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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for South Carolina for 2007
22 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
3,529,241 |
0 |
0 |
0 |
3,529,241 |
| 1b. Fee-for-Service revenue for Services |
2,005,773 |
86,077 |
0 |
699,921 |
2,791,771 |
| 1. Total revenue for Services (Lines
1a + 1b) |
5,535,014 |
86,077 |
0 |
699,921 |
6,321,012 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
616,152 |
0 |
|
|
616,152 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
152,464 |
0 |
|
|
152,464 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
12,039 |
5,805 |
0 |
16,164 |
34,008 |
| 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) |
6,315,669 |
91,882 |
0 |
716,085 |
7,123,636 |
| Expenses |
| 5a. Capitation expenses for Services |
3,973,654 |
0 |
0 |
0 |
3,973,654 |
| 5b. Fee-for-Service expenses for Services |
3,064,297 |
92,826 |
0 |
742,633 |
3,899,756 |
5. Total expenses for Services
(Lines 5a + 5b) |
7,037,951 |
92,826 |
0 |
742,633 |
7,873,410 |
7. Total Managed Care Expenses
(Line 5) |
7,037,951 |
92,826 |
0 |
742,633 |
7,873,410 |
Surplus / Deficit
(Line 4 - Line 7) |
-722,282 |
- 944 |
0 |
-26,548 |
-749,774 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
- 10.3% |
- 1.0% |
--- |
- 3.6% |
- 9.5% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
199,097 |
0 |
0 |
0 |
199,097 |
| 8b. Member months for managed care (fee-for-service) |
38,333 |
1,604 |
0 |
27,728 |
67,665 |
8. Total Member months for managed care
(Lines 8a + 8b) |
237,430 |
1,604 |
0 |
27,728 |
266,762 |
| 9a. Managed Care Encounters (capitated) |
41,295 |
0 |
0 |
0 |
41,295 |
| 9b. Managed Care Encounters (fee-for-service) |
18,351 |
655 |
0 |
12,448 |
31,454 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
59,646 |
655 |
0 |
12,448 |
72,749 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
15,854 |
0 |
0 |
0 |
15,854 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
3,434 |
135 |
0 |
3,664 |
7,233 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
19,288 |
135 |
0 |
3,664 |
23,087 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
2,255 |
0 |
0 |
0 |
2,255 |
| 12. Number of Managed Care Contracts |
25 |
10 |
0 |
24 |
59 |
data as of: 7/22/2008 4:11:52
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