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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for West Virginia for 2007
28 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
56,387 |
0 |
0 |
161,307 |
217,694 |
| 1b. Fee-for-Service revenue for Services |
10,662,949 |
206,128 |
0 |
402,575 |
11,271,652 |
| 1. Total revenue for Services (Lines
1a + 1b) |
10,719,336 |
206,128 |
0 |
563,882 |
11,489,346 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
54,273 |
0 |
|
|
54,273 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
268,724 |
0 |
|
|
268,724 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
0 |
2,010 |
0 |
5,901 |
7,911 |
| 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) |
11,042,333 |
208,138 |
0 |
569,783 |
11,820,254 |
| Expenses |
| 5a. Capitation expenses for Services |
120,876 |
0 |
0 |
156,342 |
277,218 |
| 5b. Fee-for-Service expenses for Services |
10,938,082 |
271,654 |
0 |
474,548 |
11,684,284 |
5. Total expenses for Services
(Lines 5a + 5b) |
11,058,958 |
271,654 |
0 |
630,890 |
11,961,502 |
7. Total Managed Care Expenses
(Line 5) |
11,058,958 |
271,654 |
0 |
630,890 |
11,961,502 |
Surplus / Deficit
(Line 4 - Line 7) |
-16,625 |
-63,516 |
0 |
-61,107 |
-141,248 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
- 0.2% |
- 23.4% |
--- |
- 9.7% |
- 1.2% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
3,716 |
0 |
0 |
3,065 |
6,781 |
| 8b. Member months for managed care (fee-for-service) |
278,873 |
8,684 |
0 |
10,729 |
298,286 |
8. Total Member months for managed care
(Lines 8a + 8b) |
282,589 |
8,684 |
0 |
13,794 |
305,067 |
| 9a. Managed Care Encounters (capitated) |
3,469 |
0 |
0 |
1,132 |
4,601 |
| 9b. Managed Care Encounters (fee-for-service) |
93,447 |
2,235 |
0 |
4,542 |
100,224 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
96,916 |
2,235 |
0 |
5,674 |
104,825 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
293 |
0 |
0 |
303 |
596 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
24,765 |
848 |
0 |
921 |
26,534 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
25,058 |
848 |
0 |
1,224 |
27,130 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
11,541 |
0 |
0 |
0 |
11,541 |
| 12. Number of Managed Care Contracts |
51 |
13 |
0 |
20 |
84 |
Data as of: 7/22/2008 4:33:29
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