PlanNet Patterns August 19 2020 Introduction These drawings

Plan-Net Patterns August 19, 2020

Introduction • These drawings complement the examples provided in the implementation guide. • They refer to the example instance names. • The drawings do not annotate the full data payload of the examples. Their purpose is to graphically illustrate the relationships between the instances. Instance IDs are in purple. • See the examples data for full data content

Example: Group Providing Service at Hospital Network Acme of CT Standard Acmeof. CTStd. Net network Organization Hartford. Orthopedics participating. Organization. Affiliation Code: Provider Hartford. Orthopedic. Affil Organization Hospital provided. By Healthcare Service category: Group Specialty: Orthopedics (207 X 00000 X) Hartford. Orthopedic. Services managing. Organization Location type: Hospital Hosp. Loc 1 location organization Represents: Hartford Orthopedics (is a group) providing Orthopods for Network Acme of CT at Hartford General Hospital and is in-network for Acme of CT’s standard network.

Example: Clinic That is Owned by a Hospital Network Acmeof. CTStd. Net network Organization Hamilton. Clinic participating. Organization. Affiliation Code: Outpatient Hamilton. Clinic. Affil part. Of Organization Hospital provided. By Healthcare Service category: Outpatient Specialty: Family Medicine (207 Q 00000 X ) Hamilton. Clinic. Services managing. Organization Location type: Hospital Hosp. Loc 1 location Represents: Hamilton Clinic, owned by Hartford General Hospital, provides Family Medicine Services at Hospital Location 1

Example: Clinic Provides Services to a Hospital Network Acmeof. CTStd. Net network Organization Burr. Clinic Hospital participating. Organization. Affiliation Code: Outpatient Burrn. Clinic. Affil provided. By Healthcare Service category: Outpatient Specialty: Family Medicine (207 Q 00000 X ) Burr Clinic. Services managing. Organization Location type: Hospital Hosp. Loc 1 location organization Represents: Burr Clinic is located at Hartford General Hospital’s site #1 and provides outpatient family medicine services. It is in network for Acme of CT’s standard network.

Example: Clinic Belongs to an HIE Organization participating. Organization. Affiliation Code: bt (Member Of) Burr. Clinic Organization Conn. HIE organization Conn. HIEAffil Represents: - Burr Clinic belongs to the Connecticut HIE

Example: Pharmacy Chain Network Pharm. Chain participating. Organization. Affiliation Code: Pharmacy Specialty: Retail Pharmacy Big. Box Organization Type: Provider Acmeof. CTStd. Net network Organization Type: bus managing. Organization provided. By Healthcare Service category: Pharmacy Specialty: Retail Pharmacy Pharm. Chain. Retail. Service Location Pharm. Loc 1 Pharm. Loc 2 Pharm. Loc 3 Pharm. Loc 4 Pharm. Chain. Affil 1 Represents: - Chain of pharmacies provided by Pharm. Chain - Only 2 of the pharmacy locations are in-network for Acme of CT Standard Network - 2 of the pharmacy locations are managed by Big. Box

Example: Compounding Pharmacy Network Organization Acmeof. CTStd. Net network Pharm. Chain participating. Organization. Affiliation Code: Pharmacy Specialty: Compounding. Pharmacy managing. Organization provided. By Healthcare Service category: Pharmacy Specialty: Compounding. Pharmacy Pharm. Chain. Comp. Service Location Pharm. Loc 1 Pharm. Loc 2 Pharm. Chain. Affil 2 Represents: - Chain of Compounding pharmacies provided by Pharm. Chain - 2 of the pharmacy locations are in-network for Acme of CT Standard Network

Example: Mail. Order Chain Network Organization Acmeof. CTStd. Net network Pharm. Chain participating. Organization. Affiliation Specialty: Mail Order provided. By Healthcare Service category: Pharmacy Specialty: Mail Order Pharm. Chain. Mail. Service Pharm. Chain. Affil 3 Represents: - Mail order pharmacy provided by Pharmchain - In-Network for Acme of Connecticut PPO Network

Example: Practitioner Location • Dr Smith works at a the Burr Clinic during the week Moonlights at the Hartford Hospital on the weekend in the ER Has admitting privileges at Harford Hospital Practitioner Joe. Smith practitioner location Hosp. Loc 2 Joe. Smith. Role 2 Organization Burr. Clinic organization network practitioner Network Acmeof. CTStd. Net Organization code: Admitting Privileges (AP) network Practitioner. Role Hospital organization healthcareservice code: Emergency Medicine organization Organization Hospital provided. By healthcareservice code: Physician Practitioner. Role Joe. Smith. Role 3 category: Outpatient specialty: Internal Medicine Burr. Clinic. Services Practitioner. Role practitioner Health. Care. Service provided. By Health. Care. Service Joe. Smith. Role 1 category: Emergency Specialty: Emergency Medicine Location Hosp. Loc 1 location Hosp. ERService

Practitioner. Role – Example #2 Location 123 Main St Ste 4 Chicago IL 60601 Practitioner. Role code: Physician Specialty: Internal Medicine Available: M-W-F Dr Smith works M-W-F in one group works tu-Th in another group has hospital admitting privileges location healthcareservice Health. Care. Service category: Group specialty: Internal Medicine organization Practitioner practitioner Name: Jane Smith Qualifications: - Medical Doctor (issuer IL) - Internal Medicine (issuer ABIM) - Cardiology (issuer ABIM) provided. By Network Name: Acme Network of IL Organization Name: Internal Medicine LLC Type: Provider Group practitioner part. Of Organization practitioner Practitioner. Role code: Physician (PH) Specialty: - Internal Medicine - Cardiology - Available: Tu-Th Practitioner. Role code: Admitting Privileges (AP) Specialty: - Internal Medicine - Cardiology Organization Name: Physicians’ Group LTD Type: Provider Group Name: Multi-specialty Group Assoc Type: Provider Group provided. By healthcareservice Health. Care. Service Location organization Organization Not Implemented part. Of organization Name: Some Hospital Type: Provider Location 123 Main St Ste 1 Chicago IL 60601 location category: Group Specialty: Cardiology, Internal Medicine, etc

Example: Solo Practitioner Location Hans. Solo. Clinic location Solo Practitioner Hans. Solo. Service Practitioner. Role Hans. Solo. Role 1 Practitioner Health. Care. Service practitioner Hans. Solo Network Acmeof. CTStd. Net healthcareservice

Practitioner. Role – Example #4 Practitior. Role without a specific Practitioner. Specifying a role. Location location Health. Care. Service Cancer. Clinic. Loc Cancer. Clinic. Service Practitioner. Role code: Physician Specialty: Internal Medicine healthcareservice provided. By Anon. Role organization Network Acmeof. CTStd. Net Organization Cancer. Clinic

Example: Insurance Plan and Network. Acme of CT Medicare Advantage Network Organization name: Acme of CT Standard Network owned. By Insurance. Plan Name: Acme Medicare Advantage Type: Medicare. Advantage Not Implemented coverage. Area Location name: State of CT location-boundarygeojson: shape of CT address: CT Endpoint name: Acme Formulary Connection-type: hl 7 -fhir-rest payloadtype: NA address: url of formulary Usecase. type = TREAT Usecase. standard = Formulary IG URL

Example: Insurance Plan and Network. Acme QHP Plans Network Organization Acmeof. CTStd. Net Acmeof. CTPrem. Net network Location owned. By coverage. Area Insurance. Plan Type: QHP Plan. type: Gold Insurance. Plan Type: QHP Plan. type: Bronze Acme. QHPGold Acme. QHPBronze State. Of. CTLocation Endpoint Connection-type: non-fhir-rest payloadtype: NA Usecase. type = HOPERAT Acme. Of. CTPortal. Endpoint