URSA-PHF-R01: Patients with Active Membership

  • Published on Apr 23, 2026
  • 21 minute(s) read
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Measure Description

Patients with active membership in any plan. This measure represents a view of the Data Mart for URSA-CORE Patient Timelines and provides 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 Identifier: URSA-PHF-R01
  • 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 -- The internal database identifier (used, e.g., for joins and primary keys) for the patient. This value is typically mastered, i.e., all records for the same patient, regardless of the source data system from which that record originated, should have the same Patient ID value. (Note that while the mastered Patient ID value might resemble a local identifier used in one of the upstream data sources, this does not indicate any special priority of that source system in determining the characteristics of the patient.) (See also [URSA-CORE] Patient)
    • Primary Payor ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Primary Payor. (See also [URSA-CORE] Primary Payor)
    • Primary Plan ID -- The identifier for the health insurance plan product that is the first party responsible for payment.
    • Primary Plan Attributee Provider ID
    • Primary Plan Attributee Individual Provider ID
    • Primary Plan Attributee Provider Group Provider ID
    • Empirical Attributee Primary Care Individual Provider ID
    • Empirical Attributee Primary Care Provider Group Provider ID

  • Patient Fields

    • Is Hospice in Last 12 Months -- Evidence of CMS hospice status or evidence of hospice services in the last 12 months. Typically used as a denominator exclusion.
    • Patient Last Name
    • Patient Date of Birth -- The patient's date of birth. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the date of birth found on that particular type of record in the source data.
    • Patient Age Integer -- Patient age, expressed as an integer, as of a reference date or interval.
    • Patient Age Category Tier 1 -- Non-overlapping ranges of the patient age in years into three categories; [01] Pediatrics < 19, [02] Adults 19 - 64, and [03] Older Adults >= 65. Coarser grain to the Patient Age Category Tier 2. (See also [URSA-CORE] Patient Age Category Tier 2)
    • Patient Age Category Tier 2 -- Non-overlapping ranges of the patient age in years representing finer grain categories than the Patient Age Category Tier 1. This field incorporates findings from publications on defining meaningful age groups in the context of disease. These ranges closely, but not exactly, align with standard age ranges such as those defined by the Medical Subject Headings (MeSH). See results of K-Means simple clustering method at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825015/ (See also [URSA-CORE] Patient Age Category Tier 1)
    • Patient Sex Category
    • Is Patient Sex Female -- Indicates the patient's sex is female. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the patient sex documented on that particular type of record in the source data.
    • Is Patient Sex Male -- Indicates the patient's sex is male. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the patient sex documented on that particular type of record in the source data.
    • 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 -- The start date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. (See also [URSA-CORE] Continuous Primary Payor Membership Episode)
    • Current Continuous Primary Payor Membership Episode End Date -- The end date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates. (See also [URSA-CORE] Continuous Primary Payor Membership Episode, [URSA-CORE] Period 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.

  • Provider Fields

    • Is Patient with Primary Plan Attributed Provider
    • Is Patient with Empirically Attributed Individual PCP
    • 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
    • Is Empirically Attributed Individual PCP Match to Plan Attributed PCP

  • Location Fields

    • Patient State Abbreviation
    • Patient ZIP Code 5-Digit
    • Patient County Description
    • UW HIP Area Deprivation Index National Percentile -- A value between 1 and 100 representing the composite measure of socioeconomic deprivation from University of Wisconsin’s School of Medicine and Public Health. Scores are for Census Block Group geographic level, which generally contains between 600 and 3,000 people. Higher scores indicate more deprivation, so a score of 1 indicates the least deprivation while a score of 100 indicates the most deprivation. Percentiles are constructed by ranking the ADI from low to high for the nation and grouping the block groups into bins corresponding to each 1% range of the ADI. The 2019 ADI was constructed using the 2015-2019 5-year estimates from the US Census' American Community Survey and includes 17 component measures that span the domains of income, education, employment, and housing quality. It may be linked with the 9-digit ZIP code crosswalk, which was built to correspond directly to Census block groups. The 2019 ADI was released on 07/14/2021 and is the most recent version as of 02/02/22.
    • UW HIP ADI Quintile Category -- The UW HIP Area Deprivation Index National Percentile grouped into 5 levels, each spanning 20 percentile points (ADI 1 is percentile scores from 1 to 20 while ADI 5 is scores from 81 to 100). Higher scores indicate more deprivation, so ADI 1 is the least deprived while ADI 5 is the most deprived. Quintiles are frequently used in health research. They give larger sample sizes per group and are easier to plot and interpret. Quintiles also carry less information and group more dissimilar patients. Quintiles are good for descriptive analyses while the original percentile measure is preferable for predictive modeling. (See also [URSA-CORE] UW HIP Area Deprivation Index National Percentile)
    • UW HIP ADI Decile Category
    • CDC SVI Overall Quintile Category -- The CDC SVI Overall National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. Quintiles are frequently used in health research. They give larger sample sizes per group and are easier to plot and interpret. Quintiles also carry less information and group more dissimilar patients. Quintiles are good for descriptive analyses while the original percentile measure is preferable for predictive modeling.
    • CDC SVI Socioeconomic Quintile Category -- The CDC SVI Socioeconomic Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. (See also [URSA-CORE] CDC SVI Socioeconomic Theme National Percentile )
    • CDC SVI Household / Disability Quintile Category -- The CDC SVI Household/Disability Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. (See also [URSA-CORE] CDC SVI Household / Disability Theme National Percentile )
    • CDC SVI Minority / Language Quintile Category -- The CDC SVI Minority/Language Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. (See also [URSA-CORE] CDC SVI Minority / Language Theme National Percentile)
    • CDC SVI Housing / Transportation Quintile Category -- The CDC SVI Housing/Transportation Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. (See also [URSA-CORE] CDC SVI Housing / Transportation Theme National Percentile)

  • Insurance Fields

    • 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 -- Indicates the patient meets the Medicare ESRD eligibility criterion as of a particular date; can be derived from the CMS Medicare Beneficiary Status Code. (See also [URSA-CORE] CMS Medicare Beneficiary Status Code)
    • Is CMS Hospice Status -- Indicates the patient is considered to be Hospice status.
    • Is Dual Medicare-Medicaid Enrolled -- Indicates that the patient is concurrently enrolled in both Medicare and Medicaid programs. (Identifies the population often described as "dually eligible" or "duals".)
    • CMS Dual Status Code -- The standard 2-character CMS Dual Status Code, which identifies the patient's most recent entitlement status for Medicaid and other qualifying non-Medicare programs; e.g., 01 = QMB only, 02 = QMB + full Medicaid, etc.
    • Member Medicaid Number

  • Diagnosis Fields

    • CCW Count Category
    • Count CCW Conditions -- The total of both Chronic Conditions and Potentially Disabling Events included in the CMS Chronic Condition Warehouse (CCW) library. (See also [URSA-CORE] CCW Comorbidity Category, [URSA-CORE] Count Potentially Disabling Events, [URSA-CORE] CMS Chronic Condition Warehouse (CCW), [URSA-CORE] Count Chronic Conditions)
    • Is CCW Acquired Hypothyroidism -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Acute Myocardial Infarction -- At least 1 inpatient claim with one or more of the DX codes from the corresponding CCW value set as the first or second diagnosis position in the prior 1 year.
    • Is CCW ADHD, Conduct Disorders, and Hyperkinetic Syndrome -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Alzheimers Disease -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 3 years.
    • Is CCW Alzheimers Disease and Related Disorders or Senile Dementia -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 3 years.
    • Is CCW Anemia -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Anxiety Disorders -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Asthma -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Atrial Fibrillation -- At least 1 inpatient OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set as the first or second diagnosis position in the prior 1 year.
    • Is CCW Autism Spectrum Disorder -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Benign Prostatic Hyperplasia -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year. Exclusion: If any of the qualifying claims also have an ICD-10 DX of D29.1, then it is excluded.
    • Is CCW Bipolar Disorder -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Blindness and Visual Impairment -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Breast Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in prior 1 year.
    • Is CCW Cataract -- At least 1 HOP or Carrier claim with one or more of the DX codes from the corresponding CCW value set as the principal diagnosis position in the prior 1 year.
    • Is CCW Cerebral Palsy -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with DX codes over the last 2 years (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW CKD -- Indicates that the patient meets the CMS Chronic Condition Warehouse criteria for chronic kidney disease; i.e., 2 or more qualifying outpatient or professional ICD codes in the prior 2 years, or 1 or more non-outpatient institutional claim ICD codes in the prior 2 years.
    • Is CCW Colorectal Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW COPD and Bronchiectasis -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Cystic Fibrosis and Other Metabolic Disorder -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Deafness and Hearing Impairment -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Depression -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Depressive Disorders -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Diabetes -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Endometrial Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Epilepsy -- At least 1 inpatient claim OR 2 other non-drug claims of any service type during the two-year period (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW Fibromyalgia and Chronic Pain and Fatigue -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Glaucoma -- At least 1 Carrier claim with one or more of the DX codes from the corresponding CCW value set as the principal diagnosis position in the prior 1 year.
    • Is CCW Heart Failure -- At least 1 inpatient, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Hip or Pelvic Fracture -- At least 1 inpatient or SNF claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Hyperlipidemia -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Hypertension -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Intellectual Disability -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Ischemic Heart Disease -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Learning Disability -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Leukemia -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Lung Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Migraine and Chronic Headache -- At least 1 inpatient claim OR 2 non-inpatient claims with DX codes within a 2 year period. (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW Mobility Impairment -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Multiple Sclerosis -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Muscular Dystrophy -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Obesity -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Osteoporosis -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Other Developmental Delay -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Personality Disorder -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Pressure or Chronic Ulcer -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Prostate Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW PTSD -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW PVD -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Rheumatoid Arthritis or Osteoarthritis -- At least 2 inpatient, SNF, HHA, HOP, or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Schizophrenia -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with DX codes at least one day apart in the prior within the 2 year reference period. Qualifying codes can also be found as a subset of those in the CCW "Schizophrenia or Other Psychotic Disorders". (See also [URSA-CORE] Is CCW Schizophrenia or Other Psychotic Disorders)
    • Is CCW Schizophrenia or Other Psychotic Disorders -- At least 1 inpatient OR 2 other nondrug claims of any service type with one ore more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Stroke or Transient Ischemic Attack -- At least 1 inpatient OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
      EXCLUSIONS: If any of the qualifying claims have : 800 <= DX Code <=
      804.9, 850 <= DX Code <= 854.1 in any DX position OR DX V57xx as the principal DX Code, then the claim is excluded.
    • CCW Systems Category
    • Count CCW Systems -- The count of distinct systems of the body with one or more active CCW Condition. CCW Systems are as a parent category to the individual CCW Conditions grouping them based primarily on the human body system they impact such as; Behavioral Health, Cancers, Cardiovascular, Cerebrovascular, Endocrine, Genitourinary, Musculoskeletal, and Pulmonary. (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW System Behavioral Health -- Indicates the patient has one or more of the following CCW conditions; ADHD, Conduct Disorders, and Hyperkinetic Syndrome, Anxiety Disorders, Autism Spectrum Disorder, Bipolar Disorder, Depression, Depressive Disorders, Personality Disorders, PTSD, Schizophrenia, or Schizophrenia and Other Psychotic Disorders.
    • Is CCW System Cardiovascular -- Indicates the patient has one or more of the following CCW conditions; Acute Myocardial Infarction (AMI), Atrial Fibrillation, Heart Failure, Hypertension, Ischemic Heart Disease, or Peripheral Vascular Disease (PVD).
    • Is CCW System Congenital -- Indicates the patient has one or more of the following CCW conditions; Cerebral Palsy, Cystic Fibrosis and Other Metabolic Disorder, Intellectual Disability, Learning Disability, Muscular Dystrophy, or Other Developmental Delays.
    • Is CCW System Endocrine/Metabolic -- Indicates the patient has one or more of the following CCW conditions; Diabetes, Acquired Hypothyroidism, Hyperlipidemia, or Obesity.
    • Is CCW System Genitourinary -- Indicates the patient has one or more of the following CCW conditions; Benign Prostatic Hyperplasia or Chronic Kidney Disease (CKD).
    • Is CCW System Hematologic -- Indicates the patient has one or more of the following CCW conditions; Anemia.
    • Is CCW System Musculoskeletal -- Indicates the patient has one or more of the following CCW conditions; Hip or Pelvic Fracture, Rheumatoid Arthritis or Osteoarthritis, or Osteoporosis.
    • Is CCW System Neurological -- Indicates the patient has one or more of the following CCW conditions; Alzheimer's Disease, Alzheimer's Disease and Related Disorders or Senile Dementia, Stroke or Transient Ischemic Attack, Epilepsy, Migraine and Chronic Headache, Mobility Impairment, Multiple Sclerosis, or Deafness and Hearing Impairment.
    • Is CCW System Oncologic -- Indicates the patient has one or more of the following CCW conditions; Breast Cancer, Colorectal Cancer, Endometrial Cancer, Lung Cancer, Prostate Cancer, or Leukemia.
    • Is CCW System Ophthalmologic -- Indicates the patient has one or more of the following CCW conditions; Cataract, Glaucoma, or Blindness and Visual Impairment.
    • Is CCW System Pulmonary -- Indicates the patient has one or more of the following CCW conditions; Asthma, or Chronic Obstructive Pulmonary Disease (COPD) and Bronchiectasis.
    • Is CCW System Other -- Indicates the patient has one or more of the following CCW conditions; Fibromyalgia and Chronic Pain and Fatigue, Pressure or Chronic Ulcer.
    • Is Patient with any CCW Condition

  • Measure Fields