The Department of Veterans Affairs has a requirement for for a new Referral, Authorization, and Utilization Management, and Care Coordination system to inform a future recompete of the existing Community Care Referral and Authorization (CCRA) product.

The mission of the VA Office of Information & Technology (OI&T), Product Delivery Service (PDS), is to provide benefits and services to U.S. Veterans. OI&T aims to deliver high-quality, effective, and efficient IT services to those providing care to Veterans at the point-of-care and throughout their healthcare journey. VA relies on Information Management/Information Technology (IM/IT) systems to achieve its mission goals.

The CCRA project currently uses HealthShare Referral Manager (HSRM), a Section 508 compliant Commercial Off-The-Shelf (COTS) product, to expedite Veterans’ access to community care. HSRM enables VA, TPAs, and community providers to manage community care referrals and authorizations more effectively. It reduces turnaround time for processing referrals, providing care, submitting claims, and receiving payments. HSRM integrates with various VA and non-VA healthcare systems and supports Emergency Care Reporting (ECR), the Veterans Affairs Precertification Portal (VAPP), and other essential functionalities to maintain continuity of care for Veterans.

However, a major pain point for community care providers is the need to create and maintain user accounts in HSRM. This process is time-consuming, technically challenging, and often a barrier to adoption. Additionally, the platform is not efficient for utilization management (UM) and care coordination. Future state, community providers will not have user-accounts, as their system interactions will be conducted in and through TPA portals, which will eliminate or reduce current-state adoption barriers. VA looks to move to an Electronic Data Interface (EDI)-based transaction system, which will reduce custom-coding needed for TPA portal integration.

• The Contractor shall provide continued capability development and sustainment services for the HSRM Managed Service solution, inclusive of ECR and IPE. The HSRM solution is hosted at the AWS FedRAMP High Government Cloud with middleware HealthConnect systems hosted at VA Regional Data Centers. This support includes software maintenance, configuration, development, testing, integration, installation, implementation (product/service), training, customer support, optimization (technical/operational), cloud and network infrastructure sustainment, and adaptive, perfective, and corrective maintenance
• The Contractor shall adhere to VA policies and procedures to include, the Product Line Management Playbook, the Veteran-focused Integration Process (VIP) Guide or VA-approved Release Processes and adopt modern practices to continuously improve VA experiences through a combination of people, processes, and technology
• The Contractor shall adhere to VA policies and procedures to include, the Product Line Management Playbook, the Veteran-focused Integration Process (VIP) Guide or VA-approved Release Processes and adopt modern practices to continuously improve VA experiences through a combination of people, processes, and technology