Beneficiary and Family centered Care and Oversight and Review Center (BFCC ORC)

THIS IS NOT A REQUEST FOR PROPOSAL (RFP) OR SOLICITATION AND NO SOLICITATION EXISTS AT THIS TIME. Purpose: This Sources Sought Notice is to obtain information regarding the availability and capability of qualified 8(a) small business, veteran-owned small businesses, service-disabled veteran-owned small businesses and/or HUBZone small businesses capable of serving the needs of the Centers for Medicare & Medicaid Services (CMS). CMS is conducting a market survey to determine the availability and technical capability of qualified 8(a) program participants to measure BFCC Quality Improvement Organization (BFCC-QIO) performance. Teaming arrangements are encouraged. This notice is for informational and planning purposes only and shall not be construed as a solicitation or as an obligation or commitment by the Government. This notice is intended strictly for Market Research is NOT a solicitation for proposals, proposal abstracts, or quotations. Your responses to the information requested will assist the Government in determining the appropriate acquisition method, including whether a set-aside is possible. PLEASE NOTE THAT THIS IS NOT A REQUEST FOR PROPOSAL, NO SOLICITATION EXISTS AT THIS TIME. A. BACKGROUND INFORMATION The BFCC-QIO Program is one of the CMS's quality improvement programs that serve to improve the quality of care for Medicare beneficiaries. Section 1862(g) of the Social Security Act (the Act) mandates that the Secretary of Health & Human Services enter into contracts with the QIOs, and other private businesses for the purpose of determining that Medicare services are reasonable and medically necessary, for the purposes of promoting the effective, efficient, and economical delivery of health care services, and for promoting the quality of services of the type for which payment may be made under Medicare. To meet these goals, BFCC-QIOs review health care services funded under Title XVIII of the Act to determine whether those services are reasonable, medically necessary, furnished in the appropriate setting, and meet professionally recognized standards of quality. Additionally, BFCC-QIOs conduct reviews in response to Medicare beneficiaries' or their representative's complaints about their quality of care or when appealing the termination of Medicare covered services or a hospital discharge. B. GENERAL TASKS The BFCC ORC Contractor (referred to as the Contractor) will utilize three methods to measure BFCC-QIO performance - Inter-Rater Reliability (IRR): CMS will utilize a Contractor to implement an inter-rater reliability (IRR) method to monitor BFCC-QIO case review effectiveness and quality and identify areas for improvement. - Monitoring and Evaluation: CMS will utilize a Contractor to monitor and evaluate the BFCC-QIO program impacts and outcomes. - Survey: CMS will utilize a Contractor to perform telephonic and/or electronic survey methodologies to query Medicare beneficiaries/representatives directly served by the BFCC-QIO to measure their effectiveness in meeting the BFCC-QIO's mission. I. Inter-Rater Reliability (IRR) The Contractor will implement an IRR method to assess the degree to which BFCC-QIOs case review determinations are consistent and meet nationally recognized standards of care. The Contractor will identify the elements of a case review, conduct an independent review of a sample of cases, and then compare the independent case review to the BFCC-QIO case review. This IRR approach will provide important information for evaluating the methods used to perform case reviews and identifying opportunities for quality improvement. The core IRR related tasks and services will include but not be limited to the following: 1.1: Select Cases for review. The Contractor will select a statistically valid representative sample of cases to support the types of analyses needed to meet CMS goals and objectives. The sampling strategy must take into account the dynamics of the region being sampled and case review types to ensure adequate representation across these characteristics in the IRR sample. 1.2: Gather Materials, Information, and Data on the Selected Cases. The Contractor will request all information and documentation that was used for each review. The types of materials requested might include: forms used to initiate reviews, records and data documenting the nature and content of reviews, records documenting the elapsed time between review milestones, records documenting review disposition, records documenting communication of review disposition to relevant stakeholders, records documenting the conduct, methods, and content of a review audit. The Contractor must use a collaborative process with CMS and other relevant stakeholders to specify the final elements of a quality review (see "1.4: Identify the elements of a quality case review." below). 1.3: Train the Independent Reviewers. The Contractor will train and provide ongoing support for the independent reviewers ensuring the study's validity. To ensure consistency across independent case reviews, the Contractor will develop detailed review manuals and train reviewers on how to conduct the reviews. The training will include a discussion of BFCC-QIO case reviews and the case review process, a review of the elements of a quality review, and sample reviews. 1.4: Identify the Elements of a Quality Case Review. The Contractor will identify specific characteristics of a quality review to use as benchmarks for the independent case review, such as who requested the case review, how quickly the case was completed, whether and how a disposition was made, how the disposition was communicated, and whether and how the case review was audited. The Contractor must use a collaborative process with CMS and other relevant stakeholders to specify a final list of these elements. 1.5: Conduct an Independent Case Review. The Contractor will conduct a review of the case using the information provided and complete a case review rating based on the key elements of a quality review described above. 1.6: Compare the BFCC-QIO Review and the Independent Review. The Contractor will compare, contrast and analyze the BFCC-QIO and independent reviews element by element to identify discrepancies based on the quality benchmarks. The Contractor will identify missing elements, lack of data availability, and/or poor quality in a BFCC-QIO case review and statistically measure agreement between the BFCC-QIO and independent case reviews. NOTE: CMS is not specifying a mode of implementing an IRR system. However, if the Contractor deems another method is in the government's best interest, the Contractor shall propose an alternative method based on appropriateness, effectiveness, and efficiency. II. BFCC Monitoring and Evaluation The framework adopted by CMS makes a distinction between monitoring and evaluation. Contractor activities for this task will focus on monitoring and evaluating program impacts and outcomes. The purpose and emphasis of each activity is described as follows: Monitoring is a process intended to provide data on BFCC-QIO program implementation and functioning (i.e., program performance). Monitoring, which entails routine tracking of program processes and outputs, does not lend itself to in-depth program analysis. Program monitoring will focus more on outputs (e.g., indicators of beneficiary access and quality of care) than on program processes. Although its analytic value is limited, monitoring offers a more current view of a program than program evaluation. Evaluation is a way to determine whether the BFCC-QIO program is meeting its goals and objectives (i.e., how well a program is working). Evaluation is conducted by analyzing the data collected on the program and using objective measurement and statistical analysis in an effort to attribute cause-and-effect relationships between policies and outcomes, enabling more informed decision-making. Evaluation is retrospective; its purpose is to study and analyze data that reflects a specific timeframe. The core BFCC monitoring and evaluation related tasks and services will include but not be limited to the following: 2.1: Develop and Implement BFCC-QIO Services Monitoring Plan. The Contractor shall monitor indicators of quality of care to identify any changes in the BFCC-QIO program that impacts beneficiaries' experience. In addition to quantitative data analysis, the monitoring activities may include qualitative methods for reviewing beneficiary complaints and other QIO and surveyor information to identify areas needing further investigation. 2.2: Develop and Implement BFCC-QIO Services Evaluation Plan. The Contractor shall conduct post-implementation analysis and form data driven conclusions about program impacts on beneficiaries, providers, and BFCC-QIOs to determine program effectiveness in achieving the desired outcomes. 2.3: Provide Evidence-based Recommendations and Reports that Promote Effect Decision Making. The Contractor shall document and submit lessons learned and/or successful promising practices drawn from BFCC-QIO services monitoring and evaluation activities and findings to CMS and QIO community. By way of example, recommendations include but are not limited to the following types of activities: - Recommend BFCC-QIO program design improvements based on findings - Identify "successful-promising practices" and create a change package that other BFCC-QIOs could use and/or replicate - Conduct business process analysis and recommend improvements to support enhancements to operational procedures or to improve performance-based outcomes III. BFCC-QIO Survey The Medicare beneficiary experience survey measures the beneficiaries' experience with the BFCC-QIO for quality of care and appeals' of termination of services or discharge and provides CMS with a formal method to obtain direct feedback from beneficiaries regarding the effectiveness of the BFCC-QIO program. The Contractor will be responsible for performing all tasks necessary to draw samples, design survey tools, produce surveys, field surveys, retrieve and collect data, analyze results, and produce reports of findings. The core survey related tasks and services will include but not be limited to the following: 3.1: Survey Maintenance. The Contractor will develop (if necessary), update, and maintain survey tool(s). This will include the identification and revision of any survey questions that are not significant. 3.2: Survey Administration. The Contractor shall prepare and distribute data collection communications (e.g., survey tool, survey invitation and reminder messages) that will achieve the goals of being efficient, effective, and minimally burdensome for respondents. 3.3: Data Collection. The Contractor shall collect survey data using a methodology that yield a high response rate (e.g., via computer-assisted telephone interviewing [CATI], internet, and/or mail). In addition, the Contractor shall monitor survey data collections and operations, which will included, but is not limited to the following: response rates, eligibility, and dispositions, problems encountered in data collection, quality control and measures. 3.4: Call Center. The Contractor shall maintain a call center with toll-free telephone numbers to handle and respond to sample members' telephonic or e-mailed questions/concerns about the survey. In addition, the Contractor must have the ability to screen calls, forward them to the appropriate personnel, record, and to log calls. 3.5: Analyze Data. The Contractor shall use analytic and scoring techniques to conduct data analysis and provide survey scores of survey tools. The Contractor will provide methodological and database documentation, including but not limited to documentation about fielding methods, coding, positive, neutral and negative responses, and overall case-level scores. 3.6: Submit Formal Analyses. The Contractor shall provide written formal analyses that effectively describe the background, objectives, methodology, quantitative and qualitative analysis, results, recommendations, and communicates findings. IV. Information Technology 4.1: Develop Web Portal. The Contractor shall develop and maintain an interactive restricted web based reporting tool (or comparable database) to present IRR, Monitoring and Evaluation, survey scores and all report findings at all levels coupled with the analytic respondent data files. The web site shall allow registered CMS users to "drill down" to the region, state, or facility to follow BFCC-QIO performance. C. INSTRUCTIONS FOR RESPONDING Responses shall be submitted in the form of a Capability and address all of the following: 1. BFCC ORC Requirements: Demonstrate capability, experience, and ability to provide all of the requirements in the order outlined above. Ensure that the same information is provided for any other parties included in the response; i.e., teaming arrangements, subcontractors, consultants, etc. 2. IRR Experience: Demonstrate experience in performing IRR audits; use of IRR tools; and IRR procedures. 3. Healthcare Program Monitoring and Evaluation: Demonstrate experience in monitoring and evaluating the impact of healthcare program(s); include methodology and description of process. 4. Surveys and Analyses: Demonstrate experience conducting healthcare surveys and results analyses; include data collection methods, survey management, tools, and methodologies and techniques used for analysis. 5. Partners/Subcontractors: If an interested party submits a response with a partner company or subcontractor, please provide an explanation of how your company as the prime will meet the requirements of FAR 52.219-14 Limitations on Subcontracting, including division of relevant requirements and contract oversight. Please explain any experience working with and managing multiple (2 or more) subcontractors for large/specialized tasks as defined above. 6. Government Contract Experience: Note any previous Government contract experience, including experience managing work on Cost Plus Fixed Fee and Time and Materials contracts. Responses must be submitted no later than May 30, 2014. Capability statements will not be returned and will not be accepted after the due date. D. PERIOD OF PERFORMANCE 12 month base year, plus 4 one year options, upon contract award. E. CONFIDENTIALITY OF INFORMATION In accordance with FAR 52.227-14(b), the Contractor shall guarantee strict confidentiality of the information/data that it is provided by the Government during the performance of the contract. The Government has determined that the information/data that the Contractor will be provided during the performance of the contract is of a sensitive nature and cannot be disclosed in any manner. The Contractor, in whole or in part, can only make disclosure of the information/data, after the Contractor receives prior written approval from the Contracting Officer. Whenever the Contractor is uncertain with regard to the proper handling of information/data under the contract, the Contractor shall obtain a written determination from the Contracting Officer. Interested firms responding to this sources sought notice must adhere to the following: a. Provide a capability statement demonstrating relevant experience, skills, and ability to fulfill the Government's requirements for the above. The capability statement should contain enough sufficient detail for the Government to make an informed decision regarding your capabilities; however, the statement should not exceed 5 pages. b. The capability statement must identify the responder's business type and size. c. The capability statement must provide company name and address, point of contact, phone/fax/email and NAICS Code(s). d. All capability statements must be submitted electronically no later than 12:00 pm eastern standard time on May 30, 2014 to BFCCMailbox@cms.hhs.gov. All capability statements can be submitted via e-mail, facsimile, or regular mail to the point of contact listed below. Responses shall be no more than 5 pages. THIS NOTICE IS NOT A REQUEST FOR PROPOSALS. 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 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 to allow the Government to determine the organization's qualifications to perform the work. Respondents 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. After a review of the responses received, a pre-solicitation synopsis and solicitation may be published in Federal Business Opportunities. However, responses to this notice will not be considered adequate responses to a solicitation. 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). A determination by the Government to proceed with the acquisition as a set-aside is within the discretion of the Government. If capability statements are not received from at least two responsible businesses by the response date or if the Government determines that no small business concerns are capable of performing this requirement based upon an evaluation of the capability statements submitted, the Government may proceed with a full and open competition. NO TELEPHONE REQUESTS WILL BE ACCEPTED.