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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Missouri for 2007
21 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
2,191,937 |
0 |
0 |
12,925 |
2,204,862 |
| 1b. Fee-for-Service revenue for Services |
14,587,946 |
54,611 |
0 |
377,835 |
15,020,392 |
| 1. Total revenue for Services (Lines
1a + 1b) |
16,779,883 |
54,611 |
0 |
390,760 |
17,225,254 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
10,943,396 |
0 |
|
|
10,943,396 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
1,322,014 |
0 |
|
|
1,322,014 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
1,154 |
0 |
0 |
176,232 |
177,386 |
| 3d. Penalties or paybacks to managed
care plans |
279,341 |
0 |
0 |
0 |
279,341 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
28,767,106 |
54,611 |
0 |
566,992 |
29,388,709 |
| Expenses |
| 5a. Capitation expenses for Services |
6,443,469 |
0 |
0 |
19,982 |
6,463,451 |
| 5b. Fee-for-Service expenses for Services |
23,859,204 |
186,197 |
0 |
761,222 |
24,806,623 |
5. Total expenses for Services
(Lines 5a + 5b) |
30,302,673 |
186,197 |
0 |
781,204 |
31,270,074 |
7. Total Managed Care Expenses
(Line 5) |
30,302,673 |
186,197 |
0 |
781,204 |
31,270,074 |
Surplus / Deficit
(Line 4 - Line 7) |
-1,535,567 |
-131,586 |
0 |
-214,212 |
-1,881,365 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
- 5.1% |
- 70.7% |
--- |
- 27.4% |
- 6.0% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
225,043 |
0 |
0 |
938 |
225,981 |
| 8b. Member months for managed care (fee-for-service) |
453,535 |
2,585 |
0 |
29,238 |
485,358 |
8. Total Member months for managed care
(Lines 8a + 8b) |
678,578 |
2,585 |
0 |
30,176 |
711,339 |
| 9a. Managed Care Encounters (capitated) |
60,770 |
0 |
0 |
100 |
60,870 |
| 9b. Managed Care Encounters (fee-for-service) |
145,988 |
2,663 |
0 |
7,452 |
156,103 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
206,758 |
2,663 |
0 |
7,552 |
216,973 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
18,342 |
0 |
0 |
127 |
18,469 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
40,248 |
200 |
0 |
2,012 |
42,460 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
58,590 |
200 |
0 |
2,139 |
60,929 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
0 |
0 |
0 |
0 |
0 |
| 12. Number of Managed Care Contracts |
34 |
3 |
0 |
6 |
43 |
data as of: 7/22/2008 3:42:48
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