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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Maryland for 2007
15 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
5,161,185 |
321,424 |
0 |
537,473 |
6,020,082 |
| 1b. Fee-for-Service revenue for Services |
43,740,957 |
37,534 |
133,049 |
1,813,006 |
45,724,546 |
| 1. Total revenue for Services (Lines
1a + 1b) |
48,902,142 |
358,958 |
133,049 |
2,350,479 |
51,744,628 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
2,253,896 |
0 |
|
|
2,253,896 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
584,189 |
0 |
|
|
584,189 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
19,609 |
0 |
180 |
119,522 |
139,311 |
| 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) |
51,759,836 |
358,958 |
133,229 |
2,470,001 |
54,722,024 |
| Expenses |
| 5a. Capitation expenses for Services |
3,965,264 |
646,264 |
0 |
1,252,898 |
5,864,426 |
| 5b. Fee-for-Service expenses for Services |
44,347,830 |
87,425 |
175,908 |
3,910,258 |
48,521,421 |
5. Total expenses for Services
(Lines 5a + 5b) |
48,313,094 |
733,689 |
175,908 |
5,163,156 |
54,385,847 |
7. Total Managed Care Expenses
(Line 5) |
48,313,094 |
733,689 |
175,908 |
5,163,156 |
54,385,847 |
Surplus / Deficit
(Line 4 - Line 7) |
3,446,742 |
-374,731 |
-42,679 |
-2,693,155 |
336,177 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
7.1% |
- 51.1% |
- 24.3% |
- 52.2% |
0.6% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
1,843 |
10,007 |
0 |
52,555 |
64,405 |
| 8b. Member months for managed care (fee-for-service) |
729,143 |
1,520 |
7,448 |
70,472 |
808,583 |
8. Total Member months for managed care
(Lines 8a + 8b) |
730,986 |
11,527 |
7,448 |
123,027 |
872,988 |
| 9a. Managed Care Encounters (capitated) |
10,288 |
4,377 |
0 |
14,483 |
29,148 |
| 9b. Managed Care Encounters (fee-for-service) |
264,351 |
584 |
2,407 |
24,050 |
291,392 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
274,639 |
4,961 |
2,407 |
38,533 |
320,540 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
142 |
885 |
0 |
4,170 |
5,197 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
61,693 |
130 |
712 |
5,849 |
68,384 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
61,835 |
1,015 |
712 |
10,019 |
73,581 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
901 |
0 |
0 |
0 |
901 |
| 12. Number of Managed Care Contracts |
53 |
5 |
2 |
30 |
90 |
data as of: 7/22/2008 3:51:35
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