CMS awards $51.6M contract for healthcare model compliance support to Reli Group Inc

Contract Overview

Contract Amount: $51,622,253 ($51.6M)

Contractor: Reli Group Inc

Awarding Agency: Department of Health and Human Services

Start Date: 2020-09-24

End Date: 2026-12-24

Contract Duration: 2,282 days

Daily Burn Rate: $22.6K/day

Competition Type: FULL AND OPEN COMPETITION

Number of Offers Received: 3

Pricing Type: COST PLUS FIXED FEE

Sector: Healthcare

Official Description: THE CENTER FOR MEDICARE AND MEDICAID INNOVATION (CMMI) SEEKS CONTRACT SUPPORT TO PROVIDE COMPLIANCE SERVICES FOR SEVERAL NEW HEALTHCARE MODELS INCLUDING: DIRECT CONTRACTING (DC) MODEL, KIDNEY CARE CHOICES (KCC) MODEL, PRIMARY CARE FIRST (PCF) MODEL A

Place of Performance

Location: WINDSOR MILL, BALTIMORE County, MARYLAND, 21244

State: Maryland Government Spending

Plain-Language Summary

Department of Health and Human Services obligated $51.6 million to RELI GROUP INC for work described as: THE CENTER FOR MEDICARE AND MEDICAID INNOVATION (CMMI) SEEKS CONTRACT SUPPORT TO PROVIDE COMPLIANCE SERVICES FOR SEVERAL NEW HEALTHCARE MODELS INCLUDING: DIRECT CONTRACTING (DC) MODEL, KIDNEY CARE CHOICES (KCC) MODEL, PRIMARY CARE FIRST (PCF) MODEL A Key points: 1. Contract aims to ensure compliance for innovative healthcare models like Direct Contracting and Kidney Care Choices. 2. The award was made under full and open competition, suggesting a robust bidding process. 3. The contract duration of over 6 years indicates a long-term need for these compliance services. 4. Reli Group Inc. is the sole awardee, highlighting their specialized expertise in this niche. 5. The contract type (Cost Plus Fixed Fee) allows for flexibility while managing costs. 6. This spending supports the Centers for Medicare and Medicaid Innovation's efforts to reform healthcare delivery.

Value Assessment

Rating: good

The contract value of $51.6 million over approximately 6 years suggests an average annual spend of around $8.6 million. Benchmarking this against similar contracts for compliance and program support within CMS or other federal health agencies is necessary for a precise value-for-money assessment. However, given the specialized nature of supporting multiple complex healthcare innovation models, the pricing appears reasonable, assuming the scope of work is comprehensive and the contractor's proposed labor mix and rates are competitive within the federal contracting landscape.

Cost Per Unit: N/A

Competition Analysis

Competition Level: full-and-open

This contract was awarded under full and open competition, indicating that all responsible sources were permitted to submit an offer. The presence of multiple bidders (implied by 'full and open competition' and the number of offers received, though not explicitly stated) generally leads to more competitive pricing and a wider selection of qualified contractors. The specific number of bids received would provide further insight into the intensity of the competition.

Taxpayer Impact: Full and open competition is beneficial for taxpayers as it drives down prices through market forces, ensuring that the government receives the best possible value for its investment in these critical healthcare compliance services.

Public Impact

Beneficiaries include Medicare and Medicaid beneficiaries who will experience potentially improved healthcare delivery models. Services delivered include crucial compliance monitoring and support for new healthcare payment and delivery initiatives. The geographic impact is national, as these models are designed to influence healthcare across the United States. Workforce implications may include the need for specialized compliance officers and healthcare policy experts within the contractor organization.

Waste & Efficiency Indicators

Waste Risk Score: 50 / 10

Warning Flags

Potential for scope creep given the multi-year duration and evolving nature of healthcare models.
Reliance on a single contractor for critical compliance functions could pose a risk if performance falters.
Ensuring consistent quality and adherence to evolving regulatory requirements over the contract's lifespan.

Positive Signals

Awarded through full and open competition, suggesting a competitive selection process.
Long contract duration indicates a stable and ongoing need for these essential services.
Focus on innovative healthcare models suggests alignment with government priorities for healthcare reform.

Sector Analysis

This contract falls within the professional, scientific, and technical services sector, specifically focusing on research and development in social sciences and humanities (NAICS 541720), though its application is directly in healthcare policy and compliance. The market for healthcare consulting and compliance services is substantial, driven by complex regulatory environments and the continuous push for innovation and efficiency within federal healthcare programs like Medicare and Medicaid. Spending in this area supports the government's strategic goals for healthcare reform and program integrity.

Small Business Impact

The data indicates this contract was not set aside for small businesses (ss: false, sb: false). As a large contract supporting significant federal programs, there may be opportunities for subcontracting to small businesses, particularly those with specialized expertise in healthcare compliance or data analysis. However, the primary awardee is not a small business, and the direct impact on the small business ecosystem would depend on the subcontracting plan, which is not detailed here.

Oversight & Accountability

Oversight is likely provided by the Centers for Medicare and Medicaid Services (CMS) program officials and contracting officers. The contract type (Cost Plus Fixed Fee) necessitates careful monitoring of costs and performance to ensure the fixed fee remains appropriate. Transparency is generally maintained through federal contract databases like FPDS. Inspector General jurisdiction would apply to investigations of fraud, waste, or abuse related to the contract.

Related Government Programs

Medicare Program Integrity
Medicaid Innovation Center Initiatives
Healthcare Model Development and Evaluation
Federal Healthcare Compliance Services

Risk Flags

Long contract duration may increase risk of performance degradation or changing requirements.
Reliance on a single awardee for critical compliance functions.
Complexity of supporting multiple, evolving healthcare models.

Frequently Asked Questions

What is this federal contract paying for?

Department of Health and Human Services awarded $51.6 million to RELI GROUP INC. THE CENTER FOR MEDICARE AND MEDICAID INNOVATION (CMMI) SEEKS CONTRACT SUPPORT TO PROVIDE COMPLIANCE SERVICES FOR SEVERAL NEW HEALTHCARE MODELS INCLUDING: DIRECT CONTRACTING (DC) MODEL, KIDNEY CARE CHOICES (KCC) MODEL, PRIMARY CARE FIRST (PCF) MODEL A

Who is the contractor on this award?

The obligated recipient is RELI GROUP INC.

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 $51.6 million.

What is the period of performance?

Start: 2020-09-24. End: 2026-12-24.

What is the track record of Reli Group Inc. in supporting federal healthcare compliance initiatives?

Reli Group Inc. has a history of providing support services to federal agencies, including those within the Department of Health and Human Services. Their experience often involves program support, data analysis, and technical assistance related to healthcare programs. For CMMI initiatives, their past performance would likely include work on various healthcare models, demonstrating their capability to understand and navigate the complexities of federal healthcare regulations and program structures. A detailed review of their past federal contracts, particularly those with CMS and CMMI, would reveal specific projects, performance ratings, and the scale of their previous engagements in compliance and program support.

How does the cost of this contract compare to similar federal contracts for healthcare compliance support?

Directly comparing the $51.6 million cost over approximately 6.3 years (2282 days) requires identifying contracts with similar scope, duration, and complexity. Contracts supporting large-scale federal healthcare models, involving compliance, data analysis, and technical assistance, can vary significantly. Factors influencing cost include the number of models supported, the depth of compliance required, the level of analysis, and the specific expertise needed. While $8.6 million annually might seem substantial, it needs to be benchmarked against contracts for similar services within CMS or other agencies like ONC or AHRQ. Without specific comparable contract data, it's difficult to definitively state if this represents superior or inferior value, but the full and open competition suggests a market-driven price.

What are the primary risks associated with this contract, and how are they being mitigated?

Key risks include the potential for scope creep as new healthcare models evolve, the contractor's ability to maintain consistent performance over a long duration, and ensuring adherence to rapidly changing healthcare regulations. Mitigation strategies likely involve robust contract management by CMS, clear definition of tasks and deliverables, performance metrics, and regular reviews. The Cost Plus Fixed Fee structure also requires diligent oversight of expenditures to ensure costs remain reasonable and the fixed fee is justified. Furthermore, CMMI's active engagement in overseeing the compliance activities will be crucial.

How effective is the Center for Medicare and Medicaid Innovation (CMMI) in achieving its goals through contracts like this?

CMMI's effectiveness is measured by its success in testing and scaling innovative payment and delivery models that improve healthcare quality, reduce costs, and enhance patient outcomes. Contracts like this are essential enablers, providing the necessary expertise to ensure these models operate within regulatory frameworks and achieve their intended objectives. The effectiveness of this specific contract hinges on Reli Group Inc.'s ability to provide accurate and timely compliance support, enabling CMMI to gather reliable data, make informed decisions about model expansion or modification, and ultimately achieve its reform goals. Success metrics would likely include the smooth operation of the supported models and the integrity of the data collected.

What are the historical spending patterns for compliance and support services within CMMI or similar CMS innovation programs?

Historical spending patterns for CMMI and similar CMS innovation programs show a consistent and often increasing investment in program support, technical assistance, and compliance oversight. As CMMI develops and tests more complex and numerous healthcare models (like Direct Contracting, Kidney Care Choices, Primary Care First), the need for specialized support services grows. Annual spending can fluctuate based on the number and maturity of models being supported, but overall, there's a trend towards significant investment in ensuring these innovations are implemented effectively and compliantly. This $51.6 million award aligns with the substantial resources required to manage and evaluate a portfolio of advanced healthcare initiatives.

What is the potential impact of this contract on the development and adoption of new healthcare payment models?

This contract plays a critical role in facilitating the development and adoption of new healthcare payment and delivery models by ensuring their operational and regulatory compliance. By providing expert support to models like Direct Contracting (DC), Kidney Care Choices (KCC), and Primary Care First (PCF), Reli Group Inc. helps CMMI manage the complexities inherent in these innovations. Robust compliance oversight builds confidence among participants (providers, beneficiaries) and regulators, which is essential for the successful testing, scaling, and eventual widespread adoption of these models. The contract's success directly contributes to CMMI's mission of transforming healthcare delivery and payment systems.

Industry Classification

NAICS: Professional, Scientific, and Technical Services › Scientific Research and Development Services › Research and Development in the Social Sciences and Humanities

Product/Service Code: SUPPORT SVCS (PROF, ADMIN, MGMT) › PROFESSIONAL SERVICES

Competition & Pricing

Extent Competed: FULL AND OPEN COMPETITION

Solicitation Procedures: SUBJECT TO MULTIPLE AWARD FAIR OPPORTUNITY

Offers Received: 3

Pricing Type: COST PLUS FIXED FEE (U)

Evaluated Preference: NONE

Contractor Details

Address: 5520 RESEARCH PARK DRIVE, SUITE 105, CATONSVILLE, MD, 21228

Business Categories: 8(a) Program Participant, Category Business, Corporate Entity Not Tax Exempt, DoT Certified Disadvantaged Business Enterprise, HUBZone Firm, Minority Owned Business, Self-Certified Small Disadvantaged Business, Small Business, Special Designations, Subchapter S Corporation, Indian (Subcontinent) American Owned Business, U.S.-Owned Business

Financial Breakdown

Contract Ceiling: $53,263,976

Exercised Options: $51,622,253

Current Obligation: $51,622,253

Actual Outlays: $40,904,240

Contract Characteristics

Commercial Item: COMMERCIAL PRODUCTS/SERVICES PROCEDURES NOT USED

Cost or Pricing Data: NO

Parent Contract

Parent Award PIID: 75FCMC19D0094

IDV Type: IDC

Timeline