Managed Care Support Services

Solicitation: T2017 Agency/Office: Defense Health Agency Location: Contract Operations Division - Aurora (Colorado) Title: TRICARE PROGRAM - MANAGED CARE SUPPORT CONTRACT Request for Information (RFI) DESCRIPTION: DEFENSE HEALTH AGENCY (DHA) is contemplating the future generation of managed care contracts which includes cost reimbursable line items, fixed price line items, and requirements line items for the TRICARE Program of the Military Health System (MHS) in the United States to support active duty service members (ADSMs); active duty family members (ADFMs); retired service members and their eligible family members; survivors; Medal of Honor recipients; qualified former spouses; National Guard and Reserve members and their family members (including qualified non-active duty members of the Selected Reserve of the Ready Reserve, Retired Reserve, and certain members of the Individual Ready Reserve). TRICARE supplements the care provided in Department of Defense (DoD) Medical Treatment Facilities (MTFs), as well as provides care to those eligible beneficiaries living in regions without access to MTFs. The period of performance is anticipated to be a transition-in phase of 14 months, plus five one-year options, and phase-out (if exercised). This Request for Information (RFI) solicits industry's feedback on capabilities currently available to meet the later described MHS requirement. The intent of this RFI is to accomplish the following: To gather information from potential offerors to be utilized by the DHA TRICARE Program as support in our continuous market research for upcoming contract requirements. The information will not be utilized for any purpose other than for market research in determining the proper acquisition strategy, type of contract, and to achieve its overall objectives under the TRICARE Program. PROGRAM BACKGROUND: DISCUSSION: TRICARE is comprised of three health care options: Prime, Standard, and Extra. TRICARE Prime is similar to a Health Maintenance Organization (HMO) with a Point of Service Option and requires beneficiary enrollment. All ADSMs are TRICARE Prime enrollees, although they are required to receive all of their care either in the MTF or under special rules that apply to Active Duty health care, further explained in the TRICARE Operations Manual, Chapter 17. ADFMs may elect to enroll and are not required to pay an annual enrollment fee; other eligible beneficiaries pay an annual enrollment fee to enroll in TRICARE Prime. TRICARE Extra, which requires no enrollment, is an option in which the beneficiary may choose to use a provider in a TRICARE contractor-developed network, at a reduced cost-share for a particular instance of care, but is not restricted to use of the provider network. TRICARE Standard is a fee-for-service option, essentially the program formerly called the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), in which the beneficiary is free to use any authorized provider. The three options of TRICARE are described fully in 32 Code of Federal Regulations (CFR) Parts 199.17 and 199.18. The MHS is organized into three TRICARE Regions within the United States and coverage extends overseas. CONTRACT PURPOSE: DHA is contemplating the award of a contract utilizing a full and open competition acquisition approach to provide support to MTFs in providing health care services in the United States to ADSMs; ADFMs; retired service members and their eligible family members; survivors; Medal of Honor recipients; qualified former spouses; National Guard and Reserve members and their family members (including qualified non-active duty members of the Selected Reserve of the Ready Reserve, Retired Reserve, and certain members of the Individual Ready Reserve). The Uniformed Services include the U.S. Army, the U.S. Navy, the U.S. Air Force, the U.S. Marine Corps, the U.S. Coast Guard, the Commissioned Corps of the National Oceanic and Atmospheric Administration (NOAA), and the Commissioned Corps of the Public Health Service (PHS). The anticipated future contract will supplement DoD MTFs by providing medical care provider networks and support services in required Prime Service Areas (PSAs) in the following location: the 50 United States and the District of Columbia. CONTRACT OBJECTIVES: The following performance-based objectives are to be accomplished in an anticipated future contract: - Objective 1 - In partnership with the MHS, optimize the delivery of health care services in the direct care system (see the definition of Military Treatment Facility Optimization in the TRICARE Operations Manual, Appendix B) for all MHS beneficiaries (active duty personnel, MTF enrollees, civilian network enrollees, and non-enrollees). - Objective 2 - Beneficiary satisfaction at the highest level possible throughout the period of performance, through the delivery of world-class health care as well as customer-friendly program services. Beneficiaries must be completely satisfied with each and every service provided by the Contractor during each and every contact. - Objective 3 - Attain "best value health care" (See TRICARE Operations Manual, Appendix B) services in support of the MHS mission utilizing commercial practices when practical. - Objective 4 - Fully operational services and systems at the start of health care delivery and minimal disruption to beneficiaries and MTFs. - Objective 5 - Full and real-time access to Contractor maintained data to support DoD financial planning, health system planning, medical resource management, clinical management, disease management, and contract administration activities. MAJOR TASKS AND SERVICES: The following tasks and services are anticipated to be the major parts of the contract's scope: - General medical care provider networks in the 50 United States and the District of Columbia - Claims processing and provider reimbursement (cashless/claimless for the ADSM and ADSM beneficiaries) - Customer service - Program enrollment and processing related fees/premiums - Beneficiary and provider education - Medical management and case management for beneficiaries - Referral management for care which beneficiaries receive for specialty care REQUEST FOR INFORMATION: The following questions and request for information are provided for consideration during this "market research" phase of the acquisition. Please review and provide your responses to the Government for possible consideration/alternatives for satisfying mission needs of the TRICARE Program. Question #1: In its next generation of Managed Care Support Services for the TRICARE Program the Government is seeking ways to achieve greater operational efficiencies and cost savings while improving healthcare services for program beneficiaries. To this purpose the Government is seeking industry input regarding the consideration of consolidating the current support provided by three regional MCSCs into a single national MCSC contract to be awarded for the TRICARE Program. a.What economies of scale and other cost savings could the Government expect to achieve by consolidating the TRICARE Program's managed care support activities under one national contract? b.What are reasons that the TRICARE Program's managed care support activities should not be consolidated under one national contract? c.What are any additional costs which the Government may incur (that are not incurred under the present managed care support services contracts) as a result of the consolidation of the TRICARE Program's managed care support activities under one national contract? Question #2: Considering solicitation characteristics such as contract type, options, multiple versus single award, performance incentives, what specific solicitation characteristics would encourage your organization to submit an offer in response to a solicitation for the managed care support services of the TRICARE Program under one national contract? Question #3: What solicitation characteristics would discourage or prevent your organization from submitting an offer for the managed care support services of the TRICARE Program under one national contract? Question #4: What would be the level of interest by commercial health plans in submitting an offer for a future subsequent MCSC contract once an initial single, national TRICARE Program contract for managed care support services was awarded? RESPONSES REQUIRED: Responses to this RFI should be no more than a total of 15pages (including cover page). Responses should be submitted to Laura.Sells@dha.mil no later than December 13,2013, 1500 MST. Please include reference data for a designated point of contact (name, title, address, phone/fax, email). Government Primary Point of Contact: Laura Sells Contracting Office Address: Defense Health Agency Contract Operations Division-Aurora Branch 16401 East CentreTech Parkway Aurora, Colorado 80011-9066 United States Place of Contract Performance: United States Classification Code: Q - Medical Services NAICS Code: Insurance Carriers and Related Activities/524114 - Direct Health and Medical Insurance Carriers