HHS awarded Livanta LLC $87.5M for Medicare quality improvement services over 4 years

Contract Overview

Contract Amount: $87,506,046 ($87.5M)

Contractor: Livanta 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: $44.9K/day

Competition Type: FULL AND OPEN COMPETITION

Number of Offers Received: 2

Pricing Type: COST PLUS FIXED FEE

Sector: Healthcare

Official Description: THE 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 1PERIOD OF PERFORMANCE: MAY 6, 2014 - MAY 5, 2019 IGF::CT::IGF

Place of Performance

Location: ANNAPOLIS JUNCTION, HOWARD County, MARYLAND, 20701

State: Maryland Government Spending

Plain-Language Summary

Department of Health and Human Services obligated $87.5 million to LIVANTA LLC for work described as: THE 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 C… Key points: 1. Contract focuses on enhancing healthcare services for Medicare beneficiaries through quality reviews and appeals. 2. The contract's performance period spanned over four years, indicating a substantial commitment to the services. 3. The award was made under full and open competition, suggesting a robust market for these services. 4. The services provided are critical for ensuring beneficiary rights and healthcare quality within the Medicare system. 5. The contractor, Livanta LLC, has a significant role in overseeing healthcare quality for a large federal program. 6. The contract type, Cost Plus Fixed Fee, allows for flexibility while managing costs for complex services.

Value Assessment

Rating: good

The contract value of approximately $87.5 million over four years for Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO) services appears reasonable given the scope. These services are essential for Medicare beneficiaries, involving complex reviews and appeals. Benchmarking against similar QIO contracts would provide a more precise value-for-money assessment, but the scale of operations suggests a competitive pricing structure was likely sought.

Cost Per Unit: N/A

Competition Analysis

Competition Level: full-and-open

This contract was awarded under full and open competition, indicating that multiple qualified bidders had the opportunity to compete. The presence of two bidders suggests a healthy level of competition for these specialized healthcare quality improvement services. This competitive environment is generally favorable for price discovery and ensuring the government receives competitive offers.

Taxpayer Impact: Taxpayers benefit from full and open competition as it typically drives down costs and encourages innovation, leading to more efficient use of federal funds for essential Medicare services.

Public Impact

Medicare beneficiaries directly benefit from improved healthcare quality reviews and timely resolution of complaints and appeals. The services delivered include quality of care reviews, beneficiary complaint reviews, discharge appeals, medical necessity reviews, and EMTALA reviews. The geographic impact is nationwide, covering all Medicare beneficiaries. The contract supports a specialized workforce in healthcare quality assessment and administration.

Waste & Efficiency Indicators

Waste Risk Score: 50 / 10

Warning Flags

Potential for scope creep in complex review functions.
Ensuring consistent quality of reviews across all provider settings.
Managing the volume and complexity of beneficiary appeals effectively.

Positive Signals

Clear statutory functions defined for the QIO program.
Awarded through full and open competition, indicating market readiness.
Contract duration suggests a stable and ongoing need for these services.

Sector Analysis

The healthcare services sector, particularly within government contracting, is characterized by significant spending on quality assurance and beneficiary support. This contract fits within the broader category of health management and consulting services for federal agencies. Comparable spending benchmarks would involve other QIO contracts and similar large-scale healthcare oversight programs managed by CMS, which collectively represent billions in annual federal expenditure.

Small Business Impact

Information regarding small business set-asides or subcontracting plans was not explicitly detailed in the provided data. However, given the specialized nature of QIO services, the primary contractor likely possesses extensive expertise. Future contracts could explore opportunities for small businesses in supporting roles or specific analytical tasks within the broader program.

Oversight & Accountability

Oversight of this contract would typically fall under the Centers for Medicare and Medicaid Services (CMS), with potential involvement from the HHS Office of Inspector General (OIG) for audits and investigations. The contract's performance metrics and reporting requirements would serve as key accountability measures, ensuring Livanta LLC fulfills its statutory obligations for Medicare beneficiaries.

Related Government Programs

Medicare Quality Improvement Organization (QIO) Program
Healthcare Quality Assurance
Beneficiary Complaint and Appeals Systems
Medical Necessity Reviews
EMTALA Compliance

Risk Flags

Potential for inconsistent quality of reviews across different providers.
Risk of delays in processing beneficiary appeals.
Ensuring compliance with evolving healthcare regulations.

Frequently Asked Questions

What is this federal contract paying for?

Department of Health and Human Services awarded $87.5 million to LIVANTA LLC. THE 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

Who is the contractor on this award?

The obligated recipient is LIVANTA 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 $87.5 million.

What is the period of performance?

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

What is the historical spending trend for the BFCC QIO program under Livanta LLC?

The provided data reflects a single definitive contract awarded to Livanta LLC for the period of May 6, 2014, to May 5, 2019, with an actual performance period extending to September 7, 2019, totaling approximately $87.5 million. This represents the spending for this specific contract. To understand historical trends, one would need to examine prior QIO contracts awarded to Livanta LLC or other contractors for similar services, as well as analyze the overall budget allocated to the BFCC QIO program across different contract cycles. Analyzing year-over-year spending within this contract's performance period could also reveal spending patterns and fluctuations in service delivery.

How does Livanta LLC's performance on this contract compare to other QIO contractors?

Direct comparison of Livanta LLC's performance to other QIO contractors requires access to performance evaluation reports, quality metrics, and potentially beneficiary satisfaction data for all relevant contracts. The provided data indicates the contract was awarded under full and open competition with two bidders, suggesting a competitive landscape. Without specific performance metrics (e.g., timeliness of reviews, accuracy of decisions, beneficiary feedback scores) and comparative data from other QIO contracts, it is difficult to definitively assess how Livanta LLC's performance stacks up against its peers. A comprehensive analysis would involve reviewing CMS's contractor performance assessment reports (CPARs) and any public reports on QIO effectiveness.

What are the key performance indicators (KPIs) for this BFCC QIO contract?

The key performance indicators (KPIs) for this BFCC QIO contract would be tied to the statutory review functions outlined, such as the quality of care reviews, beneficiary complaint reviews, discharge and termination of service appeals, medical necessity reviews, and EMTALA reviews. Specific KPIs likely included metrics related to the timeliness of case resolution, accuracy of determinations, adherence to regulatory requirements, and potentially beneficiary satisfaction surveys. The Cost Plus Fixed Fee (CPFF) contract structure suggests that performance against these defined objectives would be critical for achieving the fixed fee component of the contract.

What is the risk profile associated with this type of healthcare quality improvement contract?

The risk profile for this type of healthcare quality improvement contract includes operational risks such as managing a high volume of complex reviews and appeals, ensuring consistent quality across diverse provider settings, and adapting to evolving healthcare regulations and policies. Financial risks might involve cost overruns if not managed effectively under the CPFF structure, although the fixed fee component provides some cost control. Reputational risk is also significant, as failures in quality oversight can impact Medicare beneficiaries and public trust. Furthermore, there's a risk associated with the potential for litigation or disputes arising from review decisions.

How has the scope of work for QIO services evolved over time, and how does this contract reflect that?

The scope of work for QIO services has evolved significantly since the program's inception, adapting to changes in healthcare delivery, policy, and technology. Initially focused on traditional quality assessment, QIOs now play a broader role in patient safety, care coordination, health IT adoption, and public health initiatives. This contract, awarded in 2014, reflects a mature stage of the QIO program, encompassing a wide array of statutory review functions including appeals, medical necessity, and EMTALA compliance, which represent a comprehensive mandate. The specific tasks and emphasis may differ from earlier iterations, reflecting CMS's strategic priorities at the time of award.

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: 9090 JUNCTION DRIVE STE 9, ANNAPOLIS JUNCTION, MD, 20701

Business Categories: Category Business, Limited Liability Corporation, Not Designated a Small Business, Special Designations, U.S.-Owned Business

Financial Breakdown

Contract Ceiling: $87,506,046

Exercised Options: $87,506,046

Current Obligation: $87,506,046

Actual Outlays: $-189,666

Contract Characteristics

Multi-Year Contract: Yes

Commercial Item: COMMERCIAL PRODUCTS/SERVICES PROCEDURES NOT USED

Cost or Pricing Data: YES

Timeline