Q701--VA Community Care Network Request for Information Integrated Veteran Care Utilization Management

2 Community Care Network Request for Information Department of Veterans Affairs Integrated Veteran Care Veterans Health Administration Date: June 12, 2024 FAR Part 52.215-3 (a) The Government does not intend to award a contract on the basis of this solicitation or to otherwise pay for the information solicited except as an allowable cost under other contracts as provided in subsection 31.205-18, Bid and proposal costs, of the Federal Acquisition Regulation. (b) Although "proposal" and "offeror" are used in this Request for Information, your response will be treated as information only. It shall not be used as a proposal. (c) This solicitation is issued for the purpose of information and planning. THIS IS NOT A SOLICITATION. The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) is issuing this Request for Information (RFI) as Market Research used for the potential procurement of services for Utilization Management (UM). This RFI is issued solely for information and planning purposes. There is no obligation for the Government to acquire any products or services described in this RFI. In accordance with the Federal Acquisition Regulations (FAR) Subpart 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. No funds have been authorized, appropriated, or received for this effort. The information provided may be used by VA in developing its acquisition strategy. Interested parties are responsible for adequately marking proprietary, confidential, restricted, or competition sensitive information contained in their response. Only electronic responses to this RFI will be accepted. The Government will not pay for any time expended or information submitted in response to this RFI. Eligibility in participating in a future acquisition does not depend upon a response to this RFI. Request For Information (RFI) for Department of Veterans Affairs, Office of Integrated Veteran Care (IVC) Background Information VA is researching utilization management (UM) (e.g., Prospective, Concurrent and Retrospective) and other medical management activities to support Veterans receiving care in the community. In all models VA is exploring, there are specific VA requirements including, but not limited to: VA providing the parameters for the medical policies applied to UM, VA providing the authorization for care, and VA determining the medical necessity for any care requested. These and other VA functions cannot be delegated to non-VA entities. Given these parameters, VA is interested in receiving industry feedback on the use of UM with the Community Care Network contracts. Information Sought The VA is seeking the following information to be provided by the vendors when responding to the RFI: Vendor Information Vendor Responses to Questions Vendor Information Vendors shall provide the following information: Vendor Name Vendor Address DUNS Number Vendor Website Vendor Point of Contact name, telephone number, and email address Unique Entity Identifier (EUID), number under which the vendor is registered in SAM.gov and/or VetBiz.gov. Vendor Socioeconomic Status; Business Size and Status [e.g., Large Business, Service-Disabled Veteran-Owned Small Business (SDVOSB), Veteran-Owned Small Business (VOSB), Small Business (SB), etc.] GSA or similar Governmentwide contract vehicle to include contract number, schedule, and SIN category(s), if applicable. The number of years in business operating under NAICS 524114, if applicable. Vendor Responses to Questions The vendor shall provide answers to each question in the List of Questions below. The vendor s response shall address the vendor s approach to satisfy the objectives, constraints, and requirements described in this notice and shall consider all additional information contained in this RFI. Submission Instructions Please submit responses via email only to VA SAC Contracting Officer, Mr. Gary Basile, at gary.basile@va.gov. Submissions are due no later than June 28, 2024, at 4:00 p.m. EST. The email subject line must contain the following: Response to RFI 36C10G24Q0131, Community Care Network Utilization Management. VA reserves the right to not reply to any emails, responses, questions, and materials submitted in response to the RFI. Mark your response as Proprietary Information if the information included is considered to be business sensitive and/or includes trade secrets. Interested vendors are directed to respond to this RFI with documents in PDF format and RFI responses shall not exceed 20 pages total (exclusive of the title/cover page, and table of contents). VA may not review any other data or attachments that are in excess of the 20-page limit. All documents must measure 8.5 x 11-inches (charts may be landscaped but must be 8.5 x 11-inches) and shall be in Times New Roman, font size (12), with 1 margins. All pages of the response shall be appropriately numbered, and identified with the RFI number (i.e., 36C10G24Q0131). Any documents not in conformance with these requirements may not be reviewed. List of Questions for Vendor Response As it relates to the above requirements, please provide a response to the following UM questions: What should VA consider when evaluating the inclusion of UM in the Community Care Network (CCN)? Please provide feedback on the following: Contracting approach (e.g., embedded in the CCN Next Gen solicitation or a standalone solicitation) Integrating UM people, process, tools/technology with the CCN referral management and claims payment processes Interoperability of UM tools/data/technology with VA and any other third-party administrator (e.g., inclusion of VA UM guidelines, Clinical Determinations Indications, shared decision-making, claims processing traceability) Bi-directional communication during the referral lifecycle and UM determination process (e.g., additional service requests from community providers, right of first refusal for care at VA, medical documentation, publishing necessary guidelines for community providers, etc.) What is your ability and experience in applying pre-defined UM business rules and policies to your UM ecosystem? Please provide feedback on the following: Have you adopted Utilization Review Accreditation Commission (URAC) or National Committee for Quality Assurance (NCQA) UM standards? How well have you worked with other organizations to ensure a seamless patient and provider experience during the UM process and meeting Utilization Review (UR) timeliness metrics? What is your experience / capability to configure your UM platforms to support a tailored model for both inpatient and outpatient encounters? Are these applications/platforms web-based or cloud-based/FedRAMP certified? Are these applications/platforms able to leverage EDI transactions? What information, tools, resources, or support are most needed to address barriers and challenges to UM, Utilization Reviews and UM determinations between multiple parties? To ensure VA is delivering quality and cost-effective care, what other managed care strategies would your organization recommend VA consider implementing? What current UM tools or dashboards are considered industry standard in the provider networks you coordinate with? Can UM determinations be communicated/displayed to VA providers while the Veteran is seeking care in the community? What other recommendations do you have for VA to effectively manage the following: Care coordination for Veterans between VA Medical Centers and community visits such as emergency department, inpatient admissions, and complex care appointments Coordination of Benefits (COB) when Veterans have other health insurance. UM of specialized diagnostic or pharmaceuticals What recommendations do you have for incentivizing high performance and quality in the UM program provided by your organization? A Community Care consult in VA starts with an Authorization that then requires end-to-end management and offers opportunity at several inflection points for application of Medical Management including UM, Care Coordination and Case management. What tools does your organization offer for VA to achieve bidirectional communication, ability to link to VA electronic health records, and provide UM over the entire life cycle of that CC consult end to end? Please provide feedback and/or recommendations related to the NAICS codes identified below for consideration: 621999 Medical care and/or case management services 541611 Medical Office Management Consulting Services or Consultants 524114 Direct Health and Medical Insurance Carriers 524298 Medical cost evaluation services Please provide feedback and/or recommendations related to the PSC codes identified below for consideration: Q701 Specialized Medical Support R799: Management Support Services/Management Advisory Services Q999: Medical Other/Other Medical Healthcare Services R499: Support Professional/Other Management Advisory Services