URSA-PHF-901: Patients with Active Membership (Reduced Fields)

Measure Description

This measure is designed specifically for validation exercises in comparing patient counts to reports provided by the entity generating the source data (e.g., the payor) and has only critical and validation fields published. For analytics please use URSA-PHF-R01. The measure is the count of patients which, as of the snapshot date, are alive and have active plan membership in any plan. Patients are considered to be alive unless a date of death available from a validated data source.

Metadata

• Measure Type: Registry
• Temporal Structure: Entity
• Component Class: Normal-Form
• Denominator Case Field: Patient ID
• Target Direction: None

Published Fields

• Data Model Keys

  • Patient ID
  • Primary Plan Attributee Provider ID
  • Primary Plan Attributee Individual Provider ID
  • Primary Plan Attributee Provider Group Provider ID
  • Primary Payor ID
  • Primary Plan ID

• Patient Fields

  • Patient Last Name
  • Patient Date of Birth
  • Patient Age Integer
  • Patient Sex Category
  • Is Hospice in Last 12 Months

• 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)
  • 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.

• Location Fields

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

• Insurance Fields

  • Is Patient with Multiple Active Plan Memberships
  • Count Active Plan Memberships
  • Primary Payor Description
  • Primary Plan Description
  • Primary Plan Financial Class Description
  • Plan CMS Contract Number
  • Plan CMS PBP Number
  • Is Dual Medicare-Medicaid Enrolled
  • Is MMP
  • Is SNP
  • Is C-SNP
  • Is D-SNP
  • Is I-SNP

• Diagnosis Fields

  • CCW Count Category

• Metadata Fields

  • Count Distinct Data Sources
  • Is Medical Claim Data Coverage
  • Is Professional Claim Data Coverage
  • Is Pharmacy Claim Data Coverage

• Measure Fields

  • Denominator