FHIR © HL7.org  |  Server Home  |  XIG Home  |  Server Source  |  FHIR  

FHIR IG Statistics: CodeSystem/hcplan-framework

Packagehl7.fhir.us.davinci-vbpr
TypeCodeSystem
Idhcplan-framework
FHIR VersionR4
Sourcehttp://hl7.org/fhir/us/davinci-vbpr/https://build.fhir.org/ig/HL7/davinci-vbpr/CodeSystem-hcplan-framework.html
URLhttp://terminology.hl7.org/CodeSystem/hcp-lan-apm-framework
Version1.1.0
Statusactive
Date2025-07-21T02:13:33+00:00
NameHCPLANFrameworkCS
TitleHCPLAN Framework Categories Codes
Realmus
Authorityhl7
DescriptionHCPLAN 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.
Contentcomplete

Resources that use this resource

ValueSet
hcplan-frameworkHCPLAN Framework Categories

Resources that this resource uses

No resources found


Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: CodeSystem hcplan-framework

This case-sensitive code system http://terminology.hl7.org/CodeSystem/hcp-lan-apm-framework defines the following codes:

CodeDisplayDefinition
2A Category 2AFoundational Payments for Infrastructure and Operations, e.g., care coordination fees and payments for HIT investments.
2B Category 2BPay for Reporting, e.g., bonuses for reporting data or penalies for not reporting data.
2C Category 2CPay-for-Performance, e.g., bonuses for quality performance.
3A Category 3AAPMs with Shared Savings, e.g., shared savings with upside risk only.
3B Category 3BAPMs with Shared Savings and Downside Risk, e.g., episode-based payments for procedures and comprehensive payments with upside and downside risk.
3N Category 3NRisk Based Payments not linked to quality.
4A Category 4ACondition-Specific Population-Based Payment, e.g., per member per month payments, payments for speciality services, such as oncology or mental health.
4B Category 4BComprehensive Population-Based Payment, e.g., global budgets or full/percent of premium payments.
4C Category 4CIntegrated Finance and Delivery System, e.g., global budgets or full/percent of premium payments in integrated systems.
4N Category 4NCapitated Payments not linked to quality.

Source

{
  "resourceType": "CodeSystem",
  "id": "hcplan-framework",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "cqi"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 1,
      "_valueInteger": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/us/davinci-vbpr/ImplementationGuide/hl7.fhir.us.davinci-vbpr"
          }
        ]
      }
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "trial-use",
      "_valueCode": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/us/davinci-vbpr/ImplementationGuide/hl7.fhir.us.davinci-vbpr"
          }
        ]
      }
    }
  ],
  "url": "http://terminology.hl7.org/CodeSystem/hcp-lan-apm-framework",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113883.4.642.40.30.16.1"
    }
  ],
  "version": "1.1.0",
  "name": "HCPLANFrameworkCS",
  "title": "HCPLAN Framework Categories Codes",
  "status": "active",
  "experimental": false,
  "date": "2025-07-21T02:13:33+00:00",
  "publisher": "HL7 International / Clinical Quality Information",
  "contact": [
    {
      "name": "HL7 International / Clinical Quality Information",
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/cqi"
        }
      ]
    }
  ],
  "description": "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": "urn:iso:std:iso:3166",
          "code": "US",
          "display": "United States of America"
        }
      ]
    }
  ],
  "caseSensitive": true,
  "content": "complete",
  "count": 10,
  "concept": [
    {
      "code": "2A",
      "display": "Category 2A",
      "definition": "Foundational Payments for Infrastructure and Operations, e.g., care coordination fees and payments for HIT investments."
    },
    {
      "code": "2B",
      "display": "Category 2B",
      "definition": "Pay for Reporting, e.g., bonuses for reporting data or penalies for not reporting data."
    },
    {
      "code": "2C",
      "display": "Category 2C",
      "definition": "Pay-for-Performance, e.g., bonuses for quality performance."
    },
    {
      "code": "3A",
      "display": "Category 3A",
      "definition": "APMs with Shared Savings, e.g., shared savings with upside risk only."
    },
    {
      "code": "3B",
      "display": "Category 3B",
      "definition": "APMs with Shared Savings and Downside Risk, e.g., episode-based payments for procedures and comprehensive payments with upside and downside risk."
    },
    {
      "code": "3N",
      "display": "Category 3N",
      "definition": "Risk Based Payments not linked to quality."
    },
    {
      "code": "4A",
      "display": "Category 4A",
      "definition": "Condition-Specific Population-Based Payment, e.g., per member per month payments, payments for speciality services, such as oncology or mental health."
    },
    {
      "code": "4B",
      "display": "Category 4B",
      "definition": "Comprehensive Population-Based Payment, e.g., global budgets or full/percent of premium payments."
    },
    {
      "code": "4C",
      "display": "Category 4C",
      "definition": "Integrated Finance and Delivery System, e.g., global budgets or full/percent of premium payments in integrated systems."
    },
    {
      "code": "4N",
      "display": "Category 4N",
      "definition": "Capitated Payments not linked to quality."
    }
  ]
}