Medicare quality improvement contract awarded to Ohio Keppro, LLC for $65.3M over 5 years

Contract Overview

Contract Amount: $65,344,473 ($65.3M)

Contractor: Ohio Kepro, LLC

Awarding Agency: Department of Health and Human Services

Start Date: 2014-05-08

End Date: 2019-09-07

Contract Duration: 1,948 days

Daily Burn Rate: $33.5K/day

Competition Type: FULL AND OPEN COMPETITION

Number of Offers Received: 2

Pricing Type: COST PLUS FIXED FEE

Sector: Healthcare

Official Description: IGF::CT::IGFTHE PURPOSE OF THE BENEFICIARY AND FAMILY CENTERED CARE (BFCC) QUALITY IMPROVEMENT ORGANIZATION (QIO) CONTRACT IS TO IMPROVE HEALTHCARE SERVICES FOR MEDICARE BENEFICIARIES THROUGH BFCC PERFORMANCE OF NUMEROUS STATUTORY REVIEW FUNCTIONS, INCLUDING, BUT NOT LIMITED TO, QUALITY OF CARE REVIEWS, BENEFICIARY COMPLAINT REVIEWS, DISCHARGE AND TERMINATION OF SERVICE APPEALS IN VARIOUS PROVIDER SETTINGS, MEDICAL NECESSITY REVIEWS, AND EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA) REVIEWS.AREA 3PERIOD OF PERFORMANCE: MAY 6, 2014 - MAY 5, 2019

Place of Performance

Location: SEVEN HILLS, CUYAHOGA County, OHIO, 44131

State: Ohio Government Spending

Plain-Language Summary

Department of Health and Human Services obligated $65.3 million to OHIO KEPRO, LLC for work described as: IGF::CT::IGFTHE PURPOSE OF THE BENEFICIARY AND FAMILY CENTERED CARE (BFCC) QUALITY IMPROVEMENT ORGANIZATION (QIO) CONTRACT IS TO IMPROVE HEALTHCARE SERVICES FOR MEDICARE BENEFICIARIES THROUGH BFCC PERFORMANCE OF NUMEROUS STATUTORY REVIEW FUNCTIONS, INCLUDING, BUT NOT LIMITED TO, … Key points: 1. Contract aims to enhance healthcare services for Medicare beneficiaries through quality of care reviews and complaint resolutions. 2. The scope includes statutory review functions such as medical necessity and EMTALA compliance. 3. Awarded via full and open competition, suggesting a robust market for these specialized services. 4. Performance period spans five years, indicating a long-term commitment to improving healthcare quality. 5. The contract's success hinges on effective execution of complex review processes and stakeholder engagement.

Value Assessment

Rating: good

The contract value of $65.3 million over approximately five years for Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO) services appears reasonable given the extensive scope of work. This includes quality of care reviews, beneficiary complaint reviews, discharge appeals, medical necessity reviews, and EMTALA reviews. Benchmarking against similar QIO contracts would provide a more precise value-for-money assessment, but the breadth of services suggests a significant undertaking. The cost-plus-fixed-fee (CPFF) contract type allows for flexibility while providing a defined profit margin.

Cost Per Unit: N/A

Competition Analysis

Competition Level: full-and-open

The contract was awarded through full and open competition, indicating that multiple qualified vendors had the opportunity to bid. This competitive process is expected to drive fair pricing and encourage innovation. The presence of two bidders suggests a moderately competitive market for these specialized healthcare quality improvement services. The agency's decision to use full and open competition implies confidence in the availability of multiple sources capable of meeting the requirements.

Taxpayer Impact: Taxpayers benefit from a competitive process that is likely to result in a more cost-effective award for essential Medicare services.

Public Impact

Medicare beneficiaries across the nation will benefit from improved healthcare quality and access to grievance resolution. Services delivered include critical reviews of care quality, patient complaints, and medical necessity. The contract supports the Centers for Medicare and Medicaid Services' mission to ensure high-quality healthcare. Healthcare providers will be subject to reviews, potentially leading to improved operational standards and patient care practices.

Waste & Efficiency Indicators

Waste Risk Score: 50 / 10

Warning Flags

Potential for scope creep in complex review processes.
Ensuring consistent quality of reviews across all functions.
Managing contractor performance over a multi-year period.

Positive Signals

Awarded through full and open competition, indicating market viability.
Clear definition of statutory review functions.
Long-term contract duration allows for sustained impact.

Sector Analysis

This contract falls within the Healthcare Services sector, specifically focusing on quality improvement and oversight for Medicare. The market for QIO services is specialized, with a limited number of established organizations possessing the expertise and infrastructure to perform these complex reviews. Spending in this area is critical for ensuring the integrity and quality of the Medicare program, with comparable contracts often involving significant multi-year commitments and substantial funding to cover extensive review and administrative functions.

Small Business Impact

The contract does not indicate any specific small business set-aside provisions. Given the specialized nature of QIO services, it is unlikely that small businesses would be primary awardees unless they are subcontractors. The primary contractor, Ohio Keppro, LLC, is likely a larger entity. Further analysis would be needed to determine if subcontracting opportunities exist for small businesses within the scope of this contract.

Oversight & Accountability

Oversight is provided by the Centers for Medicare and Medicaid Services (CMS), the awarding agency. CMS is responsible for monitoring contractor performance, ensuring compliance with contract terms, and verifying the quality of services rendered. The contract type (CPFF) also includes a fixed fee component, which provides a level of accountability for performance. Transparency is generally maintained through agency reporting and public data, though specific performance metrics may not always be publicly detailed.

Related Government Programs

Medicare Quality Improvement Organizations (QIOs)
Healthcare Quality Assurance
Beneficiary Complaint Resolution
Medical Necessity Reviews
EMTALA Compliance

Risk Flags

Broad NAICS code may require careful scope management.
Performance monitoring is critical for ensuring quality of reviews.
Contractor's ability to manage diverse review functions.

Frequently Asked Questions

What is this federal contract paying for?

Department of Health and Human Services awarded $65.3 million to OHIO KEPRO, LLC. IGF::CT::IGFTHE PURPOSE OF THE BENEFICIARY AND FAMILY CENTERED CARE (BFCC) QUALITY IMPROVEMENT ORGANIZATION (QIO) CONTRACT IS TO IMPROVE HEALTHCARE SERVICES FOR MEDICARE BENEFICIARIES THROUGH BFCC PERFORMANCE OF NUMEROUS STATUTORY REVIEW FUNCTIONS, INCLUDING, BUT NOT LIMITED TO, QUALITY OF CARE REVIEWS, BENEFICIARY COMPLAINT REVIEWS, DISCHARGE AND TERMINATION OF SERVICE APPEALS IN VARIOUS PROVIDER SETTINGS, MEDICAL NECESSITY REVIEWS, AND EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA)

Who is the contractor on this award?

The obligated recipient is OHIO KEPRO, LLC.

Which agency awarded this contract?

Awarding agency: Department of Health and Human Services (Centers for Medicare and Medicaid Services).

What is the total obligated amount?

The obligated amount is $65.3 million.

What is the period of performance?

Start: 2014-05-08. End: 2019-09-07.

What is the historical spending pattern for BFCC QIO contracts, and how does this award compare?

Historical spending on BFCC QIO contracts has been substantial, reflecting the critical role these organizations play in overseeing Medicare quality. These contracts are typically awarded for multi-year periods, often with values in the tens of millions of dollars, similar to this $65.3 million award. The Centers for Medicare and Medicaid Services (CMS) regularly procures these services through competitive bidding processes. While specific historical figures for individual QIO regions or contract cycles vary, the overall investment in QIO programs remains a consistent and significant component of CMS's operational budget, aimed at ensuring high standards of care for Medicare beneficiaries. This contract appears to be within the expected range for a large-scale, multi-state QIO region.

What is Ohio Keppro, LLC's track record with federal contracts, particularly with CMS?

Ohio Keppro, LLC has a significant track record with federal contracts, particularly within the healthcare sector and specifically with the Centers for Medicare and Medicaid Services (CMS). As a QIO contractor, their core business involves performing the exact services outlined in this contract. Their experience likely includes managing complex review processes, engaging with healthcare providers, and reporting on quality metrics. Past performance evaluations and contract awards would provide a detailed picture of their capabilities, reliability, and adherence to federal regulations. A review of their contract history would reveal the duration and scope of previous engagements, any performance issues or commendations, and their success in meeting the objectives set by CMS in prior agreements.

How does the pricing structure (Cost Plus Fixed Fee) impact value for money in this contract?

The Cost Plus Fixed Fee (CPFF) pricing structure for this contract offers a balance between flexibility and cost control. Under CPFF, the contractor is reimbursed for allowable costs incurred plus a predetermined fixed fee representing profit. This structure is beneficial when the exact scope or costs are difficult to estimate precisely at the outset, as is often the case with complex review and oversight functions. For value for money, it means that while costs can fluctuate based on actual expenses, the contractor's profit margin is fixed, incentivizing efficiency rather than cost-cutting that could compromise quality. CMS must diligently monitor allowable costs to ensure they are reasonable and directly related to the contract's objectives. The fixed fee component provides a predictable profit element, preventing excessive profit accumulation if costs are lower than anticipated.

What are the key performance indicators (KPIs) used to measure the success of this QIO contract?

Key performance indicators (KPIs) for this Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO) contract are crucial for measuring its success in improving healthcare services for Medicare beneficiaries. While specific KPIs are detailed in the contract's Statement of Work (SOW), they typically revolve around the effectiveness and efficiency of the review functions. This includes metrics related to the timeliness and accuracy of quality of care reviews, the resolution rate and satisfaction levels for beneficiary complaints, the appropriateness of discharge and termination of service appeals, and the thoroughness of medical necessity and EMTALA reviews. Performance is often benchmarked against established standards and previous contract periods. CMS monitors these KPIs closely to ensure the contractor is meeting its obligations and achieving the desired outcomes in healthcare quality improvement.

What is the potential risk associated with the 'Other Management Consulting Services' NAICS code for this contract?

The NAICS code '541618 - Other Management Consulting Services' is broad and can encompass a wide range of activities. For this specific contract, which focuses on Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO) functions, the risk associated with this code lies in ensuring the services provided are precisely aligned with the statutory requirements for QIOs, rather than general management consulting. The primary risk is that the contractor might interpret 'consulting' too broadly, potentially deviating from the core mission of healthcare quality review and appeals. However, given the detailed description of the contract's purpose—including specific review functions like quality of care, complaints, appeals, and EMTALA—the agency likely has robust mechanisms to ensure the contractor stays within the defined scope. The risk is mitigated by the specificity of the SOW and CMS's oversight.

Industry Classification

NAICS: Professional, Scientific, and Technical Services › Management, Scientific, and Technical Consulting Services › Other Management Consulting Services

Product/Service Code: MEDICAL SERVICES › DEPENDENT MEDICARE SERVICES

Competition & Pricing

Extent Competed: FULL AND OPEN COMPETITION

Solicitation Procedures: NEGOTIATED PROPOSAL/QUOTE

Solicitation ID: HHSM5002014RFPBFCCQIO

Offers Received: 2

Pricing Type: COST PLUS FIXED FEE (U)

Evaluated Preference: NONE

Contractor Details

Address: 5700 LOMBARDO CTR STE 100, CLEVELAND, OH, 44131

Business Categories: Category Business, Corporate Entity Not Tax Exempt, Not Designated a Small Business, Special Designations, U.S.-Owned Business

Financial Breakdown

Contract Ceiling: $65,344,473

Exercised Options: $65,344,473

Current Obligation: $65,344,473

Actual Outlays: $705,950

Contract Characteristics

Multi-Year Contract: Yes

Commercial Item: COMMERCIAL PRODUCTS/SERVICES PROCEDURES NOT USED

Cost or Pricing Data: YES

Timeline