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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Ohio for 2007
26 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
0 |
0 |
0 |
0 |
0 |
| 1b. Fee-for-Service revenue for Services |
22,332,457 |
45,988 |
0 |
702,669 |
23,081,114 |
| 1. Total revenue for Services (Lines
1a + 1b) |
22,332,457 |
45,988 |
0 |
702,669 |
23,081,114 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
5,469,660 |
6,842 |
|
|
5,476,502 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
970,330 |
883 |
|
|
971,213 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
1,096,129 |
111 |
0 |
813 |
1,097,053 |
| 3d. Penalties or paybacks to managed
care plans |
0 |
0 |
0 |
0 |
0 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
29,868,576 |
53,824 |
0 |
703,482 |
30,625,882 |
| Expenses |
| 5a. Capitation expenses for Services |
0 |
0 |
0 |
0 |
0 |
| 5b. Fee-for-Service expenses for Services |
33,875,495 |
76,254 |
0 |
1,131,798 |
35,083,547 |
5. Total expenses for Services
(Lines 5a + 5b) |
33,875,495 |
76,254 |
0 |
1,131,798 |
35,083,547 |
7. Total Managed Care Expenses
(Line 5) |
33,875,495 |
76,254 |
0 |
1,131,798 |
35,083,547 |
Surplus / Deficit
(Line 4 - Line 7) |
-4,006,919 |
-22,430 |
0 |
-428,316 |
-4,457,665 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
- 11.8% |
- 29.4% |
--- |
- 37.8% |
- 12.7% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
0 |
0 |
0 |
0 |
0 |
| 8b. Member months for managed care (fee-for-service) |
900,993 |
2,142 |
0 |
49,158 |
952,293 |
8. Total Member months for managed care
(Lines 8a + 8b) |
900,993 |
2,142 |
0 |
49,158 |
952,293 |
| 9a. Managed Care Encounters (capitated) |
0 |
0 |
0 |
0 |
0 |
| 9b. Managed Care Encounters (fee-for-service) |
282,730 |
449 |
0 |
9,876 |
293,055 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
282,730 |
449 |
0 |
9,876 |
293,055 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
0 |
0 |
0 |
0 |
0 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
82,834 |
153 |
0 |
4,064 |
87,051 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
82,834 |
153 |
0 |
4,064 |
87,051 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
0 |
0 |
0 |
0 |
0 |
| 12. Number of Managed Care Contracts |
74 |
9 |
0 |
7 |
90 |
data as of: 7/22/2008 3:08:02
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