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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
Regional Summary for Region III for 2007
105 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
28,633,569 |
470,411 |
290,087 |
4,937,330 |
34,331,397 |
| 1b. Fee-for-Service revenue for Services |
82,735,712 |
4,005,139 |
312,526 |
7,402,464 |
94,455,841 |
| 1. Total revenue for Services (Lines
1a + 1b) |
111,369,281 |
4,475,550 |
602,613 |
12,339,794 |
128,787,238 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
29,225,628 |
21,838 |
|
|
29,247,466 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
17,769,682 |
100,872 |
|
|
17,870,554 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
1,331,499 |
316,827 |
32,440 |
543,651 |
2,224,417 |
| 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) |
159,696,090 |
4,915,087 |
635,053 |
12,883,445 |
178,129,675 |
| Expenses |
| 5a. Capitation expenses for Services |
48,147,134 |
991,809 |
501,606 |
9,143,499 |
58,784,048 |
| 5b. Fee-for-Service expenses for Services |
105,161,180 |
5,081,234 |
462,131 |
12,435,300 |
123,139,845 |
5. Total expenses for Services
(Lines 5a + 5b) |
153,308,314 |
6,073,043 |
963,737 |
21,578,799 |
181,923,893 |
7. Total Managed Care Expenses
(Line 5) |
153,308,314 |
6,073,043 |
963,737 |
21,578,799 |
181,923,893 |
Surplus / Deficit
(Line 4 - Line 7) |
6,387,776 |
-1,157,956 |
-328,684 |
-8,695,354 |
-3,794,218 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
4.2% |
- 19.1% |
- 34.1% |
- 40.3% |
- 2.1% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
1,648,357 |
26,526 |
24,132 |
348,721 |
2,047,736 |
| 8b. Member months for managed care (fee-for-service) |
1,641,752 |
69,695 |
13,751 |
193,036 |
1,918,234 |
8. Total Member months for managed care
(Lines 8a + 8b) |
3,290,109 |
96,221 |
37,883 |
541,757 |
3,965,970 |
| 9a. Managed Care Encounters (capitated) |
354,556 |
9,149 |
4,711 |
83,260 |
451,676 |
| 9b. Managed Care Encounters (fee-for-service) |
716,754 |
38,539 |
4,575 |
100,787 |
860,655 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
1,071,310 |
47,688 |
9,286 |
184,047 |
1,312,331 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
143,140 |
2,186 |
2,200 |
28,620 |
176,146 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
144,328 |
6,540 |
1,289 |
16,945 |
169,102 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
287,468 |
8,726 |
3,489 |
45,565 |
345,248 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
16,209 |
0 |
0 |
0 |
16,209 |
| 12. Number of Managed Care Contracts |
263 |
73 |
28 |
160 |
524 |
Data as of: 7/3/2008 11:30:39
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