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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Arizona for 2007
14 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
13,425,459 |
0 |
2,804,317 |
232,802 |
16,462,578 |
| 1b. Fee-for-Service revenue for Services |
41,292,953 |
2,328,072 |
198,580 |
2,446,937 |
46,266,542 |
| 1. Total revenue for Services (Lines
1a + 1b) |
54,718,412 |
2,328,072 |
3,002,897 |
2,679,739 |
62,729,120 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
21,642,256 |
0 |
|
|
21,642,256 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
7,359,580 |
107,108 |
|
|
7,466,688 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
85,391 |
19,807 |
0 |
135,902 |
241,100 |
| 3d. Penalties or paybacks to managed
care plans |
292,588 |
0 |
0 |
0 |
292,588 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
83,513,051 |
2,454,987 |
3,002,897 |
2,815,641 |
91,786,576 |
| Expenses |
| 5a. Capitation expenses for Services |
18,175,815 |
0 |
3,552,974 |
995,511 |
22,724,300 |
| 5b. Fee-for-Service expenses for Services |
51,251,969 |
1,566,521 |
177,547 |
3,320,681 |
56,316,718 |
5. Total expenses for Services
(Lines 5a + 5b) |
69,427,784 |
1,566,521 |
3,730,521 |
4,316,192 |
79,041,018 |
7. Total Managed Care Expenses
(Line 5) |
69,427,784 |
1,566,521 |
3,730,521 |
4,316,192 |
79,041,018 |
Surplus / Deficit
(Line 4 - Line 7) |
14,085,267 |
888,466 |
-727,624 |
-1,500,551 |
12,745,558 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
20.3% |
56.7% |
- 19.5% |
- 34.8% |
16.1% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
577,324 |
0 |
53,208 |
28,016 |
658,548 |
| 8b. Member months for managed care (fee-for-service) |
788,405 |
27,799 |
0 |
65,022 |
881,226 |
8. Total Member months for managed care
(Lines 8a + 8b) |
1,365,729 |
27,799 |
53,208 |
93,038 |
1,539,774 |
| 9a. Managed Care Encounters (capitated) |
158,848 |
0 |
11,824 |
6,083 |
176,755 |
| 9b. Managed Care Encounters (fee-for-service) |
308,946 |
8,436 |
755 |
25,336 |
343,473 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
467,794 |
8,436 |
12,579 |
31,419 |
520,228 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
49,827 |
0 |
4,361 |
2,402 |
56,590 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
68,707 |
2,317 |
0 |
5,701 |
76,725 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
118,534 |
2,317 |
4,361 |
8,103 |
133,315 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
0 |
0 |
0 |
0 |
0 |
| 12. Number of Managed Care Contracts |
64 |
3 |
1 |
25 |
93 |
data as of: 7/22/2008 11:07:25
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