- 28 Jun 2025
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URSA-PHF-009: URSA-CORE Encounter PMPM Plan Spending
- Updated on 28 Jun 2025
- 5 Minutes to read
- Print
- DarkLight
Measure Description
Among active plan membership patient-periods, the per-member-per-month plan spending on any of the URSA-CORE encounter types: hospital inpatient admission encounters; clinician office visit encounters; ED visit parent encounters; observation stay parent encounters; SNF encounters; and other hospital outpatient encounters.
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 was alive and had medical claims data coverage.
Numerator Description
Total plan spending associated with an URSA-CORE encounter with encounter start date falling within the observation period start and end dates; URSA-CORE encounters include: hospital inpatient admission encounters; clinician office visit encounters; ED visit parent encounters; observation stay parent encounters; SNF encounters; and other hospital outpatient encounters.
Published Fields
Data Model Keys
- Patient ID
- Primary Plan Attributee Provider ID
- Empirical Attributee Primary Care Individual Provider ID
- Empirical Attributee Primary Care Provider Group Provider ID
- Primary Payor ID
- Primary Plan ID
Patient Fields
- Is Hospice in Last 12 Months
- 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
- Current Continuous Primary Payor Membership Episode Start Date
- Current Continuous Primary Payor Membership Episode End 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)
- Segmented Period Start Date
- Segmented Period End Date
Provider Fields
- Primary Plan Attributee Provider 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
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 Financial Class Description
- 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
Numerator Fields
- Encounter ID
- Encounter Primary Payor ID
- Encounter Primary Plan ID
- Facility Provider ID
- Attending Provider ID
- Service Provider ID
- Provider Group Provider ID
- Primary HCPCS Procedure Provider ID
- Encounter Start Date
- Encounter End Date
- Encounter LOS in Elapsed Midnights
- Encounter LOS in Distinct Calendar Days
- Is Multi-Day Encounter
- Is Single-Day Encounter
- Ursa Encounter Type Tier 1 Category
- Ursa Encounter Type Tier 2 Category
- Is Surgery Encounter
- Ursa Surgery Encounter Type Category
- Is Any Hospital Encounter Type
- Is Hospital Inpatient Admission Encounter
- Is Hospital Observation Stay Parent Encounter
- Is Emergency Department Visit Parent Encounter
- Is Ambulatory Surgical Center Encounter
- Is Hospital Outpatient Surgery Encounter
- Is Other Hospital Outpatient Encounter
- Is Clinician Office Visit Encounter
- Is Primary Care Clinician Office Visit
- Is Urgent Care Visit
- Is SNF Encounter
- Is Home Health Care Visit Encounter
- Is Birthing Center Encounter
- Primary HCPCS Procedure HCPCS Code
- Primary HCPCS Procedure Short Description
- Primary HCPCS Procedure AHRQ CCS Single-Level Procedure Category Code
- Primary HCPCS Procedure AHRQ CCS Single-Level Procedure Category Description
- Principal Discharge Diagnosis ICD-10-CM Code
- Principal Discharge Diagnosis ICD-10-CM Description
- Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
- Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
- Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
- Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
- MS-DRG Code
- MS-DRG Description
- MS-DRG MDC Code
- MS-DRG MDC Code Description
- APR-DRG Code
- APR-DRG Description
- APR-DRG MDC Code
- APR-DRG MDC Description
- Facility Provider Description
- Facility Practice Address State Abbreviation
- Facility Practice Address ZIP Code 5-Digit
- Attending Provider Description
- Attending Provider Taxonomy Code
- Attending Provider Taxonomy Description
- Service Provider Description
- Service Provider Taxonomy Code
- Service Provider Taxonomy Description
- Provider Group Provider Description
- Primary Plan Allowed Amount
- Primary Plan Paid Amount
- Total Plan Paid Amount from All Plans
- Patient Paid Amount
Measure Fields
- Denominator
- Numerator
[No Field Group]
- Ursa Serial ID