{ "resourceType" : "MeasureReport", "id" : "vbp-measurereport101", "meta" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/instance-name", "valueString" : "VBP MeasureReport Example 101" }, { "url" : "http://hl7.org/fhir/StructureDefinition/instance-description", "valueMarkdown" : "This is an example Value-Based Performance MeasureReport for the *VBP MeasureReport* profile., which includes examples for payment streams shared savings - gated on quality, care coordination fee, quality incentive payment for the chronic care management incentive program, quality incentive payment for the annual office visits, and quality measure performance." }], "profile" : ["http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/vbp-performance-measurereport"] }, "text" : { "status" : "extensions", "div" : "

Generated Narrative: MeasureReport vbp-measurereport101

Profile: Value-Based Performance MeasureReport

Measure Report Category: Value-Based Performance

status: Complete

type: Summary

measure: Example Value-Based Contract - ABC Payer and GoodHealth

subject: Good Health Clinic

date: 2023-01-15

reporter: Organization ABC Payer

period: 2022-01-01 --> 2022-12-31

group

id

ccf-group-01

Payment Stream

  • type: Care coordination fee

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Care coordination fee

measureScore:

stratifier

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

group

id

ssq-group-starscore

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Weighted average star

measureScore: 3.8

group

id

ssq-group-01

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Member months

measureScore: 300

stratifier

stratum

value: HMO cohort

measureScore: 100

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 50

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 50

stratum

value: PPO cohort

measureScore: 200

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 150

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 50

group

id

ssq-group-02

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Average risk score

measureScore: 0.7

stratifier

stratum

value: HMO cohort

measureScore: 0.8

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 0.9

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 1

stratum

value: PPO cohort

measureScore: 1.1

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 1.2

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 1.3

group

id

ssq-group-03

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Total revenue

measureScore: 10000

stratifier

stratum

value: HMO cohort

measureScore: 6000

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 3000

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 3000

stratum

value: PPO cohort

measureScore: 4000

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 2000

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 2000

group

id

ssq-group-04

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Revenue PMPM

measureScore: 33

stratifier

stratum

value: HMO cohort

measureScore: 60

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 60

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 60

stratum

value: PPO cohort

measureScore: 20

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 13

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 40

group

id

ssq-group-05

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Medical pharmacy cost

measureScore: 9000

stratifier

stratum

value: HMO cohort

measureScore: 5000

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 3000

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 2000

stratum

value: PPO cohort

measureScore: 4000

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 2000

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 3000

group

id

ssq-group-06

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Medical pharmacy cost PMPM

measureScore: 30

stratifier

stratum

value: HMO cohort

measureScore: 50

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 60

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 40

stratum

value: PPO cohort

measureScore: 20

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 13

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 60

group

id

ssq-group-07

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Medical cost fund

measureScore: 90 % (Details: UCUM code% = '%')

stratifier

stratum

value: HMO cohort

measureScore: 83.3 % (Details: UCUM code% = '%')

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 100 % (Details: UCUM code% = '%')

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 66.7 % (Details: UCUM code% = '%')

stratum

value: PPO cohort

measureScore: 100 % (Details: UCUM code% = '%')

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 100 % (Details: UCUM code% = '%')

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 150 % (Details: UCUM code% = '%')

group

id

ssq-group-08

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Medical cost target

measureScore: 85 % (Details: UCUM code% = '%')

stratifier

stratum

value: HMO cohort

measureScore: 85 % (Details: UCUM code% = '%')

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 85 % (Details: UCUM code% = '%')

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 85 % (Details: UCUM code% = '%')

stratum

value: PPO cohort

measureScore: 85 % (Details: UCUM code% = '%')

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 85 % (Details: UCUM code% = '%')

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 85 % (Details: UCUM code% = '%')

group

id

ssq-group-09

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Medical pharmacy cost target

measureScore: 8500

stratifier

stratum

value: HMO cohort

measureScore: 5100

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 2550

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 2550

stratum

value: PPO cohort

measureScore: 3400

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 1700

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 1700

group

id

ssq-group-10

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Variance cost

measureScore: -500

stratifier

stratum

value: HMO cohort

measureScore: 100

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 450

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 550

stratum

value: PPO cohort

measureScore: -600

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: -300

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: -1300

group

id

ssq-group-11

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Average risk score market

measureScore: 0.7

stratifier

stratum

value: HMO cohort

measureScore: 0.71

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 0.72

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 0.72

stratum

value: PPO cohort

measureScore: 0.71

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 0.7

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 0.69

group

id

ssq-group-12

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Market average revenue PMPM

measureScore: 35

stratifier

stratum

value: HMO cohort

measureScore: 40

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 32

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 36

stratum

value: PPO cohort

measureScore: 50

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 29

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 30

group

id

ssq-group-13

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Market average medical pharmacy cost PMPM

measureScore: 94.3 % (Details: UCUM code% = '%')

stratifier

stratum

value: HMO cohort

measureScore: 102.5 % (Details: UCUM code% = '%')

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 109.4 % (Details: UCUM code% = '%')

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 83.3 % (Details: UCUM code% = '%')

stratum

value: PPO cohort

measureScore: 70 % (Details: UCUM code% = '%')

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 103.4 % (Details: UCUM code% = '%')

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 110 % (Details: UCUM code% = '%')

group

id

ssq-group-14

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Care coordination fee

measureScore: 1500

stratifier

stratum

value: HMO cohort

measureScore: 500

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 250

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 250

stratum

value: PPO cohort

measureScore: 1000

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 750

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 250

group

id

ssq-group-15

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Qulaity payment chronic

measureScore: 11900

stratifier

stratum

value: HMO cohort

measureScore: 3966.67

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 1983.33

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 1983.33

stratum

value: PPO cohort

measureScore: 7933.33

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 5950

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 1983.33

group

id

ssq-group-16

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Qulaity payment office visit

measureScore: 300

stratifier

stratum

value: HMO cohort

measureScore: 100

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: 50

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 50

stratum

value: PPO cohort

measureScore: 200

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: 150

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: 50

group

id

ssq-group-17

Payment Stream

  • type: Shared savings gated on quality

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Shared saving deficit

measureScore: -400

stratifier

stratum

value: HMO cohort

measureScore: 50

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 1

measureScore: -360

stratum

component

code: Cohort

value: HMO cohort

component

code: Facility

value: Region 2

measureScore: 275

stratum

value: PPO cohort

measureScore: -480

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 1

measureScore: -240

stratum

component

code: Cohort

value: PPO cohort

component

code: Facility

value: Region 2

measureScore: -1040

group

id

qip-group-01

Payment Stream

  • type: Quality incentive payment
  • incentive: Annual office visit

Service Period: 2022-01-01 --> 2022-11-30

Paid Through Date: 2022-12-31

code: Average members with office visit

measureScore: 87 % (Details: UCUM code% = '%')

group

id

qip-group-02

Payment Stream

  • type: Quality incentive payment
  • incentive: Chronic care management incentive program

Service Period: 2022-01-01 --> 2022-09-30

Paid Through Date: 2022-09-30

code: Eligible member

measureScore: 500

stratifier

code: Condition count

stratum

value: 1

measureScore: 100

stratum

value: 2

measureScore: 200

stratum

value: 3

measureScore: 50

stratum

value: 4

measureScore: 50

stratum

value: 5+

measureScore: 100

group

id

qip-group-03

Payment Stream

  • type: Quality incentive payment
  • incentive: Chronic care management incentive program

Service Period: 2022-01-01 --> 2022-09-30

Paid Through Date: 2022-09-30

code: 1 gap closed

measureScore: 100

stratifier

code: Condition count

stratum

value: 1

measureScore: 20

stratum

value: 2

measureScore: 30

stratum

value: 3

measureScore: 20

stratum

value: 4

measureScore: 10

stratum

value: 5+

measureScore: 20

group

id

qip-group-04

Payment Stream

  • type: Quality incentive payment
  • incentive: Chronic care management incentive program

Service Period: 2022-01-01 --> 2022-09-30

Paid Through Date: 2022-09-30

code: 2 gap closed

measureScore: 0

stratifier

code: Condition count

stratum

value: 1

measureScore: 0

stratum

value: 2

measureScore: 0

stratum

value: 3

measureScore: 0

stratum

value: 4

measureScore: 0

stratum

value: 5+

measureScore: 0

group

id

qip-group-05

Payment Stream

  • type: Quality incentive payment
  • incentive: Chronic care management incentive program

Service Period: 2022-01-01 --> 2022-09-30

Paid Through Date: 2022-09-30

code: Interim payment rate

stratifier

code: Condition count

stratum

value: 1

measureScore: 20

stratum

value: 2

measureScore: 50

stratum

value: 3

measureScore: 100

stratum

value: 4

measureScore: 200

stratum

value: 5+

measureScore: 300

group

id

qip-group-06

Payment Stream

  • type: Quality incentive payment
  • incentive: Chronic care management incentive program

Service Period: 2022-01-01 --> 2022-09-30

Paid Through Date: 2022-09-30

code: Earned incentive

measureScore: 11900

stratifier

code: Condition count

stratum

value: 1

measureScore: 400

stratum

value: 2

measureScore: 1500

stratum

value: 3

measureScore: 2000

stratum

value: 4

measureScore: 2000

stratum

value: 5+

measureScore: 6000

evaluatedResource:

" }, "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/measurereport-category", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/CodeSystem/measurereport-category", "code" : "vbp" }] } }], "status" : "complete", "type" : "summary", "measure" : "https://build.fhir.org/ig/HL7/davinci-vbpr/Measure-vbp-measure01", "subject" : { "reference" : "Group/goodhealth-group", "display" : "Good Health Clinic" }, "date" : "2023-01-15", "reporter" : { "reference" : "Organization/vbp-payer01" }, "period" : { "start" : "2022-01-01", "end" : "2022-12-31" }, "group" : [{ "id" : "ccf-group-01", "extension" : [{ "extension" : [{ "url" : "type", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/payment-stream", "code" : "ccf" }], "text" : "Care coordination fee" } }], "url" : "http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/payment-stream" }, { "url" : "http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/service-period", "valuePeriod" : { "start" : "2022-01-01", "end" : "2022-11-30" } }, { "url" : "http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/paid-through-date", "valueDate" : "2022-12-31" }], "code" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/vbp-performance-metric", "code" : "ccf" }], "text" : "Care coordination fee" }, "measureScore" : { "extension" : [{ "url" : "http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/alternate-measurescore", "valueMoney" : { "value" : 500, "currency" : "USD" } }] }, "stratifier" : [{ "stratum" : [{ "component" : [{ "code" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-stratifier-example", "code" : "cohort" }] }, "value" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/vbp-cohort", "code" : "hmo" }] } }, { "code" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-stratifier-example", "code" : "facility" }] }, "value" : { "text" : "Region 1" } }] }, { "component" : [{ "code" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-stratifier-example", "code" : "cohort" }] }, "value" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/vbp-cohort", "code" : "hmo" }] } }, { "code" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-stratifier-example", "code" : "facility" }] }, "value" : { "text" : "Region 2" } }] }, { "component" : [{ "code" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-stratifier-example", "code" : "cohort" }] }, "value" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/vbp-cohort", "code" : "ppo" }] } }, { "code" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-stratifier-example", "code" : "facility" }] }, "value" : { "text" : "Region 1" } }] }, { "component" : [{ "code" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-stratifier-example", "code" : "cohort" }] }, "value" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/vbp-cohort", "code" : "ppo" }] } }, { "code" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/measure-stratifier-example", "code" : "facility" }] }, "value" : { "text" : "Region 2" } }] }] }] }, { "id" : "ssq-group-starscore", "extension" : [{ "extension" : [{ "url" : "type", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/us/davinci-vbpr/CodeSystem/payment-stream", "code" : "ssq" }], "text" : "Shared savings gated on quality" } }], "url" : "http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/payment-stream" }, { "url" : "http://hl7.org/fhir/us/davinci-vbpr/StructureDefinition/service-period", "valuePeriod" : { "start" : "2022-01-01", 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