URSA-PHF-001b: Simplified PMPM Plan Spending

Measure Description

Among distinct patient-months with any active plan membership, the per-member-per-month plan spending. This measure simplifies the PMPM calculation by always assigning observations an integer-valued denominator contribution (either 1 or 0, depending on whether their membership was active at any time during the month) even if member are not enrolled for the full month; this simplification follows many organization's existing conventions, and so is meant to provide backward compatibility with existing analytics.

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Event
• Component Class: Long-Form
• Denominator Case Field: Patient ID, Month Start Date Text YYYYMM
• Target Direction: Down

Denominator Description

One per distinct patient-month in which the patient had an active plan membership, was alive, and has medical claims data coverage.

Numerator Description

Total payor spending from claims with covered start date falling within the observation patient-month; includes claim financials with a non-zero plan paid our allowed amount.

Related Key Concepts

None.

FAQs

None.