URSA-PHF-903: PMPM Plan Spending (Reduced Fields)

Measure Description

This measure is designed specifically for validation exercises in comparing patient counts to reports provided by the entity generating the source data (e.g., the payor) and has only critical and validation fields published. For analytic use cases, please use measure URSA-PHF-001. Among active plan membership periods, the per-member-per-month payor spending. Note: this measure does not restrict on periods of medical claim data coverage.

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Interval
• Component Class: Long-Form
• Denominator Case Field: Patient ID
• Target Direction: Down

Denominator Description

The elapsed patient-months of active plan membership periods during which the patient is alive and has active plan coverage; includes periods of without medical claim coverage which is change from the standard URSA-PHF-001 PMPM measure.

Numerator Description

Total payor spending for claims with covered start date falling within the observation period start and end dates; includes claim financials with a non-zero plan paid or allowed amount.