Code | Display | Definition |
2A | Category 2A | Foundational Payments for Infrastructure and Operations, e.g., care coordination fees and payments for HIT investments. |
2B | Category 2B | Pay for Reporting, e.g., bonuses for reporting data or penalies for not reporting data. |
2C | Category 2C | Pay-for-Performance, e.g., bonuses for quality performance. |
3A | Category 3A | APMs with Shared Savings, e.g., shared savings with upside risk only. |
3B | Category 3B | APMs with Shared Savings and Downside Risk, e.g., episode-based payments for procedures and comprehensive payments with upside and downside risk. |
3N | Category 3N | Risk Based Payments not linked to quality. |
4A | Category 4A | Condition-Specific Population-Based Payment, e.g., per member per month payments, payments for speciality services, such as oncology or mental health. |
4B | Category 4B | Comprehensive Population-Based Payment, e.g., global budgets or full/percent of premium payments. |
4C | Category 4C | Integrated Finance and Delivery System, e.g., global budgets or full/percent of premium payments in integrated systems. |
4N | Category 4N | Capitated Payments not linked to quality. |