URSA-PHU | Basics of the Preventable Hospital Utilization Module

Overview

Due to the high costs of hospital based care, Potentially Preventable Hospital Encounters (PPHEs) is often one of the first areas a risk bearing entity will evaluate when looking for opportunities to reduce total cost of care after or in parallel to establishing a strong foundation of preventive primary care for a population.
This report introduces users to the Ursa Preventable Hospital Utilization (PHU) module which employs real world experience and industry research including research from the Agency for Healthcare Research and Quality (AHRQ) on Prevention Quality Indicators (PQIs), New York University (NYU) & Johns Hopkins University (JHU) Emergency Department Algorithm (NYU/JHU-EDA), and syndicated best practices from Ursa Health's work with collaborators.

Use this report to

• Develop an understanding of various types of Potential Preventable Hospital Encounters (PPHEs).
• Analyze the financial impact of PPHEs on your total cost of care.
• Surface drivers of PPHEs and identify potential interventions to avoid future PPHEs.
• Monitor performance across plans, markets, provider panels, and patient cohorts across time.

Potential takeaways

• How much is being spent on Potentially Preventable Hospital Encounters?
• What are the reasons for these PPHEs?
• What is the population rate for PPHEs and how does that vary by market, plan, PCP panel?
• What is the case distribution or are there subset of patients driving a significant portion?
• Who is managing care for patients with PPHEs and what is their level of PCP engagement?
• Which patients have a recent increase in ED utilization?
• What types of interventions should be further evaluated based on these PPHEs?

Measures included in this report

• URSA-PHU-001: PMPM Plan Spending
• URSA-PHU-002: PPHEs Per 1000 Patient-Years
• URSA-PHU-003: Spending per 90-Day PPHE Episode
• URSA-PHU-004: PHU Encounter PMPM Plan Spending
• URSA-PHU-005: 30-Day Return to Hospital After ED Visit
• URSA-PHU-006: PMPY Plan Spending on PPHEs
• URSA-PHU-007: PMPY on all IP and ED Encounters
• URSA-PHU-008: Percent Potentially Preventable ED and IP Admits
• URSA-PHU-R01: Patients with Active Membership
• URSA-PHU-R02: Potentially Preventable Hospital Encounters