philadelphia county: calendar year 2014 aggregate …...emergency room dental dental / oral surgery...

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.

Exhibit C-2: Four Surrounding Counties

Four Surrounding Counties: Calendar Year 2014 Aggregate Data

TANF-HB-MAGI

0-18

TANF-HB-MAGI

19+ SSI w/ Medicare

SSI w/o

Medicare

Breast and


2014 MCO Member Months 1,212,399 414,464 4,794 621,590 2,811 2,256,057




Pharmaceutical


Laboratory

Radiology


Vision


Hospice




Therapy


Medical Diagnostic


Emergency Room

Dental



Specialty Physician

Other Practitioners


Other Outpatient


Inpatient - Rehab

Nursing Home


Appendix 14

Appendix 16 and 16a

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

23.23

0.73

2.93

4.30

7.09

1.55

2.37

(0.00)

6.87

0.22

0.08

2.29

0.78

2.59

0.51

12.01

16.00

0.85

21.47

11.55

0.18

11.96

0.02

52.88

0.17

0.16

0.00

23.30

6.16

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

68.27

1.53

6.84

18.92

0.25

1.39

3.81

0.10

3.99

4.62

1.55

6.35

2.24

4.36

0.40

24.18

9.25

1.83

20.67

38.58

1.18

28.71

0.95

114.10

0.21

0.33

0.04

22.46

11.24

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

1,062.72

47.11

5.65

14.62

0.07

(0.41)

35.93

0.34

90.23

0.25

2.54

11.15

2.06

5.06

1.26

11.84

(3.17)

1.57

12.81

20.86

0.56

19.77

0.70

83.63

1.78

6.16

-

80.55

6.32

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

254.63

5.75

7.13

16.71

1.21

1.61

36.31

1.58

118.20

0.44

0.17

20.51

5.25

9.73

0.32

19.69

9.64

1.45

22.40

36.90

1.52

37.18

7.00

161.67

5.21

3.86

0.15

81.89

11.22

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

1,077.62

3.74

23.90

86.61

-

2.19

21.39

9.60

11.92

0.69

0.30

216.60

2.40

25.92

0.35

14.73

9.22

1.70

28.45

135.46

2.23

168.23

3.33

233.11

9.45

0.05

0.58

117.02

31.19

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

98.78

2.37

4.84

10.53

4.19

1.54

12.08

0.47

37.20

1.09

0.38

8.34

2.29

4.92

0.44

16.37

12.96

1.20

21.57

23.68

0.74

22.20

2.12

94.39

1.58

1.22

0.05

39.53

8.52

Gross Medical Expenses $ 212.30 $ 398.37 $ 1,521.97 $ 879.35 $ 2,237.97 $ 435.57

Mercer 2 of 12 12/19/2016, 1:33 PM

Commonwealth of Pennsylvania

Notes:




Exhibit C-3: Southeast Zone

Southeast Zone: Fiscal Year 2013-2014 Maternity Data

2013-2014 MCO Deliveries - C-Section¹ 5,170

2013-2014 MCO Deliveries - Vaginal¹ 12,987

Category of Service

Total Zone C-2

Section Costs

Total Zone Vaginal 3

Costs4

Total Zone Costs C-Section

5 Cost/Delivery

Vaginal 5

Cost/Delivery

Combined 5

Cost/Delivery

Pharmaceutical


Laboratory

Radiology


Vision


Hospice




Therapy


Medical Diagnostic


Emergency Room

Dental



Specialty Physician

Other Practitioners


Other Outpatient


Inpatient - Rehab

Nursing Home


Appendix 14

Appendix 16 and 16a

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

1,038,531

89,393

367,786

1,774,160

777

25,608

133,339

-

209,324

663,506

8,697

9,146

156,820

120,980

304,170

253,678

130,095

6,742

815,719

9,939,907

377,009

3,698,157

64,167

40,610,742

8,500

-

4,270

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

1,272,496

121,881

748,247

2,963,113

2,580

63,490

173,272

-

347,889

437,303

16,731

18,993

408,433

153,089

796,133

588,921

325,813

17,677

2,861,707

19,932,643

968,671

8,838,128

171,947

55,888,757

-

-

2,901

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

2,311,028

211,274

1,116,033

4,737,273

3,357

89,098

306,611

-

557,213

1,100,810

25,428

28,139

565,253

274,070

1,100,303

842,599

455,908

24,419

3,677,426

29,872,550

1,345,680

12,536,286

236,114

96,499,499

8,500

-

7,171

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

200.88

17.29

71.14

343.16

0.15

4.95

25.79

-

40.49

128.34

1.68

1.77

30.33

23.40

58.83

49.07

25.16

1.30

157.78

1,922.61

72.92

715.31

12.41

7,855.08

1.64

-

0.83

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

97.98

9.38

57.62

228.16

0.20

4.89

13.34

-

26.79

33.67

1.29

1.46

31.45

11.79

61.30

45.35

25.09

1.36

220.35

1,534.82

74.59

680.54

13.24

4,303.44

-

-

0.22

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

127.28

11.64

61.47

260.91

0.18

4.91

16.89

-

30.69

60.63

1.40

1.55

31.13

15.09

60.60

46.41

25.11

1.34

202.53

1,645.24

74.11

690.44

13.00

5,314.73

0.47

-

0.39

-

-

Gross Maternity Expenses $ 60,811,225 $ 97,120,816 $ 157,932,041 $ 11,762.33 $ 7,478.31 $ 8,698.14

Mercer 3 of 12 12/19/2016, 1:33 PM


Notes:




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


2014 MCO Member Months 818,871 337,027 3,907 456,639 2,114 1,618,558

2014 MCO Deliveries - C-Section¹ 17 978 0 62 0 1,057



Pharmaceutical


Laboratory

Radiology


Vision


Hospice




Therapy


Medical Diagnostic


Emergency Room

Dental



Specialty Physician

Other Practitioners


Other Outpatient


Inpatient - Rehab

Nursing Home


Appendix 14

Appendix 16 and 16a

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

24.88

0.51

3.16

3.52

7.52

2.38

2.68

0.00

3.72

0.37

0.64

1.25

1.14

1.92

1.04

13.78

14.82

1.04

13.88

16.10

0.37

8.21

0.00

39.82

1.29

0.38

0.00

12.82

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

52.55

1.67

14.27

15.42

0.14

3.05

4.13

0.03

2.25

5.90

5.34

2.38

3.35

2.64

0.99

18.99

11.64

2.48

11.93

33.93

0.70

20.84

0.29

89.03

1.04

0.57

0.00

10.18

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

238.47

5.31

5.63

11.74

0.27

3.11

21.30

-

23.90

0.88

0.84

5.56

3.89

3.91

1.32

6.75

11.98

2.60

7.45

23.18

0.94

11.50

2.10

119.36

3.60

6.72

-

38.75

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

267.42

6.91

13.71

19.41

1.45

3.54

31.95

1.53

49.99

0.77

0.94

9.48

7.47

6.88

1.00

20.53

12.52

2.33

17.07

38.31

1.62

27.87

8.90

161.04

5.15

6.06

0.00

44.40

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

536.62

4.88

32.36

76.88

-

4.53

11.69

0.81

17.39

0.66

0.84

118.33

3.76

7.82

0.72

9.66

12.72

2.83

19.43

73.49

2.23

75.40

-

162.69

-

1.96

-

64.44

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

100.25

2.58

8.49

10.60

4.24

2.85

11.30

0.44

16.54

1.63

1.70

3.97

3.40

3.48

1.02

16.74

13.50

1.71

14.37

26.17

0.80

16.48

2.58

84.62

2.33

2.04

0.00

21.31

-

Gross Medical Expenses $ 177.23 $ 315.73 $ 561.05 $ 768.27 $ 1,242.16 $ 375.13

Mercer 4 of 12 12/19/2016, 1:33 PM

Notes:



1 Number of deliveries are actual maternity outcome counts as reported by the HealthChoices Southwest Managed Care Organizations on Annual Report 27.


Mercer 5 of 12 12/19/2016, 1:33 PM

Exhibit C-5: Thirteen Surrounding Counties

Thirteen Surrounding Counties: Calendar Year 2014 Aggregate Data

TANF-HB-MAGI

0-18

TANF-HB-MAGI

19+ SSI w/ Medicare

SSI w/o

Medicare

Breast and






Pharmaceutical


Laboratory

Radiology


Vision


Hospice




Therapy


Medical Diagnostic


Emergency Room

Dental



Specialty Physician

Other Practitioners


Other Outpatient


Inpatient - Rehab

Nursing Home


Appendix 14

Appendix 16 and 16a

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

29.59

0.64

3.23

3.80

8.42

2.61

2.74

0.02

4.65

0.39

0.68

1.40

1.09

1.63

1.25

9.20

15.90

1.41

17.43

14.00

0.35

7.03

0.00

35.89

0.62

0.28

0.00

13.02

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

66.82

1.59

13.95

17.88

0.14

3.43

4.82

0.09

1.69

6.88

4.87

2.89

2.42

3.48

1.24

18.54

12.04

3.71

11.64

38.60

0.98

20.48

0.15

78.61

0.72

0.19

0.00

10.86

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

230.32

6.28

8.20

8.27

0.30

3.41

17.88

0.20

13.82

0.09

0.44

7.54

2.17

4.56

1.21

6.53

13.36

3.96

11.31

21.46

0.66

11.51

9.30

66.30

0.88

6.39

-

37.97

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

287.86

7.76

15.55

22.23

1.36

3.76

35.51

2.06

45.96

0.85

1.17

10.49

5.87

8.05

1.47

18.11

12.79

2.83

19.48

40.51

1.74

27.48

5.33

137.53

3.98

6.13

0.00

44.35

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

642.83

5.33

47.52

102.19

-

4.41

19.32

3.13

16.05

2.69

1.10

195.29

1.82

12.41

1.36

12.55

10.77

2.66

20.39

93.69

2.12

75.23

-

169.88

7.12

6.49

-

67.62

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

118.36

3.06

9.22

12.40

4.58

3.13

13.39

0.67

16.95

1.80

1.65

4.77

2.84

4.01

1.31

13.79

14.17

2.30

16.93

27.15

0.91

16.10

1.71

76.05

1.69

2.10

0.00

22.46

-


Notes:




Exhibit C-6: Southwest Zone

Southwest Zone: Fiscal Year 2013-2014 Maternity Data



Category of Service

Total Zone C-2

Section Costs


Costs4


5 Cost/Delivery

Vaginal 5

Cost/Delivery

Combined 5

Cost/Delivery

Pharmaceutical


Laboratory

Radiology


Vision


Hospice




Therapy


Medical Diagnostic


Emergency Room

Dental



Specialty Physician

Other Practitioners


Other Outpatient


Inpatient - Rehab

Nursing Home


Appendix 14

Appendix 16 and 16a

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

456,809

77,008

345,563

633,624

1,056

41,016

42,449

-

15,186

1,420,739

168

6,841

127,042

42,253

22,264

123,040

188,012

6,435

227,846

4,753,958

16,168

1,494,216

-

12,448,363

-

13,269

-

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

1,000,387

103,770

795,677

1,081,293

2,751

107,137

78,372

-

50,435

686,065

3,138

14,235

329,210

83,932

54,734

269,881

497,306

12,967

866,996

10,373,967

73,734

4,153,641

-

19,550,898

-

-

-

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

1,457,197

180,778

1,141,240

1,714,917

3,806

148,154

120,821

-

65,622

2,106,804

3,306

21,076

456,252

126,185

76,998

392,921

685,319

19,402

1,094,842

15,127,925

89,902

5,647,856

-

31,999,261

-

13,269

-

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

167.82

28.29

126.95

232.78

0.39

15.07

15.59

-

5.58

521.95

0.06

2.51

46.67

15.52

8.18

45.20

69.07

2.36

83.71

1,746.49

5.94

548.94

-

4,573.24

-

4.87

-

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

140.46

14.57

111.72

151.82

0.39

15.04

11.00

-

7.08

96.33

0.44

2.00

46.22

11.78

7.69

37.89

69.83

1.82

121.73

1,456.61

10.35

583.21

-

2,745.14

-

-

-

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

148.03

18.36

115.93

174.21

0.39

15.05

12.27

-

6.67

214.02

0.34

2.14

46.35

12.82

7.82

39.91

69.62

1.97

111.22

1,536.77

9.13

573.74

-

3,250.64

-

1.35

-

-

-


Mercer 6 of 12 12/19/2016, 1:33 PM


Notes:




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.


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






Pharmaceutical


Laboratory

Radiology


Vision


Hospice




Therapy


Medical Diagnostic


Emergency Room

Dental



Specialty Physician

Other Practitioners


Other Outpatient


Inpatient - Rehab

Nursing Home


Appendix 14

Appendix 16 and 16a

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

22.22

0.51

2.71

2.85

7.49

2.65

2.12

0.02

4.46

0.28

0.34

1.44

0.98

1.74

1.15

7.91

16.25

1.42

15.99

10.05

0.35

6.49

0.44

32.93

0.23

0.11

0.00

11.76

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

57.17

1.65

12.58

19.63

0.26

3.24

3.64

0.02

2.57

6.55

3.38

3.48

2.06

3.28

1.37

16.83

13.23

2.90

21.21

41.18

1.22

18.50

2.02

100.11

0.35

0.27

0.04

11.17

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

739.75

22.97

7.75

14.05

0.25

4.78

10.09

0.19

65.63

0.26

2.28

6.98

2.63

4.30

1.16

8.38

19.14

2.73

12.96

25.58

1.00

12.13

5.66

120.45

2.18

3.26

-

35.24

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

253.38

6.42

12.80

18.95

1.69

4.21

27.25

1.37

85.03

0.71

0.68

11.46

4.97

7.22

1.58

16.01

13.68

2.51

21.59

36.93

1.67

25.27

6.20

150.70

4.03

6.00

0.03

41.02

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

894.14

8.92

33.04

86.00

-

4.50

18.54

4.26

30.60

0.95

0.27

157.62

2.25

11.49

1.63

9.52

10.24

0.75

29.65

133.59

1.74

71.14

2.80

326.29

-

2.02

-

93.02

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

87.57

2.22

7.10

10.09

4.67

3.15

8.54

0.35

23.79

1.59

1.01

4.44

2.16

3.38

1.30

11.60

15.04

1.97

18.36

22.73

0.84

13.43

2.15

74.92

1.18

1.58

0.02

18.88

-


Mercer 7 of 12 12/19/2016, 1:33 PM


Notes:



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



Category of Service

Total Zone C-2

Section Costs


Costs4


5 Cost/Delivery

Vaginal 5

Cost/Delivery

Combined 5

Cost/Delivery

Pharmaceutical


Laboratory

Radiology


Vision


Hospice




Therapy


Medical Diagnostic


Emergency Room

Dental



Specialty Physician

Other Practitioners


Other Outpatient


Inpatient - Rehab

Nursing Home


Appendix 14

Appendix 16 and 16a

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

799,995

104,935

436,193

1,318,417

369

60,518

125,907

-

34,938

845,238

1,098

17,457

100,814

48,999

72,184

142,908

291,436

9,697

639,489

6,351,327

58,144

1,481,091

201,488

18,503,790

-

-

520

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

962,129

127,348

889,548

1,795,769

2,245

140,361

199,024

-

106,962

448,930

2,623

26,564

175,537

60,860

148,935

295,871

674,556

20,150

2,515,729

12,289,475

196,246

3,402,958

485,169

23,595,173

-

4,772

1,200

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

1,762,124

232,283

1,325,741

3,114,186

2,615

200,879

324,931

-

141,900

1,294,168

3,721

44,021

276,351

109,859

221,120

438,779

965,993

29,846

3,155,218

18,640,802

254,391

4,884,049

686,657

42,098,963

-

4,772

1,720

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

223.71

29.34

121.98

368.68

0.10

16.92

35.21

-

9.77

236.36

0.31

4.88

28.19

13.70

20.19

39.96

81.50

2.71

178.83

1,776.10

16.26

414.18

56.34

5,174.44

-

-

0.15

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

113.79

15.06

105.21

212.39

0.27

16.60

23.54

-

12.65

53.10

0.31

3.14

20.76

7.20

17.62

34.99

79.78

2.38

297.54

1,453.52

23.21

402.48

57.38

2,790.68

-

0.56

0.14

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

146.47

19.31

110.19

258.85

0.22

16.70

27.01

-

11.79

107.57

0.31

3.66

22.97

9.13

18.38

36.47

80.29

2.48

262.26

1,549.40

21.14

405.96

57.07

3,499.21

-

0.40

0.14

-

-


Mercer 8 of 12 12/19/2016, 1:33 PM


Notes:



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.


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






Pharmaceutical


Laboratory

Radiology


Vision


Hospice




Therapy


Medical Diagnostic


Emergency Room

Dental



Specialty Physician

Other Practitioners


Other Outpatient


Inpatient - Rehab

Nursing Home


Appendix 14

Appendix 16 and 16a

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

22.47

0.63

3.31

3.72

7.79

2.18

2.32

0.00

11.32

0.18

0.31

0.83

1.20

1.03

3.21

4.65

12.93

0.26

15.61

8.03

0.20

5.17

0.15

31.92

0.19

0.00

0.02

2.27

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

56.81

1.61

13.79

16.54

(0.08)

2.68

3.00

0.05

1.26

3.60

2.79

2.96

2.05

3.00

4.01

10.25

11.33

0.79

15.36

36.49

0.97

19.74

1.20

82.79

0.53

0.15

0.03

2.00

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

297.01

9.55

19.61

22.81

0.31

5.26

30.99

1.67

222.44

0.89

1.00

17.26

4.29

9.08

6.78

11.49

17.81

1.24

111.81

38.69

2.32

38.50

7.97

187.54

7.70

5.88

0.04

12.89

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

240.12

6.92

14.61

17.76

1.47

3.39

25.67

1.83

89.96

0.62

0.73

9.87

3.99

6.44

5.28

10.43

11.79

0.62

24.04

30.26

1.47

24.06

3.43

136.28

3.82

2.37

0.04

8.78

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

823.83

1.73

38.71

66.02

(0.02)

3.60

12.87

4.33

3.86

0.69

0.43

114.43

1.83

7.76

5.93

7.15

11.60

1.49

23.05

85.93

1.95

65.46

0.31

151.05

0.04

1.68

0.19

22.11

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

87.43

2.48

8.42

10.04

4.55

2.60

8.60

0.49

30.22

0.98

0.91

3.77

2.10

2.86

3.92

7.29

12.32

0.46

17.98

19.65

0.69

13.14

1.23

69.70

1.22

0.66

0.03

3.96

-


Mercer 9 of 12 12/19/2016, 1:33 PM


Notes:



1 Number of deliveries are actual maternity outcome counts as reported by the HealthChoices Northeast Managed Care Organizations on Annual Report 27.

Exhibit C-10: Northeast Zone

Northeast Zone: Fiscal Year 2013-2014 Maternity Data



Category of Service

Total Zone C-2

Section Costs


Costs4


5 Cost/Delivery

Vaginal 5

Cost/Delivery

Combined 5

Cost/Delivery

Pharmaceutical


Laboratory

Radiology


Vision


Hospice




Therapy


Medical Diagnostic


Emergency Room

Dental



Specialty Physician

Other Practitioners


Other Outpatient


Inpatient - Rehab

Nursing Home


Appendix 14

Appendix 16 and 16a

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

478,837

29,734

284,215

773,997

237

14,939

40,051

-

17,278

221,696

591

4,626

36,127

23,944

69,275

57,940

23,509

1,043

107,276

3,068,688

29,914

958,465

103,384

10,907,134

-

-

64

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

851,139

28,283

467,663

930,541

1,148

32,076

68,377

321

52,446

44,359

2,879

7,448

60,213

30,426

135,420

96,449

48,180

1,557

339,177

5,433,683

84,202

1,742,616

212,696

14,081,746

-

-

167

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

1,329,976

58,017

751,878

1,704,539

1,385

47,015

108,429

321

69,724

266,056

3,470

12,074

96,341

54,370

204,695

154,389

71,689

2,600

446,453

8,502,370

114,115

2,701,081

316,080

24,988,881

-

-

230

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

225.44

14.00

133.81

364.41

0.11

7.03

18.86

-

8.13

104.38

0.28

2.18

17.01

11.27

32.62

27.28

11.07

0.49

50.51

1,444.77

14.08

451.25

48.67

5,135.19

-

-

0.03

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

179.15

5.95

98.43

195.86

0.24

6.75

14.39

0.07

11.04

9.34

0.61

1.57

12.67

6.40

28.50

20.30

10.14

0.33

71.39

1,143.69

17.72

366.79

44.77

2,963.95

-

-

0.04

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

193.45

8.44

109.36

247.93

0.20

6.84

15.77

0.05

10.14

38.70

0.50

1.76

14.01

7.91

29.77

22.46

10.43

0.38

64.94

1,236.71

16.60

392.88

45.98

3,634.75

-

-

0.03

-

-


Mercer 10 of 12 12/19/2016, 1:33 PM


Notes:



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.


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


2014 MCO Member Months 728,375 282,826 2,965 422,663 1,670 1,438,500




Pharmaceutical


Laboratory

Radiology


Vision


Hospice




Therapy


Medical Diagnostic


Emergency Room

Dental



Specialty Physician

Other Practitioners


Other Outpatient


Inpatient - Rehab

Nursing Home


Appendix 14

Appendix 16 and 16a

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

26.72

0.55

3.37

3.42

7.48

2.27

2.87

0.06

5.89

0.49

0.53

1.06

0.98

1.51

3.53

8.27

14.10

1.11

12.88

10.69

0.22

7.41

0.06

32.92

0.43

0.03

0.00

3.81

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

52.63

1.47

14.78

20.09

0.01

3.19

3.70

0.03

2.88

7.05

4.82

2.52

1.91

3.21

4.46

17.85

10.72

3.03

11.20

36.25

1.18

19.87

0.20

77.69

0.42

0.17

0.00

2.28

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

189.09

5.37

5.30

10.48

0.26

3.41

7.21

-

72.87

0.20

0.44

3.92

2.34

2.48

2.16

6.64

10.60

2.86

7.83

15.29

0.51

8.62

7.06

110.47

8.08

1.92

0.05

7.85

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

251.34

6.15

16.05

22.67

1.25

3.51

27.00

0.96

43.66

1.16

1.04

8.90

4.96

7.91

6.51

18.37

11.61

2.19

16.85

34.18

1.18

28.25

3.73

118.30

4.10

2.65

0.02

8.30

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

858.99

7.59

45.89

90.32

-

4.10

35.46

23.90

5.90

4.88

0.47

170.93

1.80

9.28

4.73

11.41

10.90

2.53

20.15

89.26

1.52

81.19

0.18

101.76

-

-

0.12

15.89

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

99.12

2.40

9.39

12.47

4.16

2.82

10.17

0.35

16.54

1.98

1.53

3.85

2.34

3.74

4.59

13.12

12.69

1.81

13.71

22.72

0.70

16.07

1.18

67.05

1.52

0.83

0.01

4.85

-


Mercer 11 of 12 12/19/2016, 1:33 PM


Notes:



1 Number of deliveries are actual maternity outcome counts as reported by the HealthChoices Northwest Managed Care Organizations on Annual Report 27.

Exhibit C-12: Northwest Zone

Northwest Zone: Fiscal Year 2013-2014 Maternity Data



Category of Service

Total Zone C-2

Section Costs


Costs4


5 Cost/Delivery

Vaginal 5

Cost/Delivery

Combined 5

Cost/Delivery

Pharmaceutical


Laboratory

Radiology


Vision


Hospice




Therapy


Medical Diagnostic


Emergency Room

Dental



Specialty Physician

Other Practitioners


Other Outpatient


Inpatient - Rehab

Nursing Home


Appendix 14

Appendix 16 and 16a

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

250,516

32,700

189,319

469,124

142

16,561

28,887

-

32,907

929,277

88

3,474

42,965

13,248

44,990

115,793

63,942

2,584

51,173

2,123,303

8,552

443,241

1,846

5,069,166

-

1,864

-

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

251,933

42,908

303,014

647,637

563

30,245

21,296

-

43,333

76,118

961

3,971

60,034

17,429

89,380

170,307

116,894

4,697

93,814

3,343,820

95,906

862,350

3,807

6,552,864

-

2,161

-

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

502,449

75,608

492,333

1,116,761

705

46,806

50,183

-

76,240

1,005,395

1,050

7,446

102,999

30,676

134,370

286,100

180,836

7,281

144,987

5,467,123

104,458

1,305,590

5,652

11,622,030

-

4,025

-

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

202.03

26.37

152.68

378.33

0.11

13.36

23.30

-

26.54

749.42

0.07

2.80

34.65

10.68

36.28

93.38

51.57

2.08

41.27

1,712.34

6.90

357.45

1.49

4,088.04

-

1.50

-

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

101.06

17.21

121.55

259.78

0.23

12.13

8.54

-

17.38

30.53

0.39

1.59

24.08

6.99

35.85

68.31

46.89

1.88

37.63

1,341.28

38.47

345.91

1.53

2,628.51

-

0.87

-

-

-

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

134.60

20.25

131.89

299.16

0.19

12.54

13.44

-

20.42

269.33

0.28

1.99

27.59

8.22

36.00

76.64

48.44

1.95

38.84

1,464.54

27.98

349.74

1.51

3,113.32

-

1.08

-

-

-


Mercer 12 of 12 12/19/2016, 1:33 PM


Notes:



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.


philadelphia county: calendar year 2014 aggregate …...emergency room dental dental / oral surgery...

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