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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Tennessee for 2007
24 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
1,460,975 |
0 |
177,792 |
2,092,073 |
3,730,840 |
| 1b. Fee-for-Service revenue for Services |
10,663,536 |
117,310 |
0 |
3,707 |
10,784,553 |
| 1. Total revenue for Services (Lines
1a + 1b) |
12,124,511 |
117,310 |
177,792 |
2,095,780 |
14,515,393 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
9,083,738 |
0 |
|
|
9,083,738 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
3,068,974 |
0 |
|
|
3,068,974 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
68,127 |
0 |
0 |
0 |
68,127 |
| 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) |
24,345,350 |
117,310 |
177,792 |
2,095,780 |
26,736,232 |
| Expenses |
| 5a. Capitation expenses for Services |
2,617,389 |
0 |
178,541 |
1,715,118 |
4,511,048 |
| 5b. Fee-for-Service expenses for Services |
18,299,101 |
653,744 |
0 |
8,265 |
18,961,110 |
5. Total expenses for Services
(Lines 5a + 5b) |
20,916,490 |
653,744 |
178,541 |
1,723,383 |
23,472,158 |
7. Total Managed Care Expenses
(Line 5) |
20,916,490 |
653,744 |
178,541 |
1,723,383 |
23,472,158 |
Surplus / Deficit
(Line 4 - Line 7) |
3,428,860 |
-536,434 |
- 749 |
372,397 |
3,264,074 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
16.4% |
- 82.1% |
- 0.4% |
21.6% |
13.9% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
113,154 |
0 |
11,494 |
38,569 |
163,217 |
| 8b. Member months for managed care (fee-for-service) |
557,759 |
15,932 |
0 |
1,933 |
575,624 |
8. Total Member months for managed care
(Lines 8a + 8b) |
670,913 |
15,932 |
11,494 |
40,502 |
738,841 |
| 9a. Managed Care Encounters (capitated) |
19,165 |
0 |
1,025 |
13,477 |
33,667 |
| 9b. Managed Care Encounters (fee-for-service) |
152,107 |
4,365 |
0 |
29 |
156,501 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
171,272 |
4,365 |
1,025 |
13,506 |
190,168 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
10,757 |
0 |
943 |
3,484 |
15,184 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
49,442 |
1,109 |
0 |
154 |
50,705 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
60,199 |
1,109 |
943 |
3,638 |
65,889 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
1,587 |
0 |
0 |
0 |
1,587 |
| 12. Number of Managed Care Contracts |
33 |
5 |
1 |
4 |
43 |
data as of: 7/22/2008 4:14:14
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