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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Connecticut for 2007
10 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
6,881,314 |
0 |
0 |
0 |
6,881,314 |
| 1b. Fee-for-Service revenue for Services |
20,002,933 |
0 |
8,667,976 |
752,093 |
29,423,002 |
| 1. Total revenue for Services (Lines
1a + 1b) |
26,884,247 |
0 |
8,667,976 |
752,093 |
36,304,316 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
16,380,511 |
0 |
|
|
16,380,511 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
3,663,717 |
0 |
|
|
3,663,717 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
68,330 |
0 |
16,000 |
200,948 |
285,278 |
| 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) |
46,996,805 |
0 |
8,683,976 |
953,041 |
56,633,822 |
| Expenses |
| 5a. Capitation expenses for Services |
12,393,063 |
0 |
0 |
0 |
12,393,063 |
| 5b. Fee-for-Service expenses for Services |
35,121,869 |
0 |
11,553,788 |
1,027,617 |
47,703,274 |
5. Total expenses for Services
(Lines 5a + 5b) |
47,514,932 |
0 |
11,553,788 |
1,027,617 |
60,096,337 |
7. Total Managed Care Expenses
(Line 5) |
47,514,932 |
0 |
11,553,788 |
1,027,617 |
60,096,337 |
Surplus / Deficit
(Line 4 - Line 7) |
-518,127 |
0 |
-2,869,812 |
-74,576 |
-3,462,515 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
- 1.1% |
--- |
- 24.8% |
- 7.3% |
- 5.8% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
283,057 |
0 |
0 |
0 |
283,057 |
| 8b. Member months for managed care (fee-for-service) |
532,435 |
0 |
214,316 |
23,899 |
770,650 |
8. Total Member months for managed care
(Lines 8a + 8b) |
815,492 |
0 |
214,316 |
23,899 |
1,053,707 |
| 9a. Managed Care Encounters (capitated) |
79,917 |
0 |
0 |
0 |
79,917 |
| 9b. Managed Care Encounters (fee-for-service) |
224,947 |
0 |
73,776 |
7,828 |
306,551 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
304,864 |
0 |
73,776 |
7,828 |
386,468 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
23,029 |
0 |
0 |
0 |
23,029 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
57,223 |
0 |
21,247 |
2,103 |
80,573 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
80,252 |
0 |
21,247 |
2,103 |
103,602 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
0 |
0 |
0 |
0 |
0 |
| 12. Number of Managed Care Contracts |
35 |
0 |
9 |
12 |
56 |
data as of: 7/22/2008 11:21:04
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