URSA-CKD-001: CKD Patient PMPM Plan Spending

Measure Description

Among living plan members with CKD, plan spending per member, per month.

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Interval
• Component Class: Long-Form
• Denominator Case Field: Patient ID
• Target Direction: Down

Denominator Description

Each denominator observation represents a patient-period during which the patient (1) met the criteria for CKD; (2) was a member in a health plan; and (3) had claims data coverage. The denominator contribution is the length of time of the observation period, expressed in units of months.

Numerator Description

Each numerator record represents a medical or pharmacy claim header or service line item record with a non-zero plan paid amount and with a claim covered start date falling within a qualifying denominator observation period. The numerator contribution is the plan paid amount associated with that claim header or service line item.

Related Key Concepts

• CKD Patient
• Claim Financials

FAQs

Q: I see restrictions for patients to be alive and active members in the denominator logic; why don't I see a restriction for patients to have CKD?
The restriction to patient-period during which the patient met the criteria for CKD is applied upstream, in Patient Timelines Master for URSA-CKD Concepts.

Q: When does the numerator include medical claim headers vs. service line items?
[coming soon]