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
Cervical Cancer Total
2014 MCO Member Months 1,212,399 414,464 4,794 621,590 2,811 2,256,057
2014 MCO Deliveries - C-Section¹ 44 1,534 0 79 0 1,657
2014 MCO Deliveries - Vaginal¹ 183 3,559 0 130 0 3,872
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
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
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:
- 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.
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
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
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
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
Commonwealth of Pennsylvania
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.
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
2014 MCO Deliveries - C-Section¹ 17 978 0 62 0 1,057
2014 MCO Deliveries - Vaginal¹ 113 2,595 0 137 0 2,845
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
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
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:
- 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.
Commonwealth of Pennsylvania
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
Cervical Cancer Total
2014 MCO Member Months 1,179,411 467,945 5,552 747,040 2,963 2,402,910
2014 MCO Deliveries - C-Section¹ 34 1,426 0 103 0 1,563
2014 MCO Deliveries - Vaginal¹ 222 3,638 0 214 0 4,074
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
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
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
-
Gross Medical Expenses $ 177.28 $ 328.72 $ 494.32 $ 770.21 $ 1,523.97 $ 393.50
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.
1 Number of deliveries are actual maternity outcome counts as reported by the HealthChoices Southwest Managed Care Organizations on Annual Report 27.
Exhibit C-6: Southwest Zone
Southwest Zone: Fiscal Year 2013-2014 Maternity Data
2013-2014 MCO Deliveries - C-Section¹ 2,722
2013-2014 MCO Deliveries - Vaginal¹ 7,122
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
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
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
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
-
-
-
Gross Maternity Expenses $ 22,503,325 $ 40,190,525 $ 62,693,850 $ 8,267.20 $ 5,643.15 $ 6,368.74
Mercer 6 of 12 12/19/2016, 1:33 PM
Commonwealth of Pennsylvania
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.
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
2014 MCO Deliveries - C-Section¹ 102 3,235 2 181 0 3,520
2014 MCO Deliveries - Vaginal¹ 372 7,647 37 330 1 8,387
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
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
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
-
Gross Medical Expenses $ 154.87 $ 349.94 $ 1,131.76 $ 763.37 $ 1,934.95 $ 344.04
Mercer 7 of 12 12/19/2016, 1:33 PM
Commonwealth of Pennsylvania
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.
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
2013-2014 MCO Deliveries - C-Section¹ 3,576
2013-2014 MCO Deliveries - Vaginal¹ 8,455
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
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
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
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
-
-
Gross Maternity Expenses $ 31,646,953 $ 48,568,136 $ 80,215,090 $ 8,849.82 $ 5,744.31 $ 6,667.37
Mercer 8 of 12 12/19/2016, 1:33 PM
Commonwealth of Pennsylvania
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.
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
2014 MCO Deliveries - C-Section¹ 70 1,928 0 131 0 2,129
2014 MCO Deliveries - Vaginal¹ 301 4,431 2 248 1 4,983
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
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
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
-
Gross Medical Expenses $ 141.90 $ 295.69 $ 1,092.84 $ 686.05 $ 1,458.02 $ 317.72
Mercer 9 of 12 12/19/2016, 1:33 PM
Commonwealth of Pennsylvania
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.
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
2013-2014 MCO Deliveries - C-Section¹ 2,124
2013-2014 MCO Deliveries - Vaginal¹ 4,751
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
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
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
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
-
-
Gross Maternity Expenses $ 17,252,965 $ 24,753,212 $ 42,006,177 $ 8,122.86 $ 5,210.11 $ 6,109.99
Mercer 10 of 12 12/19/2016, 1:33 PM
Commonwealth of Pennsylvania
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.
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
2014 MCO Deliveries - C-Section¹ 28 1,075 0 104 0 1,207
2014 MCO Deliveries - Vaginal¹ 110 2,215 4 151 1 2,481
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
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
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
-
Gross Medical Expenses $ 152.65 $ 303.63 $ 493.28 $ 652.83 $ 1,599.17 $ 331.68
Mercer 11 of 12 12/19/2016, 1:33 PM
Commonwealth of Pennsylvania
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.
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
2013-2014 MCO Deliveries - C-Section¹ 1,240
2013-2014 MCO Deliveries - Vaginal¹ 2,493
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
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
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
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
-
-
-
Gross Maternity Expenses $ 9,935,662 $ 12,835,440 $ 22,771,102 $ 8,012.63 $ 5,148.59 $ 6,099.95
Mercer 12 of 12 12/19/2016, 1:33 PM
Commonwealth of Pennsylvania
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.
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.