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Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Integrated Veteran Care (IVC) Request for Information (RFI) Advanced Medical Cost Management Solution (AMCMS) SaaS Tool THIS IS... Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Integrated Veteran Care (IVC) Request for Information (RFI) Advanced Medical Cost Management Solution (AMCMS) SaaS Tool THIS IS A REQUEST FOR INFORMATION (RFI) ONLY (as defined in Federal Acquisition Regulation (FAR) 15.201(e)), and shall not be considered an Invitation for Bids, Request for Quotations, or a Request for Proposal. Do not submit a proposal or quote. This market research is issued for information and planning purposes only and does not constitute a solicitation nor does it restrict the Government as to the ultimate acquisition approach. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Additionally, there is no obligation on the part of the Government to acquire any products or services described in this RFI. You will not be entitled to payment for direct or indirect costs that you incur in responding to this RFI. Any contract that might be awarded based on information received or derived from this market research will be the outcome of a competitive process. Interested parties are responsible for adequately marking proprietary, restricted or competition sensitive information contained in their response. The Government does not intend to pay for the information submitted in response to this RFI. Be advised that set-aside decisions may be made based on the information provided in response to this RFI. Responses should be as complete and informative as possible. The North American Industry Classification System (NAICS) for this requirement is 541519 with a size standard of 150 employees. A company that is a Service-Disabled Veteran-Owned Small Business (SDVOSB) or a Veteran-Owned Small Business (VOSB) must be VetCert registered and verified (https://veterans.certify.sba.gov). The purpose of this RFI is to conduct market research to obtain information pertaining to industry capabilities and commercially available solutions for an AMCMS. VA is seeking input on potential solutions and requesting the capabilities and experience from industry partners interested in contributing to the solution or providing these services for VA. Businesses of all sizes are encouraged to respond. The Government requests that contractors respond to the specific questions provided in this Request for Information. Responses should demonstrate capability, not just confirm the company s belief that the capability exists. The agency does not intend to award a contract as a result of this RFI, but rather gather capabilities and market information pertinent for project and acquisition planning. The responses to this RFI will be captured as market research and may contribute to the development of an acquisition strategy. Information provided may be used to assess tradeoffs and alternatives available for the potential requirement and may lead to the development of a solicitation. All submissions become Government property and will not be returned. The Government reserves the right to use information provided by respondents for any purpose deemed necessary and legally appropriate. The information provided in the RFI is subject to change and is not binding on the Government. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed. PURPOSE This Request for Information (RFI) is for Market Research Only. BACKGROUND The Department of Veterans Affairs (VA) is the largest clinically integrated health system in the Nation, providing access to medical care for approximately nine million enrolled Veterans. To ensure that all patients have adequate access to timely, high-quality, specialized care, VA continues to deploy modernization efforts and clinical care innovations to maximize care efficiency without jeopardizing quality or access. In this mission of enhanced access through modernization, VA has determined there is opportunity to improve the management, forecasting and monitoring of the costs associated with care provided to Veterans by providers in the community. Optimizing these cost management functions would allow VA to more efficiently plan and execute the clinical and financial processes associated with providing Community Care to their Veteran population. To effectively capitalize on this opportunity, VA must continue to address the need for more robust processes to define, document and manage Community Care costs through the utilization of an Advanced Medical Cost Management Solution (AMCMS) Software as a Service (SaaS) tool. The Veteran Health Administration (VHA) Integrated Veteran Care (IVC) leads operational functions to ensure the care provided to Veterans by community providers is scheduled, accessed, and paid for in a timely manner. The passing of the VA Maintaining Systems and Strengthening Integrated Outside Networks (MISSION) Act and the recent passing of the Promise to Address Comprehensive Toxics (PACT) Act of 2022, further solidifies the importance of IVC s role in maintaining responsible Veteran care through efficient allocation of resources. In an effort to better manage, forecast and monitor health care purchased outside of VA Medical Centers (VAMC) through the Community Care and Choice Programs, IVC is embarking on the continued development of an AMCMS SaaS, to leverage commercial healthcare organization best practices. EXISTING APPLICATIONS VA has multiple data sources to include, (but not limited to) Corporate Data Warehouse, Financial Service Center and Electronic Claims Administration and Management System (eCAMS), which will need to continue to be utilized as sources for data gathering/mining. Additional data expectations are outlined in the salient characteristics section of the PD/PWS. DESIRED END STATE System shall have or achieve an Enterprise-wide (VA-wide) Authority to Operate System shall support VA trusted internet connection (TIC) System shall be accessible both within VA facilities and remotely. System shall be a configurable Commercial-off-the-shelf (COTS) SaaS product. System shall enable direct Single-Sign-On (SSO) through integration with VA s SSOe System shall have adaptable integration options to support integrations with future VA systems. System shall allow for integration with current and future COTS software and analytical tools utilized by VA, including but not limited to Tableau, MS Power BI, Service Now System shall have or achieve an Enterprise-wide (VA-wide) Authority to Operate VA Users shall be able to appropriately export information from the system, consistent with VA security and privacy requirements (User Role access or other solutions to restrict access to protect PII) System shall facilitate role-based user access and authorization. System shall be able to provide continuous release capability. System shall be able to offer Application Program Interfaces (APIs) that can be consumed by VA systems, e.g., VA.GOV System shall maintain capacity to have data refreshed on Referral, Claim and Data Validation for Check Sums and Financial Reconciliation weekly. Provide unlimited end user access to AMCMS SaaS solution via a secure website. Incorporate comparison of VA established benchmarks to industry standard benchmarks by type of care by VISN, VAMC and/or CCNR(s). Provide data storage capacity that includes the current fiscal year as well as six (6) prior fiscal years. Currently up to 50 million claims are processed annually. Provide a reporting structure that will allow for development of new metrics to analyze outliers in financial and utilization benchmarks. Provide capabilities required to predict, forecast, and analyze the availability of healthcare services to assess network adequacy. Allow VHA IVC to monitor and analyze the physical coverage of their CCN (Community Care Network) in proximity to Veteran locations and across medical specialties. Provide Community Care Projection Reports that manage, track, and monitor all CCN administrative (admin) fees for the purposes of supporting budget formulation and decision-making processes. INSTRUCTIONS FOR RESPONDING TO THIS RFI 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). Response Format/Page Limitations: The overall total page limit for responses to this RFI is six (6) pages. Responses should be submitted in Microsoft Word format with Times New Roman font, 12 pt. minimum that addresses the above information. Interested parties should limit marketing material to allow sufficient space for adequately, directly, and substantively responding with the information of most interest to the Government. In all correspondence relevant to this RFI please identify it as a response to the VA-24-00035655 AMCMS SaaS Tool (Response and Subject Line of email) Any organization responding to this notice should ensure that its response is complete and sufficiently detailed. Respondents are requested to limit responses to the information, and in the format provided below. A - GENERAL INFORMATION Organization Name and the year in which the company was established / founded (please list any previous names used). Unique Entity ID: Address: Point of Contact: Phone Number: Fax Number: Email Address: Any applicable schedules (General Services Administration (GSA), Mission Oriented Business Integrated Services (MOBIS), Veterans Technology Services (VETS) Government wide Acquisition Contract (GWAC), etc.): Business size status based upon the applicable NAICS code of 541519 Other Computer Related Services. (For more information refer to http://www.sba.gov/): If SDVOSB/VOSB, is your business verified in the VetCert database (https://veterans.certify.sba.gov) Company ownership (public, private, joint venture). B APPROACH, CAPABILITY, AND EXPERIENCE INFORMATION Describe your experience as a contractor (specify prime or sub,) and current capability to execute software/system solutions efforts in large, complex regional (preferably national) health care networks. How have you integrated with or transitioned from legacy solutions? What experience do you have integrating claim payment and medical cost utilization systems with multiple modalities and locations across regional or national healthcare systems? What were the timelines? What were the outcomes?  What are the most important lessons learned from similar efforts? Detail your company s capability and experience supporting healthcare cost management technology that provides modeling of data that includes standard healthcare codes, Medicare reimbursement rates, fee schedules and other required data to accurately manage healthcare cost. Detail your company s capability to determine and manage appropriate accruals for outstanding liabilities of healthcare obligations based on approved referrals for healthcare. Describe how your company, partner or sub-contractor's system could best meet the following requirements: Provide real-time interfacing data repositories, electronic health record systems and VA systems to display financial and utilization data. System displays Key Performance Indicators (KPI s) in canned reports and available through ad hoc needs. System displays and stores raw data from different data sources. System tracks, monitors, updates data on a weekly basis. How does/will your company, partner or sub-contractor s solution meet requirements for VA FedRamp approval at the software and hosting level? Describe how your company, partner or sub-contractor s solution qualifies as a VA Software as a Service (SaaS) and describe its hosting environment. How does your company, partner, or sub-contractor s system gather and display the real-data refreshes and at what capacity? How many end users can access large data sets and reporting tools concurrently? What are the average load times for the number of users identified? How does your company, partner or sub-contractor system ensure uninterrupted access to data and reporting tools during data refreshes? Explain how your company, partner or sub-contractor s process to address data integrity, validation, and reconciliation? Explain how your company, partner or sub-contractors experience working with large commercial or government agencies such as DOD, HHS, DVA, etc. Small businesses should also include information as to: The intent and ability to meet set-aside requirements for performance of this effort, if set-aside, as set forth in Veterans Affairs Acquisition Regulation (VAAR) 852.219-73 (JAN 2023) (DEVIATION) and VAAR 852.219-74 (JAN 2023) (DEVIATION) VA Notice of Total Set-Aside for Certified SDVOSB, and VA Notice of Total Set-Aside for Certified VOSBs , respectively, and 13 CFR §125.6, the contractor will not pay more than 50% of the amount paid by the Government to it to firms that are not SDVOSBs or VOSBs as defined by VAAR 852.219-73 (JAN 2023) (DEVIATION) and VAAR 852.219-74 (JAN 2023) (DEVIATION). Please note that in accordance with 13 CFR §125.6 limitations on subcontracting requirements, demonstrate how you will not pay more than 50% of the amount paid by the Government to firms that are not similarly situated. Offerors shall complete the Capabilities Worksheet, Capabilities Worksheet.xlsx . (Not included in page count.) Please limit responses in the notes section to 250 characters or less per each capability. **************************************************************************** Submission: Responses to this RFI shall be submitted to the following points of contact via email to Erica.Wortman@va.gov and Edward.Hebert@va.gov no later than at 2:00PM ET on Monday, February 12, 2024. Please note VA-24-00035655 AMCMS SaaS Tool in the subject line of your response. Questions: Questions related to this RFI and/or the draft PD shall be submitted on, or before 2:00PM ET on Monday, February 12, 2024. Submit questions, in writing, regarding this RFI to Erica.Wortman@va.gov and Edward.Hebert@va.gov.