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Difference between revisions of "Da Vinci Risk Based Contract Member Identification FHIR IG Proposal"

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(Clarified sections.)
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==Scope of coverage==
 
==Scope of coverage==
The implementation guide will reuse the existing US Core Patient profile and bulk data to support patient inclusion in a risk based contract or create such a patient in the PM/EHR if the patient does already exist and the PM/EHR has the capability.
+
The implementation guide will enable Payers and Providers to exchange Member Attribution Lists which are a necessity for Risk Based Contracts. The IG builds on US Core 3.1.0 and Bulk Data IG to enable the Member Attribution list data exchange.  
  
 
==Content location==
 
==Content location==
https://github.com/HL7/davinci-rbc
+
https://github.com/hl7/davinci-atr
  
 
==Proposed IG realm and code==
 
==Proposed IG realm and code==
us/DaVinci-RBC
+
us/DaVinci-ATR
  
 
==Maintenance Plan==
 
==Maintenance Plan==
Line 42: Line 42:
  
 
==Short Description==
 
==Short Description==
Enable systems to exchange a roster of patients for inclusion in a risk based contract  
+
Enable Payers and Providers to exchange a roster of patients for inclusion in a risk based contract  
  
 
==Long Description==
 
==Long Description==
The implementation guide will define how to use the bulk data IG for payers and providers to synchronize data from practice management and EHRs, and to enable providers and payer organization to validate enrollment in Value-Based Care (VBC) programs at the point of care and for population level program management.  
+
The implementation guide will define the mechanisms, resources, profiles and extensions required to exchange Member Attribution Lists. The Member Attribution Lists enable providers and payer organization to validate enrollment in Value-Based Care (VBC) programs and support reporting requirements and payment reconciliation.  
  
 
==Involved parties==
 
==Involved parties==
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| colspan="2" |'''1) Cambia Healthcare Solutions'''
 
| colspan="2" |'''1) Cambia Healthcare Solutions'''
 
|-
 
|-
| colspan="2" |2) BCBS Michigan
+
| colspan="2" |2) MultiCare
 
|-
 
|-
| colspan="2" |3) United Healthcare
+
| colspan="2" |3) Providence
 
|-
 
|-
| colspan="2" |4) BCBS Florida
+
| colspan="2" |
 
|-
 
|-
| colspan="2" |5) Humana
+
| colspan="2" |
 
|}
 
|}
  
 
==Content sources==
 
==Content sources==
Requirements are drawn from payer organizations as part of the Da Vinci initiative
+
Requirements are drawn from payer and provider organizations as part of the Da Vinci initiative
  
 
==Example Scenarios==
 
==Example Scenarios==
A payer may provide a roster of patients to a clinical system to notify patient enrollment
+
A payer may provide a roster of patients to a provider for a specific risk based contract.
  
An EHR may provide a roster of patients to a payer to confirm patient enrollment
+
A Provider organization may submit a roster of patients to a payer to confirm patient enrollment
  
 
==IG Relationships==
 
==IG Relationships==
This project build on US Core 3.1.0 (based on R4) and the HRex implementation guide for the automated exchange of information between a payer and provider using standard profiles and constraints on existing exchange methods, including Bulk Data.
+
This project build on US Core 3.1.0 (based on R4) and the Bulk Data implementation guide for defining rosters and exchange roster information.
  
 
==Timelines==
 
==Timelines==

Revision as of 14:06, 24 October 2019



Risk Based Contract Member Identification

Owning Workgroup

Financial Management

Committee Approval Date:

TBD

Publishing Lead

Nagesh (Dragon) Bashyam (nagesh.bashyam@drajer.com)

Contributing or Reviewing Work Groups

Attachments (Now PIE!)

FHIR Development Project Insight ID

1517

Scope of coverage

The implementation guide will enable Payers and Providers to exchange Member Attribution Lists which are a necessity for Risk Based Contracts. The IG builds on US Core 3.1.0 and Bulk Data IG to enable the Member Attribution list data exchange.

Content location

https://github.com/hl7/davinci-atr

Proposed IG realm and code

us/DaVinci-ATR

Maintenance Plan

Da Vinci project intends to provide ongoing support of this implementation guide

Short Description

Enable Payers and Providers to exchange a roster of patients for inclusion in a risk based contract

Long Description

The implementation guide will define the mechanisms, resources, profiles and extensions required to exchange Member Attribution Lists. The Member Attribution Lists enable providers and payer organization to validate enrollment in Value-Based Care (VBC) programs and support reporting requirements and payment reconciliation.

Involved parties

This implementation guide has been developed by U.S. Payer organizations, providers, and EHR as part of the Da Vinci project.

Expected implementations

Da Vinci participants -

1) Cambia Healthcare Solutions
2) MultiCare
3) Providence

Content sources

Requirements are drawn from payer and provider organizations as part of the Da Vinci initiative

Example Scenarios

A payer may provide a roster of patients to a provider for a specific risk based contract.

A Provider organization may submit a roster of patients to a payer to confirm patient enrollment

IG Relationships

This project build on US Core 3.1.0 (based on R4) and the Bulk Data implementation guide for defining rosters and exchange roster information.

Timelines

Tentative Connectathon in December and/or January.

Submit for STU Ballot for 2020 Jan Ballot cycle

FMG Notes