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Medi-Cal Managed Care FSSB May 10, 2012 1

Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

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Page 1: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Medi-Cal Managed Care

FSSB May 10, 2012

1

Page 2: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

2,000,000

2,250,000

2,500,000

2,750,000

3,000,000

3,250,000

3,500,000

3,750,000

4,000,000

4,250,000

4,500,000

Bene

ficia

ries

Month of Eligibility

Trend in Medi-Cal Program Enrollment by Managed Care Status

FFS Managed Care

Source: DHCS, Trend in Medi-Cal Program Enrollment by Managed Care Status for FY 2003-2010 2

Page 3: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

9-10 10-11 11-12 12-13State FY

Managed Care Enrollment and Expenditures as a Percent of Total Medi-Cal Enrollment and Expenditures

Managed Care Expenditures as a Percent of Total Medi-Cal Costs

Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment

Source: DHCS, Trend in Medi-Cal Program Enrollment by Managed Care Status for FY 2003-2010; DHCS Local Assistance Estimate, May 2009, May 2010, May 2011, and November 2011.

3

Page 4: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Medi-Cal AID Categories

• Adult and Family Majority of beneficiaries Mostly moms and kids

Medi-Cal is the source of coverage for one in three California children and pays for forty-six percent of all births in California1

Traditional managed care member Majority subject to mandatory managed care enrollment

• Seniors and Persons with Disabilities (SPD’s), Medi-Cal only Older, less healthy Traditionally only 3-8% of membership Previously - voluntary managed care enrollment All being transitioned to managed care

1Source: Medi-Cal Facts and Figures, September 2009, California HealthCare Foundation 4

Page 5: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Medi-Cal AID Categories

Duals (Medicare/Medi-Cal) Few current members Will be transitioned to Managed Care

Few other AID categories such as Share of Cost – not enrolled in Managed Care

5

Page 6: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

3,193,837 68%

476,456 , 10%

1,021,551 22%

Medi-Cal Managed Care Enrollment (Dec 2011)

Two-Plan

GMC

COHS

6

Page 7: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Managed Care Models

• Two-Plan Beneficiaries offered a choice of 2 plans Majority of managed care beneficiaries State contracts with 2 plans Local Initiative – locally organized, established by

county Board of Supervisors Commercial Plan such as Health Net or Anthem Blue

Cross

14 Two-Plan counties

7

Page 8: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Managed Care Models

• GMC Multiple commercial plans permitted to operate in

the county Exists in 2 California Counties – Sacramento and

San Diego Beneficiaries offered a choice of 4 plans in

Sacramento and 5 plans in San Diego

8

Page 9: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Managed Care Models

• County Organized Health System (COHS) Local agencies created by the County Board of

Supervisors All Medi-Cal beneficiaries in the county are

enrolled in the COHS Responsible for, and at risk for, providing more

services than Two-Plan and GMC models 6 COHS operating in 14 counties (some COHSs

operate in multiple counties).

9

Page 10: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Managed Care Counties

10

Page 11: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Managed Care Enrollment Dec 2011

Model County Plan Enrollment Model County Plan Enrollment Alameda Alameda Alliance for Health 118,863 Sacramento Anthem Blue Cross 95,391 Anthem Blue Cross 33,798 Health Net 61,197 Contra Costa Contra Costa Health Plan 72,497 Kaiser Foundation 28,107 Anthem Blue Cross 12,315 Molina Healthcare 34,023 Fresno CalViva Health 146,370 GMC San Diego Care 1st Health Plan 25,487 Anthem Blue Cross 76,758 Community Health Group 115,733 Kern Kern Family Health 114,385 Health Net 35,489 Heath Net 38,658 Kaiser 13,862 Kings CalViva Health 13,311 Molina Healthcare 67,167 Anthem Blue Cross 10,431 Total GMC Enrollment 476,456 Los Angeles LA Care 956,239 Marin Partnership Health Plan of CA 17,371 Health Net 472,361 Mendocino 20,334 Madera CalViva Health 17,934 Napa 14,459 Two-Plan Anthem Blue Cross 10,839 Solano 62,747 Riverside Inland Empire Health Plan 220,353 Sonoma 54,566 Molina Healthcare 42,177 Yolo 26,899 San Bernardino Inland Empire Health Plan 249,809 COHS Merced Central California Alliance for Health 74,108 Molina Healthcare 57,609 Monterey 73,029 San Francisco San Francisco Health Plan 50,819 Santa Cruz 35,023 Anthem Blue Cross 13,523 Santa Barbara CenCal 64,513 San Joaquin Heath Plan of San Joaquin 92,845 San Luis Obispo 28,903 Anthem Blue Cross 28,952 Orange CalOptima 382,644 Santa Clara Santa Clara Family Health 112,348 San Mateo Health Plan of San Mateo 62,055 Anthem Blue Cross 34,459 Ventura Gold Coast Health Plan 104,900 Stanislaus Anthem Blue Cross 55,125 Total COHS Enrollment 1,021,551 Health Net 26,551 Subtotal for Two-Plan, GMC and COHS 4,691,844 Tulare Anthem Blue Cross 70,862 Health Net 43,646 Total Two-Plan Enrollment 3,193,837

11

Page 12: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Managed Care Enrollment

• Subcontracting Relationships – LA Care

• Anthem Blue Cross • Care1st • Kaiser

– Health Net – LA • Molina

– Molina – Riverside and San Bernardino • Health Net

12

Page 13: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

51%

24%

24%

14%

13%

26%

12%

36%

Beneficiaries Expenditures

Beneficiaries and Cost

Non-Elderly Adults withDisabilitiesSeniors

Non-Elderly Adults

Children

Source: Medi-Cal Facts and Figures, September 2009, California HealthCare Foundation 13

Page 14: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

• Managed care carve outs (FFS risk) – CCS services – Mental Health – Long Term Care – Certain transplants

Medi-Cal Managed Care

14

Page 15: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Medi-Cal Managed Care

• Delivery Networks Variety of reimbursement methods Areas such as LA Majority of professional services are delegated

(capitated) to full risk medical groups and IPA’s Large amount of delegated full risk hospital capitation Risk share agreements between groups and hospitals Global subcontracting

Areas such as the Central Valley Some capitation, mostly FFS (plans at full risk)

15

Page 16: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Medi-Cal Managed Care

• Delivery Networks Generally – More cap in S. Calif and more FFS in N.

Calif PCP cap only with risk sharing – mostly N. Calif

and Central Valley Delegated group compensation to providers varies Plan to Plan subcontracts FQHC’s starting to request capitation

16

Page 17: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Seniors and Persons w/Disabilities (SPDs)

• Close to 400,000 high cost, high acuity SPDs transitioned to managed care from June 2011 to May 2012

• High dollar exposure – 4 to 5 times the standard family member

• Most plans appear to be experiencing MLRs in excess of 100% on the new transitioning SPDs

• Many delegated providers are beginning to experience losses on transitioning SPDs

17

Page 18: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Seniors and Persons w/Disabilities

• Rates were based on FFS base costs adjusted for anticipated managed care efficiencies

• Risk score acuity adjusted, based on current SPD managed care risk relative to FFS SPD risk – Ranged from .905 in San Diego (FFS acuity

approximately 10% higher than existing managed care) to 1.126 in Tulare (existing managed care acuity approximately 13% higher than FFS)

– In rural counties, higher risk SPDs supposedly already in managed care

18

Page 19: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Seniors and Persons w/Disabilities

• Costs for SPD beneficiaries were anticipated to decrease over time with implementation of managed care policies and procedures

• Taking much longer than anticipated for plans and providers to assess and develop care plans for new SPDs

• Not yet experiencing anticipated cost reductions

19

Page 20: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Managed Care Factors Applied to SPD FFS Costs to Determine Managed Care Rates

Utilization Unit Cost Inpatient Hospital 0.750 1.069 Outpatient Hospital 0.875 0.851 ER 0.750 1.091 LT Care 0.400 1.391 Primary Care 1.250 0.793 Specialty 1.050 0.965 FQHC 1.000 0.523 Other Medical Prof 1.250 1.053 Pharmacy 1.100 0.650 Lab and Radiology 1.050 1.050 Transportation 0.750 1.050 All Other 1.000 1.000

20

Page 21: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Financial Pressures on Medi-Cal Managed Care Plans and Providers

• Transitioning from traditional moms and kids to an older and less healthy population

• Absorbing the SPD population • Transition of ADHCs (CBAS) to managed care • Transition of Medi-Medis to managed care • Potential transition of Healthy Families to Medi-

Cal (approximately 26% reduction in funding) • Fewer managed care carve outs (for example – no

CCS carve out for higher acuity adults)

21

Page 22: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Financial Pressures on Medi-Cal Managed Care Plans and Providers

• AB 97 cuts – 10% reduction, copays, benefit limits • Health Exchange and/or Basic Health Plan(BHP)

impact on Medi-Cal managed care plans • FQHC reimbursement change • Preparing for the 133% ( ACA impact will be to

add approximately 2 million new Medi-Cal beneficiaries with unknown costs)

• Transition of remaining 28 California counties to managed care

22

Page 23: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Medi-Cal Managed Care Rate Development Process

• Rate set by DHCS – Mercer certifies as actuarially sound

• Detailed rate development template filed by each plan – Base data – prior fiscal year – Details utilization and unit cost by category of service, for

each AID category – Expected trends

• Anticipated program changes • Efficiency adjustments • Maternity kick payment • Admin/profit

23

Page 24: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Medi-Cal Managed Care Rate Development Process

• Mercer Low, Mid, High actuarial range – Plans paid at low range

• Risk adjusted county average rate – Medicaid Rx – Assigns risk scores to beneficiaries based on pharmacy

data – Aggregate risk score applied to county average rate – Blend plan specific (75%) and risk adjusted county

average rate (25%)

24

Page 25: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Medi-Cal Managed Care Rate Development Process

• Efficiency adjustments – Potentially preventable admissions (PPA) – MAC pharmacy pricing – Low Acuity non emergent visit (LANE)

• Timing – 2 year lag from base data – For example, Two-Plan 2010 calendar year base data

filed late in 2011 and is then used to determine rates for the rate period October 2012 to September 2013

25

Page 26: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Medi-Cal Managed Care Rate Development Process

• Flow thru add-ons to rates - – Rates can appear to be much higher than they

really are – MCO (premium tax) – Intergovernmental Transfers (IGTs) – Hospital taxes

26

Page 27: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Appendix

• Sample RDT and DHCS rate development documents

27

Page 28: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

RDT Base Cost Format Medi-Cal Managed Care

Contract Year 11/12 Rate Development Utilization Cost Experience January 2009 through December 2009

Fill out one for each COA group and county (if applicable)

Family

Plan Name County COA Group

Medi-Cal Member Months January 2009 - December 2009 - (Enter Member Months information in Schedule 1-C)

(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K) (L) (M)

Fee-For-Service Capitation Total Cost

Description of Units (e.g., days, claims,

units of service) Total Gross

Cost Total Units

Annual Units per 1000 Members

Gross Cost per Unit Total Copays

Net Cost per Unit

Net Cost PMPM Total Cost

Total Encounters Units of Service Cost PMPM Total Net Cost Cost PMPM

All State-Plan Health Care Services(1)

Inpatient Hospital Days - $ - $ - $ - $ - $ - $ -

Outpatient Facility Visits - $ - $ - $ - $ - $ - $ -

Emergency Room Facility Visits - $ - $ - $ - $ - $ - $ -

Long-Term Care Facility Visits - $ - $ - $ - $ - $ - $ -

Physician Primary Care Visits - $ - $ - $ - $ - $ - $ -

Physician Specialty Services - $ - $ - $ - $ - $ - $ -

FQHC Scripts - $ - $ - $ - $ - $ - $ -

Other Medical Professional Procedures - $ - $ - $ - $ - $ - $ -

Pharmacy Visits - $ - $ - $ - $ - $ - $ -

Laboratory and Radiology Days - $ - $ - $ - $ - $ - $ -

Transportation Trips - $ - $ - $ - $ - $ - $ -

Other Services - $ - $ - $ - $ - $ - $ -

Global Subcapitation Expenditures $ - $ - $ - $ -

Hospital Incentive Payments $ -

Professional Incentive Payments $ -

Other Incentive Payments $ -

Net reinsurance costs $ -

UM/QA Costs $ -

TPL Recoveries (enter recoveries as negative values) $ -

Total Costs Including Provider Incentive Payments $ - $ -

Total Provider Incentive Payments $ - $ -

Total Costs Excluding Provider Incentive Payments $ - $ -

28

Page 29: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

RDT Trends Medi-Cal Managed Care Contract Year 11/12 Rate Development Trend and Other Adjustments

Fill out one for each COA group and county

Family

Plan Name County COA Group

Months of Trend (should be 33 if data from 2009 calendar year used as the base): 33 33

If different than 33, please explain:

Fee-For-Service Fee-For-Service Fee-For-Service Capitation

Annualized Trend Rates Trend Factors Other Adjustments Trend Trend

Utilization Gross Unit

Cost Copay / Unit Gross PMPM Utilization Gross Unit

Cost Copay / Unit Gross PMPM Factors Description Rates Factors

All State-Plan Health Care Services

Inpatient Hospital 0.00% 1.000 1.000 1.000 1.000 1.000 1.000

Outpatient Facility 0.00% 1.000 1.000 1.000 1.000 1.000 1.000

Emergency Room Facility 0.00% 1.000 1.000 1.000 1.000 1.000 1.000

Long-Term Care Facility 0.00% 1.000 1.000 1.000 1.000 1.000 1.000

Physician Primary Care 0.00% 1.000 1.000 1.000 1.000 1.000 1.000

Physician Specialty 0.00% 1.000 1.000 1.000 1.000 1.000 1.000

FQHC 0.00% 1.000 1.000 1.000 1.000 1.000 1.000

Other Medical Professional 0.00% 1.000 1.000 1.000 1.000 1.000 1.000

Pharmacy 0.00% 1.000 1.000 1.000 1.000 1.000 1.000

Laboratory and Radiology 0.00% 1.000 1.000 1.000 1.000 1.000 1.000

Transportation 0.00% 1.000 1.000 1.000 1.000 1.000 1.000

Other (Utilization & Unit Cost Trends for Other) 0.00% 1.000 1.000 1.000 1.000 1.000 1.000

Global Subcapitation Expenditures 1.000

Hospital Incentive Payments 1.000 1.000

Professional Incentive Payments 1.000 1.000

Other Incentive Payments 1.000 1.000

Net reinsurance costs 1.000 1.000

UM/QA Costs 1.000 1.000

TPL Recoveries 1.000 1.000

29

Page 30: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

RDT Projected Costs Medi-Cal Managed Care Contract Year 11/12 Rate Development Projected Health Care Costs Based on Medi-Cal Experience Projection

Family

Plan Name County COA Group

(A) (B) (C) (D) (E)

Fee-For Service Capitation Total MMs 0

Annual Units per 1000 Members

Gross Cost per Unit Copay per Unit Net Cost per Unit Cost PMPM Cost PMPM Cost PMPM

All State-Plan Health Care Services

Inpatient Hospital - $ - $ - $ - $ - $ - $ -

Outpatient Facility - $ - $ - $ - $ - $ - $ -

Emergency Room Facility - $ - $ - $ - $ - $ - $ -

Long-Term Care Facility - $ - $ - $ - $ - $ - $ -

Physician Primary Care - $ - $ - $ - $ - $ - $ -

Physician Specialty - $ - $ - $ - $ - $ - $ -

FQHC - $ - $ - $ - $ - $ - $ -

Other Medical Professional - $ - $ - $ - $ - $ - $ -

Pharmacy - $ - $ - $ - $ - $ - $ -

Laboratory and Radiology - $ - $ - $ - $ - $ - $ -

Transportation - $ - $ - $ - $ - $ - $ -

Other - $ - $ - $ - $ - $ - $ -

Global Subcapitation Expenditures $ - $ -

Hospital Incentive Payments $ -

Professional Incentive Payments $ -

Other Incentive Payments $ -

Net reinsurance costs $ -

UM/QA Costs $ -

TPL Recoveries (enter recoveries as negative values) $ -

Total Costs Including Provider Incentive Payments $ -

Total Provider Incentive Payments $ -

Total Costs Excluding Provider Incentive Payments $ -

30

Page 31: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

RDT Projected Rate Medi-Cal Managed Care Contract Year 11/12 Rate Development Administrative Cost and Total Rate Projections

Family Plan Name COA Group County

Cost PMPM

Percent of Total Cost

PMPM Administrative Costs MMs 0

Compensation 0.00% Interest Expense 0.00% Occupancy, Depreciation and Amortization 0.00% Management Fees 0.00% Marketing 0.00% Affiliate Administration Services 0.00% Other Administration (Details below) 0.00% Profit 0.00% Total administration/risk/profit $ - 0.00% Total health care costs from Schedule 3 $ - 0.00% Total health care costs plus administration/risk/profit $ - 0.00%

Supplemental Payment Per Delivery Projected cost per delivery $ - 0.00% Administration/risk/profit $ - 0.00% Health care costs plus Administration/risk/profit $ - 0.00% AB 1422 tax $ - 2.35% Supplemental Payment Per Delivery $ -

Health Care Services Excluding State Funded Services (excluding delivery services) Health care costs from Schedule 3 $ - Less supplementary delivery health care costs pmpm $ - Health care costs net of supplemental maternity $ - 0.00% Administration/risk/profit $ - 0.00% Health care costs plus Administration/risk/profit $ - 0.00% AB 1422 tax $ - 2.35% PMPM capitation rate $ -

Health Care Services - State Funded Services Only Health care costs from Schedule 3 $ - 0.00% Administration/risk/profit $ - 0.00% Health care costs plus Administration/risk/profit $ - 0.00% AB 1422 tax $ - 2.35% PMPM capitation rate $ -

31

Page 32: Medi-Cal Managed Care · 2016-02-17 · Managed Care Expenditures as a Percent of Total Medi-Cal Costs. Managed CareEnrollment as a Percent of Total Medi-Cal Enrollment. Source: DHCS,

Rate Development Summary Plan:

LOWER BOUND

Model Type: Two-Plan RATE DETAIL

County: Managed Care Rate

Category of Aid: Adult & Family October 01, 2011 - September 30, 2012

Lower Bound Midpoint Upper Bound

Member Months Time Periods

Base Projected Change Base Data Midpoint Contract Midpoint Trend Months

July 1, 2009 April 1, 2012 33.0

Base Data Adjustments Projected MC MC Adjustments Managed Care

(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K) (L) (M) (N) (O) (P) (Q)

Category of Service Util/1,000 Unit Cost PMPM Utilization Trend

Unit Cost Trend

Util Program Changes

U.C. Program Changes Util/1,000 Unit Cost PMPM Util/1,000 Unit Cost Util/1,000 Unit Cost Pre-MAT

PMPM MAT

carve-out Post-MAT

PMPM

Inpatient Hospital $ - $ - 0.0% 0.0% 0.0% 0.0% $ - $ - 1.00 1.00 $ - $ - $ - $ -

Outpatient Facility $ - $ - 0.0% 0.0% 0.0% 0.0% $ - $ - 1.00 1.00 $ - $ - $ - $ -

Emergency Room $ - $ - 0.0% 0.0% 0.0% 0.0% $ - $ - 1.00 1.00 $ - $ - $ - $ -

Long-Term Care $ - $ - 0.0% 0.0% 0.0% 0.0% $ - $ - 1.00 1.00 $ - $ - $ - $ -

Physician Primary Care $ - $ - 0.0% 0.0% 0.0% 0.0% $ - $ - 1.00 1.00 $ - $ - $ - $ -

Physician Specialty $ - $ - 0.0% 0.0% 0.0% 0.0% $ - $ - 1.00 1.00 $ - $ - $ - $ -

FQHC $ - $ - 0.0% 0.0% 0.0% 0.0% $ - $ - 1.00 1.00 $ - $ - $ - $ -

Other Medical Professional $ - $ - 0.0% 0.0% 0.0% 0.0% $ - $ - 1.00 1.00 $ - $ - $ - $ -

Pharmacy $ - $ - 0.0% 0.0% 0.0% 0.0% $ - $ - 1.00 1.09 $ - $ - $ - $ -

Laboratory and Radiology $ - $ - 0.0% 0.0% 0.0% 0.0% $ - $ - 1.00 1.00 $ - $ - $ - $ -

Transportation $ - $ - 0.0% 0.0% 0.0% 0.0% $ - $ - 1.00 1.00 $ - $ - $ - $ -

All Other $ - $ - 0.0% 0.0% 0.0% 0.0% $ - $ - 1.00 1.00 $ - $ - $ - $ -

All Services $ - 0.0% 0.0% $ - $ - $ - $ -

Administration (Applied as a % of premium) $ - $ - $ -

Underwriting Profit/Risk/Contingency (Applied as a % of premium) $ - $ - $ -

Total Admin/Underwriting Profit/Risk/Contingency Adjustments $ - $ - $ -

Administration (Percentage Value) 8.00% 4.00% 8.50%

Underwriting Profit/Risk/Contingency (Percentage Value) 2.00% 2.00% 2.00%

Total Admin/Underwriting Profit/Risk/Contingency (Percentage Value) 10.00% 6.00% 10.50%

Lower Bound Premium $ - $ - $ -

32


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Health & Medicine
Ventura County Medi-Cal Managed Care Commission (VCMMCC

Ventura County Medi-Cal Managed Care Commission (VCMMCC

Documents
Quality of Care in Medi-Cal - DHCS Homepage · 2019. 7. 5. · Children in Medi-Cal • Children in . Medi-Cal receive services through Managed Care Plans, Fee-For-Service, and Specialty

Quality of Care in Medi-Cal - DHCS Homepage · 2019. 7. 5. · Children in Medi-Cal • Children in . Medi-Cal receive services through Managed Care Plans, Fee-For-Service, and Specialty

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Original: Peter Lee · Article. (2) Certified Medi-Cal Managed Care Plan: a Medi-Cal Managed Care Plan who has been certified pursuant to this Article. (3) Certified Medi-Cal Managed

Original: Peter Lee · Article. (2) Certified Medi-Cal Managed Care Plan: a Medi-Cal Managed Care Plan who has been certified pursuant to this Article. (3) Certified Medi-Cal Managed

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Ventura County Medi-Cal Managed Care Commission (VCMMCC) … · 2020. 7. 27. · Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan (GCHP) June 22,

Ventura County Medi-Cal Managed Care Commission (VCMMCC) … · 2020. 7. 27. · Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan (GCHP) June 22,

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Mandatory Or Voluntary Enrollment Medi - Cal Managed Care

Mandatory Or Voluntary Enrollment Medi - Cal Managed Care

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Medi-Cal Managed Care Performance Dashboard Glossary · Medi-Cal Managed Care Performance Dashboard Glossary Released December 14, 2017 Glossary Page 1 of 3 Percentage metrics are

Medi-Cal Managed Care Performance Dashboard Glossary · Medi-Cal Managed Care Performance Dashboard Glossary Released December 14, 2017 Glossary Page 1 of 3 Percentage metrics are

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2021 California Medi-Cal Managed Care Formulary

2021 California Medi-Cal Managed Care Formulary

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MEDI-CAL MANAGED CARE PLAN MENTAL HEALTH SERVICES

MEDI-CAL MANAGED CARE PLAN MENTAL HEALTH SERVICES

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MEDI-CAL MANAGED CARE TRAINING

MEDI-CAL MANAGED CARE TRAINING

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Medi-Cal Managed Care Program Quality Improvement Projects ... · Medi-Cal Managed Care Program Quality Improvement Projects Status Report October 1, 2011 – December 31, 2011 Medi-Cal

Medi-Cal Managed Care Program Quality Improvement Projects ... · Medi-Cal Managed Care Program Quality Improvement Projects Status Report October 1, 2011 – December 31, 2011 Medi-Cal

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Presentation to Medi-Cal Managed Care Advisory Committee

Presentation to Medi-Cal Managed Care Advisory Committee

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Adolescent Healthcare in Medi-Cal Managed Care › services › Documents › Adolescent_Health… · Adolescent Healthcare in Medi-Cal Managed Care. Anna Lee Amarnath, MD, MPH. Medical

Adolescent Healthcare in Medi-Cal Managed Care › services › Documents › Adolescent_Health… · Adolescent Healthcare in Medi-Cal Managed Care. Anna Lee Amarnath, MD, MPH. Medical

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Medi-Cal Managed Care Quality Strategy Report

Medi-Cal Managed Care Quality Strategy Report

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Medi-Cal Managed Care Program 2011 Quality Awards … · Medi-Cal Managed Care Program 2011 Quality Awards Presentation Presented by Toby Douglas, Director California Department of

Medi-Cal Managed Care Program 2011 Quality Awards … · Medi-Cal Managed Care Program 2011 Quality Awards Presentation Presented by Toby Douglas, Director California Department of

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Paying Medi-Cal Managed Care Plans for Value: Design

Paying Medi-Cal Managed Care Plans for Value: Design

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Medi-Cal Managed Care and Quality · Medi-Cal Managed Care and Quality Improvement ... Availability of standardized measures and data ... • Participation in the National Governors

Medi-Cal Managed Care and Quality · Medi-Cal Managed Care and Quality Improvement ... Availability of standardized measures and data ... • Participation in the National Governors

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Volume 1 of 3 Medi-Cal Managed Care External Quality ... · Medi-Cal Managed Care External Quality Review Technical Report July 1, 2018–June 30, 2019 . Medi-Cal Managed Care Technical

Volume 1 of 3 Medi-Cal Managed Care External Quality ... · Medi-Cal Managed Care External Quality Review Technical Report July 1, 2018–June 30, 2019 . Medi-Cal Managed Care Technical

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Financial Summary of Medi-Cal Managed Care Plans

Financial Summary of Medi-Cal Managed Care Plans

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Ventura County Medi-Cal Managed Care Commission ......2020/06/22  · Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan (GCHP) Regular Meeting Monday,

Ventura County Medi-Cal Managed Care Commission ......2020/06/22  · Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan (GCHP) Regular Meeting Monday,

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Developed by Medi-Cal Managed Care Health Plans

Developed by Medi-Cal Managed Care Health Plans

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Medi-Cal Managed Care Advisory Group Meeting

Medi-Cal Managed Care Advisory Group Meeting

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Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba …€¦ ·  · 2017-12-01Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan (GCHP)

Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba …€¦ ·  · 2017-12-01Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan (GCHP)

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Ventura County Medi-Cal Managed Care Commission (VCMMCC) … · 2012. 5. 21. · Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan Commission Meeting

Ventura County Medi-Cal Managed Care Commission (VCMMCC) … · 2012. 5. 21. · Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan Commission Meeting

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The Landscape for Improving Medi-Cal Managed Care

The Landscape for Improving Medi-Cal Managed Care

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Medi-Cal Managed Care Performance Dashboard...Medi-Cal Managed Care Performance Dashboard Released March 16, 2016 ACCESS: Grievances for Q3 (July-September 2015) Statewide Grievance

Medi-Cal Managed Care Performance Dashboard...Medi-Cal Managed Care Performance Dashboard Released March 16, 2016 ACCESS: Grievances for Q3 (July-September 2015) Statewide Grievance

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