|
|
 |
|
|
TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
Regional Summary for Region VI for 2007
120 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
6,832,192 |
222,573 |
1,512,408 |
2,381,171 |
10,948,344 |
| 1b. Fee-for-Service revenue for Services |
22,799,475 |
462,567 |
1,844,646 |
893,491 |
26,000,179 |
| 1. Total revenue for Services (Lines
1a + 1b) |
29,631,667 |
685,140 |
3,357,054 |
3,274,662 |
36,948,523 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
17,280,360 |
0 |
|
|
17,280,360 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
4,427,561 |
0 |
|
|
4,427,561 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
673,080 |
154,833 |
254,510 |
363,120 |
1,445,543 |
| 3d. Penalties or paybacks to managed
care plans |
27,901 |
0 |
0 |
0 |
27,901 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
51,984,767 |
839,973 |
3,611,564 |
3,637,782 |
60,074,086 |
| Expenses |
| 5a. Capitation expenses for Services |
10,646,516 |
142,210 |
1,224,788 |
2,529,487 |
14,543,001 |
| 5b. Fee-for-Service expenses for Services |
39,226,957 |
556,850 |
2,973,643 |
2,141,612 |
44,899,062 |
5. Total expenses for Services
(Lines 5a + 5b) |
49,873,473 |
699,060 |
4,198,431 |
4,671,099 |
59,442,063 |
7. Total Managed Care Expenses
(Line 5) |
49,873,473 |
699,060 |
4,198,431 |
4,671,099 |
59,442,063 |
Surplus / Deficit
(Line 4 - Line 7) |
2,111,294 |
140,913 |
-586,867 |
-1,033,317 |
632,023 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
4.2% |
20.2% |
- 14.0% |
- 22.1% |
1.1% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
382,243 |
2,089 |
60,029 |
55,720 |
500,081 |
| 8b. Member months for managed care (fee-for-service) |
611,534 |
3,075 |
59,704 |
37,042 |
711,355 |
8. Total Member months for managed care
(Lines 8a + 8b) |
993,777 |
5,164 |
119,733 |
92,762 |
1,211,436 |
| 9a. Managed Care Encounters (capitated) |
118,799 |
1,566 |
8,616 |
22,566 |
151,547 |
| 9b. Managed Care Encounters (fee-for-service) |
273,544 |
5,852 |
28,153 |
36,061 |
343,610 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
392,343 |
7,418 |
36,769 |
58,627 |
495,157 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
42,422 |
167 |
5,008 |
4,760 |
52,357 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
57,712 |
360 |
6,977 |
4,005 |
69,054 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
100,134 |
527 |
11,985 |
8,765 |
121,411 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
101,067 |
0 |
0 |
0 |
101,067 |
| 12. Number of Managed Care Contracts |
149 |
21 |
45 |
79 |
294 |
Data as of: 7/7/2008 5:24:56
|
