URSA-PHF-009b: Hospital Encounter PMPM Plan Spending

Measure Description

Among active plan membership patient-periods, the per-member-per-month plan spending on any of the URSA-CORE hospital encounter types: (1) Emergency Department Visits without Admissions, (2) Hospital Observation Stays without Admission, (3) Hospital Inpatient Admissions, (4) Hospital Outpatient Surgery Encounters, and (5) Other Hospital Outpatient Department 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 Hospital Encounter with encounter start date falling within the observation period start and end dates; URSA-CORE encounters include: (1) Emergency Department Visits without Admissions, (2) Hospital Observation Stays without Admission, (3) Hospital Inpatient Admissions, (4) Hospital Outpatient Surgery Encounters, and (5) Other Hospital Outpatient Department Encounters.

Related Key Concepts

None.

FAQs

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