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Value Based Performance Reporting Implementation Guide (Jira PSS-2113)

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Basics

Value Based Performance Reporting Implementation Guide (Jira PSS-2113)

1781
Ballot - STU

FHIR

FHIR Implementation Guide

Implementation Guide

STU
Details

This project aims to develop a FHIR implementation guide to support value-based performance reporting for quality and risk contracts. Standardized bi-directional, FHIR-based communication will connect payer baseline reporting data with provider organization data at the population level. It will also provide the flexibility to compare interim progress at different times during the contract performance period, in addition to notifying providers of non-clinical pre-defined events that may have a direct effect on financial performance and ultimately success.

Payers and providers need a standards-based methodology to calculate the quality and financial performance of a provider organization on a value-based contract including but not limited to these parameters:

- Contract detail at a population level

- Population pool funding

- Expenditures (current and target)

- Quality and risk (current and target)

- Earnings

- Performance and incentives

The project is supported by the Da Vinci Project. The project team will select an initial set of various terms and measures for contract level financial metrics to use as demonstrations and examples of the underlying framework. Wherever applicable, this project will work with existing FHIR artifacts and utilize and reference prior work from, but not limited to, USCore, Da Vinci implementation guides such as Data Exchange for Quality Measure (DEQM), Risk Adjustment, Member Attribution (ATR), Clinical Data Exchange (CDex), Payer Data Exchange (PDex), Health Record Exchange (Hrex), etc.

This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile, we will follow the Cross Group Projects WG's variance request process, and provide the US Realm Steering Committee an approved rationale for deviation in the implementation guide where applicable.


A Value-Based Contract is a written contractual agreement between parties in which the payment for health care goods and services is tied to predetermined, mutually agreed upon terms that are based on clinical circumstances, patient outcomes, financial benchmarks and other specified measures of the appropriateness and effectiveness of the services rendered. With the shift from fee for service to value-based care, Value-Based Contracts have emerged as a mechanism that payers may use to better align their contracting structures with broader changes in the health care system.

Standardization of payer/provider performance reporting for quality and risk contracts is crucial for health systems and other provider organizations to receive timely interim reports to track and manage their performance on value-based contracts during the term.

Payer-generated value based performance reports are crucial because payers are generally in the best position to be the arbiters in determining financial performance on risk contracts with health systems. Unfortunately, there is a lack of standardizations for reporting format, the process is usually resource intensive, not very scalable and data reconciliation process is complex. Payers are also facing challenges such as lacking common contract term definitions, for example Total Cost of Care could have many different calculations, retrieving data is time and resource intensive, data is error-prone based on human errors when entering reporting system, and applying rules across different line of business (i.e., PPO, HMO, Federal Employee Benefits).



FHIR IG - Release 1 - Target: STU ballot cycle 2023 Sept


http://github.com/HL7/davinci-vbpr PSS: https://jira.hl7.org/browse/PSS-2113?src=confmacro

None

FHIR R4, US-Core

Other (specify in Misc. Notes below)

Humana Providence Edifecs Novillus

CMS is driving the national movement towards Value-Based Contracting through Medicare programs such as Medicare Shared Savings Program (MSSP), Hospital Value-Based Purchasing (VBP) Program and others. CMS is also driving State Medicaid agencies to submit 1115 waiver requests (Delivery System Reform Incentive Payment (DSRIP)) to radically transform programs with Value-Based Contracting transformations. Provider organization are increasing participation in Medicare Value-Based Contracts.

Value Based Performance Reporting, Value Based Performance Report, VBPR, DaVinci VBPR


Don't Know

N/A

No

2026 Feb: TSC approved an STU Extension Request for HL7 FHIR® Implementation Guide: Value Based Performance Reporting (VBPR), Edition 1 - US Realm 2024 May: TSC approved STU Publication Request for HL7 FHIR Implementation Guide: Value Based Performance Reporting (VBPR), Edition 1 - US Realm for 2 years Stakeholders: Association/Goverment Agency, Healthcare IT Vendors, Healthcare Provider/user, Other, Payer/Third Party Administrator, Providers, Regulatory Agency, Accountable Care Organizations (ACOs)
Organization & Realm

Realm Specific - US

People

Yan Heras



Clinical Quality Information Work Group

Payer/Provider Info Exchange Work Group

Status & Dates

Active

STU - Test Period/Accepting Comments

09/21/2022

09/01/2028

2028 Sept WGM/Ballot

09/15/2028

2028 Sept WGM/Ballot

2023 Sept Ballot Cycle Info: STU Ballot results: Met basic vote requirements. 2 Negatives to reconcile Document Name: HL7 FHIR Implementation Guide: Value Based Performance Reporting (VBPR), Release 1 - US Realm
Approvals

10/26/2022


Received


All Received




FHIR Management Group -- Agreed -- (PSS-2116)
US Realm -- Agreed -- (PSS-2117)
System Info

194609

PSS-2113

https://jira.hl7.org/browse/PSS-2113
View Ballot Items (with NIBs)



04/09/2026

Anne Wizauer
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