Presolicitation Notice – R– Actuarial Support Services
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Notice Type: Presolicitation Notice
Classification Code: R - Professional, administrative, and management support services
Solicitation Number: VA798S13I0043
Contact: Clifford SnipeContract Specialist (540) 479-8450 x248 mailto:[email protected] [Contract Specialist]
VA Strategic Acquisition Center
VA Strategic Acquisition Center
This notice is for planning purposes and a solicitation is not available at this time. This request for capability information does not constitute a request for proposals, quotes, or bids. Submission of any information in response to this market survey is voluntary and the Government assumes no financial responsibility for any cost incurred. This announcement is to gain knowledge of potential qualified sources relative to NACIS 541611. Responses will be used by the Government to make appropriate acquisition decisions.
Federal Supply Schedule holders, Service-Disabled Veteran Owned Small Business, Veteran Owned Small Business, HUB-Zone Small Business, Small Disadvantaged Business, and Women-Owned Small Business, are encouraged to respond.
If your organization has the potential capacity to perform/supply this service, please provide the following information: 1) Organization name, address, email address, Web site address, telephone number, size and type of ownership for the organization, small business status; and 2) Tailored capability statements addressing the particulars of this effort, with appropriate documentation supporting claims of organizational and staff capability. Please limit your response package to no more than 15 pages. If significant subcontracting or teaming is anticipated in order to deliver technical capability, organizations should address the administrative and management structure of such arrangements.
The government will evaluate market information to ascertain potential market capacity to 1) provide the commodity/service consistent in scope and scale with those described in this notice and otherwise anticipated; 2) secure and apply the full range of corporate financial, human capital, and technical resources required to successfully perform similar requirements; 3) implement a successful project management plan that includes: compliance with delivery schedules; and meeting the rigid listed specifications.
Background - In
The development of the EHCPM requires an extensive collaborative effort between VA and its actuarial consultant. The actuarial consultant provides actuarial and analytical expertise and access to leading experts on health care trends, management efficiencies, and the broader health care environment. ADUSH/PP leads EHCPM development and enhancements, collaborates with VA program offices and outside organizations to support the EHCPM, and communicates with stakeholders on the EHCPM methodology and projections. VA program offices, field staff, and research staff provide expertise on the Veteran enrollee population, VA programs and initiatives, and the VA health care system.
The EHCPM is an actuarial model for projecting Veteran enrollment and demand for VA health care for 20 years into the future. The projections and supporting analyses are central in the development of the VA medical care budget, strategic, capital, and workforce planning, and policy analysis. VA is dependent on the EHCPM projections to support the development of approximately 92 percent of the VA medical care budget. The ADUSH/PP and its actuarial consultants use the EHCPM to provide insight on Veteran demand for VA health care to VA, the
For each of the 20 projection years, the EHCPM projects the number of Veterans expected to be enrolled in a geographic area, their total health care needs, and the portion of that care they are expected to receive in VA versus from other health care providers. The expenditure projections that support the VA health care budget request are based on the anticipated costs associated with the projected utilization of services (not projected numbers of patients). A key function of the EHCPM is the ability to modify the underlying assumptions in order to produce projections results for multiple scenarios assuming any of the underlying assumptions change over the 20-year projection period.
The EHCPM currently projects utilization for 81 health care service categories, including long-term care services. Generally, the services VA provides that are comparable to services provided in the private sector are modeled using private sector-based utilization benchmarks. Services that are unique to VA (e.g., blind rehabilitation) or services where VA's practice pattern differs significantly from the private sector (e.g., prosthetics) are modeled using VA experienced-based utilization benchmarks.
The EHCPM accounts for the impact of the following attributes when projecting Veteran enrollment and use of VA health care services:
" Enrollee age, gender, morbidity, and geographic migration patterns
" Enrollee reliance on VA health care versus other health care providers
" Enrollee income, local unemployment rates, and travel distance to VA facilities
" Enrollee transition between enrollment priorities, e.g., movement into service connected priorities and transitions due to changes in income
" Unique utilization patterns of various population cohorts, such as females, new enrollees, specific age cohorts, and veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND).
" New policies, regulations, and legislation and changes in the broader environment, such as the implementation of the
" VA health care initiatives, such as the mental health capacity improvement initiative
" A continually evolving VA health care system, e.g., quality and efficiency initiatives
" Future changes in health care practice and technology.
The EHCPM has evolved into a very complex health actuarial model to account for all of the known drivers of Veteran demand for VA health care. Projections are developed at a very detailed level-by 13 enrollment priorities (1a, 1b, 2, 3, 4, 5, 6, 7a, c, 8a, b, c, d), two genders, and 14 five-year age bands. Geographically, projections are developed for sectors, which consist of one or more counties. In addition, projections are developed separately for enrollees who used VA prior to Eligibility Reform, for OEF/OIF/OND veterans, and for female Veterans.
The EHCPM is developed using VA actual enrollment, utilization, unit cost, and expenditure data, private sector health care utilization data, nationally recognized actuarial data sets, VA/
The VA health care system and the broader environment are continually changing, and the enrollment, utilization, and expenditure projections must reflect the impact of these changes. This requires that the ADUSH/PP and its actuarial consultants work closely with VA program offices, field staff, and researchers to incorporate their vision for the future delivery of health care services (Patient Aligned Care Team or PACT), the impact of health care initiatives (mental health), the impact of changes in VA's infrastructure, and assess and incorporate the impact of proposed policies (cost sharing), legislation, and regulations (Affordable Care Act), and external events (economic recession) on the VA health care system.
A key challenge in modeling for the Veteran enrollee population is that enrollees have many other options for health care coverage (private insurance,
Description of Work - To support efforts to understand and project Veteran demand for VA health care, VA requires a health care actuarial consulting firm as prime vendor to provide actuarial consulting, modeling, and analytical services. This will be a five-year contract with a base year plus four option periods.
VA requires a wide range of health care actuarial expertise and experience in areas such as morbidity-risk scoring, population and health status assessments, dual or triple eligible populations, U.S. health care trends, health policy analysis, and actuarial modeling capabilities dynamic enough to project utilization for strategic planning at the medical facility-level and at a more global level for budget formulation. Historically, VA has required a significant volume of consulting hours to meet the needs of stakeholders; however, the volume of hours required is not consistent throughout the year.
A high-level description of the requirements follows. These tasks will require extensive collaboration with VA and its stakeholders. This collaboration will be lead by the ADUSH/PP staff.
" Actuarial consulting, modeling, and analytical services to assess the impact of an evolving VA health care system and broader environment on Veteran demand for VA health care.
Tasks are generally defined and accomplished with internal or external workgroups led by ADUSH/PP staff. VA and VHA staff that have clinical and programmatic expertise in the task area provide insight into the VA health care system, data, policies, and programmatic guidance. The Contractor will provide the necessary volume of staff with the appropriate technical and analytical expertise to serve on and assist the workgroup. Together, the workgroup will assess the potential impact on VA and develop assumptions for input into the EHCPM. A significant volume of the tasks completed each year and the staff mix required are not known in advance.
" Maintain, enhance, and annually update the EHCPM with new data from the most recently completed fiscal year (base year) and other newly available data, update supporting analyses, integrate new or updated assumptions and enhanced methodology, and produce Veteran, enrollment, utilization, and expenditure projections for multiple scenarios assuming any or all of the underlying assumptions change over the 20-year projection period.
The annual EHCPM update process begins in June and ends the following April. The enhancements required are developed collaboratively with stakeholders during the update process. The specifics and the number of EHCPM projection scenarios that VA will require are not known in advance.
The EHCPM consists of four main component projection models. The methodology, supporting analyses, and assumptions for the 2012 EHCPM are documented in the 2012 VA Enrollee Health Care Projection Model Documentation and Analysis Report,
" Veteran and enrollment projection model
" Utilization projection model based on private sector utilization benchmarks
" Utilization projection model based on VA experience based utilization benchmarks
" Unit cost projection model
The EHCPM has evolved over the past twelve years into a complex model designed to meet stakeholders' needs. The Contractor will assume responsibility for maintaining and updating EHCPM as currently structured. The EHCPM will continue to evolve from its current state to meet stakeholders' needs, and the Contractor will be a key partner with VA in defining how the EHCPM evolves to meet those needs. VA will provide the necessary data, documentation of the methodology and assumptions, and the SAS code that constitutes the EHCPM in its current state.
Contractors will need to propose a comparable methodology or benchmarks for the utilization projection model based on private sector utilization benchmarks. This methodology must meet the objective of projecting Veteran enrollees' total demand for health care services and the portion of that demand that enrollees will receive in VA for services modeled using this model at the level of detail identified in the 2012 VA Enrollee Health Care Projection Model Documentation and Analysis Report,
Responses to this notice shall be e-mailed or faxed to
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