HHS awards $5.76M contract for actuarial review and estimates for Medicare Advantage plans

Contract Overview

Contract Amount: $5,766,421 ($5.8M)

Contractor: Sensa Solutions, Inc.

Awarding Agency: Department of Health and Human Services

Start Date: 2023-05-01

End Date: 2027-04-30

Contract Duration: 1,460 days

Daily Burn Rate: $4.0K/day

Competition Type: FULL AND OPEN COMPETITION

Number of Offers Received: 7

Pricing Type: FIRM FIXED PRICE

Sector: Healthcare

Official Description: ACTUARIAL REVIEW AND ESTIMATES FOR PRESCRIPTION DRUG & MEDICARE ADV PLAN

Place of Performance

Location: WINDSOR MILL, BALTIMORE County, MARYLAND, 21244

State: Maryland Government Spending

Plain-Language Summary

Department of Health and Human Services obligated $5.8 million to SENSA SOLUTIONS, INC. for work described as: ACTUARIAL REVIEW AND ESTIMATES FOR PRESCRIPTION DRUG & MEDICARE ADV PLAN Key points: 1. Contract awarded to SENSA SOLUTIONS, INC. for actuarial services. 2. Focus on prescription drug and Medicare Advantage plan estimates. 3. Contract duration spans over four years. 4. Firm Fixed Price contract type suggests predictable costs. 5. Competition level was full and open. 6. Services fall under Administrative Management and General Management Consulting. 7. Delivery Order under a larger contract vehicle.

Value Assessment

Rating: good

The contract value of $5.76 million over four years for actuarial services appears reasonable given the specialized nature of the work. Benchmarking against similar contracts for actuarial consulting within HHS or CMS would provide a more precise value-for-money assessment. The firm fixed-price structure helps control costs, but the ultimate value will depend on the quality and accuracy of the estimates provided by SENSA SOLUTIONS, INC.

Cost Per Unit: N/A

Competition Analysis

Competition Level: full-and-open

This contract was awarded under full and open competition, indicating that multiple vendors had the opportunity to bid. The presence of 7 bids suggests a healthy level of interest and competition for these services. This broad competition is generally favorable for price discovery and ensures the government can select from a range of qualified offerors.

Taxpayer Impact: Full and open competition typically leads to more competitive pricing, potentially saving taxpayer dollars compared to sole-source or limited competition awards.

Public Impact

Benefits Medicare beneficiaries by ensuring accurate plan estimates and prescription drug cost projections. Supports the Centers for Medicare and Medicaid Services (CMS) in program oversight and financial planning. Impacts the healthcare sector by providing critical data for plan development and regulatory compliance. Workforce implications are likely within specialized actuarial and data analysis fields.

Waste & Efficiency Indicators

Waste Risk Score: 50 / 10

Warning Flags

Potential for scope creep if the definition of 'actuarial review and estimates' is not tightly defined.
Reliance on the accuracy of data provided to SENSA SOLUTIONS, INC. for their estimates.
Ensuring continued availability of specialized actuarial talent within the contractor.

Positive Signals

Awarded under full and open competition, suggesting a competitive bidding process.
Firm Fixed Price contract type provides cost certainty.
Long-term contract (4 years) allows for continuity of essential services.
Contractor is performing a critical function for Medicare Advantage plans.

Sector Analysis

This contract falls within the professional services sector, specifically administrative and management consulting, with a focus on healthcare analytics. The market for actuarial services supporting government health programs is specialized, with a limited number of firms possessing the necessary expertise. Spending in this area is driven by the complexity of healthcare regulations and the need for accurate financial projections for programs like Medicare Advantage.

Small Business Impact

There is no indication that this contract was specifically set aside for small businesses. Given the specialized nature of actuarial services, it is possible that larger, more established firms are the primary bidders. Subcontracting opportunities for small businesses may exist if SENSA SOLUTIONS, INC. chooses to engage them for specific tasks, but this is not guaranteed.

Oversight & Accountability

Oversight will likely be managed by the Centers for Medicare and Medicaid Services (CMS) contracting officers and program managers. Accountability measures are inherent in the firm fixed-price contract, requiring delivery of specified services. Transparency is generally maintained through contract award databases, though the detailed work products may be internal to CMS.

Related Government Programs

Medicare Prescription Drug Benefit Program
Medicare Advantage Program
Health Insurance Marketplace Actuarial Support
CMS Program Integrity

Risk Flags

Potential for reliance on contractor expertise without sufficient internal government validation.
Accuracy of actuarial models is critical and subject to inherent estimation uncertainties.
Ensuring data security and privacy for sensitive Medicare beneficiary information.

Frequently Asked Questions

What is this federal contract paying for?

Department of Health and Human Services awarded $5.8 million to SENSA SOLUTIONS, INC.. ACTUARIAL REVIEW AND ESTIMATES FOR PRESCRIPTION DRUG & MEDICARE ADV PLAN

Who is the contractor on this award?

The obligated recipient is SENSA SOLUTIONS, 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 $5.8 million.

What is the period of performance?

Start: 2023-05-01. End: 2027-04-30.

What is the historical spending by CMS on similar actuarial review and estimation services?

Historical spending data for similar actuarial review and estimation services by CMS is crucial for benchmarking. While this specific contract is valued at $5.76 million over four years, understanding past investments in comparable services can reveal trends in pricing, contractor performance, and the overall demand for such expertise. Analyzing previous awards, including their duration, scope, and final costs, would help determine if the current award represents a fair market price and if spending in this area has increased or decreased. This context is vital for assessing the value-for-money proposition of the current contract and for future budget planning.

How does SENSA SOLUTIONS, INC.'s pricing compare to other firms offering similar actuarial services?

A detailed comparison of SENSA SOLUTIONS, INC.'s pricing structure against that of other firms providing similar actuarial review and estimation services is essential for assessing value. This involves examining their proposed rates, overhead, and profit margins in relation to industry benchmarks and the bids submitted by competitors during the full and open competition process. If available, data from previous contracts awarded to SENSA SOLUTIONS, INC. or to its competitors for comparable work can provide a baseline. Understanding the competitive landscape and the specific cost drivers for actuarial services will illuminate whether this $5.76 million award represents an efficient use of taxpayer funds or if there were opportunities for greater cost savings.

What are the key performance indicators (KPIs) for this contract, and how will contractor performance be measured?

The key performance indicators (KPIs) for this contract are critical for ensuring that SENSA SOLUTIONS, INC. delivers high-quality actuarial reviews and estimates that meet CMS's needs. While not explicitly detailed in the provided data, typical KPIs for such a contract would likely include accuracy and timeliness of estimates, adherence to actuarial standards of practice, clarity and usability of reports, and responsiveness to CMS inquiries. Performance measurement would involve regular reviews by CMS program managers, potentially including formal evaluations at contract milestones or annually. The effectiveness of these KPIs and the rigor of the measurement process directly impact the perceived value and success of the contract.

What is the potential impact of these actuarial estimates on Medicare Advantage plan premiums and prescription drug costs for beneficiaries?

The actuarial estimates generated under this contract have a direct and significant impact on Medicare Advantage plan premiums and the out-of-pocket costs for prescription drugs for millions of beneficiaries. Accurate estimations are vital for CMS to set appropriate payment rates to plans and to ensure that plans offer competitive premiums and comprehensive drug coverage. Inaccurate or biased estimates could lead to plans overcharging beneficiaries, underfunding benefits, or creating financial strain on the Medicare program. Therefore, the quality and reliability of SENSA SOLUTIONS, INC.'s work are paramount to the financial well-being of beneficiaries and the fiscal integrity of the Medicare program.

Has SENSA SOLUTIONS, INC. had any past performance issues on similar government contracts?

Assessing SENSA SOLUTIONS, INC.'s past performance on similar government contracts is crucial for risk assessment. Information regarding their track record, including any history of performance issues, contract disputes, or quality deficiencies on prior engagements, should be reviewed. Government agencies typically collect past performance data, which is considered during the source selection process. A history of successful contract completion, timely delivery, and high-quality work would increase confidence in their ability to meet the requirements of this new $5.76 million contract. Conversely, any documented performance problems would raise concerns about potential risks and the overall value proposition.

Industry Classification

NAICS: Professional, Scientific, and Technical Services › Management, Scientific, and Technical Consulting Services › Administrative Management and General Management Consulting Services

Product/Service Code: SPECIAL STUDIES/ANALYSIS, NOT R&D › SPECIAL STUDIES - NOT R and D

Competition & Pricing

Extent Competed: FULL AND OPEN COMPETITION

Solicitation Procedures: SUBJECT TO MULTIPLE AWARD FAIR OPPORTUNITY

Offers Received: 7

Pricing Type: FIRM FIXED PRICE (J)

Evaluated Preference: NONE

Contractor Details

Address: 11911 FREEDOM DR STE 790, RESTON, VA, 20190

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

Financial Breakdown

Contract Ceiling: $7,182,177

Exercised Options: $5,766,421

Current Obligation: $5,766,421

Actual Outlays: $4,380,857

Contract Characteristics

Commercial Item: COMMERCIAL PRODUCTS/SERVICES

Parent Contract

Parent Award PIID: GS00F349CA

IDV Type: FSS

Timeline