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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Rhode Island for 2007
7 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
6,444,218 |
0 |
0 |
0 |
6,444,218 |
| 1b. Fee-for-Service revenue for Services |
3,241,887 |
108,912 |
0 |
92,571 |
3,443,370 |
| 1. Total revenue for Services (Lines
1a + 1b) |
9,686,105 |
108,912 |
0 |
92,571 |
9,887,588 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
6,136,395 |
48,267 |
|
|
6,184,662 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
102,468 |
34,250 |
|
|
136,718 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
2,687,882 |
23,757 |
0 |
24,428 |
2,736,067 |
| 3d. Penalties or paybacks to managed
care plans |
0 |
0 |
0 |
0 |
0 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
18,612,850 |
215,186 |
0 |
116,999 |
18,945,035 |
| Expenses |
| 5a. Capitation expenses for Services |
7,328,634 |
0 |
0 |
0 |
7,328,634 |
| 5b. Fee-for-Service expenses for Services |
9,924,321 |
196,514 |
0 |
137,916 |
10,258,751 |
5. Total expenses for Services
(Lines 5a + 5b) |
17,252,955 |
196,514 |
0 |
137,916 |
17,587,385 |
7. Total Managed Care Expenses
(Line 5) |
17,252,955 |
196,514 |
0 |
137,916 |
17,587,385 |
Surplus / Deficit
(Line 4 - Line 7) |
1,359,895 |
18,672 |
0 |
-20,917 |
1,357,650 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
7.9% |
9.5% |
--- |
- 15.2% |
7.7% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
329,438 |
0 |
0 |
0 |
329,438 |
| 8b. Member months for managed care (fee-for-service) |
58,617 |
4,867 |
0 |
4,511 |
67,995 |
8. Total Member months for managed care
(Lines 8a + 8b) |
388,055 |
4,867 |
0 |
4,511 |
397,433 |
| 9a. Managed Care Encounters (capitated) |
80,306 |
0 |
0 |
0 |
80,306 |
| 9b. Managed Care Encounters (fee-for-service) |
62,278 |
1,603 |
0 |
1,075 |
64,956 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
142,584 |
1,603 |
0 |
1,075 |
145,262 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
27,004 |
0 |
0 |
0 |
27,004 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
5,219 |
431 |
0 |
372 |
6,022 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
32,223 |
431 |
0 |
372 |
33,026 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
4 |
0 |
0 |
0 |
4 |
| 12. Number of Managed Care Contracts |
17 |
4 |
0 |
3 |
24 |
data as of: 7/22/2008 4:10:48
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