HCG JA

JUSTIFICATION AND APPROVAL

FOR OTHER THAN FULL AND OPEN COMPETITION

U.S. Office of Personnel Management
Procurement Services Division (PSD)

DOCUMENT TYPE:

FAR AUTHORITY:

ACQUISITION METHOD:

CONTRACT TYPE:

BASE PERIOD VALUE:

TOTAL ESTIMATED VALUE (Base + 2

Option Years):

Justification and Approval (J&A) — Sole Source
FAR 6.302-1 — Only One Responsible Source
Sole Source — Other Than Full and Open Competition
Firm Fixed Price (FFP)
$300,000
$927,270

1. Contracting Activity

U.S. Office of Personnel Management (OPM), Procurement Services Division (PSD), 1900 E Street NW, Washington, DC 20415.

2. Description of Supplies or Services and Estimated Value OPM's Healthcare and Insurance, Office of Health Systems Analytics (HSA) requires access to external healthcare claims benchmark data and the proprietary software grouper necessary to analyze that data in a methodologically consistent manner. Specifically, OPM requires:
(a) MedInsight Data Products License — A de-identified, longitudinal closed commercial claims dataset covering approximately 80 million commercial lives across approximately 100 contributors, with medical and pharmacy claims, enrollment records, provider identifiers, and fully adjudicated financial fields. Data history is available from 2017 forward with monthly refreshes covering all 50 states. This product will serve as OPM's external benchmark for comparing Federal Employees Health Benefits (FEHB) utilization, reimbursement, provider activity, and care patterns against broader commercial healthcare experience, supporting fraud, waste, and abuse (FW&A) review, provider analysis, and program integrity oversight of existing programs.
(b) Application of Health Cost Guidelines (HCGs) — Milliman's proprietary Health Cost Guideline grouper software applied to OPM's approximately 8,000,000 FEHB lives. HCGs organize FEHB claim lines into standardized service categories and utilization measures using the same proprietary methodology that underlies the MedInsight benchmark data. This alignment is essential to ensure that OPM's FEHB claims can be categorized and counted using the identical framework reflected in the benchmark, enabling valid cost, utilization, and FW&A comparisons.

Delivery of the MedInsight Data Products will be via Secure File Transfer Protocol (SFTP) or another mutually agreed-upon secure method. HCG grouper software will be delivered as a software package. Data delivery will commence following contract award and include 12 monthly refreshes over the contract year.