Da Vinci Value-Based Performance Reporting Implementation Guide
1.0.0 - STU1 United States of America flag

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

: Example Value-Based Contract - ABC Payer and GoodHealth - XML Representation

Active as of 2024-06-17

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<Measure xmlns="http://hl7.org/fhir">
  <id value="vbp-measure01"/>
  <meta>
    <extension url="http://hl7.org/fhir/StructureDefinition/instance-name">
      <valueString value="Payer"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/StructureDefinition/instance-description">
      <valueMarkdown
                     value="This is an example measure for the *VBP Measure* profile."/>
    </extension>
    <profile
             value="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/vbp-measure"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Measure </b><a name="vbp-measure01"> </a><a name="hcvbp-measure01"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">ResourceMeasure &quot;vbp-measure01&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-vbp-measure.html">Value-Based Performance Measure</a></p></div><p><b>Line of Business</b>: MEDICARE <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-SOPT.html">Source of Payment Typology</a>#1)</span></p><blockquote><p><b>Program Model</b></p><blockquote><p><b>url</b></p><code>hcplan</code></blockquote><p><b>value</b>: Category 3A <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-hcplan-framework.html">HCPLAN Framework Categories Codes</a>#3A)</span></p><blockquote><p><b>url</b></p><code>cohort</code></blockquote><p><b>value</b>: HMO cohort <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-vbp-cohort.html">Cohort Codes</a>#hmo)</span></p></blockquote><blockquote><p><b>Program Model</b></p><blockquote><p><b>url</b></p><code>hcplan</code></blockquote><p><b>value</b>: Category 3B <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-hcplan-framework.html">HCPLAN Framework Categories Codes</a>#3B)</span></p><blockquote><p><b>url</b></p><code>cohort</code></blockquote><p><b>value</b>: PPO cohort <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-vbp-cohort.html">Cohort Codes</a>#ppo)</span></p></blockquote><blockquote><p><b>Payment Stream</b></p><blockquote><p><b>url</b></p><code>type</code></blockquote><p><b>value</b>: Shared savings gated on quality <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-payment-stream.html">Payment Stream Codes</a>#ssq)</span></p></blockquote><blockquote><p><b>Payment Stream</b></p><blockquote><p><b>url</b></p><code>type</code></blockquote><p><b>value</b>: Care coordination fee <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-payment-stream.html">Payment Stream Codes</a>#ccf)</span></p></blockquote><blockquote><p><b>Payment Stream</b></p><blockquote><p><b>url</b></p><code>type</code></blockquote><p><b>value</b>: Quality incentive payment <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-payment-stream.html">Payment Stream Codes</a>#qip)</span></p></blockquote><p><b>url</b>: <code>https://build.fhir.org/ig/HL7/davinci-vbpr/Measure-vbp-measure01</code></p><p><b>identifier</b>: <code>http://example.org/fhir/server</code>/ex-vbp-measure01 (use: temp), <a href="http://terminology.hl7.org/5.5.0/NamingSystem-uri.html" title="As defined by RFC 3986 (http://www.ietf.org/rfc/rfc3986.txt)(with many schemes defined in many RFCs). For OIDs and UUIDs, use the URN form (urn:oid:(note: lowercase) and urn:uuid:). See http://www.ietf.org/rfc/rfc3001.txt and http://www.ietf.org/rfc/rfc4122.txt 

This oid is used as an identifier II.root to indicate the the extension is an absolute URI (technically, an IRI). Typically, this is used for OIDs and GUIDs. Note that when this OID is used with OIDs and GUIDs, the II.extension should start with urn:oid or urn:uuid: 

Note that this OID is created to aid with interconversion between CDA and FHIR - FHIR uses urn:ietf:rfc:3986 as equivalent to this OID. URIs as identifiers appear more commonly in FHIR.

This OID may also be used in CD.codeSystem.">Uniform Resource Identifier (URI)</a>/urn:oid:2.16.840.1.113883.4.642.40.30.29.1</p><p><b>version</b>: 1.0.0</p><p><b>name</b>: VbprMeasureExample01</p><p><b>title</b>: Example Value-Based Contract - ABC Payer and GoodHealth</p><p><b>status</b>: active</p><p><b>experimental</b>: true</p><p><b>date</b>: 2024-06-17 14:02:59+0000</p><p><b>publisher</b>: HL7 International / Clinical Quality Information</p><p><b>contact</b>: HL7 International / Clinical Quality Information: <a href="http://www.hl7.org/Special/committees/cqi">http://www.hl7.org/Special/committees/cqi</a></p><p><b>description</b>: Example Value-Based Contract between ABC Payer and GoodHealth</p><p><b>jurisdiction</b>: United States of America <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-ISO3166Part1.html">ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code</a>#US)</span></p><p><b>effectivePeriod</b>: 2022-01-01 --&gt; 2024-12-31</p><h3>RelatedArtifacts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Extension</b></td><td><b>Type</b></td><td><b>Display</b></td><td><b>Resource</b></td></tr><tr><td style="display: none">*</td><td>, </td><td>composed-of</td><td>Breast Cancer Screening</td><td><a href="http://hl7.org/fhir/us/cqfmeasures/STU3/Measure-measure-exm125-FHIR.html">EXM125 - Breast Cancer Screening Measure</a></td></tr><tr><td style="display: none">*</td><td>, </td><td>composed-of</td><td>Colorectal Cancer Screening</td><td><a href="http://hl7.org/fhir/us/cqfmeasures/STU3/Measure-measure-exm130-FHIR.html">EXM130 - Colorectal Cancer Screening Measure</a></td></tr><tr><td style="display: none">*</td><td>, </td><td>composed-of</td><td>Diabetes Care - Blood Sugar Controlled</td><td><a href="http://example.org/Measure/measure-diabetes-care-blood-sugar-controlled-FHIR">http://example.org/Measure/measure-diabetes-care-blood-sugar-controlled-FHIR</a></td></tr><tr><td style="display: none">*</td><td>, </td><td>composed-of</td><td>Diabetes Care - Eye Exam</td><td><a href="http://example.org/Measure/measure-diabetes-care-eye-exam-FHIR">http://example.org/Measure/measure-diabetes-care-eye-exam-FHIR</a></td></tr><tr><td style="display: none">*</td><td>, </td><td>composed-of</td><td>Medication Adherence for Cholesterol (Statins)</td><td><a href="http://example.org/Measure/measure-med-adherence-cholesterol-statins-FHIR">http://example.org/Measure/measure-med-adherence-cholesterol-statins-FHIR</a></td></tr><tr><td style="display: none">*</td><td>, </td><td>composed-of</td><td>Medication Adherence for Hypertension (RAS antagonists)</td><td><a href="http://example.org/Measure/measure-med-adherence-hypertension-FHIR">http://example.org/Measure/measure-med-adherence-hypertension-FHIR</a></td></tr><tr><td style="display: none">*</td><td>, </td><td>composed-of</td><td>Medication Adherence for Diabetes Medications</td><td><a href="http://example.org/Measure/measure-med-adherence-diabetes-meds-FHIR">http://example.org/Measure/measure-med-adherence-diabetes-meds-FHIR</a></td></tr><tr><td style="display: none">*</td><td>, </td><td>composed-of</td><td>Statin Therapy for Patients with Cardiovascular Disease</td><td><a href="http://example.org/Measure/measure-statin-therapy-cardiovascular-disease-FHIR">http://example.org/Measure/measure-statin-therapy-cardiovascular-disease-FHIR</a></td></tr><tr><td style="display: none">*</td><td>, </td><td>composed-of</td><td>Statin Use in Persons with Diabetes (SUPD)</td><td><a href="http://example.org/Measure/measure-statin-use-diabetes-supd-FHIR">http://example.org/Measure/measure-statin-use-diabetes-supd-FHIR</a></td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/lob">
    <valueCodeableConcept>
      <coding>
        <system value="https://nahdo.org/sopt"/>
        <code value="1"/>
        <display value="MEDICARE"/>
      </coding>
      <text value="MEDICARE"/>
    </valueCodeableConcept>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/program-model">
    <extension url="hcplan">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/hcp-lan-apm-framework"/>
          <code value="3A"/>
          <display value="Category 3A"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="cohort">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/vbp-cohort"/>
          <code value="hmo"/>
          <display value="HMO cohort"/>
        </coding>
      </valueCodeableConcept>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/program-model">
    <extension url="hcplan">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/hcp-lan-apm-framework"/>
          <code value="3B"/>
          <display value="Category 3B"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="cohort">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/vbp-cohort"/>
          <code value="ppo"/>
          <display value="PPO cohort"/>
        </coding>
      </valueCodeableConcept>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/payment-stream">
    <extension url="type">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/payment-stream"/>
          <code value="ssq"/>
        </coding>
        <text value="Shared savings gated on quality"/>
      </valueCodeableConcept>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/payment-stream">
    <extension url="type">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/payment-stream"/>
          <code value="ccf"/>
        </coding>
        <text value="Care coordination fee"/>
      </valueCodeableConcept>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/payment-stream">
    <extension url="type">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/payment-stream"/>
          <code value="qip"/>
        </coding>
        <text value="Quality incentive payment"/>
      </valueCodeableConcept>
    </extension>
  </extension>
  <url
       value="https://build.fhir.org/ig/HL7/davinci-vbpr/Measure-vbp-measure01"/>
  <identifier>
    <use value="temp"/>
    <system value="http://example.org/fhir/server"/>
    <value value="ex-vbp-measure01"/>
  </identifier>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.40.30.29.1"/>
  </identifier>
  <version value="1.0.0"/>
  <name value="VbprMeasureExample01"/>
  <title value="Example Value-Based Contract - ABC Payer and GoodHealth"/>
  <status value="active"/>
  <experimental value="true"/>
  <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="Example Value-Based Contract between ABC Payer and GoodHealth"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
      <display value="United States of America"/>
    </coding>
  </jurisdiction>
  <effectivePeriod>
    <start value="2022-01-01"/>
    <end value="2024-12-31"/>
  </effectivePeriod>
  <relatedArtifact>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-weight">
      <valueDecimal value="1"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/contractual-status">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-contractual-status"/>
          <code value="contractual"/>
          <display value="Contractual"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <type value="composed-of"/>
    <display value="Breast Cancer Screening"/>
    <resource
              value="http://hl7.org/fhir/us/cqfmeasures/Measure/measure-exm125-FHIR"/>
  </relatedArtifact>
  <relatedArtifact>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-weight">
      <valueDecimal value="3"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/contractual-status">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-contractual-status"/>
          <code value="contractual"/>
          <display value="Contractual"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <type value="composed-of"/>
    <display value="Colorectal Cancer Screening"/>
    <resource
              value="http://hl7.org/fhir/us/cqfmeasures/Measure/measure-exm130-FHIR"/>
  </relatedArtifact>
  <relatedArtifact>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-weight">
      <valueDecimal value="3"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/contractual-status">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-contractual-status"/>
          <code value="contractual"/>
          <display value="Contractual"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <type value="composed-of"/>
    <display value="Diabetes Care - Blood Sugar Controlled"/>
    <resource
              value="http://example.org/Measure/measure-diabetes-care-blood-sugar-controlled-FHIR"/>
  </relatedArtifact>
  <relatedArtifact>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-weight">
      <valueDecimal value="3"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/contractual-status">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-contractual-status"/>
          <code value="contractual"/>
          <display value="Contractual"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <type value="composed-of"/>
    <display value="Diabetes Care - Eye Exam"/>
    <resource
              value="http://example.org/Measure/measure-diabetes-care-eye-exam-FHIR"/>
  </relatedArtifact>
  <relatedArtifact>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-weight">
      <valueDecimal value="3"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/contractual-status">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-contractual-status"/>
          <code value="reporting-only"/>
          <display value="Reporting Only"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <type value="composed-of"/>
    <display value="Medication Adherence for Cholesterol (Statins)"/>
    <resource
              value="http://example.org/Measure/measure-med-adherence-cholesterol-statins-FHIR"/>
  </relatedArtifact>
  <relatedArtifact>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-weight">
      <valueDecimal value="3"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/contractual-status">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-contractual-status"/>
          <code value="contractual"/>
          <display value="Contractual"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <type value="composed-of"/>
    <display value="Medication Adherence for Hypertension (RAS antagonists)"/>
    <resource
              value="http://example.org/Measure/measure-med-adherence-hypertension-FHIR"/>
  </relatedArtifact>
  <relatedArtifact>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-weight">
      <valueDecimal value="3"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/contractual-status">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-contractual-status"/>
          <code value="contractual"/>
          <display value="Contractual"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <type value="composed-of"/>
    <display value="Medication Adherence for Diabetes Medications"/>
    <resource
              value="http://example.org/Measure/measure-med-adherence-diabetes-meds-FHIR"/>
  </relatedArtifact>
  <relatedArtifact>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-weight">
      <valueDecimal value="1"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/contractual-status">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-contractual-status"/>
          <code value="contractual"/>
          <display value="Contractual"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <type value="composed-of"/>
    <display value="Statin Therapy for Patients with Cardiovascular Disease"/>
    <resource
              value="http://example.org/Measure/measure-statin-therapy-cardiovascular-disease-FHIR"/>
  </relatedArtifact>
  <relatedArtifact>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-weight">
      <valueDecimal value="1"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/contractual-status">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-contractual-status"/>
          <code value="contractual"/>
          <display value="Contractual"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <type value="composed-of"/>
    <display value="Statin Use in Persons with Diabetes (SUPD)"/>
    <resource
              value="http://example.org/Measure/measure-statin-use-diabetes-supd-FHIR"/>
  </relatedArtifact>
</Measure>