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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Florida for 2007
40 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
11,470,166 |
1,239,647 |
67,164 |
207,673 |
12,984,650 |
| 1b. Fee-for-Service revenue for Services |
6,318,634 |
270,936 |
692,799 |
1,388,424 |
8,670,793 |
| 1. Total revenue for Services (Lines
1a + 1b) |
17,788,800 |
1,510,583 |
759,963 |
1,596,097 |
21,655,443 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
4,584,701 |
0 |
|
|
4,584,701 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
1,437,950 |
128,858 |
|
|
1,566,808 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
1,258,742 |
30,171 |
6,525 |
52,092 |
1,347,530 |
| 3d. Penalties or paybacks to managed
care plans |
59,771 |
537 |
0 |
3,315 |
63,623 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
25,010,422 |
1,669,075 |
766,488 |
1,644,874 |
29,090,859 |
| Expenses |
| 5a. Capitation expenses for Services |
14,509,346 |
915,765 |
99,185 |
254,644 |
15,778,940 |
| 5b. Fee-for-Service expenses for Services |
12,056,292 |
313,448 |
1,102,687 |
1,792,363 |
15,264,790 |
5. Total expenses for Services
(Lines 5a + 5b) |
26,565,638 |
1,229,213 |
1,201,872 |
2,047,007 |
31,043,730 |
7. Total Managed Care Expenses
(Line 5) |
26,565,638 |
1,229,213 |
1,201,872 |
2,047,007 |
31,043,730 |
Surplus / Deficit
(Line 4 - Line 7) |
-1,555,216 |
439,862 |
-435,384 |
-402,133 |
-1,952,871 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
- 5.9% |
35.8% |
- 36.2% |
- 19.6% |
- 6.3% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
628,629 |
22,201 |
7,474 |
9,157 |
667,461 |
| 8b. Member months for managed care (fee-for-service) |
260,381 |
5,494 |
53,828 |
28,049 |
347,752 |
8. Total Member months for managed care
(Lines 8a + 8b) |
889,010 |
27,695 |
61,302 |
37,206 |
1,015,213 |
| 9a. Managed Care Encounters (capitated) |
134,513 |
8,363 |
932 |
1,935 |
145,743 |
| 9b. Managed Care Encounters (fee-for-service) |
97,017 |
3,137 |
10,478 |
15,186 |
125,818 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
231,530 |
11,500 |
11,410 |
17,121 |
271,561 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
56,234 |
2,264 |
934 |
689 |
60,121 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
20,892 |
555 |
5,455 |
2,404 |
29,306 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
77,126 |
2,819 |
6,389 |
3,093 |
89,427 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
30,844 |
0 |
0 |
0 |
30,844 |
| 12. Number of Managed Care Contracts |
119 |
38 |
21 |
44 |
222 |
data as of: 7/22/2008 11:44:46
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