Disease_Manager_PWS.pdf

PERFORMANCE WORK STATEMENT

FOR

DISEASE MANAGER

8TH MEDICAL GROUP KUNSAN AB, REPUBLIC OF KOREA

1. GENERAL: This is a non-personnel services contract to provide Disease Manager for 8th Medical, Kunsan Air Base. The Government will not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1. SCOPE: Utilizing major components of population health and health care integration, ensures health care interventions for at-risk individuals and patient care populations to promote optimum health and disease prevention, reducing healthcare costs, and improving quality of life. Also assists primary care teams and performs clinical nursing care in the execution of care coordination and disease prevention services.

1.1.1. Serves as a medical liaison/care coordinator within the military treatment facility (MTF) between specialty care (e.g., physical therapy, mental health) and primary care providers. Also serves as a medical liaison with network providers, TRICARE Operations and Patient Administration (TOPA), and the Managed Care Support Contractor to ensure appropriate follow-up care to include durable medical equipment (DME) issue.

1.2. PERIOD OF PERFORMANCE:

Period Performance Period Base Year 1 Jun 2017 – 31 Dec 2018 or date of award 1st Option year 1 Jun 2018 – 31 Dec 2019 2nd Option year 1 Jun 2019 – 31 Dec 2020 3rd Option year 1 Jun 2020 – 31 Dec 2021 4th Option year 1 Jun 2021 – 31 Dec 2022

1.3. GENERAL INFORMATION:

1.3.1. Quality Control Plan:

The contractor shall be responsible for quality control of its performance under this contract. The contractor shall establish a complete Quality Control Plan (QCP) that identifies potential and actual problem areas in providing requirements of the contract as specified and describes corrective action that will be taken throughout the life of the contract. The initial QCP Contractor Data Requirements List A001 (CDRL) shall be provided to the KO with contractor's proposal and shall be updated thereafter to maintain an effective and efficient quality control program. The QCP may be utilized for proposal evaluation purposes. The Government (the contracting officer and the COR) will make final review and acceptance of the QCP (after negotiating any needed changes) within 30 days after the contract is awarded. The basic tenet of the plan is that the contractor is responsible for quality control. All methods, procedures, metrics, and forms shall support this concept. The Government reserves the right to witness, participate in, or perform any activities associated with conformance to performance requirements. The quality control plan shall provide an overview of the contractor’s quality program, provide a work structure breakdown chart, and demonstrate direct accountability to the company’s senior management. The QCP shall cover all requirements detailed in this contract but should pay particular attention to the requirements identified in the performance requirements summary. The quality control plan shall include at a minimum:

a. A training program overview that identifies how the contractor will prepare their workforce for performance of services required by the contract and how they address the training needs as a result of any employee turnover.

b. Identify a method acceptable to the government of measuring customer satisfaction and provide a detailed process for customer complaint management. The customer complaint program shall involve the contracting officer representative (COR) in the validation and follow up portions of the process.

c. Identify a method acceptable to the government of ensuring accuracy and timeliness of any financial submissions (to include invoices) that would minimize rejections of these documents for inaccuracy, incompleteness, or time constraints.

d. Identify a process that utilizes early \ proactive problem detection and intervention to preclude impact to performance of the requirements of this contract.

e. Response process for root cause analysis and corrective action requests from the government.

f. A Contractor Data Requirements List (CDRL) schedule that clearly identifies when a data deliverable is due and charts compliance to that schedule. This schedule shall be provided monthly to the COR and can be included within the performance reporting metrics.

The quality performance metrics provided to the COR, after validation, will be utilized in conjunction with the Quality Assurance Surveillance Plan (QASP) to determine performance oversight measurement and will have direct impact on performance reporting provided to the contracting officer.

1.4. Quality Assurance:

1.4.1. Quality Assurance: The government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government will do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.5 Hours of Operation. The following is a detailed description of the duty hours, leave policy, facility closure policy, and holiday policy.

1.5.1. The contractor shall not exceed 80 hours in a two-week work period. The contractor will only be paid for actual hours worked. The medical facility is open from 0800 to 1700 hours, Monday through Friday.

1.5.2. Recognized Holidays: The Contractor shall not be required to perform normal services on U.S. holidays Contract personnel may be required to work on U.S. holidays as determined by the

COR:

U.S. Government legal holidays:

New Year’s Day, January 1st Martin Luther King’s Birthday, 3rd Monday in January President’s Day, 3rd Monday in February Memorial Day, Last Monday in May Independence Day, July 4th Labor Day, 1st Monday in September Columbus Day, 2nd Monday in October Veteran’s Day, November 11th Thanksgiving Day, 4th Thursday in November Christmas Day, December 25th

ROK legal holidays

1 and 2 January (New Year) Lunar New Year (31 December, 1 and 2 January on the Lunar Calendar) 1 March (Independence Movement Day) 1 May (Labor Day) 5 May (Children's Day) Buddha's Birthday (8 April on the lunar calendar) 6 June (Memorial Day) 17 July (Constitution Day) 15 August (Liberation Day) Chu-Suk (14, 15, and 16 August on the Lunar Calendar) 3 October (National Foundation Day) 25 December (Christmas Day)

1.5.3. Contract person shall report to medical facility as scheduled during base exercises. Contract person shall also report to work during emergencies that a disease manager services is needed such as disease outbreak, disasters, or during adverse weather conditions. Contract services are still required during these situations. However, if transit to work is not possible, personnel are to notify COR and/or immediate supervisor.

1.5.4. During anticipated closure of the facility due to severe weather, scheduled “down-days,” or other occasions, the contractor shall not invoice the government for services not performed and the Government will not be liable for any such closures.

1.5.5. The contractor shall not provide on-call/after-hours or overtime duties.

1.5.6. Unscheduled absences due to illness or emergency must be coordinated with the COR and/or immediate supervisor as early as possible.

1.5.7. Scheduled absences shall be coordinated with both the COR and/or immediate supervisor no less than 30 days prior to anticipated leave.

1.5.8. The contractor is responsible for submitting an accurate invoice.

1.6. Management Plan: The contractor shall be responsible for recruiting, retaining and if required, the replacing qualified personnel to perform the tasks identified in this PWS. The contractor shall provide skilled and experienced person to satisfy all tasks of the requirement. The offeror shall demonstrate how the offeror shall provide a replacement and back-up support when the contractor's person is on leave more than 10 working days.

1.7. QUALIFICATIONS.

1.7. Key Person: Disease Manager

1.7.1. Before removing, replacing, or diverting any of the listed or specified key person, the Contractor shall:

(1) Notify the Contracting Officer reasonably in advance (at minimum14 calendar days is considered reasonable);

(2) Submit justification (including proposed substitutions with resumes of equal qualifications stated in this section 1.8.3. in sufficient detail to permit evaluation of the impact on this contract; and

(3) Obtain the Contracting Officer's written approval. Notwithstanding the foregoing, if the Contractor deems immediate removal or suspension of any member of its management team is necessary to fulfill its obligation to maintain satisfactory standards of employee competency, conduct, and integrity under the clause at 48 CFR 970.5203–3, Contractor's Organization, the Contractor may remove or suspend such person at once, although the Contractor shall notify the Contracting Officer prior to or concurrently with such action.

1.7.2. The list of key person may, with the consent of the contracting parties, be amended from time to time during the course of the contract to add or delete personnel so long as the aforementioned items are addressed.

1.7.3: Qualification of Disease Manager:

1.7.3.1. Experience. The disease manager shall have a minimum of three (3) years nursing experience as a Registered Nurse (RN) within seven (7) years, with preferred experience in utilization management, disease management, or case management of adult patient populations or previous experience as a health care integrator. The disease manager should have knowledge of clinical application of principles and practices related to the nursing process or healthcare management. Requires prior experience in case management, discharge planning, utilization management, process improvement, and personnel management. Must be able to review a wide range of medical disorders, conditions, and disease processes for the adult patient, to include in-person and via-telephone assessments, evaluations, and diagnoses. In addition, must be able to educate and apply preventive health and disease management principles with a primary focus on treatment and prevention protocols. The contractor shall have a working knowledge of commonly used pharmacological agents used in the adult population. Knowledge of computer applications and software to include Microsoft Office programs, MS Outlook (e-mail), internet, Excel, and PowerPoint. Knowledge of electronic healthcare record documentation in Composite Health Care Systems (CHCS) and Armed Forces Health Longitudinal Technology Application (AHLTA) is required. The contractor shall successfully complete all facility orientation requirements as a clinical nurse. The contractor shall be skilled in analyzing and defining healthcare needs of a defined population using standardized assessment tools. Able to meet administrative requirements for proper documentation of patient’s condition including disease progress, education, and follow-up care. The contractor shall be able to use problem-solving techniques to articulate medical requirements to patients, family members, care givers and medical as well as non-medical staff in a professional and courteous way.

1,7.3.2. Education: The disease manager shall have a minimum of associate’s degree in nursing, obtained from an agency accredited by the US Department of Education. The disease manager should have a working knowledge of performance standards and successful completion of associated healthcare coursework (i.e., experience in care coordination, health care integration, case management).

1.7.3.3. License: The disease manager shall have Licensed Registered Nurse (RN) and shall maintain an active, valid, current, and unrestricted license (with no limitations, stipulations or pending adverse actions) to practice in any US state or jurisdiction.

1.7.3.4. Certification. The contractor shall have certification or meet certification eligibility requirements in medical management related areas of expertise, to include but not limited to:

Chronic Care Professional (CCP) by Health Sciences Institute, Certified Health Coach (CHC) by National Society of Health Coaches, patient education body such as Certified Diabetes Educator (CDE) by National Certification Board for Diabetes Educators, and Certified Asthma Educator (AE-C) by National Asthma Educator Certification Board.

1.8. Status of Forces Agreement. The contractor shall comply with requirements generated by the Status of Forces Agreements (SOFA) with Korea and applicable countries. Contractor personnel who obtain SOFA status are eligible for logistics support as described in USFK Regulation 700-19.

This support is based on availability of services and SOFA accreditation status. The contractor is responsible for and shall meet Korea and applicable countries government requirements for contractors working these respective countries to include accreditation compliance. SOFA status submissions, for both the contract and for the contractor employees, require additional planning time for processing the status requests. The contractor shall execute SOFA submission requirements in such a manner as to ensure there are no mission failures due to lack of adequate personnel with the proper skills and experience.

More information concerning SOFA requirements and submission procedures for Korea and applicable countries can be found at http://www.usfk.mil/usfk. Personnel designated as other than US Ordinarily Resident (OR) are not authorized logistical support. The government has no objections to the contractor hiring Ordinarily Resident contractor personnel who have the necessary prerequisites to perform work under this contract.

2. DEFFINITIONS:

MTF: military Treatment Facility TOPA: TRICARE(health care program of the United States Department of Defense Military Health System) Operations and Patient Administration MDE: Durable Medical Equipment QCP: Quality Control Program CHCS: Composite Health Care Systems AHLTA: Armed Forces Health Longitudinal Technology Application RN: Registered Nurse CHC: Certified Health Coach CDE: Certified Diabetes Educator AE-C: Certified Asthma Educator HEDIS: Healthcare Effectiveness Data and Information Set SGH: Chief of Medical Staff(IAW AFI 44-102 para 1.3.2.)

GPM: Group Practice Manager http://www.usfk.mil/usfk

EKG: Electrocardiogram UEI: Unit Effectiveness Inspection EEO: Equal Employment Opportunity COR: Contracting Officer Representative

3. GOVERNMENT FURNISHED ITEMS AND SERVICES:

3.1. The Government will provide the following resources for utilization in the performance of services covered under this contract. No other use is authorized or permitted.

a. Office Space.

b. Desks/chairs.

c. Local telephone services and telephone sets (charges generated by use will be monitored closely by the COR ).

d. Office supplies.

f. Network/ LAN access.

g. Document reproduction support.

4. CONTRACTOR FURNISHED MATERIAL: N/A.

5. SPECIFIC TASKS:

5.1. General:

5.1.1. The contractor shall collaborate with the Chief of Medical Staff (SGH) to coordinate adult patient care through a continuum of prevention, identification, treatment, and promotion of optimal outcomes in relation to clinical care, quality and cost effectiveness.

5.1.2. The contractor shall identify and stratify individual patients and populations of patients at risk for chronic diseases, but with primary focus on treatment and prevention. Must work with referral management and TOPA to coordinate inter-facility referrals and patient care team management.

Must maintain an accurate knowledge of TRICARE benefits and capabilities in local area network.

Must plan using Air Force Medical Service (AFMS) policies, accreditation requirements, performance improvement, local and state laws, legal and other regulatory requirements.

5.1.3. The contractor shall facilitate identification, adoption, implementation and utilization of standardized clinical practice guidelines and protocols for management of specific diseases/conditions.

5.1.4. The contractor shall identify, develop, and execute appropriate prevention and treatment interventions such as, but not limited to, individual and/or group training classes. Facilitates education, resources, access to services, and self-care programs for at-risk adult patients.

5.1.5. The contractor shall conduct a thorough evaluation of the patient’s current physical, psychosocial, and health status. Documents treatment plans that match level of patient’s care to clinical risk assessments, readiness to change, and health literacy. Reports healthcare initiatives through trending of results at the MTF level, such as clinical Healthcare Effectiveness Data and Information Set measures.

5.1.6. The contractor shall identify, collect, interpret and evaluate measureable outcomes of care within established timeframes (i.e., quality of services, cost and cost savings, disease prevention, management and improvement). Conducts studies as required based upon at-risk populations, involving population health programs and other military related indicators.

5.1.7. The contractor shall report data as required to the patient care team and Chief of Medical Staff. The contractor shall reports at-risk population management efforts to MTF leadership through committees such as Population Health Working Group. The contractor shall use chain of command to focus attention on innovative ideas, best practices, identified challenges, and MTF-specific opportunities for improvement.

5.1.8. The contractor shall assist in development of facility’s Medical Management and at-risk population in support of the annual strategic plan, ensuring a process for collecting and collaborating data with group practice manager (GPM) to facilitate performance monitoring, process improvements, and prevention interventions.

5.1.9. The contractor shall work with providers to coordinate required education for patients on specialized medical equipment such as cardiac monitoring devices, Electrocardiogram , oxygen analyzers, nebulizers, and other clinic-specific equipment to include Durable Medical Equipment

(DME) .

5.1.10. The contractor shall set priorities for the identified populations at-risk. The contractor shall share knowledge, coordinates and participates in interdisciplinary team meetings to include medical care coordination meetings. The contractor shall attend meetings as required by Chief of Medical Staff (e.g., Executive Committee of the Medical Staff, Prostaff) to report compiled data.

5.1.11. The contractor shall maintain a level of productivity and quality consistent with the complexity of the assignment; facility policies and guidelines; established principles, ethics and standards of practice of professional nursing or healthcare administration; The Joint Commission (TJC); Unit Effectiveness Inspection (UEI); and other applicable DoD and Service specific guidance and policies. Must also comply with the Equal Employment Opportunity (EEO) Program, infection control, as well as safety policies and procedures.

5.1.12. The contractor shall complete medical record documentation and designated tracking logs and data reports as required by local MTF, Air Force (AF), and DoD instructions, policies and guidance.

5.1.13. The contractor shall complete all required electronic medical record training, MTF-specific orientation and training programs, and AF/DoD-mandated training to include Health Care Integrator and/or Disease Manager Course.

5.2. Orientation and Training:

5.2.1. When commencing work under this contract, the contract personnel shall obtain in-processing checklist from the COR or designated office. All contract personnel are required to complete the applicable items on the checklist and turn it in to the designated office. Upon completion of the duty assignment, the contract personnel need to complete an out-processing checklist and return it to the designated office.

5.2.2. The contract personnel shall be provided with a government paid orientation to familiarize the contract personnel with the policies and procedures of the medical facility, assigned department, and specific unit. This shall be completed within 30 days of starting the contract performance.

5.2.3. The contractor shall ensure the contract personnel complete any mandatory training requirements in accordance with medical facility procedures.

5.2.4. The contractor who have any interaction with the Military Treatment Facility (MTF) computer systems must receive training for the applicable systems. The COR will coordinate the necessary computer training and it will take place on-site and during normal duty hours. The training will be at no cost to the contractor. This includes but is not limited to Composite Health Care Systems (CHCS) and Armed Forces Health Longitudinal Technology Application (AHLTA).

5.3. Conduct: The contractor shall comply with facility policies regarding dress, appearance, good order, and discipline. The contractor shall abide by all regulations regarding the nature of limited privileged communication between patients and the contract personnel, who may be necessary for security and personal reliability programs. Additionally, the contractor shall also abide by all regulations concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act of 1996. All medical records and reports will remain the property of the U.S. Government.

5.4. Health Requirement:

5.4.1. The contractor shall comply with 8th Medical Group health and immunization requirements.

The expense to comply with the health and immunization requirements shall be borne by the contractor at no additional cost to the Government.

5.4.2. Not later than five (5) working days prior to commencement of work, certification shall be provided to the COR that contract Medical Care Manager has completed medical evaluation required, as above. This certification shall state the date on which the examination was completed, the name of the medical provider that performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement:

“(name of contract employee) is free from contagious diseases.”

5.4.3. The 8th Medical Group will provide emergency health care for contract personnel for injuries occurring while on duty in the MTF. These services will be billed to the contractor at the current full reimbursement rate.

5.4.4. It is the responsibility of the contractor to notify the COR of a pregnant employee. MTF Employee Health Office will provide information concerning any work hazards in that area. The contractor is to notify their pregnant employee of any work hazards. The contractor will provide a replacement for any time required off for maternity leave.

6. CDRL:

CDRL

PWS Section Description Format Frequency Distribution

A001 1.4 Quality Control Plan

Contractor Format

With Proposal KO \ COR

A002 5.1.7 Report at risk population management efforts

Contractor Format

Monthly COR

A003 5.4.2. Certification with name of

Government Format

No later than 5 working days

COR

contract employee prior to commencement of work

7. PERFORMANCE REQUIREMENT SUMMARY:

7.1. The contract performance requirements are summarized in performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimally acceptable levels of service required for each requirement.

7.2. The PRS and the contractor’s QCP provide information on contract requirements, the expected level of contractor performance and the expected method of government validation and confirmation of services provided. These thresholds are critical to mission success. Procedures as set forth in the FAR 52.212-4. The COR or designated representative will conduct the inspections, and any deficiencies are to be provided to the contractor in writing.

Performance Objective Acceptable Quality Level

Contra ct Refere nce

Assessment Method Remedy

Collaborates with the Chief of Medical Staff (SGH) to coordinate adult patient care through a continuum of prevention, identification, treatment, and promotion of optimal outcomes in relation to clinical care, quality and cost effectiveness

Every day between 95% to 100%, unless prearranged with the SGN

PWS

5.1.1.

COR will assess performance of contractor based on periodic surveillance, Monthly Contractor Performance Assessment Report, and customer service feedback

Provide re-training/re-orientation as required.

Identifies and stratifies individual patients and populations of patients at risk for chronic diseases, but with primary focus on treatment and prevention.

Must work with referral management and TOPA to coordinate interfaculty referrals and patient care team management.

Must maintain an accurate knowledge of TRICARE benefits and capabilities in local area network. Must plan using Air Force Medical Service (AFMS) policies, accreditation requirements, performance improvement, local and state laws, legal and other regulatory requirements.

Every day between 95% to 100%, unless prearranged with the SGN

5.1.2. COR will assess

performance of contractor based on periodic surveillance, Monthly Contractor Performance Assessment Report, and customer service feedback

Provide re-training/re-orientation as required.

8. CONTRACTOR MANAGEMENT REPORTING (CMR):

The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract via a secure data collection site.

The contractor is required to completely fill in all required data fields using the following web address: http://www.ecmra.mil/, and then click on "Department of the Army CMRA" or the icon of the DoD organization that is receiving or benefitting from the contracted services.

Reporting inputs will be for the labor executed during the period of performance during each Government fiscal year FY, which runs October 1 through September 30. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year, beginning with 2016. Contractors may direct questions to the help desk by clicking on "Send an email" which is located under the Help Resources ribbon on the right side of the login page of the applicable Service/Component's CMR website".