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Module: PM (Practice Management)
Feature: PM-25 Value-Based Payment & APM Tracking
Last Updated: 2026-03-01

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Overview

The VBP & APM Tracking feature lets organizations manage value-based payment programs, quality measures, and incentive payments. It supports tracking performance against benchmarks and reconciling incentive revenue.

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Programs

Navigate to Practice Management → Value-Based Payment to view programs.

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Creating a Program

  1. Click Add Program (requires pm.vbp.manage permission).
  2. Fill in:
    • Program Name (required)
    • Payer (optional — select from existing payers)
    • Contract Type: Shared Savings, Quality Bonus, Capitation, Bundled Payment, or Other
    • Measurement Period: Free text (e.g., “2025-Q1”, “CY2025”)
    • Status: Active, Completed, or Suspended
    • Notes (optional)
  3. Click Save.

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Archiving a Program

Click Archive on the program detail page. Archived programs remain visible with an “Archived” banner but cannot be edited. Measures and incentive payments for archived programs are read-only.

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Quality Measures

On a program detail page, select the Measures tab.

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Adding a Measure

  1. Click Add Measure (requires pm.vbp.manage).
  2. Fill in:
    • Measure ID: External identifier (e.g., HEDIS code like “BCS”)
    • Measure Name: Display name (e.g., “Breast Cancer Screening”)
    • Numerator: Count of patients meeting criteria
    • Denominator: Count of eligible patients (must be > 0)
    • Benchmark: Target rate (decimal, e.g., 0.75 for 75%)
  3. Rate and Performance Level are computed automatically:
    • Rate = Numerator ÷ Denominator
    • Performance: Exceeded (rate ≥ benchmark) or Not Met (rate < benchmark)
  4. Click Save.

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Allowed Values

FieldAllowed Values
Contract Typeshared_savings, quality_bonus, capitation, bundled_payment, other
Program Statusactive, completed, suspended
Performance Levelexceeded, not_met (auto-derived)
Payment Statuspending, paid, adjusted

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Incentive Payments

On a program detail page, select the Incentives tab.

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Recording a Payment

  1. Click Add Payment (requires pm.vbp.manage).
  2. Fill in:
    • Payment Period: Free text (e.g., “2025-Q1”)
    • Earned Amount: Expected incentive amount
    • Paid Amount: Actual payment received
    • Status: Pending, Paid, or Adjusted
    • Notes (optional)
  3. Click Save.

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Permissions

Permission KeyDescriptionDefault Roles
pm.vbp.viewView programs, measures, paymentsorg_admin, site_admin, staff
pm.vbp.manageCreate, edit, archive programs; manage measures and paymentsorg_admin

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Integration Notes

  • PM-11 (Revenue Cycle Analytics): VBP data (pm_vbp_* tables) is available for dashboard widgets and reports.
  • CL-10 / CL-15: Future integration for automated measure numerator/denominator population from outcomes and quality data.
  • PM-02 / PM-01: Patient/member attribution for measure denominators (Phase 2).

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Data Retention

  • Programs use soft delete (deleted_at). Archived programs and their child records remain in the database.
  • Measures and incentive payments are hard-deleted when removed by a user with pm.vbp.manage permission.