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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Massachusetts for 2007
34 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
8,298,576 |
206,436 |
51,030 |
21,930 |
8,577,972 |
| 1b. Fee-for-Service revenue for Services |
48,505,326 |
1,371,480 |
7,919,803 |
14,318,091 |
72,114,700 |
| 1. Total revenue for Services (Lines
1a + 1b) |
56,803,902 |
1,577,916 |
7,970,833 |
14,340,021 |
80,692,672 |
| 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) |
83,329 |
0 |
|
|
83,329 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
254,925 |
317,022 |
20,626 |
1,527,674 |
2,120,247 |
| 3d. Penalties or paybacks to managed
care plans |
16,378 |
0 |
0 |
40,945 |
57,323 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
57,125,778 |
1,894,938 |
7,991,459 |
15,826,750 |
82,838,925 |
| Expenses |
| 5a. Capitation expenses for Services |
7,017,563 |
296,507 |
9,384 |
183,359 |
7,506,813 |
| 5b. Fee-for-Service expenses for Services |
51,822,955 |
1,677,306 |
9,651,018 |
20,459,600 |
83,610,879 |
5. Total expenses for Services
(Lines 5a + 5b) |
58,840,518 |
1,973,813 |
9,660,402 |
20,642,959 |
91,117,692 |
7. Total Managed Care Expenses
(Line 5) |
58,840,518 |
1,973,813 |
9,660,402 |
20,642,959 |
91,117,692 |
Surplus / Deficit
(Line 4 - Line 7) |
-1,714,740 |
-78,875 |
-1,668,943 |
-4,816,209 |
-8,278,767 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
- 2.9% |
- 4.0% |
- 17.3% |
- 23.3% |
- 9.1% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
212,635 |
4,913 |
1,458 |
1,241 |
220,247 |
| 8b. Member months for managed care (fee-for-service) |
1,077,620 |
14,308 |
187,059 |
446,981 |
1,725,968 |
8. Total Member months for managed care
(Lines 8a + 8b) |
1,290,255 |
19,221 |
188,517 |
448,222 |
1,946,215 |
| 9a. Managed Care Encounters (capitated) |
45,073 |
2,042 |
68 |
1,066 |
48,249 |
| 9b. Managed Care Encounters (fee-for-service) |
377,321 |
13,589 |
69,527 |
141,441 |
601,878 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
422,394 |
15,631 |
69,595 |
142,507 |
650,127 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
17,558 |
399 |
0 |
117 |
18,074 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
98,766 |
1,330 |
24,720 |
39,849 |
164,665 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
116,324 |
1,729 |
24,720 |
39,966 |
182,739 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
14,448 |
31 |
0 |
839 |
15,318 |
| 12. Number of Managed Care Contracts |
81 |
15 |
54 |
153 |
303 |
data as of: 7/22/2008 2:59:37
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