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    URSA-PHF-001b: Simplified PMPM Plan Spending (Patient-Month)
    • 28 Jun 2025
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    URSA-PHF-001b: Simplified PMPM Plan Spending (Patient-Month)

    • Updated on 28 Jun 2025
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    Article summary

    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.

    Published Fields

    • Data Model Keys

      • Patient ID
      • Month Start Date Text YYYYMM
      • Primary Plan ID
      • Primary Payor ID
      • Last Continuous Primary Payor Membership Episode Payor ID
      • Next Continuous Primary Payor Membership Episode Payor ID
      • Primary Plan Attributee Provider ID
      • Empirical Attributee Primary Care Individual Provider ID
      • Empirical Attributee Primary Care Provider Group Provider ID

    • Patient Fields

      • Is Patient Alive
      • Is Hospice in Last 12 Months
      • Patient Last Name
      • Patient Date of Birth
      • Patient Age Integer
      • Patient Age Category Tier 1
      • Patient Age Category Tier 2
      • Patient Sex Category
      • Is Patient Sex Female
      • Is Patient Sex Male
      • Count Hospital Inpatient Admissions in Last 12 Months
      • Count ED Visits Without Inpatient Admissions in Last 12 Months
      • PCP Attribution Category
      • Primary Care Engagement Category
      • Count Primary Care Visits in Last 36 Months
      • 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

    • Date Fields

      • Month Start Date
      • Earliest Membership Date in Month
      • Next Month Start Date
      • Last Continuous Primary Payor Membership Episode Start Date
      • Last Continuous Primary Payor Membership Episode End Date
      • Next Continuous Primary Payor Membership Episode Start Date
      • Next Continuous Primary Payor Membership Episode End Date
      • Current Continuous Primary Payor Membership Episode Start Date
      • Current Continuous Primary Payor Membership Episode End Date
      • Current Non-Membership Episode Start Date
      • Current Non-Membership Episode End Date
      • Current Continuous Medical Claim Data Coverage Episode End Date
      • Current Continuous Pharmacy Claim Data Coverage Episode Start Date
      • Current Continuous Pharmacy Claim Data Coverage Episode End Date
      • Current Continuous Medical Claim Data Coverage Episode Start Date
      • 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)

    • Provider Fields

      • Primary Plan Attributee Provider Description
      • Primary Plan Attributee Primary NUCC Provider Taxonomy Description
      • Empirical Attributee Primary Care Individual Provider Description
      • Empirical Attributee Primary Care Provider Group Provider Description
      • Count Visits with Attributee Individual Primary Care Provider in Last 36 Months
      • Count Visits with Attributee Primary Care Provider Group in Last 36 Months

    • Location Fields

      • Patient State Abbreviation
      • Patient ZIP Code 5-Digit
      • Patient County Description
      • UW HIP ADI Quintile Category
      • CDC SVI Overall Quintile Category
      • CDC SVI Socioeconomic Quintile Category
      • CDC SVI Household / Disability Quintile Category
      • CDC SVI Minority / Language Quintile Category
      • CDC SVI Housing / Transportation Quintile Category

    • Insurance Fields

      • Is Any Current Plan Membership
      • Is Patient with Multiple Active Plan Memberships
      • Count Active Plan Memberships
      • Primary Payor Description
      • Primary Plan Description
      • Primary Plan Employer Description
      • Primary Plan Financial Class Description
      • Is Primary Plan Financial Class Commercial
      • Is Primary Plan Financial Class Medicare Advantage
      • Is Primary Plan Financial Class Medicare FFS
      • Is Primary Plan Financial Class Medicaid
      • Is Primary Plan Financial Class Other
      • Is Primary Plan Coverage Type Medical
      • Is Primary Plan Coverage Type Pharmacy
      • Is Any Plan Coverage Type Medical
      • Is Any Plan Coverage Type Pharmacy
      • Is Any Plan Financial Class Commercial
      • Is Any Plan Financial Class Medicare FFS
      • Is Any Plan Financial Class Medicare Advantage
      • Is Any Plan Financial Class Medicaid
      • Is Any Plan Financial Class Other
      • Member HICN
      • Member MBI
      • Is CMS ESRD Status
      • Is CMS Hospice Status
      • Is Dual Medicare-Medicaid Enrolled
      • CMS Dual Status Code
      • Member Medicaid Number

    • Diagnosis Fields

      • CCW Count Category
      • Count CCW Conditions
      • Is CCW Acquired Hypothyroidism
      • Is CCW Acute Myocardial Infarction
      • Is CCW ADHD, Conduct Disorders, and Hyperkinetic Syndrome
      • Is CCW Alzheimers Disease
      • Is CCW Alzheimers Disease and Related Disorders or Senile Dementia
      • Is CCW Anemia
      • Is CCW Anxiety Disorders
      • Is CCW Asthma
      • Is CCW Atrial Fibrillation
      • Is CCW Autism Spectrum Disorder
      • Is CCW Benign Prostatic Hyperplasia
      • Is CCW Bipolar Disorder
      • Is CCW Blindness and Visual Impairment
      • Is CCW Breast Cancer
      • Is CCW Cataract
      • Is CCW Cerebral Palsy
      • Is CCW CKD
      • Is CCW Colorectal Cancer
      • Is CCW COPD and Bronchiectasis
      • Is CCW Cystic Fibrosis and Other Metabolic Disorder
      • Is CCW Deafness and Hearing Impairment
      • Is CCW Depression
      • Is CCW Depressive Disorders
      • Is CCW Diabetes
      • Is CCW Endometrial Cancer
      • Is CCW Epilepsy
      • Is CCW Fibromyalgia and Chronic Pain and Fatigue
      • Is CCW Glaucoma
      • Is CCW Heart Failure
      • Is CCW Hip or Pelvic Fracture
      • Is CCW Hyperlipidemia
      • Is CCW Hypertension
      • Is CCW Intellectual Disability
      • Is CCW Ischemic Heart Disease
      • Is CCW Learning Disability
      • Is CCW Leukemia
      • Is CCW Lung Cancer
      • Is CCW Migraine and Chronic Headache
      • Is CCW Mobility Impairment
      • Is CCW Multiple Sclerosis
      • Is CCW Muscular Dystrophy
      • Is CCW Obesity
      • Is CCW Osteoporosis
      • Is CCW Other Developmental Delay
      • Is CCW Personality Disorder
      • Is CCW Pressure or Chronic Ulcer
      • Is CCW Prostate Cancer
      • Is CCW PTSD
      • Is CCW PVD
      • Is CCW Rheumatoid Arthritis or Osteoarthritis
      • Is CCW Schizophrenia
      • Is CCW Schizophrenia or Other Psychotic Disorders
      • Is CCW Stroke or Transient Ischemic Attack
      • CCW Systems Category
      • Count CCW Systems
      • Is CCW System Behavioral Health
      • Is CCW System Cardiovascular
      • Is CCW System Congenital
      • Is CCW System Endocrine/Metabolic
      • Is CCW System Genitourinary
      • Is CCW System Hematologic
      • Is CCW System Musculoskeletal
      • Is CCW System Neurological
      • Is CCW System Oncologic
      • Is CCW System Ophthalmologic
      • Is CCW System Pulmonary
      • Is CCW System Other

    • Metadata Fields

      • Is Any Current Data Coverage
      • Random Integer 1 to 1000
      • Count Distinct Data Sources
      • Is Medical Claim Data Coverage
      • Is Institutional Claim Data Coverage
      • Is Institutional Claim Paid Amount Data Coverage
      • Is Institutional Claim Service Line Item Paid Amount Data Coverage
      • Is Professional Claim Data Coverage
      • Is Professional Claim Paid Amount Data Coverage
      • Is Professional Claim Service Line Item Paid Amount Data Coverage
      • Is Pharmacy Claim Data Coverage
      • Is Pharmacy Claim Paid Amount Data Coverage
      • Days in This Month
      • Is Member on Month Start Date

    • Measure Fields

      • Denominator
      • Numerator

    • Numerator

      • Document ID
      • Claim ID
      • Claim Service Line Item ID
      • Document Effective Date
      • Document Type Category
      • Claim Class Category
      • Ursa Setting Tier 1 Description
      • Ursa Encounter Type Tier 1 Category
      • Ursa Encounter Type Tier 2 Category
      • Ursa Surgery Encounter Type Category
      • Ursa Service Type Tier 1 Description
      • Billing Provider Description
      • CMS Type of Bill Code
      • CMS Place of Service Code
      • CMS Place of Service Description
      • HCPCS Code
      • HCPCS Description
      • CMS Revenue Center Code
      • CMS Revenue Center Description
      • Principal Diagnosis ICD-10-CM Code
      • Principal Diagnosis ICD-10-CM Description
      • Principal Diagnosis AHRQ CCS Diagnosis Category Tier 1 Description
      • Principal Diagnosis AHRQ CCS Diagnosis Category Tier 2 Description
      • NDC Code
      • Label Description
      • AHFS Therapeutic Class Tier 1 Description
      • AHFS Therapeutic Class Tier 2 Description
      • Document Allowed Amount
      • Document Plan Paid Amount
      • Document Patient Paid Amount

    • [No Field Group]

      • Ursa Serial ID
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