Da Vinci Value-Based Performance Reporting Implementation Guide
1.0.0-ballot - ballot United States of America flag

This page is part of the Da Vinci Value-Based Performance Reporting Implementation Guide (v1.0.0-ballot: STU1 Ballot 1) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

ValueSet: HCPLAN Framework Categories

Official URL: http://hl7.org/fhir/us/davinci-vbpr/ValueSet/hcplan-framework Version: 1.0.0-ballot
Active as of 2023-07-31 Computable Name: HCPLANFrameworkVS

HCPLAN framework categories for value-based performance. HCPLAN framework represents payments from public and private payers to provider organizations.

References

Logical Definition (CLD)

 

Expansion

This value set contains 10 concepts

Expansion based on HCPLAN Framework Categories Codes v1.0.0-ballot (CodeSystem)

CodeSystemDisplayDefinition
  2Ahttp://hl7.org/fhir/us/davinci-vbpr/CodeSystem/hcplan-frameworkCategory 2A

Foundational Payments for Infrastructure and Operations, e.g., care coordination fees and payments for HIT investments.

  2Bhttp://hl7.org/fhir/us/davinci-vbpr/CodeSystem/hcplan-frameworkCategory 2B

Pay for Reporting, e.g., bonuses for reporting data or penalies for not reporting data.

  2Chttp://hl7.org/fhir/us/davinci-vbpr/CodeSystem/hcplan-frameworkCategory 2C

Pay-for-Performance, e.g., bonuses for quality performance.

  3Ahttp://hl7.org/fhir/us/davinci-vbpr/CodeSystem/hcplan-frameworkCategory 3A

APMs with Shared Savings, e.g., shared savings with upside risk only.

  3Bhttp://hl7.org/fhir/us/davinci-vbpr/CodeSystem/hcplan-frameworkCategory 3B

APMs with Shared Savings and Downside Risk, e.g., episode-based payments for procedures and comprehensive payments with upside and downside risk.

  3Nhttp://hl7.org/fhir/us/davinci-vbpr/CodeSystem/hcplan-frameworkCategory 3N

Risk Based Payments not linked to quality.

  4Ahttp://hl7.org/fhir/us/davinci-vbpr/CodeSystem/hcplan-frameworkCategory 4A

Condition-Specific Population-Based Payment, e.g., per member per month payments, payments for speciality services, such as oncology or mental health.

  4Bhttp://hl7.org/fhir/us/davinci-vbpr/CodeSystem/hcplan-frameworkCategory 4B

Comprehensive Population-Based Payment, e.g., global budgets or full/percent of premium payments.

  4Chttp://hl7.org/fhir/us/davinci-vbpr/CodeSystem/hcplan-frameworkCategory 4C

Integrated Finance and Delivery System, e.g., global budgets or full/percent of premium payments in integrated systems.

  4Nhttp://hl7.org/fhir/us/davinci-vbpr/CodeSystem/hcplan-frameworkCategory 4N

Capitated Payments not linked to quality.

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code