WASHINGTON – The Department of Veterans Affairs plans to contract for management services to streamline and modernize the processing of its healthcare claims and develop tools to detect fraud and waste. It will also update IT services to help control costs in its beneficiary travel program.
Through the Health Care Efficiency effort, VA hopes to reduce program operational costs by such initiatives as standardizing clinical and business practices, and by monitoring and coordinating its IT services.
[See also: VA awards contracts for healthcare innovations.]
“Nationally, healthcare costs are accelerating without significant evidence of a correlating rise in healthcare delivery value or quality, and the Veterans Health Administration is experiencing similar circumstances,” according to a March 25 announcement in Federal Business Opportunities.
Many VHA systems have not been updated for cost effectiveness due to local variations in how they are established, according to the announcement.
Potential vendors will need to handle the efficient processing, payment or denial of healthcare claims submitted by non-VA providers. This includes making sure that systems are in place to determine and pay claims and supply program integrity tools that can assure accurate payments for non-VA healthcare services.
Vendors will also evaluate current state practices and procedures for beneficiary travel, which is available to obtain VA health services for those who meet certain criteria. The VA wants to minimize variations, control costs, and establish a more rigorous system for monitoring incorrect payments. Vendors will develop requirements for electronic authorization capabilities as part of this effort.
The VA also needs a middleware tool that enables program managers to analyze data, integrate information and generate reports from multiple VA real-time location systems (RTLS) and link to VA’s VistA electronic medical record system and other department corporate systems.
A number of VA facilities use existing RTLS technologies, which support asset and surgical instrument tracking and clinic and operating room workflow.
[See also: VA centers test mobile tech for home-based nurses.]
The contract will be for one year with the option of another year. The vendor will have to adhere to the Project Management Accountability System (PMAS), a process that tracks the delivery of VA products and services. Under PMAS, VA IT projects use an incremental development approach, requiring frequent delivery of new capabilities that program managers test and accept.
The contractor will also use ProPath, a process management tool used across VA that provides a snapshot of each step in the software development process.
