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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Washington for 2007
25 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
40,173,101 |
0 |
21,782,364 |
0 |
61,955,465 |
| 1b. Fee-for-Service revenue for Services |
6,823,284 |
251,205 |
1,993,577 |
83,051 |
9,151,117 |
| 1. Total revenue for Services (Lines
1a + 1b) |
46,996,385 |
251,205 |
23,775,941 |
83,051 |
71,106,582 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
62,013,494 |
0 |
|
|
62,013,494 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
4,044,779 |
0 |
|
|
4,044,779 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
23,321,211 |
0 |
15,887,180 |
3,159 |
39,211,550 |
| 3d. Penalties or paybacks to managed
care plans |
50,849 |
213 |
2,923 |
0 |
53,985 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
136,325,020 |
250,992 |
39,660,198 |
86,210 |
176,322,420 |
| Expenses |
| 5a. Capitation expenses for Services |
60,432,980 |
0 |
29,020,101 |
0 |
89,453,081 |
| 5b. Fee-for-Service expenses for Services |
10,833,659 |
445,848 |
1,819,008 |
71,554 |
13,170,069 |
5. Total expenses for Services
(Lines 5a + 5b) |
71,266,639 |
445,848 |
30,839,109 |
71,554 |
102,623,150 |
7. Total Managed Care Expenses
(Line 5) |
71,266,639 |
445,848 |
30,839,109 |
71,554 |
102,623,150 |
Surplus / Deficit
(Line 4 - Line 7) |
65,058,381 |
-194,856 |
8,821,089 |
14,656 |
73,699,270 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
91.3% |
- 43.7% |
28.6% |
20.5% |
71.8% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
1,345,167 |
0 |
656,102 |
0 |
2,001,269 |
| 8b. Member months for managed care (fee-for-service) |
200,374 |
6,426 |
21,029 |
2,033 |
229,862 |
8. Total Member months for managed care
(Lines 8a + 8b) |
1,545,541 |
6,426 |
677,131 |
2,033 |
2,231,131 |
| 9a. Managed Care Encounters (capitated) |
327,175 |
0 |
149,110 |
0 |
476,285 |
| 9b. Managed Care Encounters (fee-for-service) |
54,928 |
3,910 |
6,410 |
498 |
65,746 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
382,103 |
3,910 |
155,520 |
498 |
542,031 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
111,007 |
0 |
54,140 |
0 |
165,147 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
16,766 |
680 |
1,938 |
339 |
19,723 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
127,773 |
680 |
56,078 |
339 |
184,870 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
295 |
0 |
0 |
0 |
295 |
| 12. Number of Managed Care Contracts |
38 |
18 |
29 |
5 |
90 |
data as of: 7/22/2008 4:31:19
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