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TABLE 9C: Managed Care Enrollment/Utilization
National Summary for 2006
1002 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
375,099,979 |
13,871,390 |
42,804,557 |
38,761,144 |
470,537,070 |
| 1b. Fee-for-Service revenue for Services |
415,292,512 |
12,349,163 |
15,400,358 |
51,331,450 |
494,373,483 |
| 1. Total revenue for Services (Lines
1a + 1b) |
790,392,491 |
26,220,553 |
58,204,915 |
90,092,594 |
964,910,553 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
374,611,467 |
23,178 |
|
|
374,634,645 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
115,346,208 |
89,846 |
|
|
115,436,054 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
45,581,717 |
1,814,070 |
19,613,027 |
8,260,089 |
75,268,903 |
| 3d. Penalties or paybacks to managed
care plans |
2,820,708 |
0 |
212,399 |
321,745 |
3,354,852 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
1,323,111,175 |
28,147,647 |
77,605,543 |
98,030,938 |
1,526,895,303 |
| Expenses |
| 5a. Capitation expenses for Services |
591,823,764 |
15,860,283 |
56,772,943 |
56,300,814 |
720,757,804 |
| 5b. Fee-for-Service expenses for Services |
624,149,239 |
17,843,002 |
26,127,058 |
76,659,071 |
744,778,370 |
5. Total expenses for Services
(Lines 5a + 5b) |
1,215,973,003 |
33,703,285 |
82,900,001 |
132,959,885 |
1,465,536,174 |
7. Total Managed Care Expenses
(Line 5) |
1,215,973,003 |
33,703,285 |
82,900,001 |
132,959,885 |
1,465,536,174 |
Surplus / Deficit
(Line 4 - Line 7) |
107,138,172 |
-5,555,638 |
-5,294,458 |
-34,928,947 |
61,359,129 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
8.8% |
- 16.5% |
- 6.4% |
- 26.3% |
4.2% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
16,227,621 |
148,457 |
1,812,916 |
1,883,424 |
20,072,418 |
| 8b. Member months for managed care (fee-for-service) |
11,227,689 |
233,392 |
587,815 |
1,680,983 |
13,729,879 |
8. Total Member months for managed care
(Lines 8a + 8b) |
27,455,310 |
381,849 |
2,400,731 |
3,564,407 |
33,802,297 |
| 9a. Managed Care Encounters (capitated) |
4,574,465 |
61,618 |
383,756 |
405,649 |
5,425,488 |
| 9b. Managed Care Encounters (fee-for-service) |
4,380,348 |
136,177 |
195,402 |
600,685 |
5,312,612 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
8,954,813 |
197,795 |
579,158 |
1,006,334 |
10,738,100 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
1,397,614 |
12,850 |
155,178 |
161,182 |
1,726,824 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
1,003,057 |
19,825 |
51,620 |
163,036 |
1,237,538 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
2,400,671 |
32,675 |
206,798 |
324,218 |
2,964,362 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
396,819 |
307 |
985 |
7,827 |
405,938 |
| 12. Number of Managed Care Contracts |
7,893 |
281 |
524 |
1,111 |
9,809 |
Data as of: 7/2/2007 6:54:03
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