health and Human Services (HHS.) Their mission is to provide various occupational health and related health services to Federal employees across numerous Federal agencies to promote and maintain the physical and mental fitness of the Federal workforce.

FOH is primarily composed of Service Areas that specialize in the delivery of health and health related services to customer agencies. FOH and customer Federal agencies, utilize Inter-Agency Agreement’s (IAAs) to manage business relations and coordinate the delivery of health-related services and costs associated with receiving those services.

The Government would like to improve customer satisfaction, reduce time consuming manual data validation and reconciliation, should allow for transparency for services and charges and eliminate difficulty accessing data needed to inform and track customer billing.

3. Response Instructions

The Government is only interested in potential vendors who are active on the attached Approved Contract Vehicles list, including Small Businesses, Small Disadvantaged Businesses, 8(a) businesses, Service-Disabled Veteran-Owned Small Businesses, HUBZone Small Businesses, and Women-Owned Small Businesses.

Potential vendors shall be capable of furnishing all labor, materials, and equipment required to meet the attached Objective Statement.

The Government is seeking market information from qualified, experienced and interested vendors who can perform services outlined below and in the attached draft Objective Statement.

Interested vendors shall respond with the following:

a. Identify your company's information (name, address, phone number, CAGE code).

b. Identify if your company is a large or small business. If applicable, identify what small business program(s) (i.e. SBA Certified 8(a), Service-Disabled Veteran Owned, HubZone, etc.) your company is certified as.

c. Identify the Approved Contract Vehicle.

d. Identify the estimated amount of calendar days required to respond to a Request for Proposal (RFP).

e. What is the estimated timeframe needed from time of award to transition and begin new service.

f. Any other comments, feedback or response on how to improve this requirement is highly encouraged.

g. FOH wants to ensure transparency of this process and ensure interested companies are provided the same information. If your company has a question regarding this SSN, the Government will post your company's questions, along with the Government's response, in Sam.gov. (Note: Your company's name will not be disclosed to the public)

Business Case

Interested vendors shall complete item# 3 and submit a Business Case in response to this SSN.

For the purposes of this SSN, a Business Case is defined as: An explanation of how the vendor’s approach will meet the Objectives and why and or how the vendor’s approach is more advantageous over other known approaches. The business case may also address other areas as necessary to be as detailed and sufficient to convey vendor’s understanding and capability to meet the Objectives.

Vendors may provide a virtual presentation of their business case. Virtual presentations of business case will be scheduled within fourteen (14) calendar days of the Government receipt of vendor ‘s notice of interest. Vendor’s business case and virtual presentation may be submitted using Microsoft Office Products or in format approved by the Government.

Business Case shall demonstrate a solution and or approach to meet the Objective Statement utilizing Low Code Application Platforms (LCAP) Appian and or Salesforce. Vendor ‘s proposed solution shall accomplish the following:

• Interface with applications on existing LCAP used to manage Inter-Agency Agreements and Invoice customers. These include Customer Account Module (CAM) Interagency Agency Agreements (IAAs) and PRICES (Invoices sent to customer agencies.)

• Adhere to the Government’s platform governance model for software development and deployment.

• Ability to store patient health records.

• Ability to adapt and respond to security related events such as Department of Homeland

Security Emergency Directives, Department of Health and Human Services (HHS) Computer Security Incident Response Center, and other data calls.

• Reduce the Government’s Information Technology (IT) system footprint, minimizing the time, effort, and cost needed to maintain legacy systems and Authority to Operate while providing increased functionality, capabilities, access to data and production time.

• Microservices module approach focusing on:

o Customer Module o Data Catalog Module o Scheduling Module o Provider Module o Billing Module o Eligibility of Services Module o Data Lake (or similar reporting features) o Electronic Health Record

4. Points of Contact

Only electronic responses will be accepted. Please send responses via email to the primary point of contact, Angeleana Torres via email to angeleana.torres@hhs.gov with the subject line “FOH- Systems Integrator Services – PSC331110 - Response”. no later than Friday, August 30, 2024, 8:00 AM Eastern Time. Earlier submission is highly encouraged.

Questions regarding the contents of this Sources Sought shall be submitted via email to:

angeleana.torres@hhs.gov with the subject line “FOH-Systems Integrator Services – PSC331110 - Questions” no later than 9:00am EST on August 15, 2024. Phone calls will not be accepted. The Government reserves the right to respond to some, all, or none of the questions that will be submitted.

5. Disclaimer and Important Notes:

This notice does not obligate the Government to award a contract or otherwise pay for the information provided in response. The Government reserves the right to use information provided by the respondents for any purpose deemed necessary and legally appropriate. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed.

Information provided will be used to assess tradeoffs and alternatives available for the potential requirement and may lead to the development of a solicitation. Respondent are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted.

Any solicitation resulting from the analysis of information obtained will be announced to the public in System for Award Management (SAM) in accordance with FAR Part 5. However, responses to this notice will not be considered adequate to responses to a solicitation.

6. Confidentiality:

No proprietary, classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s).

Objective Statement

Project Background:

Federal Occupational Health (FOH) is a component of the Program Support Center (PSC) that is part of the U.S. Department of Health and Human Services (HHS.) Their mission is to provide various occupational health and related health services to Federal employees across numerous Federal agencies to promote and maintain the physical and mental fitness of the Federal workforce.

FOH is primarily composed of Service Areas that specialize in the delivery of health and health related services to customer agencies. FOH and customer Federal agencies, utilize Inter-Agency Agreement’s (IAAs) to manage business relations and coordinate the delivery of health-related services and costs associated with receiving those services.

Key Services Areas

Behavioral Health Services (BHS): Provides Employee Assistance Programs (EAP) and work/life balance services. EAP provides assessments, short-term counseling, referral, consultation, and coaching services to federal employees. Work/life services assist federal employees with balancing personal and work responsibilities. Services include assistance with childcare, elder care, and retirement planning.

Clinical Health Services (CHS): Provides clinical services to the federal workforce. Doctors and Nurses provide critical medical services through Health and Wellness Centers in federal buildings and through a large network of private providers. Services provided include Hearing Conservation, Medical Employability Program, Medical Surveillance, Clinic Management within federal buildings, Walk-In Care, Respirator Evaluations, and Worker's Compensation Management.

Environmental Health and Safety Services (EHSS): Provides environmental health services using an integrated approach that helps agencies comply with the Occupational Safety and Health Administration (OSHA) and environmental health regulations. EHSS responds to safety, environmental, or health incidents to provide support and expert consultation. Services also include the expertise and experience needed to anticipate, evaluate, and control hazards in the federal workplace while also maintaining and improving employee health, productivity, and morale. EHSS conducts Ergonomics, Firing Range, Food Safety, Indoor Air Quality, and Job Hazard services.

Wellness and Health Promotion Services (WHPS): Offers health and wellness programs including FedStrive Virtual, an online wellness portal, fitness center management, fitness classes, nutrition and health coaching, and onsite health promotion programs. The WHPS team additionally can assist with designing and implementing wellness programs that best suit the unique interests and needs of a federal agency.

Quality and Performance Improvement (QPI): Coordinates the policy and performance of the other FOH Service Areas, provides the credentials and privileges for medical staff, manages safety within CHS and WHPS locations, maintains customer agency and patient records and leads the development of FOH policy.

In addition to the key service areas, the "Agreements" or "Fiscal Team" provides critical support to the five service areas by creating, implementing, and managing IAAs between FOH and customer agencies and coordinating Service Orders for delivering of services from FOH to its customer agencies.

Information Technology (IT) is a significant enabler to delivering health-related services from FOH to customer agencies. Currently, FOH operates under a decentralized IT governance model comprised of multiple systems that support the agency’s clinical, behavioral, wellness and health promotion, and environmental health mission. These systems are used inconsistently across FOH’s service areas, resulting in information silos, service delivery delays, billing inconsistencies, and reporting and data access issues. The following three legacy systems are particularly challenging and require a more modernized, comprehensive solution: FedHealth Occupational HealthManagement (FedHealth), Service Tracking and Management (STM), and the Medical Evaluation/Requirements Information Tracking System (MERITS).

Legacy Systems

FedHealth is a customized web-based system built upon Commercial Off-the-Shelf products.

FedHealth manages employee personal health records, medical history, pre-appointment forms, and appointment requests for FOH lines of business. It also contains information essential for billing customers and tracking customer service agreements.

STM is a web-based application designed to maintain customer agreements, verify fulfillment of those agreements, and provide external financial systems with information needed to bill for services rendered. STM also has tools that allow the user to view data in the form of reports. The system has limited system documentation. The interface between STM and FedHealth is error-prone and requires significant manual data manipulation and validation to calculate billing correctly.

MERITS is a system that uses Microsoft Access as the front-end and is a conglomeration of multiple sub-systems that serve different functions. This system was designed to manage medical data and produce medical reports on the ability of Federal applicants to perform essential job functions for a specific position. MERITS is a legacy system with security challenges which make it difficult for FOH to bill customers accurately and timely. Also, MERITS does not handle multiple users well.

Objectives:

Ultimately, FOH would like to improve customer satisfaction, reduce time consuming manual data validation and reconciliation, should allow for transparency for services and charges and eliminate difficulty accessing data needed to inform and track customer billing.

In the Fall of 2020, FOH had an assessment conducted of its business processes and IT solutions to help determine the best way to move forward. The results of the assessment (hereinafter referred to as “the Assessment”) consist of the Business Automation Report (See Attachment 1) and Enterprise Architecture Assessment (See Attachment 2). The Assessment recommended that FOH retire legacy systems and replace them with a platform built on a microservices architecture to execute FOH’s core processes. Core goals for the modernized system(s) are as follows:

• Leverage PSC’s existing Low Code Application Platforms (LCAPs), Appian-WorkSmarter

(See Attachment 3) and Salesforce-OneView (See Attachment 4) that are in production and have Authorizations to Operate (ATO).

• Interface with applications on PSC’s existing LCAPs and other applications used to manage Inter- Agency Agreements and invoice our customers.

• Adhere to PSC’s platform governance model for software development and deployment. (See Attachment 5).

• Offer the ability to securely send large documents (e.g., medical records, x-rays)

• Improve FOH’s security posture, increasing FOH’s ability to quickly adapt and/or respond to:

o Department of Homeland Security Emergency Directives, HHS Computer Security Incident Response Center, and other HHS and PSC data calls.

• Reduce FOH’s system footprint, minimizing the time, effort, and cost needed to maintain o legacy systems and ATOs while providing increased functionality, capabilities, improved access to data, and quicker time to production.

• Leverage the recommended microservices approach from the Assessment, including but not limited to the following modules:

• Customer Module

• Digital Catalog Module

• Scheduling Module

• Provider Module

• Billing Module

• Eligibility Service Module

• Data Lake (or similar reporting features)

• Clinical Practice Module (potentially including electronic health records)

Requirements

The Government has completed in-depth requirements gathering as part of its effort to modernize its core business processes. A future awarded solution developer will be able to utilize a +2100 Requirement Traceability Matrix (RTM) that was built through stakeholder interaction with FOH Service Areas and validated through feedback. This document outlines the needs of each FOH Service Area through key requirements, sub-requirements, gaps, wants and context. Additionally, business process flows for each FOH Service Area were developed in Visio to guide an awarded solution developer in how FOH Service Areas conduct business.

FOH is interested in a modernized LCAP solution that focuses on key capabilities given below. The LCAP solution must be built within FOH’s existing Salesforce or Appian platforms.

• Manage IAAs (Inter-Agency Agreements) between FOH and customer agencies.

• Tracking interface for capturing critical dates and action items during IAA development.

• Ability to create and manage Service Orders within IAAs. Service Orders outline specific services FOH will provide to a customer agency.

• Catalog of Services that will consist of offerings by FOH and associated prices.

• Ability to bill customer agencies through IAAs for services provided.

• Electronic Health Record for patient management.

• Patient scheduling system for FOH clinics.

• Reporting features

Approved Contract Vehicles

Owner Contract Name Contract

Type

NIH

NITAAC CIO-SP3: NIH

Information Technology Acquisition and Assessment Center (NITAAC) Chief Information Officer- Solutions and Partners 3 (CIO-SP3)

GWAC

NITAAC CIO-SP3

Small Business: NIH Information Technology Acquisition and Assessment Center (NITAAC) Chief Information Officer- Solutions and Partners 3 (CIO-SP3) Chief Information Officer- Solutions and Partners 3 (CIO-SP3) Small Business

GWAC

NASA NASA SEWP: GWAC

GSA MAS IT

FSS

GSA

VETS 2: Veteran's Technology Services 2

GSA

8(a) STARS III

GWAC

GSA

Alliant 2 GWAC

GSA

OASIS: One Acquisition Source for Integrated Solutions GWAC

GSA

OASIS SB: One Acquisition Source for Integrated Solutions for Small Business

NITAAC CIO-CS: NIH

Information Technology Acquisition and Assessment Center (NITAAC) Chief Information Officer- Commodity Solutions

(CIO-CS)

EIS: Enterprise Infrastructure Solutions

CMS

Strategic Partners Acquisition Readiness Contract (SPARC)

IDIQ

PSS: Professional Services Schedule (PSS) FSS

GSA

OASIS: One Acquisition Source for Integrated Solutions GWAC

GSA

OASIS SB: One Acquisition Source for Integrated Solutions for Small Business

OASIS 8(a): One Acquisition Source for Integrated Solutions for 8(a) Small Business GWAC

NIHBPSS II: National Institutes of Health Business and Professional Support Services III IDIQ

Attachment 1

HHS FOH

Business Automation Report

EXECUTIVE SUMMARY

The United States Department of Health and Human Services (HHS) Federal Occupational Health (FOH) delivers comprehensive occupational health solutions exclusively to federal employees in the areas of Behavioral Health Services, Clinical Health Services, Environmental Services, and Wellness and Health Promotion Services. Currently, FOH relies on various legacy systems that lack interconnectivity to facilitate the FOH Business Life Cycle. Although there was intent to modernize FEDHEALTH and decommission STM, the previous leadership decided to halt the modernization and that decision caused a lot of problems for FOH. As a result, FOH continues to operate in a decentralized manner with unclear business model, and with systems that do not support the full business life cycle. This has led to labor intensive processes, problems with billing transparency and reporting, and a lack of focus on the customer experience.

A Future State Enterprise Architecture cannot be established without first understanding the business model and business life cycle. To establish a clear business model, FOH engaged stakeholders in Design Thinking (DT) and Human Centered Design (HCD) to determine the vision of the future based on empathetic elicitation of needs and pain points. We found that the root cause of the frustration amongst stakeholders is the lack of digitization. This is largely a result of current systems being used inconsistently across the organization. Additionally, these systems do not effectively digitize the creation and execution of the Inter Agency Agreement (IAA) established at the beginning of the life cycle, causing an abundance of manual work for the workforce, customers, and partners downstream.

Through HCD and DT, opportunities were identified to reimagine the business model, identify opportunities to automate processes, and help make the lives of FOH employees and their customers better. We recommend that FOH adopt a Healthcare Broker Business Model which focuses on the facilitation of connecting their customers with service providers who can deliver care in the four major areas of occupational health and manage customer medical records. As a healthcare broker, FOH’s core competencies are contracting with customers who wish to acquire these services, tracking the delivery of these services, and facilitating the billing and collection of payment for the services rendered. In addition, we recommend retiring both FEDHEALTH and STM systems and replacing them with a platform built on a Microservices Architecture (MSA). This MSA should consist of autonomous, custom microservices for the core competencies listed above and commercial microservices to extend the core processes.

The following report details our innovative approach to reimagining the FOH business processes and enterprise architecture to ensure it meets the business needs.

INTRODUCTION

FOH would like to uncover opportunities to modernize core business processes (such as electronic health records, billing, and reporting) and supporting systems to improve the delivery of solutions to federal employees. Using human-centered design and discovery, FOH will uncover meaningful insights to help define the boundaries of a modern solution set, which will result in improved customer satisfaction, streamlined business processes, and data transparency. FOH procured an Assessment contractor to identify modern, cost-effective, and fully functional alternative IT solutions that meet the current business needs of each FOH service area. Through engagement with stakeholders and an evaluation of the current enterprise architecture, we identified the fundamental issue: an unclear vision and business model, partially resulting from the implementation of IT systems which facilitate both service broker and service delivery, stifling FOH’s ability to modernize. This has resulted in numerous business challenges, summarized in the table below.

Figure 1. Business Challenges

# BUSINESS CHALLENGES DESCRIPTION

1 BILLING TRANSPARENCY /

REPORTING

FOH uses two cost models for services: Per Capita and Fee for Service. The contracts, delivery of services, and billing for these services is tracked in various systems, requiring reconciliation to determine appropriate billing and status of funding. This results in time-consuming research, reconciliation, customer complaints, customers receiving services they have not paid for, and delays in paying invoices.

2 LEGACY ARCHITECTURE /

TECHNOLOGIES

FOH is responsible for processing healthcare for thousands of federal employees using outdated systems plagued with data errors and frequent system downtime that introduce substantial administrative burden into the process.

3 LABOR INTENSIVE PROCESS FOH’s IT systems do not facilitate all parts of the health care life cycle, causing much of the work to be done on paper or over email, which is prone to errors and delays.

4 LACK OF CUSTOMER FOCUS FOH’s IT systems do not currently operate to support the business functions due to poor decision making by prior stakeholders. This resulted in an incomplete modernization, unsettled decisions, and unhappy customers.

5 COMPLEX IT GOVERNANCE FOH adopted a decentralized IT governance model, which currently consists of numerous different core and support systems, to support the Health Delivery Life Cycle. Many of these systems are not used consistently across all service areas, resulting in silos of information, causing delays in service delivery, billing, and reporting. While FOH attempted to modernize these systems through the implementation of FEDHEALTH and migration of STM into FEDHEALTH, a change in leadership halted decision-making and modernization efforts, leaving FOH with gaps in their business and technical architecture.

STRATEGY & APPROACH

The approach to digital transformation is to apply a disciplined process by which ideas are conceived, transformed, and scaled to systematically reduce risk and continuously deliver high-value solutions to customers at an accelerated pace.

Figure 2. Federal Occupational Health Business Life Cycle

The business life cycle for FOH identifies the personas and how they engage with the business during each phase of the life cycle. Through DT and HCD, ideas are conceptualized for each phase of the life cycle. The conceptualization of ideas is often triggered by some sort of change such as legislation, disruptive technology, or market shift. Through meticulous interaction, innovation, iteration, and refinement, ideas are reshaped into the most appropriate solutions for FOH.

Figure 3. Personas

HUMAN CENTERED DESIGN

Using HCD and DT, we conducted workshops, interviews, and observation sessions with executive, management, business, and technology stakeholders, and industry partners. The following lists the major insights from these meetings.

Figure 4. Major Pain Points

# HCD / DT PAIN POINTS

1 EXECUTIVES ▪ Unstandardized Business Services Catalog

▪ Complicated and Manual Business Processes

▪ Legacy Systems and Architecture

▪ Lack of Oversight and Reporting

2 CLINICAL HEALTH SERVICES ▪ Difficulty in Reporting Due to Multiple Data Sources

▪ Data Not Harmonized Across Systems

▪ System Downtime

▪ Convoluted Business Processes

▪ Unclear Business Requirements

3 BEHAVIORAL HEALTH SERVICES ▪ Difficulty in Developing Required Monthly Reports

▪ Inconsistent Use of EMR Capability Across Service Areas

▪ Lack of System Capability to Easily Query Agreements

4 ENVIRONMENTAL HEALTH

SERVICES

▪ Time-Consuming Reconciliation of Large Invoices to Services Provided

▪ Manual Tracking of Expenses for Each Service Order

▪ No Centralized Platform for Storing and Sharing Data

5 WELLNESS AND HEALTH

PROMOTION SERVICES

▪ Lack of Focus on Customer Experience

▪ Bureaucracy of Decision Making Hinders Achieving Business Objectives

▪ Unstandardized Business Processes

6 BUSINESS MANAGERS,

PROVIDERS, AND STAFF

▪ Difficulty in Reporting Due to Multiple Data Sources

▪ Lack of Focus on Delivering Exceptional Customer Service

▪ System Downtime

▪ Reimagine Service Delivery

▪ Lack of Clarity Around Future Direction of the Business

▪ Difficulty Tracking Customer Burn Rates

7 TECHNOLOGY TEAM ▪ Unclear Business Model and Requirements to Drive IT Decisions

▪ Difficulty Maintaining Legacy Systems

▪ Lack of Clarity Around Where Medical Records are Stored and Who Should Store Them

▪ Heavily Paper-Based Documentation Leads to Difficulty in Finding Records

8 CUSTOMERS ▪ Lack of Billing Transparency and Accuracy

▪ Time-Consuming Reconciliation of Invoices and Services Rendered

USER EXPERIENCE

Through HCD and DT, we empathize with stakeholders, customers, and end users to elicit areas of frustration within the business life cycle. We visualize the key activities of each of the personas within the life cycle in the form of a User Journey Map. The User Journey Map identifies the user’s experience as they engage throughout the life cycle. The vertical axis determines the positive and negative sentiment that the users experience at each stage. The colors indicate the market segment. We use this Journey Map as a starting point to determine opportunities to improve the user experience. We then prototype the future solution, focusing on addressing these pain points.

Figure 5. Federal Occupational Health User Journey Map

From the HCD and DT, we learned that all users expressed a high degree of frustration with the lack of billing automation and transparency. After further investigation, we determined that the root cause of this frustration was the lack of digitalization of the IAA established earlier in the life cycle.

The lack of digitization caused the workforce, customers, and partners to manually verify and interpret the terms and conditions of the agreement throughout the life cycle, particularly, during the billing process.

BUSINESS AUTOMATION OPPORTUNITIES

By empathizing with stakeholders, HCD and DT experts elicited major areas of frustration and inspired stakeholders to imagine a better way of doing business. By understanding the needs and desires of these stakeholders, we identified opportunities to reimagine the business model, identify opportunities to automate processes, and help make the lives of employees and their customers better. The table below highlights the business automation ideas that were uncovered and how they address the pain points.

Figure 6. Business Automation Ideas

# IDEAS PAIN POINT SOLUTION

1 DIGITAL CATALOG

MICROSERVICE

The Description of Services (DOS) is currently drafted in a word document and the Interagency Agreements (IAAs) are drafted in a PDF document. Both of which are customized for each customer.

Since the process is not digitized, all service lines face numerous problems with customer service, service delivery, billing, and payment.

A Digital Catalog Microservice will allow the leaders of each service line to build a catalog of services, including standard packages and add-on services. Customer Agencies can then select from these standardized services, eliminating one-off customization of services for specific customers.

2 CUSTOMER

MICROSERVICE

The process of onboarding a new or existing customer is very labor-intensive.

The Portfolio Managers / Service Area Directors and Account Analysts consult with the customer over the phone or email to negotiate the services to be provided, drafts the IAA, sends them to the customer for review and signature, and then stores them in several systems.

Each time a work order is placed, the agreement must be referenced for service eligibility and cost of service(s).

A Customer Microservice will allow the Customer Agency to acquire occupational healthcare services made available in the Digital Catalog and streamline the customer engagement process. Like most online shopping experiences, the Customer Agency will build their agreement by selecting services in the catalog, execute their agreement, and monitor their agreement and beneficiaries (Federal Employees) in the portal.

3 SCHEDULING

MICROSERVICE

Federal Employees that either need or require occupational healthcare services must rely on traditional means of scheduling clinical visits. Customer Agencies currently submit work orders for their employees and coordinate these visits. The lack of an automated, self-service scheduling mechanism results in a lot of overhead and burden on the staff.

A Scheduling Microservice will allow Federal Employees to schedule their own clinical visits, removing the scheduling burden from the Customer Agencies and allowing the Federal Employee to schedule directly with the Provider.

The Scheduling Microservice must also maintain the anonymity of the Federal Employee for certain customers, such as law enforcement agencies.

4 PROVIDER

MICROSERVICE

Clinical Health Services provides preventative and general healthcare services including but not limited to flu shots, immunizations, vision and health screening, and medical surveillance. An important part of the patient experience depends on maintaining cases of patients that have been treated.

A Provider Microservice will provide a real-time view into the healthcare services rendered, resulting in better management of the patient experience, customer funding, and resource utilization. The Provider Microservice must maintain the anonymity of the Federal Employee. Business rules will be embedded to require certain Federal Employees to undergo specific treatments based on job category.

5 BILLING

MICROSERIVCE

Every service line has difficulty tracking funding, billing, and collecting payment for services rendered. The lack of data transparency requires the workforce to apply traditional, labor-intensive means of billing and reconciling payments.

A Billing Microservice will provide Finance

Managers with the insight and automation for billing and payment reconciliation. The Billing

Microservice will work with the Provider

Microservice and Customer Microservice to auto-generate and send bills to the payment system.

Additionally, the Billing Microservice will monitor the status of payment to continuously track customer burndown and available funds.

6 ELIGIBILITY

MICROSERVICE

Federal Employees may be required to undertake certain types of medical examinations based on their job classification such as weapon-carrying employees. The determination of eligibility is currently very manual.

An Eligibility Service will allow Healthcare

Managers to build a list of job categories and pre-assign the required healthcare services. The

Provider Microservice can look up the required services to automate the patient experience.

7 FEDERAL

OCCUPATIONAL

HEALTH DATA LAKE

The Federal Occupational Health

Business Life Cycle relies on a variety of information systems including, but not limited to service catalog, scheduling, healthcare delivery, billing, and payment. Since some of these information systems are owned by different federal agencies and private companies, such as those used by physicians to store patient records, it is difficult for Federal

Occupational Health to have a real-time holistic view of their business operations.

A Federal Occupational Health Data Lake will aggregate data from all systems supporting the business life cycle to provide business and technology leaders the ability to better understand the business model, patient experience, and operations. Knowing this information will allow leaders to improve the delivery of healthcare services to Federal

Employees.

The Digital Catalog Microservice is the foundational business automation idea that must be implemented to truly digitize the Federal Occupational Health Business Model. The Digital Catalog Microservice digitizes the process for building a service catalog that can be configured with standardized service plans and customized add-on services. All the business automation ideas are shown in the matrix below.

Figure 7. Business Automation Matrix

# BUSINESS AUTOMATION IDEAS DIMENSIONS

BUSINESS VALUE TECHNICAL COMPLEXITY EASE OF ADOPTION

1 DIGITAL CATALOG MICROSERVICE High Low High

2 CUSTOMER MICROSERVICE High Mod High

3 PROVIDER MICROSERVICE High High Mod

4 BILLING MICROSERVICE High Mod High

5 ELIGIBILITY MICROSERVICE High Low Low

6 SCHEDULING MICROSERVICE High Mod High

7 FEDERAL OCCUPATIONAL HEALTH

DATA LAKE

High High High

RECOMMENDATIONS

The Federal Occupational Health Business Model and the core systems that enable it are uniquely designed for managing the agreements with customers, as opposed to facilitating the delivery of their services. Federal Occupational Health has a unique opportunity to reinvent its business model and enterprise systems based on feedback from stakeholders across the organization. We recommend that Federal Occupational Health adopt a Healthcare Service Broker Business Model. A Healthcare Service Broker facilitates the connection between customers in need of health services with the appropriate health service providers. For FOH, the core competency is servicing federal agencies with easy access to health care resources through the digitization of the process for building a service catalog, acquiring services from that catalog, tracking the delivery of those services, and automating the billing and collection of payment for services rendered.

We recommend retiring both FEDHEALTH and STM and replacing them with a platform built on a Microservices Architecture (MSA) that consist of autonomous, custom microservices for core processes and commercial microservices to extend the core processes. We recommend custom building the core microservices, including but not limited to the Digital Catalog Microservice, Customer Microservice, Eligibility Microservice, Billing Microservice, and Data Lake. Conversely, we recommend using commercial microservices, if available, such as Scheduling Microservice for scheduling clinical visits and Provider Microservice for tracking patient cases and data.

Please refer to the Enterprise Architecture Assessment for a more detailed discussion of the Enterprise Architecture.

ASSUMPTIONS

We assumed that Federal Occupational Health is a Service Broker, providing expedient, preventative, and emergency healthcare service to Federal Agencies and Employees. Additionally, although the business model for service delivery is different for each service area, the administration of healthcare services is largely outsourced to contractors. Throughout the engagement, we could not find compelling evidence to link Electronic Medical Resources (EMR) to the core business model since clinical health services are administered by physicians who are contractors. These physicians create, maintain, and store EMR in their systems which are not operated by FOH. We assume storing EMR is not essential to the FOH business, as these records are already maintained by the contractor staff and can be transferred from the contractor physicians delivering the clinical services to the patient. Consequently, we assumed the following in writing this report:

1. As a Service Broker, Federal Occupational Health (FOH) does not retain or own medical records.

2. Although we discovered a lack of customer focus through our HCD meetings with FOH employees, we could not verify this from a customer perspective because we only spoke to one customer. To adequately verify this claim, we would like to speak to additional customer agencies to understand their customer experience.

3. We primarily targeted our analysis around FEDHEALTH and STM due to the objectives of the SOO and the limited time and resources that were allocated for this project.

Attachment 2

HHS FOH

Enterprise Architecture Assessment

BACKGROUND

The United States Department of Health and Human Services (HHS), Federal Occupational Health (FOH) delivers comprehensive occupational health solutions exclusively to federal employees. They are tasked with a critical mission to “improve the health, safety, and productivity of our Federal employees.” In an attempt to modernize their IT infrastructure a few years ago, FOH began the implementation of a Commercial-off-the-Shelf (COTS) product, FedHealth Occupational Management System (FEDHEALTH), which was initially intended to provide employees with a single system to manage Electronic Medical Records (EMR), medical history, complete pre-appointment forms, and request appointments. However, the scope of FEDHEALTH was expanded over time to include additional capabilities such as billing and Interagency Agreement (IAA) tracking, which were already being done in the legacy system, Service Tracking and Management (STM).

While the intention was to modernize their business and technical architecture through the implementation of FEDHEALTH, the intended outcome was not fully achieved, and efforts were put on hold. When the new leadership stepped in, they commenced this Enterprise Architecture Assessment to evaluate the Current State Enterprise Architecture and recommend a viable path forward. At present, the execution of the business that supports this mission relies heavily on a fragmented enterprise architecture, which consists of numerous systems performing similar functionalities, therefore resulting in redundant data entry and inconsistencies across service areas.

The goal of this Assessment is to evaluate the business processes, applications, technologies, and data; and recommend a viable, creative path forward. Additionally, the scope of the Assessment is primarily FEDHEALTH and STM.

INTRODUCTION

The Program Support Center (PSC) is a multi-function shared service provider within the United States Department of Health & Human Services (HHS). Federal Occupational Health (“FOH”), a fee for service organization under PSC, provides Behavioral Health Services, Clinical Health Services, Environmental Services, and Wellness & Health Promotion Services. FOH relies on a core set of legacy systems, FEDHEALTH and STM, that have outlived their useful life to run its business.

Consequently, these legacy systems have limited the ability of the business to scale and deliver sustainable high-quality services to customers. The table below summarizes the major technical challenges that FOH faces that are responsible for hindering its business.

Figure 1. Challenges / Opportunities

# Technical Challenges Description

1 Legacy Systems An unfinished system upgrade caused some legacy systems to remain in the current workflow which increases complexity.

Employees are accustomed to duplicative work to accommodate both new and legacy systems.

2 Frequent and Prolonged Downtime The legacy system is functionally unreliable. It experiences frequent and prolonged downtime without a viable workaround to fulfill business needs.

3 Redundant Systems The current workflow is accommodating multiple systems by asking employees to input the same information more than once in more than one system. Relying on the legacy system causes redundant work.

4 Difficult to Get Accurate Reporting Accurate reporting is difficult to achieve. Vital information sits in more than one system. There is inaccurate and missing data due to redundant and manual input. This creates extra overhead spent cleaning up and consolidating information to achieve accurate reporting. Late reports incur a penalty.

5 Information Technology Governance is Fragmented

HHS has centralized shared technology services like email, security, etc. Other technology services powering FOH mission remain decentralized. Additionally, PSC has started to centralize certain IT capabilities, taking back control of IT from FOH. The current decentralized governance model, consisting of various systems performing similar functions across the various service areas, makes it difficult for HHS to achieve economies of scale and scope through standardization.

STRATEGY & APPROACH

HHS PSC FOH contracted with an Assessment contractor to conduct the Enterprise Architecture Assessment over a 3-month period. Design Thinking (DT) and Human Centered Design (HCD) was applied to reimagine a new way of doing business by putting people first. The approach is focused on understanding the people who use the products, their needs and behaviors, and their life situations. We met with 23 executives, business leaders, and technologists across seven divisions to understand the challenges with the status quo and imagine a better future. Interview sessions were conducted across different FOH service areas and internal groups including: Clinical, Behavioral, Wellness & Health Prevention, Environmental, Fiscal, and Technical Groups. We met with all the System Owners and reviewed Policies, Plans & Procedures, System Security Plans (SSP), and data structures.

Figure 2. Federal Occupational Health Business Life Cycle

The Federal Occupational Health Business Life Cycle was created to define a standard framework for all business lines. Then, we created a user journey map to show the major pain points experienced by stakeholders throughout the business life cycle. Additionally, we built a “codeless” clickable prototype to unveil a conceptual future user experience that automates a variety of business processes including, but not limited to the (1) creation of a business service catalog; (2) delivery of occupational healthcare services; (3) management of healthcare cases; (4) invoice, billing, and tracking; and (5) compliance. To enable the future user experience, the Future State Enterprise Architecture must enable a “Best of Breed” technology strategy whereby custom or commercial microservices can be rapidly infused into the technology.

Using the clickable prototype and user journey map as a guide, we evaluated the Current State Enterprise Architecture to determine whether it can support the future state vision and user experience. The Enterprise Architecture Assessment applied a lean version of The Open Group Architecture Framework (TOGAF), which is a framework that defines business goals and aligns them with architectural objectives. TOGAF is based on four interrelated areas of specialization called architecture domains: Business Architecture, Application Architecture, Data Architecture, and Technology Architecture.

Business Architecture includes information on business strategy, governance, organization and how to adapt any existing processes within the organization. Applications Architecture is a blueprint for structuring and deploying application systems and in accordance with business goals, other organizational frameworks and all core business processes. Data Architecture defines the organization’s data storage, management, and maintenance, including logical and physical data models. Technical Architecture describes all necessary hardware, software and IT infrastructure involved in developing and deploying business applications.

CURRENT STATE ENTERPRISE ARCHITECTURE

The Current State Enterprise Architecture consists of a collection of systems, each with a different technology stack. The diagram below maps the technological systems involved in the process flow from setting an Interagency Agreement (IAA) in place to invoicing for delivered services. Starting from the bottom left, the Account Analysts establish an IAA with the customer. The IAA is an annual contract that lists services that FOH will provide and the prices for the given fiscal year. The IAA consists of the Agreement, Statement of Work(s), and Service Order(s) in FEDHEALTH and an Agreement, SOW(s), and Work Orders in STM. Only services related to certain cost centers require creation of the agreement in both systems. The IAA, SOW(s), and Service Order(s) are created by Account Analysts in FEDHEALTH. Depending on the cost center, the IAA is created in both STM and FEDHEALTH. The Account Analysts also prepare the Treasury 7600A and 7600B forms which are stored in CAM and FEDHEALTH. After an agreement is finalized, the Service Area Program staff will create a SOW and begin to draft a Work Order in STM. By the next day, the Work Order Number is searchable in STM and FEDHEALTH for service(s) to be delivered. Each month, the Account Analysts work with the PSC Financial Manager to manually input invoice files, generated from FEDHEALTH and CAM, into PRICES. Customers can view their generic invoices from PRICES. The invoices in PRICES is a listing of the information provided via IPAC to the customer.

Figure 3. Current State Enterprise Architecture

FOH systems interfaces with CAM, PRICES, UFMS, IPAC, FBIS, and PAY.GOV and to bill customers, process payments, and reconcile accounting. All bills are sent to PRICES, which then sends the bills to UFMS. UFMS processes the payment via IPAC, PAY.GOV, and FBIS.

SYSTEM INVENTORY

Although FOH has undertaken efforts to consolidate systems, each business line continues to use its own respective systems since each service line provides different types of occupational health services. For example, Clinical Health Services have several cost centers that provide unique service delivery. The System Inventory below highlights the mission critical systems used by FOH’s business lines.

Figure 4. Core Systems

BUSINESS LIFE

CYCLE

SYSTEMS PURPOSE

SETUP --- ---

CAPTURE CUSTOMER ACCOUNT MODULE

(CAM)

CSA (IAA)

FEDHEALTH CSA (IAA); EMR

STM CSA (IAA)

SERVICE CLINICAL LAB (CL) Lab Tests and Results

FMSS / MERITS Physical Exams; Hazardous Exposures

OME Medical Clearance for Respirator

PPN Medical Exams

WORKLIFE Work Life Services

BILL PAY.GOV Payment

PRICES Billing

UFMS Financial Management

MONITOR FBIS Financial Reporting

OPTIMIZE --- ---

All service lines use STM and FEDHEALTH to varying degrees. Other systems, such as those used during the SERVICE stage of the life cycle, are specific to a particular service area. A lot of the pain experienced by staff is caused by redundant functionality in STM, FEDHEALTH, and CAM.

FEDHEALTH, STM, and CAM independently interface with PRICES, UFMS, IPAC, FBIS, and PAY.GOV to invoice customers, process payments, and reconcile accounting. All invoices are sent to PRICES, which then sends the invoices to customers in UFMS. UFMS processes the payment via IPAC, PAY.GOV, and FBIS.

ENTERPRISE ARCHITECTURE ASSESSMENT

The United States Department of Health & Human Services, Program Support Center, and Federal Occupational Health adopted a decentralized IT governance model. While a decentralized governance model incentivizes innovation, if not done well, it could lead to a fragmented enterprise architecture, an unusually high total cost of ownership, and a lack of business agility. Here, the lack of a clear and effective IT governance model contributed to a variety of failed IT modernization initiatives that then limited the ability of the business to deliver high quality services to customers.

BUSINESS

While FOH began efforts to modernize their IT infrastructure through the consolidation of systems into FEDHEALTH, organizational changes were made that led the leadership to take a step back to re-examine their approach. At the time, the decision to halt major investments made sense, but now may be the time to rethink past decisions. A major roadblock preventing the agency from moving forward is the lack of a practical Vision and Business Model for the future, clear business and technical requirements, and a viable product roadmap. While evaluating the overall business, we observed many opportunities to “digitally transform” the business using a modern microservices architecture. The modern Business Model will automate the service catalog, digitize the customer service agreements, and adopt a self-service model allowing the managers, customers, providers, and federal employees to engage through a digital experience and completely abolish the reliance on paper.

APPLICATION

The existing applications, specifically FEDHEALTH and STM, are optimized for contract management and not service delivery, as their main functionality surrounds the storage of IAAs and the invoicing against those IAAs. They do not facilitate the ability for FOH staff to work collaboratively with customers and providers to deliver services, such as scheduling appointments, verifying eligibility, tracking services rendered by customers.