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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
Regional Summary for Region VII for 2007
50 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
2,191,937 |
0 |
0 |
80,043 |
2,271,980 |
| 1b. Fee-for-Service revenue for Services |
19,679,901 |
113,179 |
0 |
377,835 |
20,170,915 |
| 1. Total revenue for Services (Lines
1a + 1b) |
21,871,838 |
113,179 |
0 |
457,878 |
22,442,895 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
11,334,754 |
0 |
|
|
11,334,754 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
1,596,271 |
0 |
|
|
1,596,271 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
82,894 |
0 |
0 |
176,232 |
259,126 |
| 3d. Penalties or paybacks to managed
care plans |
289,722 |
0 |
0 |
0 |
289,722 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
34,596,035 |
113,179 |
0 |
634,110 |
35,343,324 |
| Expenses |
| 5a. Capitation expenses for Services |
6,443,469 |
0 |
0 |
77,661 |
6,521,130 |
| 5b. Fee-for-Service expenses for Services |
30,111,595 |
261,943 |
0 |
761,222 |
31,134,760 |
5. Total expenses for Services
(Lines 5a + 5b) |
36,555,064 |
261,943 |
0 |
838,883 |
37,655,890 |
7. Total Managed Care Expenses
(Line 5) |
36,555,064 |
261,943 |
0 |
838,883 |
37,655,890 |
Surplus / Deficit
(Line 4 - Line 7) |
-1,959,029 |
-148,764 |
0 |
-204,773 |
-2,312,566 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
- 5.4% |
- 56.8% |
--- |
- 24.4% |
- 6.1% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
225,043 |
0 |
0 |
3,761 |
228,804 |
| 8b. Member months for managed care (fee-for-service) |
654,656 |
5,606 |
0 |
29,238 |
689,500 |
8. Total Member months for managed care
(Lines 8a + 8b) |
879,699 |
5,606 |
0 |
32,999 |
918,304 |
| 9a. Managed Care Encounters (capitated) |
60,770 |
0 |
0 |
597 |
61,367 |
| 9b. Managed Care Encounters (fee-for-service) |
200,276 |
3,464 |
0 |
7,452 |
211,192 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
261,046 |
3,464 |
0 |
8,049 |
272,559 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
18,342 |
0 |
0 |
359 |
18,701 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
57,711 |
454 |
0 |
2,012 |
60,177 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
76,053 |
454 |
0 |
2,371 |
78,878 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
18,388 |
11 |
0 |
229 |
18,628 |
| 12. Number of Managed Care Contracts |
51 |
5 |
0 |
8 |
64 |
Data as of: 7/7/2008 5:31:29
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