GPMP, NHS QOF, CMS Chronic Care: building one care plan that works in every country

When we started building the care-plan layer, the obvious approach was three apps — one for AU GPMP, one for UK NHS QOF, one for US CMS Chronic Care Management. Each system has its own item codes, its own templates, its own review cycles.

We chose the harder path: one care plan model, with regional renderers.

The shape that worked

• Plan → Goals → Tasks, agnostic of the billing system.
• Per-task metadata: claim_code (MBS, QOF, CPT), review cadence, evidence reference.
• A renderer picks the right code by the patient's country at draft time, not at template-design time.

The benefit shows up at the patient app layer: Marcus in Sydney and Marcus in Bristol see the same plan UI, with the same review reminders. The billing happens differently behind the scenes, but the patient-clinician conversation looks identical.

What this lets us do next

Adding a new country (Canada's Family Health Group model, NZ's Health Care Home) is now a config file, not a feature build. The first new region is queued for the next quarter.