URSA-PHARM-203: Patients with Opioid Use Last 12 Months

  • Published on Apr 10, 2026
  • 8 minute(s) read
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Measure Description

Among patients with active plan membership and one or more outpatient medication fill in the last 12 months, the percentage with 2+ Opioid Fills and an aggregate days supply of 15 or great in the last 12 months. Excludes patients with any active CCW cancer condition or evidence of hospice at in the prior 12 months.

Metadata

  • Measure Identifier: URSA-PHARM-203
  • Measure Type: Rate Measure
  • Temporal Structure: Entity
  • Component Class: Normal-Form
  • Denominator Case Field: Patient ID
  • Target Direction: Down

Denominator Description

Patients with active plan membership and one or more outpatient medication fill in the last 12 months; excludes patients with any active CCW cancer condition or evidence of hospice in the prior 12 months.

Numerator Description

Patients meeting denominator criteria and have 2+ Opioid Fills and an aggregate days supply of 15 or great in the last 12 months.

Published Fields

  • Data Model Keys

    • Patient ID -- The internal database identifier (used, e.g., for joins and primary keys) for the patient. This value is typically mastered, i.e., all records for the same patient, regardless of the source data system from which that record originated, should have the same Patient ID value. (Note that while the mastered Patient ID value might resemble a local identifier used in one of the upstream data sources, this does not indicate any special priority of that source system in determining the characteristics of the patient.) (See also [URSA-CORE] Patient)
    • Primary Payor ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Primary Payor. (See also [URSA-CORE] Primary Payor)
    • Primary Plan ID -- The identifier for the health insurance plan product that is the first party responsible for payment.

  • Patient Fields

    • Patient Date of Birth -- The patient's date of birth. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the date of birth found on that particular type of record in the source data.
    • Patient Age Integer -- Patient age, expressed as an integer, as of a reference date or interval.
    • Patient Age Category Tier 1 -- Non-overlapping ranges of the patient age in years into three categories; [01] Pediatrics < 19, [02] Adults 19 - 64, and [03] Older Adults >= 65. Coarser grain to the Patient Age Category Tier 2. (See also [URSA-CORE] Patient Age Category Tier 2)
    • Patient Age Category Tier 2 -- Non-overlapping ranges of the patient age in years representing finer grain categories than the Patient Age Category Tier 1. This field incorporates findings from publications on defining meaningful age groups in the context of disease. These ranges closely, but not exactly, align with standard age ranges such as those defined by the Medical Subject Headings (MeSH). See results of K-Means simple clustering method at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825015/ (See also [URSA-CORE] Patient Age Category Tier 1)
    • Patient Sex Category
    • Primary Care Engagement Category
    • Specialty Care Engagement Category
    • Count Specialty Care Office Visits in Last 36 Months
    • Primary or Specialty Care Engagement Category
    • Count Clinician Office Visits in Last 3 Years
    • Count Hospital Inpatient Admissions in Last 12 Months
    • Count ED Visits Without Inpatient Admissions in Last 12 Months

  • Date Fields

    • 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)
    • Snapshot Date -- The date, evaluated at 00:00:00 AM, giving the moment the state of the world will be set to for the purposes of an analysis. The snapshot date does not represent the freshness of the data, or the date in real time at which an analysis was executed.

  • Provider Fields

    • Count Primary Care Visits in Last 36 Months
    • Count Distinct Filling Providers Last 12 Months
    • Count Distinct Prescribing Providers Last 12 Months
    • Count Distinct Opioid Prescribing Providers in Last 6 Months
    • Count Distinct Opioid Filling Providers in Last 6 Months
    • Count Distinct Opioid Prescribing Providers in Last 12 Months
    • Count Distinct Opioid Filling Providers in Last 12 Months
    • Empirical Attributee PCP Provider NPI
    • Empirical Attributee PCP Provider Description
    • Empirical Attributee Primary Care Provider Group Provider NPI
    • Empirical Attributee Primary Care Provider Group Provider Description

  • Location Fields

    • Patient State Abbreviation
    • Patient ZIP Code 5-Digit
    • UW HIP ADI Quintile Category -- The UW HIP Area Deprivation Index National Percentile grouped into 5 levels, each spanning 20 percentile points (ADI 1 is percentile scores from 1 to 20 while ADI 5 is scores from 81 to 100). Higher scores indicate more deprivation, so ADI 1 is the least deprived while ADI 5 is the most deprived. Quintiles are frequently used in health research. They give larger sample sizes per group and are easier to plot and interpret. Quintiles also carry less information and group more dissimilar patients. Quintiles are good for descriptive analyses while the original percentile measure is preferable for predictive modeling. (See also [URSA-CORE] UW HIP Area Deprivation Index National Percentile)

  • Insurance Fields

    • Primary Payor Description
    • Primary Plan Description
    • Primary Plan Financial Class Description

  • Medication Fields

    • Count Opioid Fills in Last 6 Months
    • Count Opioid Fills in Last 12 Months
    • Aggregate Opioid Days Supply in Last 6 Months
    • Aggregate Opioid Days Supply in Last 12 Months

  • Diagnosis Fields

    • CCW Count Category
    • CCW Systems Category
    • Count CCW Systems -- The count of distinct systems of the body with one or more active CCW Condition. CCW Systems are as a parent category to the individual CCW Conditions grouping them based primarily on the human body system they impact such as; Behavioral Health, Cancers, Cardiovascular, Cerebrovascular, Endocrine, Genitourinary, Musculoskeletal, and Pulmonary. (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))

  • Financial Fields

    • Medication Plan Paid Amount in Last 12 Months
    • Medication Patient Paid Amount in Last 12 Months
    • Total Medication Paid Amount Last 12 Months
    • Cumulative Calendar Year Rx Plan Paid Amount
    • Cumulative Calendar Year Rx Patient Paid Amount

  • Measure Fields

    • Denominator
    • Numerator

  • Module Fields

    • Medication Management Trigger Category -- Category description for grouping patients based on which URSA-PHARM medication management triggers are active as of a given date. Triggers include; (1) High Medication Spend, (2) Very High Medication Spend, (3) High Number of Prescribing Providers, (4) High Number of Filling Providers, (5) Multiple Opioid Prescribing Providers Last 6 Months, (6) Multiple Opioid Filling Providers Last 6 Month, (7) Active Chronic Opioid Episode, or (8) High Number of Chronic Medications (See also [URSA-PHARM] Is High Number of Chronic Medications, [URSA-PHARM] Is High Medication Spend, [URSA-PHARM] Is Very High Medication Spend, [URSA-PHARM] Is High Number of Filling Providers, [URSA-PHARM] Is High Number of Prescribing Providers, [URSA-PHARM] Is Multiple Opioid Prescribing Providers Last 6 Months, [URSA-PHARM] Is Multiple Opioid Filling Providers Last 6 Months, [URSA-PHARM] Is Active Chronic Opioid Episode)
    • Is Patient with Active Medication Management Trigger -- Indicates that, as of a given date, the patient has one or more active Medication Management Trigger. Triggers include; (1) High Medication Spend, (2) Very High Medication Spend, (3) High Number of Prescribing Providers, (4) High Number of Filling Providers, (5) Multiple Opioid Prescribing Providers Last 6 Months, (6) Multiple Opioid Filling Providers Last 6 Month, (7) Active Chronic Opioid Episode, or (8) High Number of Chronic Medications. (See also [URSA-PHARM] Is High Medication Spend, [URSA-PHARM] Is Very High Medication Spend, [URSA-PHARM] Is High Number of Filling Providers, [URSA-PHARM] Is High Number of Prescribing Providers, [URSA-PHARM] Is Multiple Opioid Prescribing Providers Last 6 Months, [URSA-PHARM] Is Multiple Opioid Filling Providers Last 6 Months, [URSA-PHARM] Is Active Chronic Opioid Episode, [URSA-PHARM] Is High Number of Chronic Medications, [URSA-PHARM] Medication Management Trigger Category)
    • Count Active Medication Management Trigger Categories -- Indicates that, as of a given date, the count of distinct Medication Management Trigger categories that are active for the patient. Triggers categories include; (1) High Medication Spend, (2) Very High Medication Spend, (3) High Number of Prescribing Providers, (4) High Number of Filling Providers, (5) Multiple Opioid Prescribing Providers Last 6 Months, (6) Multiple Opioid Filling Providers Last 6 Month, (7) Active Chronic Opioid Episode, or (8) High Number of Chronic Medications. (See also [URSA-PHARM] Is Patient with Active Medication Management Trigger, [URSA-PHARM] Medication Management Trigger Category)
    • Is High Medication Spend -- One of the Medication Management Triggers; indicates that, as of a given date, the total spending on outpatient medication fills for the patient in the prior 12 months is between $4,800 and $9,600, inclusive. Total spending includes both plan and patient paid amounts. (See also [URSA-PHARM] Medication Management Trigger Category)
    • Is Very High Medication Spend -- One of the Medication Management Triggers; indicates the total spending on outpatient medications for the patient in the prior 12 months is greater than $9,600. Total spending includes both plan and patient paid amounts.
    • Is High Number of Prescribing Providers -- One of the Medication Management Triggers; indicates that, as of a given date, the patient has filled outpatient medication prescriptions written by five or more distinct prescribing providers in the prior 12 months. (See also [URSA-PHARM] Medication Management Trigger Category)
    • Is High Number of Filling Providers -- One of the Medication Management Triggers; indicates that, as of a given date, the patient has been dispensed outpatient medications from five or more distinct pharmacies or other filling providers in the prior 12 months. (See also [URSA-PHARM] Medication Management Trigger Category)
    • Is Multiple Opioid Prescribing Providers Last 6 Months -- One of the Medication Management Triggers; indicates that, as of a given date, the patient has had medication fills for opiate agonists from two or more distinct prescribing providers in the prior 6 months. (See also [URSA-PHARM] Medication Management Trigger Category)
    • Is Multiple Opioid Filling Providers Last 6 Months -- Indicates (true = "1") if the patient has had fills for opiate agonists from two or more distinct filling providers (pharmacies) in the prior 6 months.
    • Is Active Chronic Opioid Episode -- One of the Medication Management Triggers; indicates that, as of a given date, the patient has an active Medication Therapy Episode for an Opiate Agonist (true = "1") based on the URSA-PHARM value set for Opiate Agonists and logic for classifying fills as Is Chronic. (See also [URSA-PHARM] Chronic Medication, [URSA-PHARM] Targeted Medication Therapy Episode, [URSA-PHARM] Medication Management Trigger Category)