SOURCES SOUGHT
Q -- Utilization Review Criteria (URC)
- Notice Date
- 1/30/2009
- Notice Type
- Sources Sought
- NAICS
- 813920
— Professional Organizations
- Contracting Office
- Department of Veterans Affairs, VA Center for Acquisition Innovation (Washington), VA CAI Washington, Department of Veterans Affairs;VA Central Office;Cntr. for Acquisition Innovation (049A3);810 Vermont Avenue, NW;Washington DC 20420
- ZIP Code
- 20420
- Solicitation Number
- VA-101-09-RI-0064
- Archive Date
- 3/31/2009
- Point of Contact
- Priscilla LeeCS<br />
- Small Business Set-Aside
- N/A
- Description
- THIS IS A REQUEST FOR INFORMATION (RFI) ANNOUNCEMENT ONLY FOR PURPOSES OF CONDUCTING MARKET RESEARCH. THERE IS NO SOLICITATION AVAILABLE AT THIS TIME. REQUEST FOR A SOLICITATION WILL NOT RECEIVE A RESPONSE. Background: The Veterans Health Administration (VHA) is responsible for establishing and maintaining a national standardized Utilization Management (UM) program (VHA Directive 2005-040) for its 21 healthcare networks (VISNs), 153 hospitals, 752 community and facility based outpatient clinics, and 135 nursing homes. UM includes Utilization Review (UR activities) such as admission and continued stay reviews. This program is to provide consistent UM policy and national appropriateness data that will be analyzed, reported, and used for ongoing quality improvement initiatives. UM represents the overall program used to increase efficiency of resource use and appropriateness with which services are provided. Through the UM program, the VHA seeks to prevent both under and over utilization of services and resources. The current UM program targets inpatient utilization; however, it is anticipated that the UM program will extend to include other levels of care and care delivery sites. VHA is moving from a decentralized, predominantly inpatient UM program to a national standardized inpatient/outpatient program. Presently, only a portion of acute care and behavioral health admissions and continued stays are reviewed. VHA's goal is to complete reviews on 100% of admissions and continued stay reviews for these patients and further expand the review process to include the outpatient setting. Lastly, UM reviewers are currently completing and documenting reviews manually or using locally developed software. In 2009, we will transition to a web-based application which will be used in all VHA facilities to access utilization criteria, document review outcomes, and report utilization statistics locally. Requirements: VHA currently contracts with an external organization to license UR criteria and to obtain education and training programs for VHA reviewers. In order to prepare a comprehensive Request for Proposal for a new contract beginning January 1, 2010, the VHA is issuing this Request for Information. The goal of this Request for Information process is to solicit Capability Statements that VHA will use to identify potential contractors and to refine the contract criteria that will be described in the Request for Proposal. VHA requires a potential Contractor that can provide, at a minimum, the services/capabilities listed below. Additional services and capabilities that the Contractor believes would be relevant and beneficial to include in the VHA program should be described in the Capability Statement. Minimum contract requirements are: 1. The contractor must be capable of providing a system to assess appropriateness of clinical services in a complex nationwide healthcare system of 153 medical centers. The system will include licensing agreements for evidence-based utilization review (UR) criteria sets that are updated regularly to reflect current standards of care. The sets are to be used in assessing medical necessity and appropriateness of clinical services. The UR criteria must address the full continuum of clinical services, spanning across inpatient, outpatient and specialty services (e.g., surgery, imaging, behavioral health, etc.) The contractor must have the resources and expertise to provide education and training to ensure that utilization reviewers understand the criteria and how it is applied. The ability to customize these services and materials for the needs of the VHA is a critical component of the education and training capabilities. 2. Four major elements intertwine to provide a reliable, valid, and nationally accepted VHA Utilization Review program: (1) electronic tools and written manuals (corporate license agreement); (2) the ability to integrate the contractor's utilization criteria application into the current software application, the National Utilization Management Integration (NUMI) system and to provide technical support to VHA IT programming staff and UM reviewers; (3) reporting capability to enable VHA to track contractor services received, problems as they occur, and customer support services provided (4) utilization review criteria (must be available in both print and automated format), initial and on-going education, computer based training and consultation for end-users that is compatible with VA Learning Management System (LMS) software, a customized Inter Rater reliability tool, technical support for the online criteria application, and customer support to provide guidance in the clinical application of the utilization criteria. 3. The contractor will demonstrate expertise and experience with evidence-based medicine and current literature, utilization management principles, quality management concepts, and other healthcare management and efficiency strategies. Note: Underlying all of the contract requirements is a very strong expectation of data security and maintenance of patient confidentiality that meets or exceeds VA requirements. Interested vendors may submit their capabilities and qualifications to provide the identified services via email to Priscilla Lee at Priscilla.Lee@va.gov no later than 4:00 PM EST, February 13, 2009. Vendors are asked to provide three relevant past performance references for the capabilities identified. Include the Project title, Description of the project, Contract number, Contract amount, Government Agency/Organization and Point of Contact name, phone number, and email address. If the interested vendor holds a current GSA contract, please identify Schedule and Contract number. Telephone inquiries will NOT be accepted. In addition to the provision of Capabilities Statements, an Industry Day(s) will be held to provide interested vendors a forum to expand on their capabilities in a direct conversation with Government officials. All vendors interested in participating in Industry Day shall contact Priscilla Lee starting on February 17, 2009 to schedule an appointment. Industry Day(s) will be held starting February 23, 2009. It is anticipated that each appointment will be 45 minutes to an hour in length and will be held at a VA facility in the Washington DC Metropolitan Area. All correspondence shall be sent via email to both addresses identified and shall reference the RFI number (VA-101-09-RI-0064) and title in the subject line.
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