URSA-PHF-009: URSA-CORE Encounter PMPM Plan Spending
  • 28 Jun 2025
  • 5 Minutes to read
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URSA-PHF-009: URSA-CORE Encounter PMPM Plan Spending

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Article summary

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

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