Commonwealth of Pennsylvania Exhibit C-1: Philadelphia County Philadelphia County: Calendar Year 2014 Aggregate Data TANF-HB-MAGI 0-18 TANF-HB-MAGI 19+ SSI w/ Medicare SSI w/o Medicare Breast and Cervical Cancer Total 2014 MCO Member Months 2,465,148 974,351 9,101 1,297,297 3,234 4,749,130 2014 MCO Deliveries - C-Section¹ 121 3,018 0 289 0 3,428 2014 MCO Deliveries - Vaginal¹ 631 7,559 7 594 0 8,791 Category of Service PMPMs Pharmaceutical Pharmaceutical Non-Drug Laboratory Radiology Complete EPSDT Screens Vision DME / Medical Supplies Hospice Home Health Care/ HIV-AIDS Waiver Family Planning Services Family Planning - Pharmaceutical Therapy Ambulance / Transportation Medical Diagnostic FQHC & Rural Health Clinics Emergency Room Dental Dental / Oral Surgery Primary Care Providers Specialty Physician Other Practitioners Facility Non-Inpatient (includes SPU / ASC) Other Outpatient Inpatient Acute Care Inpatient - Rehab Nursing Home Miscellaneous Medical Expense Appendix 14 Appendix 16 and 16a $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 20.45 0.57 3.03 2.92 6.65 1.82 2.44 0.00 5.98 0.32 0.15 1.91 0.76 2.20 2.06 15.77 15.31 0.83 18.11 12.31 0.33 10.22 0.03 58.38 0.33 0.21 0.00 22.57 5.67 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 53.92 1.68 6.42 14.77 0.17 1.66 3.64 0.06 4.40 4.24 2.12 3.75 2.26 3.54 2.58 26.95 10.79 1.82 16.71 37.27 2.50 24.97 0.80 113.32 0.29 0.32 0.11 19.95 10.45 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 612.51 16.16 6.63 6.77 0.08 0.88 10.12 0.35 37.38 0.05 0.69 5.99 3.29 3.83 1.53 9.09 4.77 2.23 11.80 18.24 1.22 22.65 9.18 85.29 2.01 2.74 0.09 85.95 5.84 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 312.60 8.45 7.54 17.69 0.97 2.25 31.16 2.22 67.88 0.57 0.29 20.30 8.18 10.66 2.41 31.44 11.58 1.97 23.67 49.76 4.10 42.49 15.10 258.99 5.62 5.79 0.38 87.61 14.26 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 856.26 6.19 28.19 62.92 - 2.34 43.06 9.56 21.83 0.54 0.49 249.33 12.52 18.84 1.61 17.88 11.60 1.18 26.63 136.61 5.19 161.29 6.78 311.57 4.50 10.23 0.06 116.96 31.61 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 108.83 2.98 4.98 9.44 3.75 1.91 10.58 0.63 22.63 1.19 0.59 7.49 3.11 4.80 2.26 22.33 13.34 1.35 19.34 27.75 1.81 22.19 4.33 124.67 1.78 1.77 0.13 39.98 9.01 Gross Medical Expenses $ 211.36 $ 371.45 $ 967.33 $ 1,045.92 $ 2,155.75 $ 474.95 Notes: - These values do not include reinsurance or other risk pool adjustments, but do reflect benefits from TPL-COB. - In some cases totals may not equal the sum of their respective column due to rounding. Mercer 1 of 12 12/19/2016, 1:33 PM 1 Number of deliveries are actual maternity outcome counts as reported by the HealthChoices Southeast Managed Care Organizations on Annual Report 27.
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Philadelphia County: Calendar Year 2014 Aggregate …...Emergency Room Dental Dental / Oral Surgery Primary Care Providers Specialty Physician Other Practitioners Facility Non-Inpatient
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Commonwealth of Pennsylvania Exhibit C-1: Philadelphia County
Philadelphia County: Calendar Year 2014 Aggregate Data
TANF-HB-MAGI
0-18
TANF-HB-MAGI
19+ SSI w/ Medicare
SSI w/o
Medicare
Breast and
Cervical Cancer Total
2014 MCO Member Months 2,465,148 974,351 9,101 1,297,297 3,234 4,749,130
- These values do not include reinsurance or other risk pool adjustments, but do reflect benefits from TPL-COB.
- In some cases totals may not equal the sum of their respective column due to rounding.
1 Number of deliveries are actual maternity outcome counts as reported by the HealthChoices Southeast Managed Care Organizations on Annual Report 27.
2 Total zone C-section costs are the actual C-section costs as reported by the HealthChoices Southeast Managed Care Organizations on Annual Report 26.
3 Total zone vaginal costs are the actual vaginal costs as reported by the HealthChoices Southeast Managed Care Organizations on Annual Report 26.
4 Total zone costs are the sum of the actual C-section and vaginal costs as reported by the HealthChoices Southeast Managed Care Organizations on Annual Report 26.
5 Costs/Delivery reflect the cost of live outcomes divided by the number of live outcomes.
Commonwealth of Pennsylvania Exhibit C-4: Allegheny County
Allegheny County: Calendar Year 2014 Aggregate Data
TANF-HB-MAGI
0-18
TANF-HB-MAGI
19+ SSI w/ Medicare
SSI w/o
Medicare
Breast and
Cervical Cancer Total
2014 MCO Member Months 818,871 337,027 3,907 456,639 2,114 1,618,558
- These values do not include reinsurance or other risk pool adjustments, but do reflect benefits from TPL-COB.
- In some cases totals may not equal the sum of their respective column due to rounding.
1 Number of deliveries are actual maternity outcome counts as reported by the HealthChoices Southwest Managed Care Organizations on Annual Report 27.
2 Total zone C-section costs are the actual C-section costs as reported by the HealthChoices Southwest Managed Care Organizations on Annual Report 26.
3 Total zone vaginal costs are the actual vaginal costs as reported by the HealthChoices Southwest Managed Care Organizations on Annual Report 26.
4 Total zone costs are the sum of the actual C-section and vaginal costs as reported by the HealthChoices Southwest Managed Care Organizations on Annual Report 26.
5 Costs/Delivery reflect the cost of live outcomes divided by the number of live outcomes.
Exhibit C-7: Lehigh/Capital Zone
Lehigh/Capital Zone: Calendar Year 2014 Aggregate Data
TANF-HB-MAGI
0-18
TANF-HB-MAGI
19+ SSI w/ Medicare
SSI w/o
Medicare
Breast and
Cervical Cancer Total
2014 MCO Member Months 2,263,749 775,945 9,501 976,425 4,237 4,029,856
- These values do not include reinsurance or other risk pool adjustments, but do reflect benefits from TPL-COB.
- In some cases totals may not equal the sum of their respective column due to rounding.
1 Number of deliveries are actual maternity outcome counts as reported by the HealthChoices Lehigh/Capital Managed Care Organizations on Annual Report 27.
Exhibit C-8: Lehigh/Capital Zone
Lehigh/Capital Zone: Fiscal Year 2013-2014 Maternity Data
- These values do not include reinsurance or other risk pool adjustments, but do reflect benefits from TPL-COB.
- In some cases totals may not equal the sum of their respective column due to rounding.
1 Number of deliveries are actual maternity outcome counts as reported by the HealthChoices Lehigh/Capital Managed Care Organizations on Annual Report 27.
2 Total zone C-section costs are the actual C-section costs as reported by the HealthChoices Lehigh/Capital Managed Care Organizations on Annual Report 26.
3 Total zone vaginal costs are the actual vaginal costs as reported by the HealthChoices Lehigh/Capital Managed Care Organizations on Annual Report 26.
4 Total zone costs are the sum of the actual C-section and vaginal costs as reported by the HealthChoices Lehigh/Capital Managed Care Organizations on Annual Report 26.
5 Costs/Delivery reflect the cost of live outcomes divided by the number of live outcomes.
Exhibit C-9: Northeast Zone
Northeast Zone: Calendar Year 2014 Aggregate Data
TANF-HB-MAGI
0-18
TANF-HB-MAGI
19+ SSI w/ Medicare
SSI w/o
Medicare
Breast and
Cervical Cancer Total
2014 MCO Member Months 1,372,196 511,124 5,856 664,385 2,872 2,556,434
- These values do not include reinsurance or other risk pool adjustments, but do reflect benefits from TPL-COB.
- In some cases totals may not equal the sum of their respective column due to rounding.
1 Number of deliveries are actual maternity outcome counts as reported by the HealthChoices Northeast Managed Care Organizations on Annual Report 27.
2 Total zone C-section costs are the actual C-section costs as reported by the HealthChoices Northeast Managed Care Organizations on Annual Report 26.
3 Total zone vaginal costs are the actual vaginal costs as reported by the HealthChoices Northeast Managed Care Organizations on Annual Report 26.
4 Total zone costs are the sum of the actual C-section and vaginal costs as reported by the HealthChoices Northeast Managed Care Organizations on Annual Report 26.
5 Costs/Delivery reflect the cost of live outcomes divided by the number of live outcomes.
Exhibit C-11: Northwest Zone
Northwest Zone: Calendar Year 2014 Aggregate Data
TANF-HB-MAGI
0-18
TANF-HB-MAGI
19+ SSI w/ Medicare
SSI w/o
Medicare
Breast and
Cervical Cancer Total
2014 MCO Member Months 728,375 282,826 2,965 422,663 1,670 1,438,500
- These values do not include reinsurance or other risk pool adjustments, but do reflect benefits from TPL-COB.
- In some cases totals may not equal the sum of their respective column due to rounding.
1 Number of deliveries are actual maternity outcome counts as reported by the HealthChoices Northwest Managed Care Organizations on Annual Report 27.
2 Total zone C-section costs are the actual C-section costs as reported by the HealthChoices Northwest Managed Care Organizations on Annual Report 26.
3 Total zone vaginal costs are the actual vaginal costs as reported by the HealthChoices Northwest Managed Care Organizations on Annual Report 26.
4 Total zone costs are the sum of the actual C-section and vaginal costs as reported by the HealthChoices Northwest Managed Care Organizations on Annual Report 26.
5 Costs/Delivery reflect the cost of live outcomes divided by the number of live outcomes.