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

Da Vinci Value-Based Performance Reporting Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-vbpr/ and changes regularly. See the Directory of published versions

Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Behavior: Capability Statements

The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements.

VBP Reporting Client Capability Statement

This profile defines the expected capabilities of the Value-Based Performance (VBP) Reporting Client actor, when request and consume value-based performance MeasureReports from a Value-Based Performance Reporting Server. The complete list of FHIR profiles that a VBP Reporting Server could support are defined. VBP Reporting Clients have the option of choosing from this list to access necessary data based on their local use cases and other contextual requirements.

VBP Reporting Server Capability Statement

This profile defines the expected capabilities of the Value-Based Performance (VBP) Reporting Server actor which is responsible for producing value-based performance MeasureReports to be consumed by a Value-Based Performance Reporting Client. The complete list of FHIR profiles and search parameters that a VBP Reporting Server could support are defined. VBP Reporting Servers have the option of choosing from this list to access necessary data based on their local use cases and other contextual requirements.

Behavior: Search Parameters

These define the properties by which a RESTful server can be searched. They can also be used for sorting and including related resources.

measurereport-category

Search based on the measurereport-category extension

measurereport-subject-organization

Search based on subject of type Organization

Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide.

VBP Quality MeasureReport

VBP quality measure report at the summary level for a population. This profile is derived from the Data Exchange for Quality Measure IG’s DEQM Summary MeasureReport.

Value-Based Performance Measure

The measure definition that describes value-based contract level information for a value-based performance report.

Value-Based Performance MeasureReport

Value-Based Performance MeasureReport is a payer-generated performance report against the specific details (metrics) of a value-based contract (VBC) or a value-based purchasing (VBP) which may include financial, quality, utilization, etc. over a time period.

Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide.

Alternate Measure Score

The Alternate Measure Score Extension allows other data type choices to be used for the measureScore element in addition to Quantity. The alternate data type for measure score is determined by the performance metric type.

Baseline

The Baseline Extension is a complex extension. It is used to state the baseline that the performance metric is used for comparisons.

Contractual Status

Contractual status of a measure whether it is tied to payment as specified in a value-based contract.

Group Reference

Reference to a group within the MeasureReport.

Line of Business

The Line of Business (LOB) Extension is used to indicate whether the value-based contract is for Medicare, Medicaid, or commercial (private insurance).

Organization Subject

The Organization Subject Extension allows using Organization as an alternative resource type for the Subject reference.

Paid Through Date

Paid through date is the ending date of the pay cycle.

Payment Stream

The Payment Stream Extension is a complex extension that defines the type of payment stream. A value-based contract may contain different types of payment streams, such as quality incentive payment and care coordination fee.

Program Model

The Program Model Extension is a complex extension, which defines the The Health Care Payment Learning & Action Network (HCPLAN) Alternative Payment Model (APM) framework specified APM categories and which cohort this program model applies to.

Score

The Score Extension is used to specify the score of a measure, such as star score.

Service Period

The Service period for a payment stream.

Threshold

The Threshold Extension is a complex extension that defines a threshold needed to be met when measuring performance.

Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide.

Cohort

Cohort types.

HCPLAN Framework Categories

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

Incentive

What type of incentive.

Line of Business Value Set

Type of line of business.

Measure Contractual Status

Contractual status of a measure as specified in a value-based contract.

Measure Stratifier Example

Example stratifiers that could be used to stratify measure or performance metrics.

Payment Stream Value Set

Type of payment stream.

Performance Metric

Type of value-based performance reporting performance metric.

Threshold Type

The threshold type.

VBP Measure Population Type

Measure population type that includes calculated-denominator and calculated-numerator.

Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide.

Cohort Codes

The type of cohort, which represents a group of members with a shared characteristic.

HCPLAN Framework Categories Codes

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.

Incentive Payment Codes

What type of incentive for a payment stream such as quality incentive payment.

Measure Contractual Status Codes

Contractual status whether a measure is tied to payment as specified in a value-based contract.

Measure Stratifier Example Codes

Example stratifiers that could be used to stratify measure or performance metrics.

Payment Stream Codes

Payment stream defined in a value-based contract. A value-based contract may contain multiple payment streams.

Performance Metric Codes

Type of value-based performance metrics.

Threshold Type Codes

The threshold type.

Value-Based Performance Measure Population Type Codes

Measure population type that includes calculated-denominator and calculated-numerator.

Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.

Example Value-Based Contract - ABC Payer and EveryHospital

This is an example measure for the VBP Measure profile.

Example Value-Based Contract - ABC Payer and GoodHealth

This is an example measure for the VBP Measure profile.

quality-measurereport01

This is an example Breast Cancer Screening MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport02

This is an example Colorectal Cancer Screening MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport03

This is an example Diabetes Care - Blood Sugar Controlled MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport04

This is an example Diabetes Care - Eye Exam MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport05

This is an example Medication Adherence for Cholesterol (Statins) MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport06

This is an example Medication Adherence for Hypertension (RAS antagonists) MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport07

This is an example Medication Adherence for Diabetes Medications MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport08

This is an example Statin Therapy for Patients with Cardiovascular Disease MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport09

This is an example Statin Use in Persons with Diabetes (SUPD) MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport11

This is an example Breast Cancer Screening MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport12

This is an example Colorectal Cancer Screening MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport13

This is an example Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport14

This is an example Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport15

This is an example Diabetes: Medical Attention for Nephropathy MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport20

This is an example Breast Cancer Screening MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport21

This is an example Colorectal Cancer Screening MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport22

This is an example Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Control (<8.0%) MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport23

This is an example Controlling High Blood Pressure MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport24

This is an example Plan All-Cause Readmissions MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport25

This is an example Member Satisfaction Survey MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport30

This is an example Breast Cancer Screening MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport31

This is an example Colorectal Cancer Screening MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport32

This is an example Diabetes Care - Blood Sugar Controlled MeasureReport for the VBP Quality MeasureReport profile.

quality-measurereport33

This is an example Diabetes Care - Eye Exam MeasureReport for the VBP Quality MeasureReport profile.

vbp-measurereport101

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, and quality incentive payment for the annual office visits.

vbp-measurereport102

This is an example Value-Based Performance MeasureReport for the VBP MeasureReport profile., which includes utilizations and quality.

vbp-measurereport103

This is an example Value-Based Performance MeasureReport for the VBP MeasureReport profile., which includes quality measures and alternative measures.

vbp-measurereport104

This is an example Value-Based Performance MeasureReport for the VBP MeasureReport profile.

vbp-payer01

This is an example payer

vbp-provider01

This is an example of Provider organization the Value-Based Performance Report is for.

vbp-provider02

This is an example of Provider organization the Value-Based Performance Report is for.