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.

Published Fields

• Data Model Keys

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

• Date Fields

  • Current Continuous Primary Payor Membership Episode Start Date
  • Current Continuous Primary Payor Membership Episode End Date
  • Current Dialysis Episode Start Date
  • Current Dialysis 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)
  • Segmented Period Start Date
  • Segmented Period End Date

• Module Fields

  • CKD Stage Category
  • Is CKD Stage 1
  • Is CKD Stage 2
  • Is CKD Stage 3
  • Is CKD Stage 4
  • Is CKD Stage 5
  • Is ESRD
  • Is CKD Stage Unknown
  • Is CKD Stage 3 or Higher
  • Is CKD Stage 4 or Higher
  • Is Chronic Dialysis Patient
  • Is History of Kidney Transplantation

• Patient Fields

  • Patient Date of Birth
  • Is Patient Alive
  • Patient Age Integer
  • Patient Age Category Tier 1
  • Patient Age Category Tier 2
  • Patient Sex Category
  • Count Hospital Inpatient Admissions in Last 12 Months
  • Count ED Visits Without Inpatient Admissions in Last 12 Months

• Provider Fields

  • CKD Physician Management Category
  • Plan Attributee Provider Description
  • Count Nephrology Provider Visits in Last 12 Months
  • Empirical Attributee Individual Nephrology Provider Description
  • Empirical Attributee Nephrology Group Provider Description
  • Count Primary Care Visits for CKD in Last 12 Months
  • Primary Care Engagement Category
  • Count Primary Care Visits in Last 36 Months
  • Empirical Attributee Primary Care Provider Group Description
  • Empirical Attributee Individual Primary Care 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

• Clinical Services Fields

  • Is Hospice in Last 12 Months
  • Is Last Dialysis Modality Hemodialysis
  • Is Last Dialysis Modality Peritoneal Dialysis

• Diagnosis Fields

  • Count CCW Conditions
  • Is CCW System Behavioral Health
  • Is CCW System Cardiovascular
  • Is CCW System Genitourinary
  • Is CCW System Musculoskeletal
  • Is CCW System Pulmonary
  • Is CCW Acquired Hypothyroidism
  • Is CCW Acute Myocardial Infarction
  • Is CCW Alzheimers Disease
  • Is CCW Anemia
  • Is CCW Anxiety Disorders
  • Is CCW Asthma
  • Is CCW Atrial Fibrillation
  • Is CCW Benign Prostatic Hyperplasia
  • Is CCW Bipolar Disorder
  • Is CCW Breast Cancer
  • Is CCW Cataract
  • Is CCW CKD
  • Is CCW COPD and Bronchiectasis
  • Is CCW Colorectal Cancer
  • Is CCW Depression
  • Is CCW Depressive Disorders
  • Is CCW Diabetes
  • Is CCW Endometrial Cancer
  • Is CCW Glaucoma
  • Is CCW Heart Failure
  • Is CCW Ischemic Heart Disease
  • Is CCW Hip or Pelvic Fracture
  • Is CCW Hyperlipidemia
  • Is CCW Hypertension
  • Is CCW Lung Cancer
  • Is CCW Osteoporosis
  • Is CCW Prostate Cancer
  • Is CCW Rheumatoid Arthritis or Osteoarthritis
  • Is CCW Stroke or Transient Ischemic Attack
  • Is CCW Schizophrenia or Other Psychotic Disorders
  • CCW Count Category
  • Is CCW Alzheimers Disease and Related Disorders or Senile Dementia
  • CCW Systems Category
  • Count CCW Systems
  • Is CCW System Congenital
  • Is CCW System Endocrine/Metabolic
  • Is CCW System Hematologic
  • Is CCW System Neurological
  • Is CCW System Oncologic
  • Is CCW System Ophthalmologic
  • Is CCW System Other

• Location Fields

  • Patient ZIP Code 5-Digit
  • UW HIP ADI Quintile Category

• Insurance Fields

  • Is Any Current Plan Membership
  • Primary Plan Description
  • Primary Plan Financial Class Description

• Numerator Fields

  • Document ID
  • Claim ID
  • Claim Service Line Item ID
  • Billing Provider ID
  • Payor ID
  • Plan ID
  • Source ID
  • Document Effective Date
  • Document Type Category
  • Claim Class Category
  • Ursa Setting Tier 1 Description
  • Ursa Encounter Type Tier 1 Category
  • Ursa Service Type Tier 1 Description
  • Billing Provider Description
  • CMS Type of Bill Code
  • CMS Place of Service Code
  • CMS Place of Service Description
  • HCPCS Code
  • HCPCS Description
  • CMS Revenue Center Code
  • CMS Revenue Center Description
  • Principal Diagnosis ICD-10-CM Code
  • Principal Diagnosis ICD-10-CM Description
  • Principal Diagnosis AHRQ CCS Diagnosis Category Tier 1 Description
  • Principal Diagnosis AHRQ CCS Diagnosis Category Tier 2 Description
  • NDC Code
  • Label Description
  • AHFS Therapeutic Class Tier 1 Description
  • AHFS Therapeutic Class Tier 2 Description
  • Document Allowed Amount
  • Document Plan Paid Amount
  • Document Patient Paid Amount

• [No Field Group]

  • Ursa Serial ID

• Measure Fields

  • Denominator
  • Numerator