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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Virginia for 2007
21 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
279,346 |
0 |
0 |
1,784,131 |
2,063,477 |
| 1b. Fee-for-Service revenue for Services |
6,915,968 |
264,926 |
0 |
396,056 |
7,576,950 |
| 1. Total revenue for Services (Lines
1a + 1b) |
7,195,314 |
264,926 |
0 |
2,180,187 |
9,640,427 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
1,743,650 |
0 |
|
|
1,743,650 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
2,268,376 |
492 |
|
|
2,268,868 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
596,811 |
59,784 |
0 |
64,631 |
721,226 |
| 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) |
11,804,151 |
325,202 |
0 |
2,244,818 |
14,374,171 |
| Expenses |
| 5a. Capitation expenses for Services |
558,311 |
0 |
0 |
1,925,311 |
2,483,622 |
| 5b. Fee-for-Service expenses for Services |
10,513,284 |
318,650 |
0 |
626,865 |
11,458,799 |
5. Total expenses for Services
(Lines 5a + 5b) |
11,071,595 |
318,650 |
0 |
2,552,176 |
13,942,421 |
7. Total Managed Care Expenses
(Line 5) |
11,071,595 |
318,650 |
0 |
2,552,176 |
13,942,421 |
Surplus / Deficit
(Line 4 - Line 7) |
732,556 |
6,552 |
0 |
-307,358 |
431,750 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
6.6% |
2.1% |
--- |
- 12.0% |
3.1% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
22,703 |
0 |
0 |
59,023 |
81,726 |
| 8b. Member months for managed care (fee-for-service) |
285,976 |
11,566 |
0 |
25,958 |
323,500 |
8. Total Member months for managed care
(Lines 8a + 8b) |
308,679 |
11,566 |
0 |
84,981 |
405,226 |
| 9a. Managed Care Encounters (capitated) |
4,439 |
0 |
0 |
18,285 |
22,724 |
| 9b. Managed Care Encounters (fee-for-service) |
85,811 |
2,704 |
0 |
5,893 |
94,408 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
90,250 |
2,704 |
0 |
24,178 |
117,132 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
1,705 |
0 |
0 |
4,281 |
5,986 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
29,725 |
853 |
0 |
2,464 |
33,042 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
31,430 |
853 |
0 |
6,745 |
39,028 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
3,765 |
0 |
0 |
0 |
3,765 |
| 12. Number of Managed Care Contracts |
55 |
14 |
0 |
28 |
97 |
data as of: 7/22/2008 4:17:47
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