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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for Puerto Rico for 2007
19 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
64,690,851 |
2,587,106 |
0 |
0 |
67,277,957 |
| 1b. Fee-for-Service revenue for Services |
14,247,220 |
1,887,879 |
0 |
376,389 |
16,511,488 |
| 1. Total revenue for Services (Lines
1a + 1b) |
78,938,071 |
4,474,985 |
0 |
376,389 |
83,789,445 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
2,225,440 |
0 |
|
|
2,225,440 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
8,435,387 |
40,934 |
|
|
8,476,321 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
794,008 |
724,389 |
0 |
0 |
1,518,397 |
| 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) |
90,392,906 |
5,240,308 |
0 |
376,389 |
96,009,603 |
| Expenses |
| 5a. Capitation expenses for Services |
88,257,788 |
2,433,649 |
0 |
0 |
90,691,437 |
| 5b. Fee-for-Service expenses for Services |
13,871,994 |
1,409,991 |
0 |
0 |
15,281,985 |
5. Total expenses for Services
(Lines 5a + 5b) |
102,129,782 |
3,843,640 |
0 |
0 |
105,973,422 |
7. Total Managed Care Expenses
(Line 5) |
102,129,782 |
3,843,640 |
0 |
0 |
105,973,422 |
Surplus / Deficit
(Line 4 - Line 7) |
-11,736,876 |
1,396,668 |
0 |
376,389 |
-9,963,819 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
- 11.5% |
36.3% |
--- |
--- |
- 9.4% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
2,162,690 |
37,235 |
0 |
0 |
2,199,925 |
| 8b. Member months for managed care (fee-for-service) |
20,337 |
24,275 |
0 |
0 |
44,612 |
8. Total Member months for managed care
(Lines 8a + 8b) |
2,183,027 |
61,510 |
0 |
0 |
2,244,537 |
| 9a. Managed Care Encounters (capitated) |
928,330 |
13,189 |
0 |
0 |
941,519 |
| 9b. Managed Care Encounters (fee-for-service) |
94,603 |
18,742 |
0 |
0 |
113,345 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
1,022,933 |
31,931 |
0 |
0 |
1,054,864 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
179,695 |
7,183 |
0 |
0 |
186,878 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
992 |
2,440 |
0 |
0 |
3,432 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
180,687 |
9,623 |
0 |
0 |
190,310 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
0 |
0 |
0 |
0 |
0 |
| 12. Number of Managed Care Contracts |
26 |
38 |
0 |
34 |
98 |
data as of: 7/22/2008 4:04:56
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