| Managed Care On-Line:
Information Exchange |
Capitation Detail Report*
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- Sample Group HMO
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- Hospital Inpatient
- Utilization: 218.0000 Days Per 1000 Members Per Year
; 0.01816 Per Member Per Month
- Cost Per Unit: $1,354.62
- Capitation PMPM: $24.61
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- Hospital Outpatient
- Utilization: 0.3520 Procedures Per Member Per Year
; 0.02933 Per Member Per Month
- Cost Per Unit: $191.74
- Capitation PMPM: $5.62
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- Hospital ER Facility
- Utilization: 0.1390 Visits Per Member Per Year
; 0.01158 Per Member Per Month
- Cost Per Unit: $144.57
- CapitationMPM: $1.67
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- Surgery Center
- Utilization: 0.1060 Procedures Per Member Per Year
; 0.00883 Per Member Per Month
- Cost Per Unit: $839.91
- CapitationMPM: $7.42
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- Other OP Facilities
- Utilization:0.2400 Procedures Per Member Per Year
; 0.01999 Per Member Per Month
- Cost Per Unit: $109.50
- CapitationMPM: $2.19
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- SNF/Sub Acute
- Utilization: 5.0000 Days Per 1000 Members Per Year
; 0.00041 Per Member Per Month
- Cost Per Unit: $243.82
- CapitationPMPM: $0.10
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- Home Health
- Utilization: 0.0330 Visits Per Member Per Year
; 0.00274 Per Member Per Month
- Cost Per Unit: $189.87
- CapitationPMPM: $0.52
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- Ambulance
- Utilization: 0.0220 Visits Per Member Per Year
;0.00183 Per Member Per Month
- Cost Per Unit: $220.24
- CapitationPMPM: $0.40
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- Other Institutional
- Utilization: 0.0010 Visits Per Member Per Year
; 0.00008 Per Member Per Month
- Cost Per Unit: $150.00
- CapitationPMPM: $0.01
-
- Sub Total: Institutional
- Utilization: 0.0000 Subtotal Per
Member Per Month
- Cost Per Unit: $0.00
- Capitation PMPM: $42.56
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- Primary Care Services
- Utilization: 3.2790 Visits Per Member Per Year
; 0.27325 Per Member Per Month
- Cost Per Unit: $46.18
- CapitationPMPM: $12.62
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- Specialist Referrals
- Utilization: 0.9650 Visits Per Member Per Year
; 0.08041 Per Member Per Month
- Cost Per Unit: $81.47
- CapitationPMPM: $6.55
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- Inpatient Surgeries
- Utilization: 0.0280 Procedures Per Member Per Year
; 0.00233 Per Member Per Month
- Cost Per Unit: $1,714.29
- Capitation PMPM: $4.00
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- Outpatient Surgeries
- Utilization: 0.3690 Procedures Per Member Per Year
; 0.03074 Per Member Per Month
- Cost Per Unit: $289.43
- CapitationPMPM: $8.90
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- Hospital Based MDs
- Utilization: 0.1840 Visits Per Member Per Year
; 0.01533 Per Member Per Month
- Cost Per Unit: $171.81
- CapitationPMPM: $2.63
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- Radiology
- Utilization: 0.9850 Procedures Per Member Per Year;
0.08208 Per Member Per Month
- Cost Per Unit: $69.08
- CapitationPMPM: $5.67
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- Laboratory
- Utilization: 2.4680 Procedures Per Member Per Year
;0.20566 Per Member Per Month
- Cost Per Unit: $18.48
- CapitationPMPM: $3.80
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- Physical Therapy
- Utilization: 0.2470 Visits Per Member Per Year
; 0.02058 Per Member Per Month
- Cost Per Unit: $39.97
- CapitationPMPM: $0.82
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- Other Diagnostic
- Utilization: 0.2180 Procedures Per Member Per Year
; 0.01816 Per Member Per Month
- Cost Per Unit: $32.06
- CapitationPMPM: $0.58
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- DME/Prosthetics
- Utilization: 0.0940 Procedures Per Member Per Year
; 0.00783 Per Member Per Month
- Cost Per Unit: $156.09
- CapitationPMPM: $1.22
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- Immunizations/Inj
- Utilization: 0.6570 Procedures Per Member Per Year
; 0.05474 Per Member Per Month
- Cost Per Unit: $20.66
- CapitationPMPM: $1.13
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- Other Providers
- Utilization: 0.9880 Visits Per Member Per Year
;0.08233 Per Member Per Month
- Cost Per Unit: $36.16
- CapitationPMPM: $2.98
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- Sub Total:Professional
- Utilization: 0.0000 Subtotal Per
Member Per Month
- Cost Per Unit: $0.00
- Capitation PMPM: $50.91
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- Sub Total Pharmaceutical
- Utilization: 5.2600 Rx's Per Member
Per Year 0.43833 Per Member Per Month
- Cost Per Unit: $32.85
- Capitation PMPM: $14.40
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- Sub Total:Other Services
- Utilization: 0.0000 N/A Per Member
Per Month
- Cost Per Unit: $0.00
- Capitation PMPM: $0.50
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- Sub Total: Net Reinsurance
- Utilization: 0.0000 N/A Per Member
Per Month
- Cost Per Unit: $0.00
- Capitation PMPM: $1.00
Source: MCOL Capulator™, Sample Group HMO
This file has been prepared for MCOL members only
* The Capitation Detail Report is available when using MCOL's Capulator™, a
feature availiable for Full and Gold members. Capulator™ is an easy to use
Windows-based resource to calculate and report capitation requirements for a variety of
scenarios. You can use preset scenarios or design your own. Capulator™ is also
a feature included in CAP-MAN™, a suite of capitation resources from MCOL.
CAP-MAN™ includes: Capulator™, Capulator™ Tutorial, Capitation
Seminar, and Capitation Negotiator. All features of CAP-MAN™ are included in
the Gold membership option or can be purchased as a separate stand-alone product..
For more information about our Capulator™, or CAP-MAN™ features, be
sure to contact us at 209.577.4888, or send an email to: claire@mcol.mcareol.com