URSA-PHARM-203: Patients with Opioid Use Last 12 Months

Measure Description

Among patients with active plan membership and one or more outpatient medication fill in the last 12 months, the percentage with 2+ Opioid Fills and an aggregate days supply of 15 or great in the last 12 months. Excludes patients with any active CCW cancer condition or evidence of hospice at in the prior 12 months.

Metadata

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

Denominator Description

Patients with active plan membership and one or more outpatient medication fill in the last 12 months; excludes patients with any active CCW cancer condition or evidence of hospice in the prior 12 months.

Numerator Description

Patients meeting denominator criteria and have 2+ Opioid Fills and an aggregate days supply of 15 or great in the last 12 months.

Published Fields

• Data Model Keys

  • Patient ID
  • Primary Payor ID
  • Primary Plan ID

• Patient Fields

  • Patient Date of Birth
  • Patient Age Integer
  • Patient Age Category Tier 1
  • Patient Age Category Tier 2
  • Patient Sex Category
  • Primary Care Engagement Category
  • Specialty Care Engagement Category
  • Count Specialty Care Office Visits in Last 36 Months
  • Primary or Specialty Care Engagement Category
  • Count Clinician Office Visits in Last 3 Years
  • Count Hospital Inpatient Admissions in Last 12 Months
  • Count ED Visits Without Inpatient Admissions in Last 12 Months

• Date Fields

  • Segment Start Date -- The start date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
  • Segment End Date -- The end date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
  • Snapshot Date -- The date, evaluated at 00:00:00 AM, giving the moment the state of the world will be set to for the purposes of an analysis. The snapshot date does not represent the freshness of the data, or the date in real time at which an analysis was executed.

• Provider Fields

  • Count Primary Care Visits in Last 36 Months
  • Count Distinct Filling Providers Last 12 Months
  • Count Distinct Prescribing Providers Last 12 Months
  • Count Distinct Opioid Prescribing Providers in Last 6 Months
  • Count Distinct Opioid Filling Providers in Last 6 Months
  • Count Distinct Opioid Prescribing Providers in Last 12 Months
  • Count Distinct Opioid Filling Providers in Last 12 Months
  • Empirical Attributee PCP Provider NPI
  • Empirical Attributee PCP Provider Description
  • Empirical Attributee Primary Care Provider Group Provider NPI
  • Empirical Attributee Primary Care Provider Group Provider Description

• Location Fields

  • Patient State Abbreviation
  • Patient ZIP Code 5-Digit
  • UW HIP ADI Quintile Category

• Insurance Fields

  • Primary Payor Description
  • Primary Plan Description
  • Primary Plan Financial Class Description

• Medication Fields

  • Count Opioid Fills in Last 6 Months
  • Count Opioid Fills in Last 12 Months
  • Aggregate Opioid Days Supply in Last 6 Months
  • Aggregate Opioid Days Supply in Last 12 Months

• Diagnosis Fields

  • CCW Count Category
  • CCW Systems Category
  • Count CCW Systems

• Financial Fields

  • Medication Plan Paid Amount in Last 12 Months
  • Medication Patient Paid Amount in Last 12 Months
  • Total Medication Paid Amount Last 12 Months
  • Cumulative Calendar Year Rx Plan Paid Amount
  • Cumulative Calendar Year Rx Patient Paid Amount

• Measure Fields

  • Denominator
  • Numerator

• Module Fields

  • Medication Management Trigger Category
  • Is Patient with Active Medication Management Trigger
  • Count Active Medication Management Trigger Categories
  • Is High Medication Spend
  • Is Very High Medication Spend
  • Is High Number of Prescribing Providers
  • Is High Number of Filling Providers
  • Is Multiple Opioid Prescribing Providers Last 6 Months
  • Is Multiple Opioid Filling Providers Last 6 Months
  • Is Active Chronic Opioid Episode
  • Count Active Opioids