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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
Regional Summary for Region I for 2007
84 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
21,624,108 |
206,436 |
51,030 |
604,051 |
22,485,625 |
| 1b. Fee-for-Service revenue for Services |
75,172,709 |
1,500,395 |
16,602,700 |
19,295,004 |
112,570,808 |
| 1. Total revenue for Services (Lines
1a + 1b) |
96,796,817 |
1,706,831 |
16,653,730 |
19,899,055 |
135,056,433 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
22,516,906 |
48,267 |
|
|
22,565,173 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
3,849,514 |
34,250 |
|
|
3,883,764 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
3,011,646 |
341,147 |
37,486 |
1,969,093 |
5,359,372 |
| 3d. Penalties or paybacks to managed
care plans |
16,378 |
0 |
0 |
40,945 |
57,323 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
126,158,505 |
2,130,495 |
16,691,216 |
21,827,203 |
166,807,419 |
| Expenses |
| 5a. Capitation expenses for Services |
26,739,260 |
296,507 |
9,384 |
838,325 |
27,883,476 |
| 5b. Fee-for-Service expenses for Services |
100,282,866 |
1,895,713 |
21,226,338 |
25,688,577 |
149,093,494 |
5. Total expenses for Services
(Lines 5a + 5b) |
127,022,126 |
2,192,220 |
21,235,722 |
26,526,902 |
176,976,970 |
7. Total Managed Care Expenses
(Line 5) |
127,022,126 |
2,192,220 |
21,235,722 |
26,526,902 |
176,976,970 |
Surplus / Deficit
(Line 4 - Line 7) |
-863,621 |
-61,725 |
-4,544,506 |
-4,699,699 |
-10,169,551 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
- 0.7% |
- 2.8% |
- 21.4% |
- 17.7% |
- 5.7% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
825,130 |
4,913 |
1,458 |
23,621 |
855,122 |
| 8b. Member months for managed care (fee-for-service) |
1,764,651 |
19,462 |
402,437 |
576,587 |
2,763,137 |
8. Total Member months for managed care
(Lines 8a + 8b) |
2,589,781 |
24,375 |
403,895 |
600,208 |
3,618,259 |
| 9a. Managed Care Encounters (capitated) |
205,296 |
2,042 |
68 |
6,683 |
214,089 |
| 9b. Managed Care Encounters (fee-for-service) |
696,685 |
15,572 |
143,458 |
200,982 |
1,056,697 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
901,981 |
17,614 |
143,526 |
207,665 |
1,270,786 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
67,591 |
399 |
0 |
887 |
68,877 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
169,135 |
1,816 |
46,058 |
52,165 |
269,174 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
236,726 |
2,215 |
46,058 |
53,052 |
338,051 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
59,521 |
31 |
0 |
3,992 |
63,544 |
| 12. Number of Managed Care Contracts |
138 |
23 |
64 |
218 |
443 |
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