SOURCES SOUGHT
R -- Episode Grouper for Medicine
- Notice Date
- 3/31/2010
- Notice Type
- Sources Sought
- NAICS
- 541511
— Custom Computer Programming Services
- Contracting Office
- Department of Health and Human Services, Centers for Medicare & Medicaid Services, Office of Acquisition and Grants Management, 7500 Security Blvd., C2-21-15, Baltimore, Maryland, 21244-1850
- ZIP Code
- 21244-1850
- Solicitation Number
- HHS-CMS-DRCG-SS-10-001
- Archive Date
- 4/10/2010
- Point of Contact
- Evelyn R Dixon, Phone: 410-786-1561
- E-Mail Address
-
evelyn.dixon@cms.hhs.gov
(evelyn.dixon@cms.hhs.gov)
- Small Business Set-Aside
- N/A
- Description
- This is a Small Business Sources Sought notice. This is NOT a solicitation for proposals, proposal abstracts, or quotations. The purpose of this notice is to obtain information regarding: (1) the availability and capability of qualified small business sources; (2) whether they are small business; 8(a), HUBZones small businesses; service-disabled, veteran-owned small businesses; woman-owned small businesses; or small disadvantaged businesses; and (3) their size classification relative to the North American Industry Classification System (NAICS) code for the proposed acquisition. Your responses to the information requested will assist the Government in determining the appropriate acquisition method, including whether a set-aside is possible. An organization that is not considered a small business under the applicable NAICS code should not submit a response to this notice. THIS IS STRICTLY MARKET RESEARCH. THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) WILL NOT ENTERTAIN QUESTIONS REGARDING THIS MARKET RESEARCH. BACKGROUND Episode groupers are software programs that organize claims data into a set of clinically coherent episodes, usually linked by diagnoses. When the CMS episode grouper software evaluation began in 2006, the Agency had no experience with any of the episode grouper products and published research was very limited. Acumen studies (2007 and 2008) have found issues in grouping Medicare claims with existing episode grouping software. CMS is considering two approaches to obtaining a grouper for possible use in the Medicare program. Modifications to existing software could be explored in one approach (Approach A). Alternatively, new methods could be used to define a new episode grouper (Approach B). PURPOSE OF ACTION The purpose of this effort is to modify existing episode grouping software or design new software to meet Medicare needs. Anticipated Period of Performance: It is anticipated that the periods of performance will be as follows: APPROACH A The period of performance for the base period is 15 months from the date of award. The period of performance for the options is 24 months (two 1-year options) if exercised. APPROACH B The period of performance for the base period is 15 months from the date of award. The period of performance for the options is 48 months (four 1-year options) if exercised. RESPONSE REQUESTED: CMS seeks responses from small businesses who may be available and capable of performing the work for the specified period of performance. PROJECT REQUIREMENTS I. Any potential offeror must demonstrate the following: APPROACH A - MODIFYING EXISTING GROUPING SOFTWARE • Demonstrated substantive knowledge of relevant Medicare program policy areas and populations. • Demonstrated ability to interact with stakeholders and obtain relevant information. • Demonstrated professional skills in designing and developing an episode grouper: relevant experience, a professional staff, and an established record in designing and developing an episode grouper. • Demonstrated professional skills in programming and supporting comprehensive episode grouper software, and/or comprehensive healthcare / medical grouping software that is used by health care entities, insurers, or managed care firms. Comprehensive refers to having nearly all medical conditions encountered in the Medicare populations covered by the grouping software. • Demonstrated availability of current episode grouping software: An existing condition specific, comprehensive episode grouping software program that is presently marketed and supported must be available for evaluation. The programming code and language must be sufficiently efficient to process a large number of Medicare claims. (Medicare processes an estimated 3 billion claims annually.) • Demonstrated knowledge of Medicare claims and benefit policies: Since Medicare claims are the basis for establishing episode groups, demonstrated expertise with all claims types (Inpatient hospital, Part B, DME, etc.), claims fields (payment, diagnoses codes, etc.), and claim repositories (CWF, SAF, etc.) is required. • Demonstrated knowledge of diagnosis grouping of healthcare claims: Since clinical logic for each medical condition underlies episode construction, demonstrated expertise in designing and developing clinical logic structures is necessary. • Demonstrated expertise with methods for risk-adjusting healthcare expenditures: Development of risk adjustment methods suitable for Medicare populations is needed to construct and apportion cost to episodes. • Demonstrated expertise in methods of focus groups: Leading focus groups, developing consensus with physicians and other interested parties, and synthesizing focus group findings, recruiting members, etc. is needed to vet the episode construction logic and other grouping issues. • Demonstrated corporate experience under projects for the same or similar services in terms of the currency and relevance of the information. • Identify key personnel to be utilized; to include educational background, professional experience, and special qualifications directly related to the effort. • Describe experience in organizing and managing large projects, how tasks are sequenced, in what time frames, and what management control and coordination tools will be used to assure timely and successful conduct of the project. APPROACH B - DEVELOPING NEW GROUPING SOFTWARE • Demonstrated substantive knowledge of relevant Medicare program policy areas and populations. • Demonstrated ability to interact with stakeholders and obtain relevant information. • Demonstrated professional skills in designing and developing an episode grouper: relevant experience, a professional staff, and an established record in designing and developing an episode grouper. • Demonstrated professional skills in programming an episode grouper: relevant experience, a professional staff, and an established record in programming grouper software, and/or healthcare / medical grouping software that can be used by health care entities, insurers, or managed care firms to profile physicians. • Demonstrated knowledge of Medicare claims and benefit policies: Since Medicare claims are the basis for establishing episode groups, demonstrated expertise with all claims types (Inpatient hospital, Part B, DME, etc.), claims fields (payment, diagnoses codes, etc.), and claim repositories (CWF, SAF, etc.) is required. • Demonstrated knowledge of diagnosis grouping of healthcare claims: Since clinical logic for each medical condition underlies episode construction, demonstrated expertise in designing and developing clinical logic structures is necessary. • Demonstrated expertise with methods for risk-adjusting healthcare expenditures: Development of risk adjustment methods suitable for Medicare populations is needed to construct and to apportion cost to episodes. • Demonstrated expertise in methods of focus groups: Leading focus groups, developing consensus with physicians and other interested parties, and synthesizing focus group findings, recruiting members, etc. is needed to vet the clinical logic and episode construction. • Demonstrated corporate experience under projects for the same or similar services in terms of the currency and relevance of the information. • Identify key personnel to be utilized; to include educational background, professional experience, and special qualifications directly related to the effort. • Describe experience in organizing and managing large projects, how tasks are sequenced, in what time frames, and what management control and coordination tools will be used to assure timely and successful conduct of the project. II. CMS also request the following additional information: 1. Business Information -- a. DUNS b. Company Name c. Company Address d. Current GSA Schedules appropriate to this Sources Sought e. Do you have a Government approved accounting system? If so, please identify the agency that approved the system. f. Type of company (e.g., small business, 8(a), woman owned, veteran, etc.) as validated via the Central Contractor Registration (CCR). All offerors must register on the CCR located at http://www.ccr.gov/index.asp g. Company Point of Contact, Phone and Email address Teaming Arrangements: All teaming arrangements should also include the above-cited information and certifications for each entity on the proposed team. 2. Potential offerors are hereby advised that their accounting system must be adequate for determining costs applicable to the contract. 3. FAR Clause 52.219-14 Limitations of Subcontracting will be incorporated into the solicitation and resultant contract. Prime contractor must perform at least 50% of the effort. Information Submission Instructions: 1. E-mail responses addressing the above specific requests to the following address: evelyn.dixon@cms.hhs.gov. Note whether your responses are addressed to Approach A, B, or both. All responses are due by 12:00 PM local time Baltimore, MD April 9, 2010. Please be advised that email transmitted files over 5 megabytes are not delivered during standard working hours, are only released from the CMS server after 5:00 PM EST, and may affect the timeliness of your response. In this regard please limit your electronic document to the following Page Size, Font Type and Size, Spacing and Page Numbering - Preference for Microsoft Word (or PDF) document with page size 8.5 by 11 inches. Font shall be Times New Roman Size 12 with no less than single spacing between lines. The maximum number of pages for submission is 10 pages. Resumes of key people are limited to 2 pages and may be submitted as an attachment, which will not count towards the page limit. Disclaimer and Important Notes This notice does not obligate the Government to award a contract or otherwise pay for the information provided in response. The Government reserves the right to use information provided by respondents for any purpose deemed necessary and legally appropriate. 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, responses to this notice will not be considered adequate responses to a solicitation. 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). On behalf of the Centers for Medicare & Medicaid Services, we thank you for your interest.
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