SAM #OPM202601

OPM healthcare claims benchmark data license and Health Cost Guidelines grouper

OPM’s Healthcare and Insurance office is procuring Milliman healthcare claims benchmarks and analysis for FEHB program oversight. - Award and buyer: The U.S. Office of Personnel Management (OPM), through its Procurement Services Division, supports Health Systems Analytics (HSA) within Healthcare and Insurance. The requirement is described as a sole-source, firm-fixed-price contract with Milliman Solutions, LLC. - Data license: Milliman MedInsight commercial claims data license covering approximately 80 million lives across about 100 contributors. The de-identified, longitudinal data includes medical and pharmacy claims, enrollment, provider identifiers, and adjudicated financial fields; records date from 2017 forward and cover all 50 states. - Refreshes and analysis: The license includes 12 monthly data refreshes. Milliman will also apply its proprietary Health Cost Guidelines (HCG) grouper to approximately 8 million Federal Employees Health Benefits (FEHB) lives, organizing claim lines into standardized service and utilization categories. - Intended use: Support analysis of FEHB utilization, reimbursement, providers, and potential fraud, waste, and abuse. - Pricing: Base-year value is $300,000: $200,000 for the MedInsight data license and $100,000 for HCG grouper application. Estimated total value for the base year and two options is $927,270; option years are estimated at $309,000 and $318,270, respectively, reflecting 3% annual escalation. - Period: Base year plus two option years. Data delivery begins after award, with 12 monthly refreshes during the contract year. Specific calendar start and end dates are not provided.

Description

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.

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