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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Iowa for 2007
13 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 |
67,118 |
67,118 |
| 1b. Fee-for-Service revenue for Services |
2,909,045 |
49,516 |
0 |
0 |
2,958,561 |
| 1. Total revenue for Services (Lines
1a + 1b) |
2,909,045 |
49,516 |
0 |
67,118 |
3,025,679 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
265,236 |
0 |
|
|
265,236 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
118,832 |
0 |
|
|
118,832 |
| 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) |
3,293,113 |
49,516 |
0 |
67,118 |
3,409,747 |
| Expenses |
| 5a. Capitation expenses for Services |
0 |
0 |
0 |
57,679 |
57,679 |
| 5b. Fee-for-Service expenses for Services |
3,112,034 |
63,981 |
0 |
0 |
3,176,015 |
5. Total expenses for Services
(Lines 5a + 5b) |
3,112,034 |
63,981 |
0 |
57,679 |
3,233,694 |
7. Total Managed Care Expenses
(Line 5) |
3,112,034 |
63,981 |
0 |
57,679 |
3,233,694 |
Surplus / Deficit
(Line 4 - Line 7) |
181,079 |
-14,465 |
0 |
9,439 |
176,053 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
5.8% |
- 22.6% |
--- |
16.4% |
5.4% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
0 |
0 |
0 |
2,823 |
2,823 |
| 8b. Member months for managed care (fee-for-service) |
95,608 |
2,916 |
0 |
0 |
98,524 |
8. Total Member months for managed care
(Lines 8a + 8b) |
95,608 |
2,916 |
0 |
2,823 |
101,347 |
| 9a. Managed Care Encounters (capitated) |
0 |
0 |
0 |
497 |
497 |
| 9b. Managed Care Encounters (fee-for-service) |
26,811 |
672 |
0 |
0 |
27,483 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
26,811 |
672 |
0 |
497 |
27,980 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
0 |
0 |
0 |
232 |
232 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
8,155 |
243 |
0 |
0 |
8,398 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
8,155 |
243 |
0 |
232 |
8,630 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
15,954 |
0 |
0 |
229 |
16,183 |
| 12. Number of Managed Care Contracts |
7 |
1 |
0 |
2 |
10 |
data as of: 7/22/2008 1:46:11
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