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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
Regional Summary for Region IV for 2007
195 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
25,926,265 |
1,239,647 |
244,956 |
4,464,925 |
31,875,793 |
| 1b. Fee-for-Service revenue for Services |
25,857,780 |
623,451 |
692,799 |
3,346,357 |
30,520,387 |
| 1. Total revenue for Services (Lines
1a + 1b) |
51,784,045 |
1,863,098 |
937,755 |
7,811,282 |
62,396,180 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
20,527,132 |
0 |
|
|
20,527,132 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
5,049,955 |
128,858 |
|
|
5,178,813 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
3,343,821 |
35,976 |
6,525 |
402,210 |
3,788,532 |
| 3d. Penalties or paybacks to managed
care plans |
60,217 |
537 |
0 |
3,315 |
64,069 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
80,644,736 |
2,027,395 |
944,280 |
8,210,177 |
91,826,588 |
| Expenses |
| 5a. Capitation expenses for Services |
31,323,493 |
915,765 |
277,726 |
3,982,070 |
36,499,054 |
| 5b. Fee-for-Service expenses for Services |
43,288,526 |
1,255,146 |
1,102,687 |
4,244,677 |
49,891,036 |
5. Total expenses for Services
(Lines 5a + 5b) |
74,612,019 |
2,170,911 |
1,380,413 |
8,226,747 |
86,390,090 |
7. Total Managed Care Expenses
(Line 5) |
74,612,019 |
2,170,911 |
1,380,413 |
8,226,747 |
86,390,090 |
Surplus / Deficit
(Line 4 - Line 7) |
6,032,717 |
-143,516 |
-436,133 |
-16,570 |
5,436,498 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
8.1% |
- 6.6% |
- 31.6% |
- 0.2% |
6.3% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
1,431,166 |
22,201 |
18,968 |
113,577 |
1,585,912 |
| 8b. Member months for managed care (fee-for-service) |
1,188,617 |
31,688 |
53,828 |
152,883 |
1,427,016 |
8. Total Member months for managed care
(Lines 8a + 8b) |
2,619,783 |
53,889 |
72,796 |
266,460 |
3,012,928 |
| 9a. Managed Care Encounters (capitated) |
267,167 |
8,668 |
1,957 |
31,773 |
309,565 |
| 9b. Managed Care Encounters (fee-for-service) |
361,699 |
9,897 |
10,478 |
46,856 |
428,930 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
628,866 |
18,565 |
12,435 |
78,629 |
738,495 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
123,223 |
2,264 |
1,877 |
9,726 |
137,090 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
104,680 |
2,520 |
5,455 |
14,931 |
127,586 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
227,903 |
4,784 |
7,332 |
24,657 |
264,676 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
141,219 |
0 |
344 |
396 |
141,959 |
| 12. Number of Managed Care Contracts |
6,324 |
58 |
22 |
107 |
6,511 |
Data as of: 7/3/2008 9:04:46
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