T-5 Preproposal Conference 18 MAY 2021.pdf

Defense Health Agency TRICARE Managed Care Support (T-5)

Preproposal Conference

HT9402-20-R-0005

18 MAY 2021

Mr. Evan Zaslow – Procuring Contracting Officer Mr. Joseph Mirrow – Program Manager Mr. Marcus Webb – Contract Specialist

Administrative Remarks

T-5 Preproposal Conference 18 MAY 2021; T-5 RFP HT9402-20-R-0005 15 APR 2021

DHA Senior Leader Opening Remarks

Dr. Barclay Butler Assistant Director – Management & Component Acquisition Executive Defense Health Agency

DHA Priorities

T-5 Transformational Aspects

• Value-based purchasing pursuant to 2017 NDAA Sec 705

• DHA will use T-5 to transform TRICARE Program

• Integration with Direct Care System

• Appointing and Appointment availability

• Increased use of telehealth

• Use of Alternate Payment Models including capitation and reduction of low value care to improve outcomes

• Demonstrations designed to impact regulatory authority and deliver innovation

T-5 RFP Journey

Market Research

Requirements

Stakeholder Feedback

Draft RFPs

Acquisition Strategy

November

April

NDAA

MILDEPs DHA/THP/Clinical Communities

MSO/VSO

Institute for Defense Analyses

OSD CAPE (RMG)

Current/former MCSCs GAO Reports DHA Director

Requests for Information Industry Days Industry Forum Current health trends Academia (Harvard, UM) ACO Demonstration Current performance Risk Workshops Defense Acquisition University

High Level Requirements TRICARE Manuals Contract Requirements NDAA 2017, Sec 703

DWR 204

Evidence Based Transformation Number of Regions Contract type Incentives Innovations Evaluation Criteria

February

June

Peer Reviews Industry Q&A

Rules of Engagement

• Questions asked in this forum will be strictly limited to the administrative matters related to the event and Microsoft Teams

• Any questions related to the RFP should be addressed using the prescribed instructions located on https://beta.sam.gov

• All content discussed today is considered informal clarification, and prospective offerors should refer to the solicitation for guidance

• Any changes to the RFP will be completed formally in writing via amendment to the solicitation

T-5 Preproposal Conference 18 MAY 2021; T-5 RFP HT9402-20-R-0005 15 APR 2021 https://beta.sam.gov/opp/4363d3939a7f445e811963d869bb352b/view

Preproposal Conference Purpose

• The purpose of this preproposal conference is to provide:

• Big picture overview of the overall solicitation

• Clearly articulate what each organization needs in its proposal to be responsive to the T-5 RFP dated

15 APR 2021

• Create partnering/subcontracting opportunities for small business via an interested party attachment that will later be added to http://beta.sam.gov

• Proposals due 13 AUG 2021 at 1200 MDT

T-5 Preproposal Conference 18 MAY 2021; T-5 RFP HT9402-20-R-0005 15 APR 2021 http://beta.sam.gov/

Agenda 0900 - 0905 Administrative Remarks

0905 - 0910 Assistant Director - Management and Component Acquisition Executive Comments – Dr. Barclay Butler

0910 - 0915 Rules of Engagement Brief and Agenda Overview – Mr. Evan Zaslow

0915 - 0920 T-5 Contract Overview – CLIN Structure, Incentives, Strategy, Key Requirements – Mr. Evan Zaslow

0920 – 0950 Solicitation Overview Sections C-H – Mr. Evan Zaslow & Mr.

Joseph Mirrow

0950 – 1000 Solicitation Overview Section I (Cybersecurity Requirements) – Mr. Steven Alvarado

1000 - 1020 Solicitation Overview Sections L-M – Mr. Evan Zaslow & Mr.

Joseph Mirrow

1020 – 1025 Small Business Overview – Mr. Marcus Webb

1025 – 1035 Future Potential Demonstrations – Mr. Joseph Mirrow

1035 – 1045 DoD Safe Usage Overview – Mr. Angelo Minisini

1045 – 1055 DMDC Brief – Mr. Joseph Mirrow

1055 – 1105 DAU Brief Performance – Mr. Joseph Mirrow

1105 – 1120 Price Evaluation Template – Mr. Evan Zaslow

1125 - 1130 Closing Remarks – Mr. Evan Zaslow

Contract Structure & Award

• The single solicitation contemplates two awards; one for each region

• Offerors shall submit separate proposals for each region

• One offeror cannot be awarded both regions

• See L-14 for market detail

West Region

East Region

Incentives

• Performance Guarantees

• Tied to areas of high risk/concern during transition and performance (Section H)

• Positive Incentive for Customer Satisfaction

• Incentive based on semi-annual surveys among beneficiaries, providers, MTF leaders, DHA customers, and Market Directors

• Award Fee Plan (Attachment J-12a) rewards continuous improvement to:

• Readiness of the Force (25%)

• Readiness of the Medical Force (25%)

• Access (25%)

• Quality (25%)

• Award Fee Plan (Attachment J-12b) rewards effective transition-out activities

T-5 Best Value Source Selection

• Section M — Evaluation Factors for Award (M.2.)

• This is a best value source selection; the Government will select the best overall offer, based upon an integrated assessment of technical, past performance, and price/cost factors.

• Basis of Evaluation (M.4.)

• Factor 1, Technical/Risk, is the most important factor.

• Technical/Risk Subfactors 1 through 5 are weighted equally and are, individually, more important than Technical/Risk Subfactor 6.

• Factor 2, Past Performance, is less important than Factor 1.

• The non-price evaluation factors (Factors 1 and 2) when combined, are significantly more important than Factor 3, Price/Cost.

• Factor 4, Small Business, does not fall into the relative importance of factors for award because it will be rated on an Acceptable/Unacceptable basis only.

Acquisition/Contract Structure Overview of Key Requirements

Section A – Solicitation/Contract Form

• Offerors shall complete:

• Block 8 – Address of offeror

• Block 14 – Acknowledgement of amendments (as applicable)

• Block 15(A/B/C) – Name and address of offeror, telephone number

• Block 16 – Name and title of person authorized to sign offer

• Block 17 – Signature

• Block 18 – Offer date

Section B – Supplies or services and prices/costs

CLIN

Number Description Contract Type Pricing Methodology

0001 Transition-In FFP Fixed price amount with four performance based payments.

0002 Contract Data Requirements List (CDRLs) NSP Not Separately Priced.

X001 Underwritten Health Care Cost CPFF Claims submitted by TEDS.

X002 Future Potential Demonstrations FFP $15,000,000 Government plug-in number for OPs 1-3, $3,000,000 for OP 4.

X003 Per Member Per Month (PMPM) FFP Government determined quantity of beneficiaries, grouped quarterly. Offerors shall propose fixed price rate and total amount for each SLIN.

X004 Clinical Support Agreements FFP To be issued via contract modifications during performance.

Section B – Supplies or services and prices/costs

CLIN

Number Description Contract Type Pricing Methodology

X005 MTF/Guard/Reserve/MSO/VSO Briefings CR Cost reimbursable with $200,000 ceiling.

X006 CDRLs NSP Not separately priced.

X007 Service Assist Teams (Mobile Disaster) CR Cost reimbursable with $200,000 ceiling.

9001 Transition-Out FFP Fixed price amount with six quarterly payments. Unit Price is equal to 1/6 of the total amount.

9002 CDRLs NSP Not separately priced.

9003 Extension of Services (FAR 52.217-8) 6-Month Option Period Extension

Hybrid For evaluation purposes, equal to 1/2 the value of OP 8. May be exercised anytime during performance.

Section C — Description/Specifications/Statement of Work

C.1.1. The purpose of this contract is to provide managed Care Support (MCS) to the Department of Defense (DoD) TRICARE program. The MCS Contractor shall assist the Military Health System (MHS) in operating an integrated healthcare delivery system combining resources of the military’s direct medical care system and the Contractor’s managed care support to provide health, medical, and administrative support services to TRICARE-eligible beneficiaries.

T-5 Contract Objectives

• Objective 1 - Readiness: Support the MHS readiness mission by partnering with the Military Medical Treatment Facilities (MTFs) to optimize the delivery of health care services to enhance the clinical expertise of providers in the direct care system (see definition of MTF optimization in the TRICARE Manual, Definitions) for all TRICARE-eligible beneficiaries (see definition at Title 32 Code of Federal Regulations (CFR) Part 199.17(a)(6)(i)).

• Objective 2 - Experience of Care: Provide a care experience that is patient and family centered, compassionate, convenient, equitable, safe, and always of the highest quality.

• Objective 3 - Manage Per Capita Cost: Create value by focusing on quality, eliminating waste, and reducing unwarranted variation;

considering the total cost of care over time, not just the cost of an individual health care activity.

• Objective 4 - Population Health: Within the constraints, boundaries, and benefits of the current program, encourage beneficiaries and providers to seek ways to improve health.

• Section C.1.4. — The following documents are incorporated by reference and form an integral part of this contract.

Documentation incorporated by reference has the same force and effect as if set forth in full text.

• Title 10, United States Code, Chapter 55

• 32 Code of Federal Regulations Part 199

• TRICARE Policy Manual (TPM) 6010.60-M, April 2021

• TRICARE Reimbursement Manual (TRM) 6010.61-M, April 2021

• TRICARE Systems Manual (TSM) 7950.3-M, April 2021

• TRICARE Operations Manual (TOM) 6010.59-M, April 2021

• Section D — Packaging and Marking

• Procedures for submission of deliverables to the Government

• Section E — Inspection and Acceptance

• Inspection of Services clauses apply

• DD250 to be submitted after completion of base and option periods

• Section F — Deliveries or Performance

• Period of Performance

• Geographic Areas of Coverage (states) Breakdown of MTF markets is available in

Section J, Attachments J-1 through J-6

• CDRL identification

Acquisition/Contract Structure Overview of Key Requirements

• Section G — Contract Administration Data

• Provide the names, addresses, phone numbers, and e-mail addresses of the Contractor’s primary and alternate points of contact (POC) (G.1.4.)

• Vouchers/invoices submitted by:

• TRICARE Encounter Data System (TEDS)

• Wide-Area Workflow (WAWF)

• PMPM (CLIN X003 series) Military Health System (MHS) Eligible Beneficiaries (G.2.)

• Each region’s count of eligible beneficiaries will be based on the eligible beneficiary’s address as contained in Defense Enrollment Eligibility Reporting System (DEERS).

• The Government will unilaterally determine the number of MHS eligible beneficiaries prospectively two times for each option period (months 1- 6 and months 7-12).

• Using the number of MHS eligible beneficiaries, the Government will calculate the PMPM quantity for the next semi-annual period as follows:

Nbeneficiaries x 3 = Nmember_months

Nmember_months x Fixed Unit Price = Extended Amount for Period

Section H — Special Contract Requirements

• Financial Underwriting of Healthcare Cost (H.1.1.) The Managed Care

Support (MCS) Contractor shall underwrite the cost of civilian healthcare services (also referred to as “private sector care” or “purchased care,” which is defined as care provided outside of the direct care system) provided to all TRICARE-eligible beneficiaries who are enrolled in TRICARE Prime or TRICARE Select in the Contractor’s geographic area of responsibility and for other TRICARE-eligible beneficiaries who reside in the Contractor’s geographic area of responsibility (For exempted, non-underwritten categories see RFP Section H.1.1.)

• H.1.3.1. …all health care costs for Prime enrolled non- TRICARE/Medicare dual-eligible CHAMPUS beneficiaries incurred outside of the Military Health System (MHS) direct care system are underwritten by the Contractor, except for Active Duty Service Members (ADSMs) and the other exclusions noted in paragraph H.1.1.

• Underwritten healthcare is cost-reimbursable

• Section H — Special Contract Requirements

• Award Fee (H.2.)

• A $20M Award Fee pool, identified under Section B, is available for the Contractor to earn based on meeting or exceeding the Government’s requirements for Readiness, Access, and Quality. (J- 12a)

• A separate Award Fee is available as a performance incentive during the transition out period. (J-12b)

• Healthcare Underwriting Incentives (H.3.)

• Network Discount Incentive: The purpose of this incentive is to encourage Contractors to proactively negotiate discounts with network providers and thereby reduce underwritten healthcare costs.

Fill in 3.2.1.1 guarantee amount.

• Limited to 5% discount from TRICARE allowable charted for care provided by individual professional providers (Health Care Provider Taxonomy specialty codes)

• Section H — Special Contract Requirements

• H.3.2.2. Network Usage Incentive

• The purpose of this incentive is to promote increased usage of network providers by enrolled beneficiaries, thereby reducing enrollee out-of-pocket costs and potentially reducing underwritten healthcare costs.

• Calculated based on a comparison between the number of network provider claims for TRICARE Prime and TRICARE Select enrolled beneficiaries with the total number of claims for these beneficiaries (after excluding some types of claims

• Section H — Special Contract Requirements

• Performance Incentive (H.4.) – up to $1.1M

• Customer Satisfaction Incentive: The purpose of this incentive is to promote a high degree of focus on customer service by the Contractor. Customers are defined as beneficiaries, providers, and MTF leadership, DHA customers and Market Directors. (J-16)

• Results of customer satisfaction surveys will be used to calculate a weighted average composite score (WACS) whereby the results of the MTF leadership survey carries the greatest weight, and the results of the provider survey carry the least.

• Section H — Special Contract Requirements

• Performance Guarantees (transition) (H.5.4. - H.5.8.)

H.5.4. Provider Loading to Systems Primary Care Manager Specialty Providers Behavioral Health Inpatient Healthcare Facilities

H.5.5. Enrollment – Fully Operational Enrollment System

(1) all hardware/software is operational

(2) system access requirements are met

(3) the system correctly interfaces with Government systems,

(4) the Contractor can perform all required billing enrollment and collection transactions, and

(5) all enrollment rules are loaded and accessible

H.5.6. Customer Service Performance Guarantee 90 days prior to Start of Health Care Delivery Government will conduct up to 500 phone calls on topics in 5.6.4.

• Section H — Special Contract Requirements

• Performance Guarantees (transition) (H.5.4. - H.5.8.)

• H.5.7. Referral Management

• Evaluation starting 31 days after the SHCD

• Standard: 90% of referrals within 24 hours and 100% of referrals within 2 business days with a 95% accuracy rate

• Review of up of to 5,000 referrals for timeliness and accuracy

• H.5.8. Claims Processing

• Evaluation starting 120 days after SHCD

• Accuracy & Auto adjudication

• Up to 1000 claims

• Section H — Special Contract Requirements

• Performance Guarantees (H.5.9. - H.5.10.)

• H.5.9. Claims Processing

• Evaluated quarterly starting 2nd quarter

• Review of a minimum of 1000 claims

• Claims accuracy

• First pass auto adjudication

• Claims reprocessing rate

• H.5.10. Provider Directory Accuracy

• Assessed 90 days after SHCD and every three months thereafter

• Increasing provider directory accuracy standards in

C.2.1.13.

• Section H — Special Contract Requirements

• H.16. Future Potential Demonstrations and Product Improvements

• Describes potential demonstrations and product improvements that the Government may pursue and implement during the contract’s period of performance.

• The following requirements must be completed:

• Quality, Efficiency, Convenience and/or Cost Effectiveness

• Detailed requirements

• Legislative or rulemaking activities

• Contract modifications

• TRICARE Manuals update

• H.17. Future Potential Competitive Demonstrations

• Notifies the Contractor that the Government may conduct one or more demonstrations that open certain markets (J-9) for local and regional providers, other than the Contractor, to compete to provide Managed Care Support to the TRICARE Program

• Enrollment Eligibility Encounter (EEE) contract interface

• Section H — Special Contract Requirements

• H.18. – Alternative Payment Models

• DHA will utilize the 2017 Health Care Payment Learning & Action Network (HCPLAN) framework for defining acceptable Alternative Payment Models (APMs)

• Identifies Acceptable Quality Level (Threshold) and Standard (Objective) levels of total network health care dollars paid under APMs for each Option Period by category

• Section I — Contract clauses have been included by reference or full text

• FAR Class Deviations to clauses:

• FAR 52.216-7 Allowable Cost and Payment

• FAR 52.237-7 Indemnification and Medical Liability

Insurance

• Network Security Requirements (Discussed in L)

• DFARS 252.204-7012 Safeguarding Covered Defense Information and Cyber Incident Reporting (DEC 2019)

• Section J — List of Attachments and Exhibits

• Section K — Representations, Certifications, & Other Statements of Offerors or Respondents

• Offerors shall complete the annual representations and certifications electronically on https://www.sam.gov

• Additional Representations and Certifications are marked and included in Section K requiring offeror attention

T-5 Preproposal Conference 18 MAY 2021; T-5 RFP HT9402-20-R-0005 15 APR 2021 https://www.sam.gov/

• Section L — Instructions, Conditions, and Notices to Offerors

• Submit anticipated organizational structure at least fifteen (15) calendar days prior to the proposal due date. (L.2.7.) The organizational structure must include the prime Contractor and first-tier subcontractors (as defined in Section L.7.1.).

• Disclose any Use of Former DoD or TMA Employees and Unformed Service Members in proposal prep (L.2.9.)

• Two Region Structure (i.e., geographical areas for contract performance) (L.2.)

• If one Contractor demonstrates the best value for both regions, that Contractor will not be awarded both regions.

• In the event an offeror is evaluated as the best value in both regions, the Source Selection Authority will make an award decision for a single region that is in the best interests of the Government.

• Offerors may propose on one or both regions.

Proposal Deliverables

PART/VOLUME

NAME

Volume I Executed Offer, to include:

• SF 33

• Completed Section B

• Completed Section K Representations &

Certifications

• Completed copy of paragraph G.1.4.

(Points of Contact)

• Completed copy of paragraph H.3.2.1.1.

(Guaranteed Network Provider Discounts)

• OCI representation statement (L.2.6.4.)

• Subcontracting Plan (L.5.2.)

• Overview Presentations (see L.6.3.)

Volume II Technical to include:

• Written Technical Proposal (see L.6.1.)

Volume III Past Performance (see L.7.)

Volume IV Price/Cost (see L.8.)

• Completion of H.3.2.1.1.

Volume V Financial Data (see L.9.) to include:

• Guarantee Agreement for Corporate

Guarantor

• Sections L & M — Technical Factors

• Factor 1 - Technical L & M (L.6. and M.7.)

• Cross reference at Attachment L-1

• Subfactor 1 – Network Management

• L-3(e) and L-3(w)

• L-9(e) and L-9(w)

• Subfactor 2 – Clinical Management

• Subfactor 3 – Administration and Customer Service

• Subfactor 4 – Claims and Systems

• Summary score of basic self assessment for each covered system to Supplier Performance Risk System

• Sample APM proposal

• Subfactor 5 – Transition Management

• Integrated Master Plan/Integrated Master Schedule

• Subfactor 6 – Future Potential Demos/Product Improvements

• Section L & M — Evaluation Factors for Award

• Evaluation Of Factor 2, Past Performance (L.7. & M.8.)

• L.7.1. “Offeror” applies to the prime contractor which may be an individual company, subsidiary, affiliate, or individual entity/entities of a joint venture. A “first-tier subcontractor” means a subcontractor that will have a subcontract directly with the prime contractor valued in excess of $100 Million (inclusive of all contract options).

• L.7.3. Submit up to ten (10) recent contracts or agreements reflecting its work most relevant to the solicitation. The ten (10) most relevant contracts or agreements may be for its own work or the work of its first-tier subcontractor(s). Each contract or agreement submitted shall also include information (NTE 3 pages/ref) on the functions performed, the time period covered, and the aspects of the work that are most relevant (see M.8.4). The Offeror shall state if it has submitted fewer than 10 (ten) contracts or agreements.

• L7.6. Submit Past Performance Questionnaire (PPQ) (Atch L-12, Sect 1 & 2 only) for each of its references and its first-tier subcontractor(s) references submitted pursuant to L.7.3. Send Section 3 of the questionnaire to references to be filled out independently and be returned directly to the Government.

Past Performance Relevancy Ratings

Past Performance

Past Performance Evaluation

Is it recent? Yes

Is it relevant

Evaluate quality of work

Yes

Confidence Assessment Rating

No

NoStop

For each reference …

All references for each offeror

M.8.1. The Government will evaluate past performance information, submitted by Offerors in accordance with Section L and obtained through other sources, to determine how well an Offeror and its first-tier subcontractors have performed in the past on recent, relevant work. The Government’s past performance evaluation will result in an assessment of each Offeror’s probability of meeting the solicitation requirements. The Government will assign one overall performance confidence assessment rating for each proposal.

• Section M — Evaluation Factors for Award

• Evaluation Of Factor 3, Price/Cost (M.9.)

• For the purpose of determining the contract Best Value, the Government will use the Total Evaluated Price (TEP) for each offeror, consisting of the sum of all priced CLINs.

• Evaluation of Professional Compensation (M.9.3.)

• M.9.3. will be reserved (removed) from the T-5 RFP under

Amendment 0001.

• Cost Realism Evaluation (M.9.4.)

• To be updated in T-5 RFP Amendment 0001.

• The Government has provided estimated reimbursable costs for underwritten healthcare which have already been evaluated for realism, therefore the Government will not perform any additional cost realism analysis on the proposed CLINs X001.

• The evaluation of CLINs X001 will be limited to validating that offerors have correctly applied their guaranteed network provider discounts.

Small Business Overview

• What Is the Small Business Administration?

• The Small Business Administration (SBA) is an autonomous

U.S. government agency established in 1953 to bolster and promote the economy in general by providing assistance to small businesses. One of the largest functions of the SBA is the provision of counseling to aid individuals trying to start and grow businesses.

• T-5 SB Subcontracting Goals: 25%

• Women-Owned Small Businesses (WOSB): 5%

• Small Disadvantaged Businesses (SDB): 5%

• Veteran-Owned Small Business (VOSB): 3%

• Service-Disabled Vet-Owned Small Businesses (SDVOSB): 3%

• Historically Underutilized Business Zone (HUBZone) SBs: 3%

• The AbilityOne Program (National Industry for the

Blind/SourceAmerica) : 1%

• Section M.10, Evaluation of Factor 4 - Small Business Participation

• The Government will evaluate the subcontracting plan and participation of small businesses on an acceptable/non-acceptable basis.

• Acceptable – Proposal clearly meets the minimum requirements of the solicitation (Strengths are not assessed for this evaluation).

• Unacceptable – Proposal does not clearly meet the minimum requirements of the solicitation.

• The Contracting Officer (CO) will evaluate the subcontracting plan submitted under Volume I for compliance with Section L.5.2.

Small Business Goals Summary

T-5 Partnering Opportunities

• T-5 Participation Email

• Registrants will receive an email requesting permission to disclose company identity

• Responses will be “Yes” or “No” via voting buttons in the email body

• Company name, Phone Number and Contact Email

Addresses

Small Business Partnering

CY 24 CY25 CY26 CY27 CY28 CY29 CY30 CY31

Clinically Integrated Networks

Advanced Primary Care (APC)

Virtual Value Networks (VVN)5

Care Collaboration Tools

Wellness & Disease Management

Centers of Excellence (COE)

Telehealth

Advanced Care Management

Targeted Utilization Management

Competitive Demos

T-5 Demonstrations/ Product Improvements

DoD SAFE Walkthrough

DoD SAFE Walkthrough (cont.)

DEERS Technical Specifications

• For prospective offerors only

• Controlled/Unclassified information subject to terms of Data Sharing Agreement (L.3.3.)

• Sent through DoD SAFE

• System to system interface specifications

• B2B Gateway Questionnaire

• Updated at Award

DEERS – Defense Enrollment Eligibility Reporting System

Price Evaluation Template (PET) Total Proposed Prices

PET – Section B

PET – Section B (cont.)

PET – Section B (cont.)

PET

Healthcare Cost & Discount

PET

CDRLs/Estimated Prices

RFP Points of Contact

Mr. Evan Zaslow, Procuring Contracting Officer 303-676-7733 evan.j.zaslow.civ@mail.mil

Mr. Marcus R. Webb, Contract Specialist 303-676-3906 marcus.r.webb.civ@mail.mil

T-5 Preproposal Conference 18 MAY 2021; T-5 RFP HT9402-20-R-0005 15 APR 2021 mailto:evan.j.zaslow.civ@mail.mil mailto:marcus.r.webb.civ@mail.mil