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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
Regional Summary for Region X 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 |
41,215,895 |
0 |
21,782,364 |
0 |
62,998,259 |
| 1b. Fee-for-Service revenue for Services |
20,233,811 |
2,024,742 |
1,993,577 |
192,530 |
24,444,660 |
| 1. Total revenue for Services (Lines
1a + 1b) |
61,449,706 |
2,024,742 |
23,775,941 |
192,530 |
87,442,919 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
65,647,651 |
0 |
|
|
65,647,651 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
29,994,550 |
77,665 |
|
|
30,072,215 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
23,703,670 |
7,148 |
15,887,180 |
343,375 |
39,941,373 |
| 3d. Penalties or paybacks to managed
care plans |
63,964 |
213 |
2,923 |
0 |
67,100 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
180,731,613 |
2,109,342 |
39,660,198 |
535,905 |
223,037,058 |
| Expenses |
| 5a. Capitation expenses for Services |
62,343,501 |
0 |
29,020,101 |
0 |
91,363,602 |
| 5b. Fee-for-Service expenses for Services |
54,015,504 |
4,874,161 |
1,819,008 |
208,620 |
60,917,293 |
5. Total expenses for Services
(Lines 5a + 5b) |
116,359,005 |
4,874,161 |
30,839,109 |
208,620 |
152,280,895 |
7. Total Managed Care Expenses
(Line 5) |
116,359,005 |
4,874,161 |
30,839,109 |
208,620 |
152,280,895 |
Surplus / Deficit
(Line 4 - Line 7) |
64,372,608 |
-2,764,819 |
8,821,089 |
327,285 |
70,756,163 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
55.3% |
- 56.7% |
28.6% |
156.9% |
46.5% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
1,391,107 |
0 |
656,102 |
0 |
2,047,209 |
| 8b. Member months for managed care (fee-for-service) |
781,033 |
49,795 |
21,029 |
2,502 |
854,359 |
8. Total Member months for managed care
(Lines 8a + 8b) |
2,172,140 |
49,795 |
677,131 |
2,502 |
2,901,568 |
| 9a. Managed Care Encounters (capitated) |
343,159 |
0 |
149,110 |
0 |
492,269 |
| 9b. Managed Care Encounters (fee-for-service) |
244,930 |
27,657 |
6,410 |
1,473 |
280,470 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
588,089 |
27,657 |
155,520 |
1,473 |
772,739 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
114,785 |
0 |
54,140 |
0 |
168,925 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
65,664 |
4,772 |
1,938 |
381 |
72,755 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
180,449 |
4,772 |
56,078 |
381 |
241,680 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
11,590 |
18 |
0 |
0 |
11,608 |
| 12. Number of Managed Care Contracts |
208 |
42 |
29 |
12 |
291 |
Data as of: 7/7/2008 5:58:52
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