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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
Regional Summary for Region V for 2007
140 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
24,355,651 |
2,191,574 |
43,545 |
9,913,890 |
36,504,660 |
| 1b. Fee-for-Service revenue for Services |
54,209,545 |
1,114,570 |
143,121 |
3,509,706 |
58,976,942 |
| 1. Total revenue for Services (Lines
1a + 1b) |
78,565,196 |
3,306,144 |
186,666 |
13,423,596 |
95,481,602 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
57,685,383 |
6,842 |
|
|
57,692,225 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
7,395,277 |
1,135 |
|
|
7,396,412 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
4,649,570 |
417,072 |
0 |
2,770,590 |
7,837,232 |
| 3d. Penalties or paybacks to managed
care plans |
497,717 |
0 |
0 |
0 |
497,717 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
147,797,709 |
3,731,193 |
186,666 |
16,194,186 |
167,909,754 |
| Expenses |
| 5a. Capitation expenses for Services |
40,644,328 |
273,812 |
168,715 |
13,324,559 |
54,411,414 |
| 5b. Fee-for-Service expenses for Services |
100,643,443 |
1,564,024 |
469,262 |
4,911,990 |
107,588,719 |
5. Total expenses for Services
(Lines 5a + 5b) |
141,287,771 |
1,837,836 |
637,977 |
18,236,549 |
162,000,133 |
7. Total Managed Care Expenses
(Line 5) |
141,287,771 |
1,837,836 |
637,977 |
18,236,549 |
162,000,133 |
Surplus / Deficit
(Line 4 - Line 7) |
6,509,938 |
1,893,357 |
-451,311 |
-2,042,363 |
5,909,621 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
4.6% |
103.0% |
- 70.7% |
- 11.2% |
3.6% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
1,091,208 |
9,301 |
2,385 |
448,351 |
1,551,245 |
| 8b. Member months for managed care (fee-for-service) |
2,552,170 |
24,909 |
11,601 |
130,141 |
2,718,821 |
8. Total Member months for managed care
(Lines 8a + 8b) |
3,643,378 |
34,210 |
13,986 |
578,492 |
4,270,066 |
| 9a. Managed Care Encounters (capitated) |
250,808 |
3,621 |
1,214 |
77,935 |
333,578 |
| 9b. Managed Care Encounters (fee-for-service) |
782,124 |
11,138 |
2,841 |
36,846 |
832,949 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
1,032,932 |
14,759 |
4,055 |
114,781 |
1,166,527 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
98,451 |
834 |
198 |
37,479 |
136,962 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
224,005 |
2,937 |
786 |
12,057 |
239,785 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
322,456 |
3,771 |
984 |
49,536 |
376,747 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
196,253 |
0 |
0 |
0 |
196,253 |
| 12. Number of Managed Care Contracts |
242 |
45 |
5 |
139 |
431 |
Data as of: 7/3/2008 11:44:37
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