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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Delaware for 2007
4 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 |
31,866 |
31,866 |
| 1b. Fee-for-Service revenue for Services |
3,620,554 |
0 |
0 |
133,282 |
3,753,836 |
| 1. Total revenue for Services (Lines
1a + 1b) |
3,620,554 |
0 |
0 |
165,148 |
3,785,702 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
0 |
0 |
|
|
0 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
0 |
0 |
|
|
0 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
0 |
0 |
0 |
0 |
0 |
| 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) |
3,620,554 |
0 |
0 |
165,148 |
3,785,702 |
| Expenses |
| 5a. Capitation expenses for Services |
0 |
0 |
0 |
38,704 |
38,704 |
| 5b. Fee-for-Service expenses for Services |
4,068,456 |
0 |
0 |
129,833 |
4,198,289 |
5. Total expenses for Services
(Lines 5a + 5b) |
4,068,456 |
0 |
0 |
168,537 |
4,236,993 |
7. Total Managed Care Expenses
(Line 5) |
4,068,456 |
0 |
0 |
168,537 |
4,236,993 |
Surplus / Deficit
(Line 4 - Line 7) |
-447,902 |
0 |
0 |
-3,389 |
-451,291 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
- 11.0% |
--- |
--- |
- 2.0% |
- 10.7% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
0 |
0 |
0 |
2,985 |
2,985 |
| 8b. Member months for managed care (fee-for-service) |
77,633 |
0 |
0 |
2,989 |
80,622 |
8. Total Member months for managed care
(Lines 8a + 8b) |
77,633 |
0 |
0 |
5,974 |
83,607 |
| 9a. Managed Care Encounters (capitated) |
0 |
0 |
0 |
256 |
256 |
| 9b. Managed Care Encounters (fee-for-service) |
26,686 |
0 |
0 |
1,073 |
27,759 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
26,686 |
0 |
0 |
1,329 |
28,015 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
0 |
0 |
0 |
255 |
255 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
6,429 |
0 |
0 |
278 |
6,707 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
6,429 |
0 |
0 |
533 |
6,962 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
0 |
0 |
0 |
0 |
0 |
| 12. Number of Managed Care Contracts |
9 |
0 |
0 |
5 |
14 |
data as of: 7/22/2008 11:42:18
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