Da Vinci Value-Based Performance Reporting Implementation Guide
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This page is part of the Da Vinci Value-Based Performance Reporting Implementation Guide (v1.0.0: STU1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: HCPLAN Framework Categories Codes - XML Representation

Active as of 2024-06-17

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="hcplan-framework"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p>This case-sensitive code system <code>http://terminology.hl7.org/CodeSystem/hcp-lan-apm-framework</code> defines the following codes:</p><table class="codes"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style="white-space:nowrap">2A<a name="hcplan-framework-2A"> </a></td><td>Category 2A</td><td>Foundational Payments for Infrastructure and Operations, e.g., care coordination fees and payments for HIT investments.</td></tr><tr><td style="white-space:nowrap">2B<a name="hcplan-framework-2B"> </a></td><td>Category 2B</td><td>Pay for Reporting, e.g., bonuses for reporting data or penalies for not reporting data.</td></tr><tr><td style="white-space:nowrap">2C<a name="hcplan-framework-2C"> </a></td><td>Category 2C</td><td>Pay-for-Performance, e.g., bonuses for quality performance.</td></tr><tr><td style="white-space:nowrap">3A<a name="hcplan-framework-3A"> </a></td><td>Category 3A</td><td>APMs with Shared Savings, e.g., shared savings with upside risk only.</td></tr><tr><td style="white-space:nowrap">3B<a name="hcplan-framework-3B"> </a></td><td>Category 3B</td><td>APMs with Shared Savings and Downside Risk, e.g., episode-based payments for procedures and comprehensive payments with upside and downside risk.</td></tr><tr><td style="white-space:nowrap">3N<a name="hcplan-framework-3N"> </a></td><td>Category 3N</td><td>Risk Based Payments not linked to quality.</td></tr><tr><td style="white-space:nowrap">4A<a name="hcplan-framework-4A"> </a></td><td>Category 4A</td><td>Condition-Specific Population-Based Payment, e.g., per member per month payments, payments for speciality services, such as oncology or mental health.</td></tr><tr><td style="white-space:nowrap">4B<a name="hcplan-framework-4B"> </a></td><td>Category 4B</td><td>Comprehensive Population-Based Payment, e.g., global budgets or full/percent of premium payments.</td></tr><tr><td style="white-space:nowrap">4C<a name="hcplan-framework-4C"> </a></td><td>Category 4C</td><td>Integrated Finance and Delivery System, e.g., global budgets or full/percent of premium payments in integrated systems.</td></tr><tr><td style="white-space:nowrap">4N<a name="hcplan-framework-4N"> </a></td><td>Category 4N</td><td>Capitated Payments not linked to quality.</td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="cqi"/>
  </extension>
  <url value="http://terminology.hl7.org/CodeSystem/hcp-lan-apm-framework"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.40.30.16.1"/>
  </identifier>
  <version value="1.0.0"/>
  <name value="HCPLANFrameworkCS"/>
  <title value="HCPLAN Framework Categories Codes"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2024-06-17T14:02:59+00:00"/>
  <publisher value="HL7 International / Clinical Quality Information"/>
  <contact>
    <name value="HL7 International / Clinical Quality Information"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/cqi"/>
    </telecom>
  </contact>
  <description
               value="HCPLAN Framework represents payments from public and private payers to provider organizations (including payments between the payment and delivery arms of highly integrated health systems). It is designed to accommodate payments in multiple categories that are made by a single payer, as well as single provider organizations that receive payments in different categories—potentially from the same payer. Although payments will be classified in discrete categories, the Framework captures a continuum of clinical and financial risk for provider organizations."/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
      <display value="United States of America"/>
    </coding>
  </jurisdiction>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <count value="10"/>
  <concept>
    <code value="2A"/>
    <display value="Category 2A"/>
    <definition
                value="Foundational Payments for Infrastructure and Operations, e.g., care coordination fees and payments for HIT investments."/>
  </concept>
  <concept>
    <code value="2B"/>
    <display value="Category 2B"/>
    <definition
                value="Pay for Reporting, e.g., bonuses for reporting data or penalies for not reporting data."/>
  </concept>
  <concept>
    <code value="2C"/>
    <display value="Category 2C"/>
    <definition
                value="Pay-for-Performance, e.g., bonuses for quality performance."/>
  </concept>
  <concept>
    <code value="3A"/>
    <display value="Category 3A"/>
    <definition
                value="APMs with Shared Savings, e.g., shared savings with upside risk only."/>
  </concept>
  <concept>
    <code value="3B"/>
    <display value="Category 3B"/>
    <definition
                value="APMs with Shared Savings and Downside Risk, e.g., episode-based payments for procedures and comprehensive payments with upside and downside risk."/>
  </concept>
  <concept>
    <code value="3N"/>
    <display value="Category 3N"/>
    <definition value="Risk Based Payments not linked to quality."/>
  </concept>
  <concept>
    <code value="4A"/>
    <display value="Category 4A"/>
    <definition
                value="Condition-Specific Population-Based Payment, e.g., per member per month payments, payments for speciality services, such as oncology or mental health."/>
  </concept>
  <concept>
    <code value="4B"/>
    <display value="Category 4B"/>
    <definition
                value="Comprehensive Population-Based Payment, e.g., global budgets or full/percent of premium payments."/>
  </concept>
  <concept>
    <code value="4C"/>
    <display value="Category 4C"/>
    <definition
                value="Integrated Finance and Delivery System, e.g., global budgets or full/percent of premium payments in integrated systems."/>
  </concept>
  <concept>
    <code value="4N"/>
    <display value="Category 4N"/>
    <definition value="Capitated Payments not linked to quality."/>
  </concept>
</CodeSystem>