| Managed Care On-Line:
Information Exchange |
- Capitation Detail Report*
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- Sample Medicare HMO
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- Hospital Inpatient
- Utilization:
956.0000 Days Per 1000 Members Per Year 0.07966Per Member Per
Month
- Cost Per Unit: $1,474.67
- Capitation PMPM: $117.48
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- Hospital Outpatient
- Utilization: 1.5760 Procedures Per
Member Per Year 0.13133 Per Member Per Month
- Cost Per Unit: $153.31
- Capitation PMPM: $20.13
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- Hospital ER Facility
- Utilization: 0.4010 Visits Per Member
Per Year 0.03341 Per Member Per Month
- Cost Per Unit: $190.48
- Capitation PMPM: $6.37
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- Surgery Center
- Utilization: 0.2520 Procedures Per
Member Per Year 0.02099 Per Member Per Month
- Cost Per Unit: $1,221.38
- Capitation PMPM: $25.65
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- Other OP Facilities
- Utilization: 3.2810 Procedures Per
Member Per Year 0.27341 Per Member Per Month
- Cost Per Unit: $94.92
- Capitation PMPM: $25.95
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- SNF/Sub Acute
- Utilization: 533.0000 Days Per 1000
Members Per Year 0.04441 Per Member Per Month
- Cost Per Unit: $342.76
- Capitation PMPM: $15.22
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- Home Health
- Utilization: 4.4960 Visits Per Member
Per Year 0.37466 Per Member Per Month
- Cost Per Unit: $85.36
- Capitation PMPM: $31.98
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- Ambulance
- Utilization: 0.6100 Visits Per Member
Per Year 0.05083 Per Member Per Month
- Cost Per Unit: $191.75
- Capitation PMPM: $9.75
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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
- Capitation PMPM: $0.01
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- Sub Total: Institutional
- Utilization: 0.0000 Subtotal Per
Member Per Month
- Cost Per Unit: $0.00
- Capitation PMPM: $252.55
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- Primary Care Services
- Utilization: 9.6690 Visits Per Member
Per Year 0.80574 Per Member Per Month
- Cost Per Unit: $57.45
- Capitation PMPM: $46.29
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- Specialist Referrals
- Utilization: 6.9610 Visits Per Member
Per Year 0.58008 Per Member Per Month
- Cost Per Unit: $71.87
- Capitation PMPM: $41.69
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- Inpatient Surgeries
- Utilization: 0.3070 Procedures Per
Member Per Year 0.02558 Per Member Per Month
- Cost Per Unit: $909.58
- Capitation PMPM: $23.27
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- Outpatient Surgeries
- Utilization: 1.7720 Procedures Per
Member Per Year 0.14766 Per Member Per Month
- Cost Per Unit: $280.77
- Capitation PMPM: $41.46
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- Hospital Based MDs
- Utilization: 0.7260 Visits Per Member
Per Year 0.06050 Per Member Per Month
- Cost Per Unit: $180.09
- Capitation PMPM: $10.90
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- Radiology
- Utilization: 3.0880 Procedures Per
Member Per Year 0.25733 Per Member Per Month
- Cost Per Unit: $55.92
- Capitation PMPM: $14.39
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- Laboratory
- Utilization: 7.6260 Procedures Per
Member Per Year 0.63549 Per Member Per Month
- Cost Per Unit: $21.03
- Capitation PMPM: $13.36
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- Physical Therapy
- Utilization: 0.5820 Visits Per Member
Per Year 0.04849 Per Member Per Month
- Cost Per Unit: $23.85
- Capitation PMPM: $1.16
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- Other Diagnostic
- Utilization: 0.8080 Procedures Per
Member Per Year 0.06733 Per Member Per Month
- Cost Per Unit: $62.74
- Capitation PMPM: $4.22
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- DME/Prosthetics
- Utilization: 1.5580 Procedures Per
Member Per Year 0.12983 Per Member Per Month
- Cost Per Unit: $118.83
- Capitation PMPM: $15.43
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- Immunizations/Inj
- Utilization: 1.1400 Procedures Per
Member Per Year 0.09500 Per Member Per Month
- Cost Per Unit: $17.03
- Capitation PMPM: $1.62
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- Other Providers
- Utilization: 0.8490 Visits Per Member
Per Year 0.07074 Per Member Per Month
- Cost Per Unit: $57.03
- Capitation PMPM: $4.03
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- Sub Total:Professional
- Utilization: 0.0000 Subtotal Per
Member Per Month
- Cost Per Unit: $0.00
- Capitation PMPM: $217.82
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- Sub Total Pharmaceutical
- Utilization: 19.7200 Rx's Per Member
Per Year 1.64333 Per Member Per Month
- Cost Per Unit: $41.88
- Capitation PMPM: $68.82
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- Sub Total:Other Services
- Utilization: 0.0000 N/A Per Member
Per Month
- Cost Per Unit: $0.00
- Capitation PMPM: $1.00
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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 Medicare 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 MCOL's Capulator™, or CAP-MAN™ features, be
sure to contact us at 209.577.4888, or send an email to: claire@mcol.mcareol.com