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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Indiana for 2007
18 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
713,995 |
0 |
0 |
230,114 |
944,109 |
| 1b. Fee-for-Service revenue for Services |
10,236,444 |
45,745 |
21,454 |
0 |
10,303,643 |
| 1. Total revenue for Services (Lines
1a + 1b) |
10,950,439 |
45,745 |
21,454 |
230,114 |
11,247,752 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
16,123,122 |
0 |
|
|
16,123,122 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
1,361,749 |
0 |
|
|
1,361,749 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
152,182 |
0 |
0 |
0 |
152,182 |
| 3d. Penalties or paybacks to managed
care plans |
104,030 |
0 |
0 |
0 |
104,030 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
28,483,462 |
45,745 |
21,454 |
230,114 |
28,780,775 |
| Expenses |
| 5a. Capitation expenses for Services |
1,747,807 |
0 |
0 |
486,819 |
2,234,626 |
| 5b. Fee-for-Service expenses for Services |
24,977,392 |
54,793 |
27,513 |
0 |
25,059,698 |
5. Total expenses for Services
(Lines 5a + 5b) |
26,725,199 |
54,793 |
27,513 |
486,819 |
27,294,324 |
7. Total Managed Care Expenses
(Line 5) |
26,725,199 |
54,793 |
27,513 |
486,819 |
27,294,324 |
Surplus / Deficit
(Line 4 - Line 7) |
1,758,263 |
-9,048 |
-6,059 |
-256,705 |
1,486,451 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
6.6% |
- 16.5% |
- 22.0% |
- 52.7% |
5.4% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
47,648 |
0 |
0 |
52,721 |
100,369 |
| 8b. Member months for managed care (fee-for-service) |
605,269 |
155 |
708 |
0 |
606,132 |
8. Total Member months for managed care
(Lines 8a + 8b) |
652,917 |
155 |
708 |
52,721 |
706,501 |
| 9a. Managed Care Encounters (capitated) |
19,691 |
514 |
236 |
3,494 |
23,935 |
| 9b. Managed Care Encounters (fee-for-service) |
185,832 |
0 |
0 |
0 |
185,832 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
205,523 |
514 |
236 |
3,494 |
209,767 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
3,992 |
0 |
0 |
4,338 |
8,330 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
52,413 |
43 |
68 |
0 |
52,524 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
56,405 |
43 |
68 |
4,338 |
60,854 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
4,852 |
0 |
0 |
0 |
4,852 |
| 12. Number of Managed Care Contracts |
49 |
1 |
1 |
2 |
53 |
data as of: 7/22/2008 2:04:18
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