URSA-PHF-001: PMPM Plan Spending

Measure Description

Among active plan membership periods, the per-member-per-month payor spending

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 is alive, has active plan coverage, and medical claim data coverage.

Numerator Description

Total payor spending for claims with covered start date falling within the observation period start and end dates; includes claim financials with a non-zero plan paid or allowed amount.

Related Key Concepts

None.

FAQs

None.