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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Wisconsin for 2007
16 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
143,137 |
0 |
0 |
28,738 |
171,875 |
| 1b. Fee-for-Service revenue for Services |
2,899,379 |
285,265 |
0 |
219,562 |
3,404,206 |
| 1. Total revenue for Services (Lines
1a + 1b) |
3,042,516 |
285,265 |
0 |
248,300 |
3,576,081 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
4,320,683 |
0 |
|
|
4,320,683 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
818,919 |
252 |
|
|
819,171 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
17,602 |
0 |
0 |
0 |
17,602 |
| 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) |
8,199,720 |
285,517 |
0 |
248,300 |
8,733,537 |
| Expenses |
| 5a. Capitation expenses for Services |
275,588 |
0 |
0 |
61,646 |
337,234 |
| 5b. Fee-for-Service expenses for Services |
7,042,078 |
437,258 |
0 |
309,835 |
7,789,171 |
5. Total expenses for Services
(Lines 5a + 5b) |
7,317,666 |
437,258 |
0 |
371,481 |
8,126,405 |
7. Total Managed Care Expenses
(Line 5) |
7,317,666 |
437,258 |
0 |
371,481 |
8,126,405 |
Surplus / Deficit
(Line 4 - Line 7) |
882,054 |
-151,741 |
0 |
-123,181 |
607,132 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
12.1% |
- 34.7% |
--- |
- 33.2% |
7.5% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
6,108 |
0 |
0 |
2,581 |
8,689 |
| 8b. Member months for managed care (fee-for-service) |
181,248 |
7,561 |
0 |
8,983 |
197,792 |
8. Total Member months for managed care
(Lines 8a + 8b) |
187,356 |
7,561 |
0 |
11,564 |
206,481 |
| 9a. Managed Care Encounters (capitated) |
1,378 |
0 |
0 |
308 |
1,686 |
| 9b. Managed Care Encounters (fee-for-service) |
47,690 |
3,011 |
0 |
2,033 |
52,734 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
49,068 |
3,011 |
0 |
2,341 |
54,420 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
531 |
0 |
0 |
213 |
744 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
15,363 |
608 |
0 |
789 |
16,760 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
15,894 |
608 |
0 |
1,002 |
17,504 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
0 |
0 |
0 |
0 |
0 |
| 12. Number of Managed Care Contracts |
23 |
8 |
0 |
12 |
43 |
Data as of: 7/22/2008 4:32:23
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