DHA Industry Partnership Network (IPN) Request for Information (RFI) - Special Notice TITLE: Value-Based Care Purchasing Initiatives INTRODUCTION: The Department of Defense, Defense Health Agency (DHA) seeks information from knowledgeable sources to conduct pilot projects and/demonstration projects that will inform the next generation TRICARE programs. DHA is seeking information about industry best practices and initiatives to understand how industry implements Value Based Purchasing (VBP) programs that align provider incentives with desired behaviors and quality outcomes. Industry's perspective will help chart the course to implement alternative payment methodologies and incentives to base reimbursements to private sector care providers on quality of care or other measures - not on the volume and quantity of services they provide. The Department's goal is to understand Industry's perspectives, business model and risks associated with Value-Based Purchasing. BACKGROUND: The TRICARE benefit is not insurance, but rather a benefit program established in law and federal regulation. Although the TRICARE program is available worldwide, DHA would focus VBP initiatives in the United States. TRICARE offers TRICARE Prime programs, which are similar to the health maintenance organization model; assignment to a Primary Care Manager (PCM) at a Military Treatment Facility (MTF) is given priority over assignment to a PCM in the TRICARE network. TRICARE also offers TRICARE Select, which includes network and non-network care with no referrals required. TRICARE already has a cost advantage since TRICARE provider reimbursement rates are tied to Medicare rates by law to the maximum extent practicable. DHA uses two regional contractors to administer the TRICARE program in the U.S, one in the East region and one in the West region (see https://tricare.mil/About/Regions). The regional contractors support the DHA and MTF efforts to provide TRICARE eligible beneficiaries access to high quality health care. The regional contractors provide program management, coverage determinations, medical care management, customer services, provider networks, and claims processing. The TRICARE network must be adequate to meet TRICARE Prime access standards. Although, the provider networks were generally limited to the 40-mile area around Military Treatment Facilities (MTFs) before this year, the contractors are expanding the network to ensure that the network covers at least 85 percent of the TRICARE Select enrolled population. he TRICARE Program is available in the United States and requires enrollment by eligible beneficiaries. The TRICARE contractors create and manage the provider networks, process claims and provide administrative functions in support of the program. AUTHORITY : The DHA Component Acquisition Executive J-4 is issuing this Special Notice Request for Information (RFI) for the purpose of Market Research as required by the Federal Acquisition Regulation (FAR) 15.201 and FAR 10.002. This notice does not obligate the Government to award a potential contract or otherwise pay for the information provided in response. Responses to this RFI are not offers and cannot be accepted by the Government to form a binding contract. GENERAL INDUSTRY PARTNERSHIP NETWORK (IPN) PURPOSE : The DHA IPN Program, within the Component Acquisition Executive (CAE) (J-4) Directorate at the DHA, intends to use industry responses and communications from this notice as market research for subsequent acquisition strategies. DHA seeks information on availabilities, capabilities, and other pertinent marketplace data to strengthen the DHA's understanding of the current and future marketplace to enhance its ability to obtain quality services economically and to efficiently and lawfully establish potential vendor source files, listings and requirements. The DHA will not award any contracts under this notice. INFORMATION SOUGHT BY THE DHA : We invite industry, to include commercial health plans, the Veterans Health Administration, the Centers for Medicare and Medicaid (CMS), health care industry / trade organizations, and academia to share perspectives about value based care initiatives and programs. This includes, but is not limited to the CMS Value Based Purchasing Program. The submissions provided should address each of the following questions: Performance Assessment and Overall Effectiveness of Value-Based Purchasing Question 1: What reasoning drove you to implement VBP? What approaches do you use for VBP? What have you found most effective? Least effective? Question 2: What reimbursement methodologies has your organization found useful to improve value and quality of care and why? (e.g., bundled payments, episode of care payments, accountable care organizations, shared savings for acceptance of risk, global payments or capitation, care management fee, or quality incentives.) Value-Based Incentives and Best Practices Question 3: What have you found to be the most effective tools for driving quality outcomes and controlling costs? Question 4: What are your key lessons learned from implementing VBP or other incentives aligned with performance? What are the keys to successful risk sharing? What approaches to sharing risk with the providers have you found to be the most effective? Key Performance Indicators and Data Reporting Question 5: What process, outcome, or experience of care and efficiency KPIs do you measure/evaluate for Value-Based purchasing in your commercial plans? Question 6: What are the keys to data points, data collection and analysis to successfully implement VBP? How do you assure accurate reporting of measures and outcomes? How do you set the target benchmarks for your KPIs? What data sources do you pull from? (e.g., NSQIP, NCQA, etc.) What reporting tools or systems are you currently using? Value, Quality, and TRICARE Question 7: What other opportunities exist in Value-Based Purchasing to improve TRICARE? Question 8: What are industry best practices for measuring clinical quality outcomes? Challenges Question 9: What are some of the challenges you have faced from implementing and sustaining VBP? DISCLAIMER AND IMPORTANT NOTES : THIS NOTICE IS NOT A REQUEST FOR PROPOSALS. This notice constitutes solely a market research effort as described under FAR 10.002. This notice does not obligate the Government to award a potential contract or otherwise pay for the information provided in response. The Government may invite certain respondents to an in-person meeting as a follow-up to this RFI. The Government will not pay for expenses related to this in-person meeting. The Government reserves the right to use results of the communications with industry for any purpose consistent with, and not otherwise prohibited by FAR Part 10. 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, in no case shall responses to this notice be considered either a response to a solicitation or a submission of an unsolicited proposal, as defined by FAR 2.101. CONFIDENTIALITY : No proprietary, classified, confidential, or sensitive information should be included in your response. Industry responses will be shared with DHA staff for the purpose of market research. All materials will be presented in an environment that protects proprietary information. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s). NEXT STEPS : Submittals should be emailed to the Government's IPN team on or before 4:00 pm Eastern Time on 22 October 2018. Responses to this RFI should be no more than 10 pages and should address each of the questions asked by the DHA in the Information Sought portion of this RFI. The Government may not review submissions that fail to address each of the questions in the section title, "Information Sought by the Government." If companies wish to include a general capability statement, it should be attached separately. All responses will be reviewed and assessed by DHA staff. Several potential industry sources may subsequently be invited to present at an in-person meeting with the Government on November 08-09, 2018. If selected, the POC sending the submission will be contacted via email to schedule a 45 min presentation to the DHA Value-Based Purchasing Council during the DHA Industry Forum (November 08-09, 2018) at La Cantera, San Antonio Texas. In your response, please indicate the priority for a one-on-one meeting time: •a) 8 Nov morning •b) 8 Nov afternoon •c) 9 Nov morning •d) 9 Nov afternoon Selected presenters will be required to submit final presentation materials by 4:00 pm Eastern Time on November 02, 2018. Each of the responses will be maintained by the DHA as a source of market research information and published on an internal SharePoint site. We greatly appreciate your time and look forward to learning from the submission. PRIMARY POINTS OF CONTACT : Submit RFI response and/or questions to DHA IPN Team email:
[email protected]