BMCO Monthly Physical Health Managed Care Program ...

NOTE: This report contains the number of consumers that are MA eligible and managed care eligible any time during the month. The data is based on capitation payments and therefore each consumer we paid for in the month is counted.

BMCO

Monthly Physical Health Managed Care Program Enrollment Report

Released: February 21, 2018

Table of Contents

HEALTHCHOICES

Map 4 Enrollment by Plan and by County 5-7 Market Share by Plan – Statewide 8 Market Share by Zone and by Plan 9 Enrollment by Plan, by Race and by County 10-19 Enrollment by Ethnicity, by Plan and by County 20-29 Plan Make Up by Age Group and Gender 30-32 Plan Make Up by Age Group 33-34 Aid Category Distribution 35 PCP Selection During Enrollment 36

MEDICAL ASSISTANCE TRANSPORTATION PROGRAM

All Zones 38-42

LINK TO MCO DIRECTORY 43

2

3

HealthChoices

Managed Care

Erie

Crawford

Mercer

Warren McKean Potter Tioga Bradford Susquehanna

Wayne

Pike

Lacka-wanna

Monroe

Luzerne

Wyoming

Carbon

Schuylkill

Columbia

Sullivan

Lycoming

Montour

North-umberland Snyder

Union

Juniata Mifflin

Centre

Clinton

Cameron Elk

Clearfield

Jefferson Clarion

Forest

Venango

Blair

Bedford

Huntingdon

Fulton Franklin

Somerset

Cambria

Lawrence

Beaver

Washington

Greene

Butler

Allegheny

Fayette

Westmoreland

Armstrong

Indiana

Perry

Cumberland

Adams York

Lancaster

Dauphin Lebanon

Berks

Lehigh

Northampton

Bucks

Montgomery

Chester

Delaware

Philadelphia

HC SE – 1997

HC SW – 1999

HC L/C – 2001

HC NW – 2012

HC NE – 2013 4

Mandatory January 201 8 ENROLLMENT BY PLAN AND BY COUNTY

SOUTHEAST

County 42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

09 Bucks 5,686 7,090 12,062 40,149 64,987

15 Chester 12,882 7,103 2,937 22,218 45,140

23 Delaware 9,095 10,676 8,689 69,577 98,037

46 Montgomery 9,576 11,135 12,407 54,809 87,927

51 Philadelphia 54,944 36,325 217,283 247,451 556,003

TOTAL 92,183 72,329 253,378 434,204 852,094

PERCENTAGE 11% 8% 30% 51%

SOUTHWEST

County 31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

02 Allegheny 58,758 20,349 101,230 7,800 188,137

03 Armstrong 1,023 499 10,025 437 11,984

04 Beaver 11,264 2,196 13,085 1,320 27,865

05 Bedford 700 1,093 5,908 704 8,405

07 Blair 6,137 3,682 13,580 2,084 25,483

10 Butler 5,370 1,127 14,421 908 21,826

11 Cambria 3,647 5,068 15,084 2,717 26,516

26 Fayette 4,023 9,138 19,521 811 33,493

30 Greene 820 3,360 3,315 376 7,871

32 Indiana 2,482 1,747 8,805 558 13,592

37 Lawrence 6,924 1,466 8,707 766 17,863

56 Somerset 1,804 2,793 6,538 1,032 12,167

63 Washington 5,671 5,089 18,490 1,406 30,656

65 Westmoreland 11,241 7,798 31,599 2,038 52,676

TOTAL 119,864 65,405 270,308 22,957 478,534

PERCENTAGE 25% 14% 56% 5%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 02/14/18

5


cont.

LEHIGH/CAPITAL

County 51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL

01 Adams 4,125 4,608 1,228 1,288 1,478 12,727

06 Berks 15,302 8,275 6,580 8,206 41,233 79,596

21 Cumberland 12,255 3,750 3,946 1,720 5,048 26,719

22 Dauphin 28,090 10,229 7,563 4,200 5,973 56,055

28 Franklin 964 659 8,177 440 12,562 22,802

29 Fulton 157 297 763 564 710 2,491

31 Huntingdon 456 650 983 3,583 1,582 7,254

36 Lancaster 23,214 10,629 3,260 9,359 29,549 76,011

38 Lebanon 14,195 1,854 1,880 2,007 3,305 23,241

39 Lehigh 22,158 5,469 2,749 5,420 36,603 72,399

48 Northampton 12,998 2,772 2,329 2,716 23,812 44,627

50 Perry 3,602 628 697 301 970 6,198

67 York 21,675 21,720 7,486 6,923 14,543 72,347

TOTAL 159,191 71,540 47,641 46,727 177,368 502,467

PERCENTAGE 32% 14% 9% 9% 35%

NORTHWEST

County 35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

12 Cameron 855 39 101 46 1,041

16 Clarion 4,201 770 571 595 6,137

17 Clearfield 10,421 1,320 1,978 1,777 15,496

20 Crawford 12,226 1,028 1,050 1,205 15,509

24 Elk 3,513 424 279 273 4,489

25 Erie 32,772 14,308 5,977 9,812 62,869

27 Forest 541 94 77 54 766

33 Jefferson 6,657 903 356 411 8,327

42 McKean 6,280 298 1,266 695 8,539

43 Mercer 13,991 3,799 2,268 2,152 22,210

53 Potter 1,819 29 1,349 74 3,271

61 Venango 7,257 875 1,096 1,025 10,253

62 Warren 4,712 693 750 509 6,664

TOTAL 105,245 24,580 17,118 18,628 165,571

PERCENTAGE 64% 15% 10% 11%


6


cont.

NORTHEAST

County 41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

08 Bradford 2,865 4,726 3,541 11,132

13 Carbon 7,309 2,797 1,014 11,120

14 Centre 2,596 6,263 2,492 11,351

18 Clinton 1,177 5,063 772 7,012

19 Columbia 1,499 7,100 1,108 9,707

34 Juniata 796 1,709 699 3,204

35 Lackawanna 7,195 31,134 5,532 43,861

40 Luzerne 17,855 44,763 8,962 71,580

41 Lycoming 5,192 15,152 1,567 21,911

44 Mifflin 2,114 4,581 1,654 8,349

45 Monroe 14,346 12,796 4,990 32,132

47 Montour 322 1,569 293 2,184

49 Northumberland 3,108 10,451 3,477 17,036

52 Pike 2,658 5,215 1,328 9,201

54 Schuylkill 8,832 14,832 3,171 26,835

55 Snyder 1,140 2,981 909 5,030

57 Sullivan 138 498 144 780

58 Susquehanna 1,116 4,528 966 6,610

59 Tioga 5,986 1,032 590 7,608

60 Union 929 2,775 742 4,446

64 Wayne 1,623 5,712 1,174 8,509

66 Wyoming 787 3,406 633 4,826

TOTAL 89,583 189,083 45,758 324,424

PERCENTAGE 28% 59% 14%


7

Mandatory January 201 8 MARKET SHARE BY PLAN – STATEWIDE

Total Enrollment = 2,323,090

AmeriHealth NE 89,583

4% Aetna

207,313 9%

AmeriHealth 194,486

8%

Gateway 303,635

13%

Health Partners 253,378

11%

Keystone 434,204

19%

United 229,128

10%

UPMC 422,280

18%

Geisinger 189,083

8%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 02/14/18 8

Mandatory January 201 8 MARKET SHARE BY ZONE AND BY PLAN

Southwest Aetna 22,957

5%

Gateway 119,864

25%

United 65,405

14%

UPMC 270,308

56%

Southeast

Aetna 72,329

8%

Health Partners 253,378

30%

Keystone 434,204

51%

United 92,183

11%

Lehigh/Capital

UPMC 46,727

9%

Aetna 47,641

10%

Ameri-Health

177,368 35%Gateway

159,191 32%

United 71,540

14%

Northwest

Aetna 18,628

11%

Gateway 24,580

15%

UPMC 105,245

64%

Ameri-Health 17,118

10%

Northeast

Aetna 45,758

14%

Ameri-Health NE

89,583 28%

Geisinger 189,083

58%


9

Mandatory January 201 8 ENROLLMENT BY PLAN, BY RACE AND BY COUNTY

Southeast 09 Bucks 15 Chester 23 Delaware 46 Montgomery 51 Philadelphia Southeast

Black or African American

42 United 648 2,477 4,691 2,236 34,535 44,587

43 Aetna 666 1,255 4,829 2,348 22,225 31,323

45 Health Partners 1,388 457 4,564 3,627 105,231 115,267

47 Keystone 4,131 3,915 33,428 12,553 151,497 205,524

Southeast MCOs 6,833 8,104 47,512 20,764 313,488 396,701

American Indian or Alaskan

Native

42 United 9 28 20 22 71 150

43 Aetna 26 35 6 55 68 190

45 Health Partners 35 12 7 50 264 368

47 Keystone 80 90 115 171 300 756

Southeast MCOs 150 165 148 298 703 1,464

Asian

42 United 237 267 565 547 3,856 5,472

43 Aetna 276 175 488 756 1,539 3,234

45 Health Partners 635 85 448 684 7,957 9,809

47 Keystone 1,375 622 4,351 3,644 18,958 28,950

Southeast MCOs 2,523 1,149 5,852 5,631 32,310 47,465

White

42 United 3,856 7,171 2,877 4,837 8,041 26,782

43 Aetna 5,148 4,426 4,354 6,184 6,893 27,005

45 Health Partners 7,894 1,847 2,532 5,907 34,742 52,922

47 Keystone 28,840 13,563 25,545 28,900 41,174 138,022

Southeast MCOs 45,738 27,007 35,308 45,828 90,850 244,731

Other or system default

42 United 614 2,124 584 1,325 6,643 11,290

43 Aetna 551 806 616 1,080 4,298 7,351

45 Health Partners 1,528 320 802 1,485 63,907 68,042

47 Keystone 4,164 2,996 4,421 7,129 29,553 48,263

Southeast MCOs 6,857 6,246 6,423 11,019 104,401 134,946

Native Hawaiian or Other

Pacific Islander

42 United 7 14 5 7 63 96

43 Aetna 6 8 17 18 48 97

45 Health Partners 14 3 10 13 189 229

47 Keystone 50 25 58 65 141 339

Southeast MCOs 77 50 90 103 441 761

Unknown

42 United 315 801 353 602 1,735 3,806

43 Aetna 417 398 366 694 1,254 3,129

45 Health Partners 568 213 326 641 4,993 6,741

47 Keystone 1,509 1,007 1,659 2,347 5,828 12,350

Southeast MCOs 2,809 2,419 2,704 4,284 13,810 26,026

MCO TOTAL

42 United 5,686 12,882 9,095 9,576 54,944 92,183

43 Aetna 7,090 7,103 10,676 11,135 36,325 72,329

45 Health Partners 12,062 2,937 8,689 12,407 217,283 253,378

47 Keystone 40,149 22,218 69,577 54,809 247,451 434,204

TOTAL 64,987 45,140 98,037 87,927 556,003 852,094

Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 02/14/18

10


Southwest 02 Allegheny 03 Armstrong 04 Beaver 05 Bedford 07 Blair 10 Butler 11 Cambria 26 Fayette

Black or African

American

31 Gateway 28,204 25 2,626 13 449 214 509 394

32 United 8,320 14 430 13 263 38 882 821

34 UPMC 33,305 149 2,112 62 619 361 1,369 1,544

59 Aetna 2,774 7 256 8 130 22 756 86

Southwest MCOs 72,603 195 5,424 96 1,461 635 3,516 2,845

American Indian or

Alaskan Native

31 Gateway 123 5 13 0 6 5 5 7

32 United 45 2 3 1 7 0 6 9

34 UPMC 303 15 31 12 24 27 24 37

59 Aetna 26 0 4 0 4 0 1 3

Southwest MCOs 497 22 51 13 41 32 36 56

Asian

31 Gateway 782 2 30 0 10 29 7 15

32 United 446 2 28 3 23 22 12 18

34 UPMC 4,956 27 119 28 70 150 41 67

59 Aetna 186 0 13 3 10 8 10 4

Southwest MCOs 6,370 31 190 34 113 209 70 104

White

31 Gateway 26,613 977 8,318 671 5,565 4,984 3,028 3,522

32 United 10,112 471 1,633 1,057 3,318 991 4,019 8,121

34 UPMC 55,056 9,719 10,306 5,677 12,592 13,296 13,272 17,461

59 Aetna 4,026 423 974 680 1,896 829 1,875 677

Southwest MCOs 95,807 11,590 21,231 8,085 23,371 20,100 22,194 29,781

Other or system

default

31 Gateway 1,760 7 202 9 62 74 63 47

32 United 768 3 67 12 36 33 102 95

34 UPMC 4,093 54 295 101 129 293 209 162

59 Aetna 340 1 47 8 23 24 50 18

Southwest MCOs 6,961 65 611 130 250 424 424 322

Native Hawaiian or

Other Pacific Islander

31 Gateway 29 0 6 0 2 3 1 2

32 United 16 0 0 0 0 0 4 1

34 UPMC 79 2 6 4 5 6 5 12

59 Aetna 8 0 1 0 0 0 1 1

Southwest MCOs 132 2 13 4 7 9 11 16

Unknown

31 Gateway 1,247 7 69 7 43 61 34 36

32 United 642 7 35 7 35 43 43 73

34 UPMC 3,438 59 216 24 141 288 164 238

59 Aetna 440 6 25 5 21 25 24 22

Southwest MCOs 5,767 79 345 43 240 417 265 369

MCO TOTAL

31 Gateway 58,758 1,023 8,638 700 6,137 5,370 3,647 4,023

32 United 20,349 499 2,196 1,093 3,682 1,127 5,068 9,138

34 UPMC 101,230 10,025 13,085 5,908 13,580 14,421 15,084 19,521

59 Aetna 7,800 437 1,320 704 2,084 908 2,717 811

TOTAL 188,137 11,984 27,865 8,405 25,483 21,826 26,516 33,493


11


Southwest cont.

30 Greene 32 Indiana 37 Lawrence 56 Somerset 63 Washington 65 Westmoreland Southwest

Black or African

American

31 Gateway 15 88 935 17 702 1,444 35,635

32 United 30 84 207 28 580 782 12,492

34 UPMC 38 236 882 56 1,647 2,123 44,503

59 Aetna 7 29 120 17 167 158 4,537

Southwest MCOs 90 437 2,144 118 3,096 4,507 97,167

American Indian or

Alaskan Native

31 Gateway 0 0 8 1 7 27 207

32 United 4 6 1 3 7 14 108

34 UPMC 6 19 12 7 30 45 592

59 Aetna 0 2 1 4 2 6 53

Southwest MCOs 10 27 22 15 46 92 960

Asian

31 Gateway 1 26 12 5 19 41 979

32 United 3 6 3 2 25 35 628

34 UPMC 9 63 42 22 121 254 5,969

59 Aetna 4 3 3 2 10 20 276

Southwest MCOs 17 98 60 31 175 350 7,852

White

31 Gateway 795 2,303 5,876 1,749 4,756 9,377 78,534

32 United 3,304 1,606 1,212 2,718 4,310 6,654 49,526

34 UPMC 3,216 8,274 7,576 6,334 15,978 27,913 206,670

59 Aetna 355 491 611 977 1,155 1,712 16,681

Southwest MCOs 7,670 12,674 15,275 11,778 26,199 45,656 351,411

Other or system

default

31 Gateway 8 31 48 25 90 180 2,606

32 United 14 17 30 24 81 151 1,433

34 UPMC 21 86 103 52 313 526 6,437

59 Aetna 5 17 17 11 29 62 652

Southwest MCOs 48 151 198 112 513 919 11,128

Native Hawaiian or


31 Gateway 0 2 1 1 0 3 50

32 United 0 1 1 0 4 1 28

34 UPMC 3 1 2 1 8 7 141

59 Aetna 0 0 0 0 1 2 14

Southwest MCOs 3 4 4 2 13 13 233

Unknown

31 Gateway 1 32 44 6 97 169 1,853

32 United 5 27 12 18 82 161 1,190

34 UPMC 22 126 90 66 393 731 5,996

59 Aetna 5 16 14 21 42 78 744

Southwest MCOs 33 201 160 111 614 1,139 9,783

MCO TOTAL

31 Gateway 820 2,482 6,924 1,804 5,671 11,241 119,864

32 United 3,360 1,747 1,466 2,793 5,089 7,798 65,405

34 UPMC 3,315 8,805 8,707 6,538 18,490 31,599 270,308

59 Aetna 376 558 766 1,032 1,406 2,038 22,957

TOTAL 7,871 13,592 17,863 12,167 30,656 52,676 478,534


12


Lehigh/Capital 01 Adams 06 Berks 21 Cumberland 22 Dauphin 28 Franklin 29 Fulton 31 Huntingdon


51 Gateway 155 1,437 1,461 10,858 91 3 21

52 United 251 757 490 3,671 52 6 28

53 Aetna 55 737 369 2,403 661 19 38

54 UPMC 45 659 160 1,202 33 8 110

57 AmeriHealth 67 3,391 529 1,784 1,071 12 52

Lehigh/Capital MCOs 573 6,981 3,009 19,918 1,908 48 249

American Indian or

Alaskan Native

51 Gateway 15 25 42 58 7 1 0

52 United 11 27 12 34 3 0 1

53 Aetna 5 13 18 32 16 1 0

54 UPMC 2 22 10 13 3 2 0

57 AmeriHealth 3 49 9 28 34 3 2

Lehigh/Capital MCOs 36 136 91 165 63 7 3

Asian

51 Gateway 32 187 324 1,506 11 0 1

52 United 41 125 141 564 1 0 1

53 Aetna 10 135 119 290 52 1 5

54 UPMC 15 112 44 221 2 2 13

57 AmeriHealth 9 291 107 219 103 0 3

Lehigh/Capital MCOs 107 850 735 2,800 169 3 23

White

51 Gateway 3,620 7,153 8,620 8,717 736 152 423

52 United 3,646 4,503 2,450 3,629 527 286 605

53 Aetna 1,008 3,828 2,874 3,419 6,528 726 924

54 UPMC 1,081 5,022 1,230 1,903 353 552 3,393

57 AmeriHealth 1,236 14,031 3,707 2,427 9,250 677 1,503

Lehigh/Capital MCOs 10,591 34,537 18,881 20,095 17,394 2,393 6,848


51 Gateway 199 6,085 1,296 5,833 73 0 9

52 United 518 2,558 462 1,775 49 5 12

53 Aetna 90 1,580 313 1,023 584 12 14

54 UPMC 85 2,048 191 602 25 0 39

57 AmeriHealth 101 22,286 478 1,155 1,396 15 12



Pacific Islander

51 Gateway 4 6 16 30 0 0 0

52 United 0 16 6 12 1 0 0

53 Aetna 1 8 7 8 10 0 0

54 UPMC 4 14 3 4 1 0 2

57 AmeriHealth 2 28 6 7 12 0 2


Unknown

51 Gateway 100 409 496 1,088 46 1 2

52 United 141 289 189 544 26 0 3

53 Aetna 59 279 246 388 326 4 2

54 UPMC 56 329 82 255 23 0 26

57 AmeriHealth 60 1,157 212 353 696 3 8


MCO TOTAL

51 Gateway 4,125 15,302 12,255 28,090 964 157 456

52 United 4,608 8,275 3,750 10,229 659 297 650

53 Aetna 1,228 6,580 3,946 7,563 8,177 763 983

54 UPMC 1,288 8,206 1,720 4,200 440 564 3,583

57 AmeriHealth 1,478 41,233 5,048 5,973 12,562 710 1,582

TOTAL 12,727 79,596 26,719 56,055 22,802 2,491 7,254

Racial/Ethnic

information is self-

reported by consumers.


13


Lehigh/Capital cont.

36 Lancaster 38 Lebanon 39 Lehigh 48 Northampton 50 Perry 67 York Lehigh/Capital

Black or African

American

51 Gateway 1,890 604 3,017 1,867 42 2,428 23,874 52 United 1,288 111 785 350 8 3,869 11,666 53 Aetna 350 77 492 328 31 1,176 6,736 54 UPMC 922 140 770 302 6 927 5,284 57 AmeriHealth 3,276 171 4,254 2,546 16 2,268 19,437 Lehigh/Capital MCOs 7,726 1,103 9,318 5,393 103 10,668 66,997

American Indian or

Alaskan Native

51 Gateway 46 11 30 23 2 58 318 52 United 30 1 11 7 1 47 185 53 Aetna 10 3 3 12 4 35 152 54 UPMC 30 1 13 10 0 35 141 57 AmeriHealth 57 5 53 70 1 66 380 Lehigh/Capital MCOs 173 21 110 122 8 241 1,176

Asian

51 Gateway 926 112 341 191 8 219 3,858 52 United 316 23 120 54 2 250 1,638 53 Aetna 77 14 66 60 6 109 944 54 UPMC 346 14 154 62 2 73 1,060 57 AmeriHealth 730 69 626 489 0 181 2,827 Lehigh/Capital MCOs 2,395 232 1,307 856 18 832 10,327

White

51 Gateway 14,707 9,522 15,456 7,559 3,436 15,679 95,780 52 United 5,845 1,232 3,707 1,855 583 12,198 41,066 53 Aetna 2,082 1,323 1,773 1,561 622 4,897 31,565 54 UPMC 5,816 1,343 3,653 1,830 279 4,600 31,055 57 AmeriHealth 15,169 1,731 26,377 15,246 910 8,569 100,833 Lehigh/Capital MCOs 43,619 15,151 50,966 28,051 5,830 45,943 300,299


51 Gateway 4,431 3,521 2,811 2,989 72 2,698 30,017 52 United 2,535 408 599 373 20 4,614 13,928 53 Aetna 529 384 301 277 17 923 6,047 54 UPMC 1,523 417 583 356 10 924 6,803 57 AmeriHealth 8,647 1,162 4,413 4,772 22 2,860 47,319 Lehigh/Capital MCOs 17,665 5,892 8,707 8,767 141 12,019 104,114

Native Hawaiian or


51 Gateway 11 13 21 8 0 19 128 52 United 19 5 28 6 0 34 127 53 Aetna 3 2 3 4 0 10 56 54 UPMC 6 0 19 10 0 4 67 57 AmeriHealth 35 5 33 25 0 19 174 Lehigh/Capital MCOs 74 25 104 53 0 86 552

Unknown

51 Gateway 1,203 412 482 361 42 574 5,216 52 United 596 74 219 127 14 708 2,930 53 Aetna 209 77 111 87 17 336 2,141 54 UPMC 716 92 228 146 4 360 2,317 57 AmeriHealth 1,635 162 847 664 21 580 6,398 Lehigh/Capital MCOs 4,359 817 1,887 1,385 98 2,558 19,002

MCO TOTAL

51 Gateway 23,214 14,195 22,158 12,998 3,602 21,675 159,191

52 United 10,629 1,854 5,469 2,772 628 21,720 71,540

53 Aetna 3,260 1,880 2,749 2,329 697 7,486 47,641

54 UPMC 9,359 2,007 5,420 2,716 301 6,923 46,727

57 AmeriHealth 29,549 3,305 36,603 23,812 970 14,543 177,368

TOTAL 76,011 23,241 72,399 44,627 6,198 72,347 502,467

Racial/Ethnic

information is self-

reported by consumers.


14


Northwest 12 Cameron 16 Clarion 17 Clearfield 20 Crawford 24 Elk 25 Erie 27 Forest


35 UPMC 21 106 103 434 43 5,046 2

36 Gateway 0 20 30 43 6 3,615 1

37 AmeriHealth 6 20 32 33 6 1,289 0

56 Aetna 0 20 22 44 2 2,415 0

New West MCOs 27 166 187 554 57 12,365 3


Native

35 UPMC 1 2 8 28 12 102 2

36 Gateway 0 1 0 2 0 25 5

37 AmeriHealth 0 2 7 1 1 12 0

56 Aetna 1 1 0 0 0 43 1

New West MCOs 2 6 15 31 13 182 8

Asian

35 UPMC 8 14 53 42 6 1,414 1

36 Gateway 0 5 2 0 0 212 1

37 AmeriHealth 0 0 8 3 0 164 0

56 Aetna 0 5 5 2 0 117 0

New West MCOs 8 24 68 47 6 1,907 2

White

35 UPMC 817 3,994 10,132 11,534 3,417 24,142 533

36 Gateway 39 731 1,269 963 413 9,395 87

37 AmeriHealth 94 537 1,902 997 269 4,123 77

56 Aetna 45 564 1,716 1,135 266 6,569 51

New West MCOs 995 5,826 15,019 14,629 4,365 44,229 748


35 UPMC 6 42 57 84 15 1,668 3

36 Gateway 0 7 13 9 3 914 0

37 AmeriHealth 1 7 15 8 1 316 0

56 Aetna 0 3 17 7 2 553 2

New West MCOs 7 59 102 108 21 3,451 5


Pacific Islander

35 UPMC 0 1 2 2 0 23 0

36 Gateway 0 0 0 3 0 8 0

37 AmeriHealth 0 0 0 0 0 4 0

56 Aetna 0 1 0 3 0 3 0

New West MCOs 0 2 2 8 0 38 0

Unknown

35 UPMC 2 42 66 102 20 377 0

36 Gateway 0 6 6 8 2 139 0

37 AmeriHealth 0 5 14 8 2 69 0

56 Aetna 0 1 17 14 3 112 0

New West MCOs 2 54 103 132 27 697 0

MCO TOTAL

35 UPMC 1,059 6,080 15,372 15,461 4,510 62,544 782

36 Gateway 39 770 1,320 1,028 424 14,308 94

37 AmeriHealth 101 571 1,978 1,050 279 5,977 77

56 Aetna 46 595 1,777 1,205 273 9,812 54

TOTAL 1,041 6,137 15,496 15,509 4,489 62,869 766


15


Northwest cont.

33 Jefferson 42 McKean 43 Mercer 53 Potter 61 Venango 62 Warren New West


35 UPMC 61 79 1,798 10 199 42 7,944

36 Gateway 8 5 706 0 28 13 4,475

37 AmeriHealth 5 7 480 18 28 5 1,929

56 Aetna 6 11 451 0 32 11 3,014

New West MCOs 80 102 3,435 28 287 71 17,362


Native

35 UPMC 8 18 16 4 13 11 225

36 Gateway 2 1 4 0 4 1 45

37 AmeriHealth 3 0 7 3 4 2 42

56 Aetna 0 5 3 0 1 4 59

New West MCOs 13 24 30 7 22 18 371

Asian

35 UPMC 17 19 88 2 27 7 1,698

36 Gateway 2 1 21 0 3 0 247

37 AmeriHealth 1 9 14 1 5 4 209

56 Aetna 0 0 12 1 1 1 144

New West MCOs 20 29 135 4 36 12 2,298

White

35 UPMC 6,510 6,095 11,730 1,771 6,907 4,599 92,181

36 Gateway 887 287 2,989 28 821 667 18,576

37 AmeriHealth 341 1,239 1,697 1,305 1,041 734 14,356

56 Aetna 399 676 1,626 71 974 485 14,577

New West MCOs 8,137 8,297 18,042 3,175 9,743 6,485 139,690


35 UPMC 33 40 188 11 52 32 2,231

36 Gateway 2 4 39 1 11 5 1,008

37 AmeriHealth 1 8 39 9 10 2 417

56 Aetna 4 2 28 1 11 5 635

New West MCOs 40 54 294 22 84 44 4,291


Pacific Islander

35 UPMC 0 3 10 0 2 2 45

36 Gateway 0 0 1 0 0 0 12

37 AmeriHealth 0 0 0 0 1 1 6

56 Aetna 0 0 0 0 1 0 8

New West MCOs 0 3 11 0 4 3 71

Unknown

35 UPMC 28 26 161 21 57 19 921

36 Gateway 2 0 39 0 8 7 217

37 AmeriHealth 5 3 31 13 7 2 159

56 Aetna 2 1 32 1 5 3 191

New West MCOs 37 30 263 35 77 31 1,488

MCO TOTAL

35 UPMC 6,657 6,280 13,991 1,819 7,257 4,712 105,245

36 Gateway 903 298 3,799 29 875 693 24,580

37 AmeriHealth 356 1,266 2,268 1,349 1,096 750 17,118

56 Aetna 411 695 2,152 74 1,025 509 18,628

TOTAL 8,327 8,539 22,210 3,271 10,253 6,664 165,571


16


Northeast

08 Bradford 13 Carbon 14 Centre 18 Clinton 19 Columbia 34 Juniata 35 Lackawanna 40 Luzerne


41 AmeriHealth NE 42 213 112 26 83 11 839 1,967

44 Geisinger 67 99 235 89 223 18 2,573 4,535

50 Aetna 53 49 153 24 70 14 683 1,373

New East MCOs 162 361 500 139 376 43 4,095 7,875

American Indian or

Alaskan Native

41 AmeriHealth NE 6 15 2 3 5 2 21 30

44 Geisinger 9 5 16 3 15 3 68 44

50 Aetna 7 3 7 0 8 2 18 11

New East MCOs 22 23 25 6 28 7 107 85

Asian

41 AmeriHealth NE 16 18 66 8 13 1 200 118

44 Geisinger 26 14 152 15 47 8 977 400

50 Aetna 6 3 98 1 9 6 191 89

New East MCOs 48 35 316 24 69 15 1,368 607

White

41 AmeriHealth NE 2,742 6,699 2,292 1,108 1,326 693 4,940 10,153

44 Geisinger 4,562 2,519 5,639 4,828 6,588 1,526 22,850 31,067

50 Aetna 3,418 872 2,129 717 965 608 3,806 5,949

New East MCOs 10,722 10,090 10,060 6,653 8,879 2,827 31,596 47,169


41 AmeriHealth NE 34 251 62 15 51 71 978 5,273

44 Geisinger 27 112 107 67 146 137 3,907 7,963

50 Aetna 20 59 54 14 37 59 653 1,362

New East MCOs 81 422 223 96 234 267 5,538 14,598


Pacific Islander

41 AmeriHealth NE 0 0 2 4 2 0 2 6

44 Geisinger 1 0 2 0 3 0 13 33

50 Aetna 3 1 5 0 1 0 12 6

New East MCOs 4 1 9 4 6 0 27 45

Unknown

41 AmeriHealth NE 25 113 60 13 19 18 215 308

44 Geisinger 34 48 112 61 78 17 746 721

50 Aetna 34 27 46 16 18 10 169 172

New East MCOs 93 188 218 90 115 45 1,130 1,201

MCO TOTAL

41 AmeriHealth NE 2,865 7,309 2,596 1,177 1,499 796 7,195 17,855

44 Geisinger 4,726 2,797 6,263 5,063 7,100 1,709 31,134 44,763

50 Aetna 3,541 1,014 2,492 772 1,108 699 5,532 8,962

TOTAL 11,132 11,120 11,351 7,012 9,707 3,204 43,861 71,580

Racial/Ethnic information is self-reported by consumers.


17


Northeast cont.

41 Lycoming 44 Mifflin 45 Monroe 47 Montour 49 Northumberland 52 Pike 54 Schuylkill 55 Snyder


41 AmeriHealth NE 898 45 2,432 15 162 336 375 46

44 Geisinger 2,122 88 2,356 38 411 333 536 92

50 Aetna 222 40 1,119 7 208 119 160 25

New East MCOs 3,242 173 5,907 60 781 788 1,071 163

American Indian or

Alaskan Native

41 AmeriHealth NE 9 1 39 1 8 17 16 1

44 Geisinger 27 5 43 5 9 23 20 4

50 Aetna 3 1 17 0 6 4 7 0

New East MCOs 39 7 99 6 23 44 43 5

Asian

41 AmeriHealth NE 18 5 173 5 12 16 48 20

44 Geisinger 75 16 194 20 53 56 69 8

50 Aetna 12 10 62 5 11 10 15 9

New East MCOs 105 31 429 30 76 82 132 37

White

41 AmeriHealth NE 4,127 2,021 8,766 291 2,697 1,910 7,707 1,037

44 Geisinger 12,632 4,385 7,571 1,453 9,420 4,347 13,352 2,760

50 Aetna 1,281 1,571 2,635 267 3,071 995 2,817 843

New East MCOs 18,040 7,977 18,972 2,011 15,188 7,252 23,876 4,640


41 AmeriHealth NE 89 35 2,392 7 189 295 557 23

44 Geisinger 184 66 2,166 33 417 322 655 80

50 Aetna 26 28 902 5 144 141 138 13

New East MCOs 299 129 5,460 45 750 758 1,350 116


Pacific Islander

41 AmeriHealth NE 7 1 33 0 1 5 7 0

44 Geisinger 4 3 12 2 8 5 7 2

50 Aetna 1 1 8 1 2 1 1 0

New East MCOs 12 5 53 3 11 11 15 2

Unknown

41 AmeriHealth NE 44 6 511 3 39 79 122 13

44 Geisinger 108 18 454 18 133 129 193 35

50 Aetna 22 3 247 8 35 58 33 19

New East MCOs 174 27 1,212 29 207 266 348 67

MCO TOTAL

41 AmeriHealth NE 5,192 2,114 14,346 322 3,108 2,658 8,832 1,140

44 Geisinger 15,152 4,581 12,796 1,569 10,451 5,215 14,832 2,981

50 Aetna 1,567 1,654 4,990 293 3,477 1,328 3,171 909

TOTAL 21,911 8,349 32,132 2,184 17,036 9,201 26,835 5,030



18


Northeast cont.

57 Sullivan 58 Susquehanna 59 Tioga 60 Union 64 Wayne 66 Wyoming New East


41 AmeriHealth NE 1 7 86 53 46 12 7,807

44 Geisinger 5 33 27 180 128 27 14,215

50 Aetna 8 13 18 45 30 7 4,440

New East MCOs 14 53 131 278 204 46 26,462

American Indian or

Alaskan Native

41 AmeriHealth NE 0 2 14 0 4 0 196

44 Geisinger 1 3 1 4 14 4 326

50 Aetna 0 5 1 1 4 3 108

New East MCOs 1 10 16 5 22 7 630

Asian

41 AmeriHealth NE 1 2 19 4 14 2 779

44 Geisinger 0 14 6 20 27 15 2,212

50 Aetna 0 0 0 2 5 1 545

New East MCOs 1 16 25 26 46 18 3,536

White

41 AmeriHealth NE 133 1,080 5,799 839 1,505 752 68,617

44 Geisinger 489 4,419 972 2,447 5,372 3,303 152,501

50 Aetna 134 936 554 677 1,089 616 35,950

New East MCOs 756 6,435 7,325 3,963 7,966 4,671 257,068


41 AmeriHealth NE 0 18 40 26 34 12 10,452

44 Geisinger 2 30 11 93 103 25 16,653

50 Aetna 1 8 12 12 26 4 3,718

New East MCOs 3 56 63 131 163 41 30,823


Pacific Islander

41 AmeriHealth NE 0 0 2 0 1 1 74

44 Geisinger 0 0 0 0 6 0 101

50 Aetna 0 0 0 0 3 0 46

New East MCOs 0 0 2 0 10 1 221

Unknown

41 AmeriHealth NE 3 7 26 7 19 8 1,658

44 Geisinger 1 29 15 31 62 32 3,075

50 Aetna 1 4 5 5 17 2 951

New East MCOs 5 40 46 43 98 42 5,684

MCO TOTAL

41 AmeriHealth NE 138 1,116 5,986 929 1,623 787 89,583

44 Geisinger 498 4,528 1,032 2,775 5,712 3,406 189,083

50 Aetna 144 966 590 742 1,174 633 45,758

TOTAL 780 6,610 7,608 4,446 8,509 4,826 324,424



19

Mandatory January 201 8 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY

Southeast

09 Bucks 15 Chester 23 Delaware 46 Montgomery 51 Philadelphia Southeast

Other/Unknown

42 United 24 33 24 33 97 211

43 Aetna 25 16 19 36 74 170

45 Health Partners 15 23 21 34 144 237

47 Keystone 62 22 57 108 208 457

Southeast MCOs 126 94 121 211 523 1,075

Non-Hispanic

42 United 5,034 9,568 8,595 8,275 48,382 79,854

43 Aetna 6,511 5,955 10,120 10,250 32,008 64,844

45 Health Partners 10,433 2,580 7,947 11,046 148,601 180,607

47 Keystone 35,641 17,966 65,760 48,477 219,333 387,177

Southeast MCOs 57,619 36,069 92,422 78,048 448,324 712,482

Hispanic

42 United 628 3,281 476 1,268 6,465 12,118

43 Aetna 554 1,132 537 849 4,243 7,315

45 Health Partners 1,614 334 721 1,327 68,538 72,534

47 Keystone 4,446 4,230 3,760 6,224 27,910 46,570

Southeast MCOs 7,242 8,977 5,494 9,668 107,156 138,537

TOTAL 64,987 45,140 98,037 87,927 556,003 852,094



20


Southwest

02 Allegheny 03 Armstrong 04 Beaver 05 Bedford 07 Blair 10 Butler 11 Cambria 26 Fayette

Other/Unknown

31 Gateway 52 0 3 0 3 8 1 1

32 United 31 1 2 0 2 2 5 5

34 UPMC 183 5 9 4 13 22 9 19

59 Aetna 23 0 2 1 3 4 1 1

Southwest MCOs 289 6 16 5 21 36 16 26

Non-Hispanic

31 Gateway 57,855 1,012 11,125 694 6,054 5,263 3,577 3,993

32 United 19,896 496 2,142 1,086 3,629 1,094 4,958 9,069

34 UPMC 98,708 9,941 12,915 5,832 13,385 14,116 14,919 19,324

59 Aetna 7,558 434 1,281 696 2,047 885 2,676 791

Southwest MCOs 184,017 11,883 27,463 8,308 25,115 21,358 26,130 33,177

Hispanic

31 Gateway 851 11 136 6 80 99 69 29

32 United 422 2 52 7 51 31 105 64

34 UPMC 2,339 79 161 72 182 283 156 178

59 Aetna 219 3 37 7 34 19 40 19

Southwest MCOs 3,831 95 386 92 347 432 370 290

TOTAL 188,137 11,984 27,865 8,405 25,483 21,826 26,516 33,493



21


Southwest cont.

30 Greene 32 Indiana 37 Lawrence 56 Somerset 63 Washington 65 Westmoreland Southwest

Other/Unknown

31 Gateway 1 0 0 1 11 6 87

32 United 2 2 1 0 3 22 78

34 UPMC 2 6 3 4 15 35 329

59 Aetna 0 3 0 0 5 4 47

Southwest MCOs 5 11 4 5 34 67 541

Non-Hispanic

31 Gateway 813 2,456 6,870 1,784 5,566 11,129 118,191

32 United 3,340 1,720 1,435 2,765 5,003 7,665 64,298

34 UPMC 3,289 8,715 8,534 6,471 18,199 31,204 265,552

59 Aetna 375 541 756 1,019 1,362 2,003 22,424

Southwest MCOs 7,817 13,432 17,595 12,039 30,130 52,001 470,465

Hispanic

31 Gateway 6 26 54 19 94 106 1,586

32 United 18 25 30 28 83 111 1,029

34 UPMC 24 84 170 63 276 360 4,427

59 Aetna 1 14 10 13 39 31 486

Southwest MCOs 49 149 264 123 492 608 7,528

TOTAL 7,871 13,592 17,863 12,167 30,656 52,676 478,534



22


Lehigh/Capital

01 Adams 06 Berks 21 Cumberland 22 Dauphin 28 Franklin 29 Fulton 31 Huntingdon

Other/Unknown

51 Gateway 2 16 13 17 5 0 0

52 United 5 9 11 20 0 0 0

53 Aetna 5 13 8 16 7 0 0

54 UPMC 0 16 4 6 5 1 0

57 AmeriHealth 3 25 9 8 26 0 0


Non-Hispanic

51 Gateway 3,841 8,262 11,372 21,908 885 156 448

52 United 3,755 5,411 3,381 8,457 613 294 638

53 Aetna 1,078 4,764 3,715 6,614 7,526 748 972

54 UPMC 1,147 5,792 1,568 3,642 415 560 3,545

57 AmeriHealth 1,321 15,870 4,644 4,717 10,633 694 1,572

Lehigh/Capital MCOs 11,142 40,099 24,680 45,338 20,072 2,452 7,175

Hispanic

51 Gateway 282 7,024 870 6,165 74 1 8

52 United 848 2,855 358 1,752 46 3 12

53 Aetna 145 1,803 223 933 644 15 11

54 UPMC 141 2,398 148 552 20 3 38

57 AmeriHealth 154 25,338 395 1,248 1,903 16 10

Lehigh/Capital MCOs 1,570 39,418 1,994 10,650 2,687 38 79

TOTAL 12,727 79,596 26,719 56,055 22,802 2,491 7,254



23

Mandatory January 2018 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY

Lehigh/Capital cont.

36 Lancaster 38 Lebanon 39 Lehigh 48 Northampton 50 Perry 67 York Lehigh/Capital

Other/Unknown

51 Gateway 25 5 13 11 1 15 123

52 United 10 5 9 6 2 19 96

53 Aetna 4 2 7 10 1 10 83

54 UPMC 31 3 17 14 0 4 101

57 AmeriHealth 35 3 53 33 1 21 217

Lehigh/Capital

MCOs 105 18 99 74 5 69 620

Non-Hispanic

51 Gateway 18,099 9,210 10,220 8,534 3,521 18,768 115,224

52 United 7,601 1,298 3,068 2,234 611 16,362 53,723

53 Aetna 2,636 1,376 1,733 1,922 680 6,404 40,168

54 UPMC 7,471 1,407 3,485 2,111 295 5,825 37,263

57 AmeriHealth 18,850 1,743 18,284 16,761 950 11,024 107,063

Lehigh/Capital

MCOs 54,657 15,034 36,790 31,562 6,057 58,383 353,441

Hispanic

51 Gateway 5,090 4,980 11,925 4,453 80 2,892 43,844

52 United 3,018 551 2,392 532 15 5,339 17,721

53 Aetna 620 502 1,009 397 16 1,072 7,390

54 UPMC 1,857 597 1,918 591 6 1,094 9,363

57 AmeriHealth 10,664 1,559 18,266 7,018 19 3,498 70,088

Lehigh/Capital

MCOs 21,249 8,189 35,510 12,991 136 13,895 148,406

TOTAL 76,011 23,241 72,399 44,627 6,198 72,347 502,467



24


Northwest

12 Cameron 16 Clarion 17 Clearfield 20 Crawford 24 Elk 25 Erie 27 Forest

Other/Unknown

35 UPMC 0 3 3 10 0 24 0

36 Gateway 0 1 0 0 0 4 0

37 AmeriHealth 0 1 0 0 0 2 0

56 Aetna 0 0 0 3 0 3 0

New West MCOs 0 5 3 13 0 33 0

Non-Hispanic

35 UPMC 832 4,163 10,349 12,089 3,478 30,700 540

36 Gateway 38 769 1,313 1,018 422 13,002 89

37 AmeriHealth 98 565 1,953 1,042 272 5,550 77

56 Aetna 45 583 1,752 1,189 268 9,031 53

New West MCOs 1,013 6,080 15,367 15,338 4,440 58,283 759

Hispanic

35 UPMC 23 35 69 127 35 2,048 1

36 Gateway 1 0 7 10 2 1,302 5

37 AmeriHealth 3 5 25 8 7 425 0

56 Aetna 1 12 25 13 5 778 1

New West MCOs 28 52 126 158 49 4,553 7

TOTAL 1,041 6,137 15,496 15,509 4,489 62,869 766



25


Northwest cont.

33 Jefferson 42 McKean 43 Mercer 53 Potter 61 Venango 62 Warren New West

Other/Unknown

35 UPMC 4 1 23 3 5 6 82

36 Gateway 0 0 1 0 1 0 7

37 AmeriHealth 0 0 9 1 1 1 15

56 Aetna 2 0 2 0 1 0 11

New West MCOs 6 1 35 4 8 7 115

Non-Hispanic

35 UPMC 6,581 6,198 13,791 1,797 7,171 4,685 102,374

36 Gateway 899 295 3,760 28 863 677 23,173

37 AmeriHealth 355 1,260 2,231 1,341 1,081 745 16,570

56 Aetna 408 694 2,129 73 1,012 506 17,743

New West MCOs 8,243 8,447 21,911 3,239 10,127 6,613 159,860

Hispanic

35 UPMC 72 81 177 19 81 21 2,789

36 Gateway 4 3 38 1 11 16 1,400

37 AmeriHealth 1 6 28 7 14 4 533

56 Aetna 1 1 21 1 12 3 874

New West MCOs 78 91 264 28 118 44 5,596

TOTAL 8,327 8,539 22,210 3,271 10,253 6,664 165,571



26


Northeast

08 Bradford 13 Carbon 14 Centre 18 Clinton 19 Columbia 34 Juniata 35 Lackawanna 40 Luzerne

Other/Unknown

41 AmeriHealth NE 7 4 6 2 1 1 17 10

44 Geisinger 4 3 13 4 5 2 42 36

50 Aetna 5 4 8 1 0 0 10 12

New East MCOs 16 11 27 7 6 3 69 58

Non-Hispanic

41 AmeriHealth NE 2,821 6,743 2,528 1,147 1,423 713 5,871 11,632

44 Geisinger 4,659 2,605 6,128 4,979 6,848 1,554 26,009 35,042

50 Aetna 3,512 925 2,413 757 1,034 625 4,621 7,213

New East MCOs 10,992 10,273 11,069 6,883 9,305 2,892 36,501 53,887

Hispanic

41 AmeriHealth NE 37 562 62 28 75 82 1,307 6,213

44 Geisinger 63 189 122 80 247 153 5,083 9,685

50 Aetna 24 85 71 14 74 74 901 1,737

New East MCOs 124 836 255 122 396 309 7,291 17,635

TOTAL 11,132 11,120 11,351 7,012 9,707 3,204 43,861 71,580




Northeast cont.

41 Lycoming 44 Mifflin 45 Monroe 47 Montour 49 Northumberland 52 Pike 54 Schuylkill 55 Snyder

Other/Unknown

41 AmeriHealth NE 4 1 13 0 2 3 2 1

44 Geisinger 10 0 21 0 3 20 5 5

50 Aetna 2 0 10 0 2 4 2 3

New East MCOs 16 1 44 0 7 27 9 9

Non-Hispanic

41 AmeriHealth NE 5,072 2,041 11,605 304 2,791 2,196 7,822 1,094

44 Geisinger 14,888 4,440 10,276 1,521 9,701 4,621 13,672 2,862

50 Aetna 1,530 1,582 3,918 290 3,254 1,104 2,930 872

New East MCOs 21,490 8,063 25,799 2,115 15,746 7,921 24,424 4,828

Hispanic

41 AmeriHealth NE 116 72 2,728 18 315 459 1,008 45

44 Geisinger 254 141 2,499 48 747 574 1,155 114

50 Aetna 35 72 1,062 3 221 220 239 34

New East MCOs 405 285 6,289 69 1,283 1,253 2,402 193

TOTAL 21,911 8,349 32,132 2,184 17,036 9,201 26,835 5,030



28


Northeast cont.

57 Sullivan 58 Susquehanna 59 Tioga 60 Union 64 Wayne 66 Wyoming New East

Other/Unknown

41 AmeriHealth NE 0 0 2 1 3 0 80

44 Geisinger 0 2 0 4 2 4 185

50 Aetna 0 2 0 0 1 0 66

New East MCOs 0 4 2 5 6 4 331

Non-Hispanic

41 AmeriHealth NE 135 1,106 5,928 858 1,530 773 76,133

44 Geisinger 484 4,449 1,023 2,580 5,481 3,329 167,151

50 Aetna 141 948 583 700 1,110 625 40,687

New East MCOs 760 6,503 7,534 4,138 8,121 4,727 283,971

Hispanic

41 AmeriHealth NE 3 10 56 70 90 14 13,370

44 Geisinger 14 77 9 191 229 73 21,747

50 Aetna 3 16 7 42 63 8 5,005

New East MCOs 20 103 72 303 382 95 40,122

TOTAL 780 6,610 7,608 4,446 8,509 4,826 324,424



29

Mandatory January 201 8 PLAN MAKE UP BY AGE GROUP AND GENDER

SOUTHEAST

42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

< 21 Yrs

Female 21,986 17,282 60,811 115,612 215,691

Male 22,854 18,558 61,720 123,926 227,058

Total 44,840 35,840 122,531 239,538 442,749

22-45 Yrs

Female 17,554 13,408 53,204 80,761 164,927

Male 14,657 12,971 31,016 46,749 105,393

Total 32,211 26,379 84,220 127,510 270,320

46-64 Yrs

Female 6,942 4,268 24,778 35,121 71,109

Male 7,566 5,428 20,260 29,490 62,744

Total 14,508 9,696 45,038 64,611 133,853

Over 64

Yrs

Female 371 274 1,016 1,612 3,273

Male 253 140 573 933 1,899

Total 624 414 1,589 2,545 5,172

TOTAL 92,183 72,329 253,378 434,204 852,094

SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

< 21 Yrs

Female 30,947 16,403 64,144 4,779 116,273

Male 32,974 17,649 68,199 4,886 123,708

Total 63,921 34,052 132,343 9,665 239,981

22-45 Yrs

Female 23,957 12,449 55,209 4,792 96,407

Male 13,452 9,003 34,349 4,582 61,386

Total 37,409 21,452 89,558 9,374 157,793

46-64 Yrs

Female 10,371 5,123 26,561 1,775 43,830

Male 7,949 4,677 21,188 2,093 35,907

Total 18,320 9,800 47,749 3,868 79,737

Over 64

Yrs

Female 140 63 403 30 636

Male 74 38 255 20 387

Total 214 101 658 50 1,023

TOTAL 119,864 65,405 270,308 22,957 478,534



LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL

< 21 Yrs

Female 45,458 19,928 11,657 11,513 48,842 137,398

Male 47,859 20,777 12,363 12,469 51,448 144,916

Total 93,317 40,705 24,020 23,982 100,290 282,314

22-45 Yrs

Female 30,909 13,464 9,966 9,575 35,490 99,404

Male 14,938 8,120 7,059 6,363 17,169 53,649

Total 45,847 21,584 17,025 15,938 52,659 153,053

46-64 Yrs

Female 11,323 4,959 3,295 3,578 14,174 37,329

Male 8,039 4,031 3,116 3,042 9,417 27,645

Total 19,362 8,990 6,411 6,620 23,591 64,974

Over 64

Yrs

Female 455 153 111 104 568 1,391

Male 210 108 74 83 260 735

Total 665 261 185 187 828 2,126

TOTAL 159,191 71,540 47,641 46,727 177,368 502,467

NORTHWEST

35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

< 21 Yrs

Female 26,609 6,220 3,837 4,645 41,311

Male 28,390 6,530 4,078 4,787 43,785

Total 54,999 12,750 7,915 9,432 85,096

22-45 Yrs

Female 20,992 4,899 3,499 3,655 33,045

Male 12,681 3,337 2,748 2,796 21,562

Total 33,673 8,236 6,247 6,451 54,607

46-64 Yrs

Female 9,490 1,914 1,477 1,471 14,352

Male 6,946 1,656 1,459 1,243 11,304

Total 16,436 3,570 2,936 2,714 25,656

Over 64

Yrs

Female 81 11 12 14 118

Male 56 13 8 17 94

Total 137 24 20 31 212

TOTAL 105,245 24,580 17,118 18,628 165,571


31


NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

< 21 Yrs Female 22,563 48,172 11,260 81,995

Male 23,768 50,680 11,896 86,344

Total 46,331 98,852 23,156 168,339

22-45 Yrs Female 18,589 38,326 9,112 66,027

Male 10,907 21,907 6,774 39,588

Total 29,496 60,233 15,886 105,615

46-64 Yrs Female 7,648 16,914 3,588 28,150

Male 5,853 12,604 3,023 21,480

Total 13,501 29,518 6,611 49,630

Over 64 Yrs Female 174 303 67 544

Male 81 177 38 296

Total 255 480 105 840

TOTAL 89,583 189,083 45,758 324,424


Mandatory January 201 8 PLAN MAKE UP BY AGE GROUP

SOUTHEAST

42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

< 21 Yrs 44,840 35,840 122,531 239,538 442,749

22-45 Yrs 32,211 26,379 84,220 127,510 270,320

46-64 Yrs 14,508 9,696 45,038 64,611 133,853

Over 64 Yrs 624 414 1,589 2,545 5,172

TOTAL 92,183 72,329 253,378 434,204 852,094

SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

< 21 Yrs 63,921 34,052 132,343 9,665 239,981

22-45 Yrs 37,409 21,452 89,558 9,374 157,793

46-64 Yrs 18,320 9,800 47,749 3,868 79,737

Over 64 Yrs 214 101 658 50 1,023

TOTAL 119,864 65,405 270,308 22,957 478,534

LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL

< 21 Yrs 93,317 40,705 24,020 23,982 100,290 282,314

22-45 Yrs 45,847 21,584 17,025 15,938 52,659 153,053

46-64 Yrs 19,362 8,990 6,411 6,620 23,591 64,974

Over 64 Yrs 665 261 185 187 828 2,126

TOTAL 159,191 71,540 47,641 46,727 177,368 502,467


33

Mandatory January 201 8 PLAN MAKE UP BY AGE GROUP

NORTHWEST

35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

< 21 Yrs 54,999 12,750 7,915 9,432 85,096

22-45 Yrs 33,673 8,236 6,247 6,451 54,607

46-64 Yrs 16,436 3,570 2,936 2,714 25,656

Over 64 Yrs 137 24 20 31 212

TOTAL 105,245 24,580 17,118 18,628 165,571

NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

< 21 Yrs 46,331 98,852 23,156 168,339

22-45 Yrs 29,496 60,233 15,886 105,615

46-64 Yrs 13,501 29,518 6,611 49,630

Over 64 Yrs 255 480 105 840

TOTAL 89,583 189,083 45,758 324,424


34

HealthChoices Enrollment 1st Quarter 2017 AID CATEGORY DISTRIBUTION

Southeast

Newly Eligible (19-44)

22%

SSI & HH 16%

TANF/HB/MAGI (Ages 0-20)

42%

B&CC <1% TANF/HB/MAGI

(Ages 21+) 10%

Newly Eligible (45+) 10%

Southwest B&CC <1%

TANF/HB/MAGI (Ages 21+)

11%


20%


SSI & HH 18%


40% Lehigh/Capital B&CC <1% TANF/HB/MAGI

(Ages 21+) 10%


21%

SSI & HH 15%


45%


Northeast B&CC <1% TANF/HB/MAGI

(Ages 21+) 10%



21%

SSI & HH 16%


42%

Northwest B&CC <1%

TANF/HB/MAGI (Ages 21+)

10%


22%


SSI & HH 18%


41%

Source: Division of Financial Analysis

New Categories of Aid: TANF/HB/MAGI is Temporary Assistance for Needy Families, Healthy Beginnings, and Modified Adjusted Gross Income.

35

HealthChoices Enrollment January 201 8 PCP SELECTION

The table displays the total number of new members that voluntarily enrolled in HealthChoices and selected a PCP as a percentage of total new members that voluntarily enrolled in HealthChoices.

January 2018

Zone Percentage

Southeast 91.9%

Southwest 92.6%

Lehigh/Capital 92.7%

Northwest 93.9%

Northeast 91.6%

Total 92.4%

Source: Maximus

36

Medical Assistance Transportation Program

Based on Data Submitted by Each County

37

MATP 1Q FY 16/17

Southeast

COUNTY Total Expenditure Para Transit Trips Mass Transit Trips

Mileage

Reimbursement

Trips

Total Trips Client Utilization

Bucks $ 535,852 20,103 - 16,035 36,138 1.5%

Chester $ 578,443 13,305 2,080 2,888 18,273 1.8%

Delaware $ 1,170,077 23,928 - 12,990 36,918 1.2%

Montgomery $ 785,331 20,509 - 7,785 28,294 1.3%

Philadelphia $ 12,327,788 278,800 822,868 13,830 1,115,498 3.5%

HC-SE Zone $ 15,397,491 356,645 824,948 53,528 1,235,121 9%

38

MATP 1Q FY 16/17

Southwest


Mileage

Reimbursement

Trips


Allegheny $ 2,198,681 39,010 142,915 34,365 216,290 4.1%

Armstrong $ 420,871 9,801 - 4,876 14,677 5.2%

Beaver $ 539,568 13,109 230 20,636 33,975 3.0%

Bedford $ 134,029 4,374 - 3,659 8,033 4.1%

Blair $ 313,204 14,110 2,052 3,519 19,681 3.3%

Butler $ 548,029 13,132 - 5,005 18,137 3.7%

Cambria $ 1,003,543 32,361 4,736 4,584 41,681 5.5%

Fayette $ 354,051 17,164 39 17,206 34,409 2.4%

Greene $ 141,094 3,909 - 2,276 6,185 3.9%

Indiana $ 287,379 7,364 478 5,508 13,350 3.8%

Lawrence $ 252,123 6,541 3,365 14,722 24,628 3.4%

Somerset $ 275,334 5,423 - 6,942 12,365 3.6%

Washington $ 592,114 17,321 1,107 14,102 32,530 4.2%

Westmoreland $ 709,300 21,053 218 15,685 36,956 2.4%

HC-SW Zone $ 7,769,320 204,672 155,140 153,085 512,897 53%

39

MATP 1Q FY 16/17

Lehigh/Capital


Mileage

Reimbursement

Trips


Berks $ 647,047 17,047 12,721 6,603 36,371 2.4%

Cumberland $ 104,192 3,770 48 1,206 5,024 1.2%

Dauphin $ 753,945 25,260 6,538 2,309 34,107 2.1%

Franklin $ 81,894 2,694 - 1,251 3,945 1.1%

Fulton $ 109,557 1,537 - 1,184 2,721 7.2%

Huntingdon $ 139,486 2,192 - 5,297 7,489 5.4%

Lancaster $ 677,839 21,899 684 5,455 28,038 1.5%

Lebanon $ 349,742 18,555 306 1,503 20,364 2.4%

Lehigh $ 844,268 25,436 1,762 6,038 33,236 0.3%

Northampton $ 408,681 12,721 1,320 7,932 21,973 0.5%

Perry $ 149,242 3,114 - 1,290 4,404 5.3%

York/Adams $ 289,984 9,005 975 3,854 13,834 0.8%

HC-L/C Zone $ 4,555,877 143,230 24,354 43,922 211,506 30%

40

MATP 1Q FY 16/17

Northwest

COUNTY Total

Expenditure

Para Transit

Trips

Mass Transit

Trips

Mileage

Reimbursement

Trips


Cameron $ 41,302 529 - 239 768 2.4%

Clarion $ 148,973 2,709 - 2,212 4,921 3.5%

Clearfield $ 247,278 6,681 - 7,196 13,877 3.7%

Crawford $ 273,966 3,272 431 10,963 14,666 4.5%

Elk $ 156,203 2,987 2 891 3,880 3.0%

Erie $ 498,198 20,000 1,271 3,505 24,776 1.0%

Forest $ 35,150 738 - 180 918 3.8%

Jefferson $ 355,917 9,268 - 4,189 13,457 6.4%

McKean $ 175,975 2,045 44 623 2,712 1.7%

Mercer $ 198,820 8,116 - 2,703 10,819 2.4%

Potter $ 153,422 1,788 - 878 2,666 5.5%

Venango $ 299,180 5,564 129 2,165 7,858 3.2%

Warren $ 61,787 1,297 122 2,560 3,979 4.0%

HC-Northwest Zone $ 2,646,171 64,994 1,999 38,304 105,297 45%

41

MATP 1Q FY 16/17

Northeast

COUNTY Total

Expenditure

Para Transit

Trips

Mass Transit

Trips

Mileage

Reimbursement

Trips


Bradford/Tioga $ 350,235 6,349 172 1,494 8,015 2.6%

Carbon $ 339,989 6,719 - 1,466 8,185 2.1%

Centre $ 141,051 5,075 188 1,712 6,975 3.1%

Clinton $ 221,447 4,172 - 507 4,679 3.5%

Columbia $ 108,532 3,076 - 2,134 5,210 1.8%

Juniata $ 23,474 745 - 294 1,039 1.5%

Lackawanna $ 243,080 7,014 1,569 3,641 12,224 0.8%

Luzerne $ 351,391 19,253 1,366 8,456 29,075 1.5%

Lycoming $ 459,253 10,293 2,373 3,452 16,118 3.2%

Mifflin $ 124,389 3,977 - 854 4,831 2.5%

Monroe $ 192,392 5,124 905 4,798 10,827 1.7%

Montour $ 34,727 473 - 1,192 1,665 2.6%

Northumberland $ 198,569 6,658 - 2,884 9,542 2.8%

Pike $ 75,429 1,214 - 2,532 3,746 0.9%

Schuylkill $ 280,381 4,576 1,008 2,709 8,293 1.8%

Snyder $ 49,843 1,597 - 794 2,391 2.1%

Sullivan $ 26,926 363 40 68 471 3.6%

Susquehanna $ 145,357 2,415 - 1,603 4,018 3.4%

Union $ 29,890 846 - 580 1,426 2.0%

Wayne $ 183,470 4,071 - 1,724 5,795 3.5%

Wyoming $ 58,236 1,351 - 710 2,061 2.0%

HC-Northeast Zone $ 3,638,061 95,361 7,621 43,604 146,586 49%

42

Useful Information

To view a complete Pennsylvania Medicaid Managed Care Organization (MCO) Directory go to http://dhs.pa.gov/provider/healthcaremedicalassistance/managedcar einformation/ and choose the Pennsylvania Medicaid MCO Directory.

43

http://dhs.pa.gov/provider/healthcaremedicalassistance/managedcareinformation/

BMCO Monthly Physical Health Managed Care Program ...

Documents

Transcript of BMCO Monthly Physical Health Managed Care Program ...