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Managed Care Enrollment/Utilization
National Summary for 2007
1067 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
401,332,229 |
21,045,401 |
44,895,023 |
39,163,151 |
506,435,804 |
| 1b. Fee-for-Service revenue for Services |
491,782,051 |
19,819,003 |
32,216,125 |
63,629,111 |
607,446,290 |
| 1. Total revenue for Services (Lines
1a + 1b) |
893,114,280 |
40,864,404 |
77,111,148 |
102,792,262 |
1,113,882,094 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
437,032,810 |
390,978 |
|
|
437,423,788 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
124,531,267 |
826,867 |
|
|
125,358,134 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
53,361,620 |
3,572,729 |
18,874,626 |
11,258,639 |
87,067,614 |
| 3d. Penalties or paybacks to managed
care plans |
3,359,376 |
750 |
3,249 |
44,260 |
3,407,635 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
1,504,680,601 |
45,654,228 |
95,982,525 |
114,006,641 |
1,760,323,995 |
| Expenses |
| 5a. Capitation expenses for Services |
653,264,165 |
20,336,030 |
63,031,422 |
59,728,028 |
796,359,645 |
| 5b. Fee-for-Service expenses for Services |
747,615,192 |
26,015,979 |
44,259,962 |
105,162,867 |
923,054,000 |
5. Total expenses for Services
(Lines 5a + 5b) |
1,400,879,357 |
46,352,009 |
107,291,384 |
164,890,895 |
1,719,413,645 |
7. Total Managed Care Expenses
(Line 5) |
1,400,879,357 |
46,352,009 |
107,291,384 |
164,890,895 |
1,719,413,645 |
Surplus / Deficit
(Line 4 - Line 7) |
103,801,244 |
-697,781 |
-11,308,859 |
-50,884,254 |
40,910,350 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
7.4% |
- 1.5% |
- 10.5% |
- 30.9% |
2.4% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
16,933,552 |
177,624 |
1,798,378 |
1,782,021 |
20,691,575 |
| 8b. Member months for managed care (fee-for-service) |
12,947,426 |
332,602 |
876,672 |
1,891,981 |
16,048,681 |
8. Total Member months for managed care
(Lines 8a + 8b) |
29,880,978 |
510,226 |
2,675,050 |
3,674,002 |
36,740,256 |
| 9a. Managed Care Encounters (capitated) |
4,689,020 |
86,647 |
403,321 |
377,485 |
5,556,473 |
| 9b. Managed Care Encounters (fee-for-service) |
5,163,366 |
192,790 |
305,680 |
784,806 |
6,446,642 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
9,852,386 |
279,437 |
709,001 |
1,162,291 |
12,003,115 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
1,453,484 |
20,495 |
160,079 |
155,171 |
1,789,229 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
1,161,122 |
30,807 |
94,176 |
172,231 |
1,458,336 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
2,614,606 |
51,302 |
254,255 |
327,402 |
3,247,565 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
545,597 |
60 |
344 |
5,149 |
551,150 |
| 12. Number of Managed Care Contracts |
8,127 |
439 |
579 |
1,186 |
10,331 |
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