URSA-PHARM-003: Targeted Med Therapy Episode Plan Paid Amount

Measure Description

Among targeted medication therapy episodes, the total plan paid amount on all targeted medications. Includes URSA-PHARM episodes for any of the following targeted medication types: antidepressants, antineoplastics, beta blockers, antidiabetics, ACEI/ARBs, statins, high-risk medications (anticoagulants, oral antiplatelets, cardiac glycosides, opiate agonists, oral hypoglycemics, insulin), and any other chronic medications

Metadata

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

Denominator Description

One record per medication therapy episode for any of the following targeted medication types: antidepressants, antineoplastics, beta blockers, antidiabetics, ACEI/ARBs, statins, high-risk medications (anticoagulants, oral antiplatelets, cardiac glycosides, opiate agonists, oral hypoglycemics, insulin), and any other chronic medications

Numerator Description

The total plan paid amount on outpatient fills for any of the following targeted medication types

Published Fields

• Data Model Keys

  • Episode ID
  • Patient ID

• Patient Fields

  • Patient Last Name
  • Patient Date of Birth
  • Patient State Abbreviation
  • Patient ZIP Code 5-Digit

• Date Fields

  • Episode Start Date
  • 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)

• Episode Fields

  • Episode Length Days
  • Is Episode >= 90 Days
  • Episode Count Fills
  • Episode Aggregate Days Supply

• Provider Fields

  • First Filling Provider Description

• Medication Fields

  • First Fill Label Description
  • First Fill AHFS Therapeutic Class Code
  • First Fill AHFS Therapeutic Class Tier 1
  • First Fill AHFS Therapeutic Class Tier 2
  • First Fill AHFS Therapeutic Class Tier 3
  • First Fill Red Book Generic Cross Reference Code
  • First Fill Red Book Generic Formulation Code

• Financial Fields

  • Episode Total Paid Amount
  • Fill Plan Paid Amount
  • Fill Patient Paid Amount

• Numerator Fields

  • Fill Document ID
  • Fill Filled Date
  • Fill Filling Provider NPI
  • Fill Filling Provider Description
  • Is Fill Filling Provider Specialty Pharmacy
  • Is Fill Filling Provider Mail Order Pharmacy
  • Fill NDC Code 11-Digit
  • Fill Label Description
  • Fill Active Ingredients Description
  • Fill Primary Agent Description
  • Fill Form Description
  • Fill Route of Administration Description
  • Is Fill OTC
  • Fill AHFS Therapeutic Class Code 6-Digit
  • Fill AHFS Therapeutic Class Tier 1 Description
  • Fill AHFS Therapeutic Class Tier 2 Description
  • Fill AHFS Therapeutic Class Tier 3 Description
  • Is Fill Chronic Medication
  • Is Fill Antidepressant
  • Is Fill Antineoplastic
  • Is Fill Antidiabetic
  • Is Fill Oral Antidiabetic
  • Is Fill Oral ACEI/ARB
  • Is Fill Statin
  • Is Fill Beta Blocker
  • Is Fill Anticoagulant
  • Is Fill Cardiac Glycosides
  • Is Fill Insulin
  • Is Fill Opiate Agonists
  • Is Fill Oral Antiplatelet
  • Is Fill Oral Hypoglycemic
  • Is Fill Generic
  • Is Fill Single Source

• Measure Fields

  • Denominator
  • Numerator

• Module Fields

  • Count Patient Episodes
  • Episode Medication Class Category
  • Is Targeted for Chronic Status Only
  • Is Chronic Medication
  • Is Episode for Priority Adherence Medication
  • Is Antidepressant
  • Is Antidiabetic
  • Is Antineoplastic
  • Is Oral ACEI/ARB
  • Is Beta Blocker
  • Is Statin
  • Is Episode for any High Risk Medication
  • Is Anticoagulant
  • Is Oral Antiplatelet
  • Is Cardiac Glycosides
  • Is Oral Hypoglycemic
  • Is Insulin
  • Is Opiate Agonists

• [No Field Group]