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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
Regional Summary for Region VIII for 2007
55 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
6,761,676 |
1,357,529 |
2,094,259 |
4,144,482 |
14,357,946 |
| 1b. Fee-for-Service revenue for Services |
138,857 |
129,687 |
1,185,787 |
202,167 |
1,656,498 |
| 1. Total revenue for Services (Lines
1a + 1b) |
6,900,533 |
1,487,216 |
3,280,046 |
4,346,649 |
16,014,444 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
9,649,075 |
0 |
|
|
9,649,075 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
0 |
0 |
|
|
0 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
21,211 |
1,357,529 |
1,283,171 |
248,669 |
2,910,580 |
| 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) |
16,570,819 |
2,844,745 |
4,563,217 |
4,595,318 |
28,574,099 |
| Expenses |
| 5a. Capitation expenses for Services |
14,743,684 |
2,447,709 |
1,812,404 |
3,932,793 |
22,936,590 |
| 5b. Fee-for-Service expenses for Services |
106,343 |
182,674 |
1,514,034 |
223,518 |
2,026,569 |
5. Total expenses for Services
(Lines 5a + 5b) |
14,850,027 |
2,630,383 |
3,326,438 |
4,156,311 |
24,963,159 |
7. Total Managed Care Expenses
(Line 5) |
14,850,027 |
2,630,383 |
3,326,438 |
4,156,311 |
24,963,159 |
Surplus / Deficit
(Line 4 - Line 7) |
1,720,792 |
214,362 |
1,236,779 |
439,007 |
3,610,940 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
11.6% |
8.1% |
37.2% |
10.6% |
14.5% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
437,011 |
11,056 |
123,442 |
118,085 |
689,594 |
| 8b. Member months for managed care (fee-for-service) |
0 |
6,419 |
28,457 |
6,494 |
41,370 |
8. Total Member months for managed care
(Lines 8a + 8b) |
437,011 |
17,475 |
151,899 |
124,579 |
730,964 |
| 9a. Managed Care Encounters (capitated) |
87,199 |
12,748 |
33,565 |
20,668 |
154,180 |
| 9b. Managed Care Encounters (fee-for-service) |
0 |
1,282 |
10,664 |
1,634 |
13,580 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
87,199 |
14,030 |
44,229 |
22,302 |
167,760 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
36,540 |
1,959 |
12,701 |
16,580 |
67,780 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
0 |
476 |
3,916 |
583 |
4,975 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
36,540 |
2,435 |
16,617 |
17,163 |
72,755 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
648 |
0 |
0 |
0 |
648 |
| 12. Number of Managed Care Contracts |
3 |
4 |
11 |
20 |
38 |
Data as of: 7/7/2008 5:45:01
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