bmco monthly physical health managed care program ... · 47 keystone 4,187 3,026 4,416 7,156 29,753...

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: March 28, 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 February 2018 ENROLLMENT BY PLAN AND BY COUNTY

SOUTHEAST

County 42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

09 Bucks 5,804 7,175 12,186 40,358 65,523

15 Chester 13,012 7,266 2,856 22,419 45,553

23 Delaware 9,136 10,685 8,704 69,637 98,162

46 Montgomery 9,697 11,314 12,166 55,196 88,373

51 Philadelphia 55,202 36,519 217,156 247,818 556,695

TOTAL 92,851 72,959 253,068 435,428 854,306

PERCENTAGE 11% 8% 30% 51%

SOUTHWEST

County 31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

02 Allegheny 58,869 20,574 102,003 7,904 189,350

03 Armstrong 1,012 495 10,055 432 11,994

04 Beaver 11,213 2,212 13,182 1,347 27,954

05 Bedford 700 1,107 5,909 696 8,412

07 Blair 6,104 3,670 13,636 2,068 25,478

10 Butler 5,398 1,156 14,612 936 22,102

11 Cambria 3,653 5,115 15,120 2,717 26,605

26 Fayette 4,000 9,135 19,582 829 33,546

30 Greene 833 3,364 3,368 382 7,947

32 Indiana 2,462 1,747 8,856 562 13,627

37 Lawrence 6,934 1,481 8,728 775 17,918

56 Somerset 1,798 2,793 6,569 1,050 12,210

63 Washington 5,681 5,099 18,622 1,411 30,813

65 Westmoreland 11,276 7,790 31,725 2,056 52,847

TOTAL 119,933 65,738 271,967 23,165 480,803

PERCENTAGE 25% 14% 56% 5%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 03/08/18

5


cont.

LEHIGH/CAPITAL

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

01 Adams 4,143 4,642 1,244 1,290 1,465 12,784

06 Berks 15,335 8,141 6,572 8,453 41,539 80,040

21 Cumberland 12,195 3,777 3,985 1,777 5,073 26,807

22 Dauphin 28,103 10,315 7,663 4,357 6,110 56,548

28 Franklin 984 673 8,169 443 12,559 22,828

29 Fulton 165 294 766 548 702 2,475

31 Huntingdon 463 635 991 3,598 1,603 7,290

36 Lancaster 23,184 10,642 3,290 9,508 29,816 76,440

38 Lebanon 14,217 1,868 1,915 1,989 3,350 23,339

39 Lehigh 22,187 5,561 2,683 5,441 36,876 72,748

48 Northampton 12,907 2,775 2,317 2,699 23,869 44,567

50 Perry 3,602 636 724 314 990 6,266

67 York 21,667 21,698 7,613 6,953 14,653 72,584

TOTAL 159,152 71,657 47,932 47,370 178,605 504,716

PERCENTAGE 32% 14% 9% 9% 35%

NORTHWEST

County 35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

12 Cameron 862 40 103 44 1,049

16 Clarion 4,219 773 562 600 6,154

17 Clearfield 10,434 1,348 1,989 1,783 15,554

20 Crawford 12,333 1,016 1,043 1,212 15,604

24 Elk 3,513 437 288 277 4,515

25 Erie 32,780 14,301 5,996 9,881 62,958

27 Forest 537 99 78 55 769

33 Jefferson 6,667 908 343 405 8,323

42 McKean 6,310 294 1,258 694 8,556

43 Mercer 14,044 3,826 2,272 2,162 22,304

53 Potter 1,835 22 1,355 64 3,276

61 Venango 7,252 874 1,095 1,037 10,258

62 Warren 4,766 681 756 511 6,714

TOTAL 105,552 24,619 17,138 18,725 166,034

PERCENTAGE 64% 15% 10% 11%


6


cont.

NORTHEAST

County 41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

08 Bradford 2,923 4,713 3,544 11,180

13 Carbon 7,300 2,773 1,020 11,093

14 Centre 2,587 6,278 2,474 11,339

18 Clinton 1,179 5,125 773 7,077

19 Columbia 1,508 7,103 1,095 9,706

34 Juniata 816 1,731 694 3,241

35 Lackawanna 7,270 31,257 5,579 44,106

40 Luzerne 18,067 44,865 8,948 71,880

41 Lycoming 5,201 15,144 1,572 21,917

44 Mifflin 2,128 4,583 1,658 8,369

45 Monroe 14,502 12,778 5,104 32,384

47 Montour 324 1,572 303 2,199

49 Northumberland 3,097 10,436 3,507 17,040

52 Pike 2,727 5,189 1,353 9,269

54 Schuylkill 8,905 14,738 3,229 26,872

55 Snyder 1,163 3,009 902 5,074

57 Sullivan 142 500 145 787

58 Susquehanna 1,134 4,587 961 6,682

59 Tioga 5,973 1,024 589 7,586

60 Union 917 2,759 766 4,442

64 Wayne 1,676 5,720 1,192 8,588

66 Wyoming 771 3,401 623 4,795

TOTAL 90,310 189,285 46,031 325,626

PERCENTAGE 28% 59% 14%


7

Mandatory February 2018 MARKET SHARE BY PLAN – STATEWIDE

Total Enrollment = 2,331,485

AmeriHealth NE 90,310

4% Aetna

208,812 9%

AmeriHealth 195,743

8%

Gateway 303,704

13%

Health Partners 253,068

11%

Keystone 435,428

19%

United 230,246

10%

UPMC 424,889

18%

Geisinger 189,285

8%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 03/08/18 8

Mandatory February 2018 MARKET SHARE BY ZONE AND BY PLAN

Southeast

Aetna 72,959

8%

Health Partners 253,068

30%

Keystone 435,428

51%

United 92,851

11%

Southwest Aetna 23,165

5%

Gateway 119,933

25%

United 65,738

14%

UPMC 271,967

56%

Lehigh/Capital

Aetna 47,932

10%

Ameri-Health

178,605 35%Gateway

159,152 32%

United 71,657

14%

UPMC 47,370

9%

Northwest

Aetna 18,725

11%

Gateway 24,619

15%

UPMC 105,552

64%

Ameri-Health 17,138

10%

Northeast

Aetna 46,031

14%

Ameri-Health NE

90,310 28%

Geisinger 189,285

58%


9

Mandatory February 2018 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 663 2,507 4,704 2,227 34,671 44,772

43 Aetna 684 1,261 4,816 2,409 22,296 31,466

45 Health Partners 1,393 450 4,551 3,548 105,043 114,985

47 Keystone 4,130 3,930 33,450 12,665 151,480 205,655

Southeast MCOs 6,870 8,148 47,521 20,849 313,490 396,878

American Indian or Alaskan

Native

42 United 10 33 17 22 73 155

43 Aetna 31 38 7 54 64 194

45 Health Partners 28 10 11 50 259 358

47 Keystone 78 94 114 174 313 773

Southeast MCOs 147 175 149 300 709 1,480

Asian

42 United 248 268 573 556 3,853 5,498

43 Aetna 279 178 485 785 1,545 3,272

45 Health Partners 651 90 453 690 8,002 9,886

47 Keystone 1,365 638 4,342 3,685 19,003 29,033

Southeast MCOs 2,543 1,174 5,853 5,716 32,403 47,689

White

42 United 3,927 7,224 2,880 4,897 8,075 27,003

43 Aetna 5,174 4,510 4,350 6,227 6,941 27,202

45 Health Partners 7,983 1,756 2,521 5,733 34,791 52,784

47 Keystone 29,020 13,676 25,560 29,051 41,169 138,476

Southeast MCOs 46,104 27,166 35,311 45,908 90,976 245,465

Other or system default

42 United 639 2,144 596 1,370 6,705 11,454

43 Aetna 564 854 622 1,118 4,340 7,498

45 Health Partners 1,532 336 832 1,488 63,788 67,976

47 Keystone 4,187 3,026 4,416 7,156 29,753 48,538

Southeast MCOs 6,922 6,360 6,466 11,132 104,586 135,466

Native Hawaiian or Other

Pacific Islander

42 United 6 12 8 9 76 111

43 Aetna 9 8 17 18 52 104

45 Health Partners 18 3 9 14 205 249

47 Keystone 50 29 62 67 143 351

Southeast MCOs 83 52 96 108 476 815

Unknown

42 United 311 824 358 616 1,749 3,858

43 Aetna 434 417 388 703 1,281 3,223

45 Health Partners 581 211 327 643 5,068 6,830

47 Keystone 1,528 1,026 1,693 2,398 5,957 12,602

Southeast MCOs 2,854 2,478 2,766 4,360 14,055 26,513

MCO TOTAL

42 United 5,804 13,012 9,136 9,697 55,202 92,851

43 Aetna 7,175 7,266 10,685 11,314 36,519 72,959

45 Health Partners 12,186 2,856 8,704 12,166 217,156 253,068

47 Keystone 40,358 22,419 69,637 55,196 247,818 435,428

TOTAL 65,523 45,553 98,162 88,373 556,695 854,306

Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 03/08/18

10

Racia thnic information is self orted b consumers.


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

Black or African

American

31 Gateway 28,212 24 2,608 16 446 228 508 396

32 United 8,408 14 442 11 253 41 898 831

34 UPMC 33,464 143 2,114 69 618 364 1,365 1,533

59 Aetna 2,802 7 267 9 130 25 756 86

Southwest MCOs 72,886 188 5,431 105 1,447 658 3,527 2,846

American Indian or

Alaskan Native

31 Gateway 130 4 13 1 7 5 6 6

32 United 45 2 3 1 7 1 4 9

34 UPMC 305 16 34 13 27 27 28 37

59 Aetna 26 1 5 0 4 0 2 5

Southwest MCOs 506 23 55 15 45 33 40 57

Asian

31 Gateway 786 2 30 0 10 27 6 14

32 United 458 2 28 3 24 22 12 17

34 UPMC 4,981 28 120 25 72 149 38 66

59 Aetna 187 0 14 3 10 10 11 4

Southwest MCOs 6,412 32 192 31 116 208 67 101

White

31 Gateway 26,645 967 8,291 667 5,535 4,993 3,034 3,508

32 United 10,208 464 1,632 1,071 3,314 1,015 4,049 8,109

34 UPMC 55,386 9,749 10,386 5,669 12,634 13,462 13,301 17,516

59 Aetna 4,068 417 988 669 1,880 847 1,872 693

Southwest MCOs 96,307 11,597 21,297 8,076 23,363 20,317 22,256 29,826

Other or system

default

31 Gateway 1,775 6 197 9 61 79 62 41

32 United 781 5 70 13 36 32 103 96

34 UPMC 4,229 57 296 102 139 301 213 176

59 Aetna 354 1 49 10 23 25 50 17

Southwest MCOs 7,139 69 612 134 259 437 428 330

Native Hawaiian or

Other Pacific Islander

31 Gateway 28 0 5 0 2 5 1 2

32 United 17 0 0 0 0 0 2 1

34 UPMC 80 2 9 4 5 4 4 13

59 Aetna 11 0 0 0 0 0 1 1

Southwest MCOs 136 2 14 4 7 9 8 17

Unknown

31 Gateway 1,293 9 69 7 43 61 36 33

32 United 657 8 37 8 36 45 47 72

34 UPMC 3,558 60 223 27 141 305 171 241

59 Aetna 456 6 24 5 21 29 25 23

Southwest MCOs 5,964 83 353 47 241 440 279 369

MCO TOTAL

31 Gateway 58,869 1,012 8,605 700 6,104 5,398 3,653 4,000

32 United 20,574 495 2,212 1,107 3,670 1,156 5,115 9,135

34 UPMC 102,003 10,055 13,182 5,909 13,636 14,612 15,120 19,582

59 Aetna 7,904 432 1,347 696 2,068 936 2,717 829

TOTAL l/E 189,350 11,994 -re27,954 p y8,412 25,478 22,102 26,605 33,546


11


Southwest cont.

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

Black or African

American

31 Gateway 15 86 944 17 707 1,453 35,660

32 United 29 84 207 25 584 796 12,623

34 UPMC 38 233 888 56 1,645 2,142 44,672

59 Aetna 7 31 125 17 163 165 4,590

Southwest MCOs 89 434 2,164 115 3,099 4,556 97,545

American Indian or

Alaskan Native

31 Gateway 0 0 7 1 7 28 215

32 United 4 6 1 4 6 13 106

34 UPMC 7 17 13 7 28 46 605

59 Aetna 0 3 1 2 2 5 56

Southwest MCOs 11 26 22 14 43 92 982

Asian

31 Gateway 2 24 12 5 20 41 979

32 United 3 5 4 2 20 30 630

34 UPMC 9 63 43 22 130 257 6,003

59 Aetna 4 2 3 3 9 20 280

Southwest MCOs 18 94 62 32 179 348 7,892

White

31 Gateway 802 2,286 5,877 1,742 4,756 9,401 78,504

32 United 3,306 1,604 1,225 2,720 4,318 6,648 49,683

34 UPMC 3,266 8,318 7,580 6,359 16,090 27,979 207,695

59 Aetna 361 490 619 998 1,162 1,721 16,785

Southwest MCOs 7,735 12,698 15,301 11,819 26,326 45,749 352,667

Other or system

default

31 Gateway 13 30 47 26 93 180 2,619

32 United 16 19 31 24 85 146 1,457

34 UPMC 20 92 108 54 322 548 6,657

59 Aetna 5 19 14 10 31 60 668

Southwest MCOs 54 160 200 114 531 934 11,401

Native Hawaiian or


31 Gateway 0 2 1 1 0 3 50

32 United 0 0 1 0 4 1 26

34 UPMC 3 1 2 1 10 17 155

59 Aetna 0 0 0 0 1 2 16

Southwest MCOs 3 3 4 2 15 23 247

Unknown

31 Gateway 1 34 46 6 98 170 1,906

32 United 6 29 12 18 82 156 1,213

34 UPMC 25 132 94 70 397 736 6,180

59 Aetna 5 17 13 20 43 83 770

Southwest MCOs 37 212 165 114 620 1,145 10,069

MCO TOTAL

31 Gateway 833 2,462 6,934 1,798 5,681 11,276 119,933

32 United 3,364 1,747 1,481 2,793 5,099 7,790 65,738

34 UPMC 3,368 8,856 8,728 6,569 18,622 31,725 271,967

59 Aetna 382 562 775 1,050 1,411 2,056 23,165

TOTAL 7,947 13,627 17,918 12,210 30,813 52,847 480,803


12


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


51 Gateway 158 1,433 1,483 10,869 94 3 21

52 United 247 751 492 3,702 61 4 27

53 Aetna 57 748 380 2,454 674 19 38

54 UPMC 47 666 164 1,243 35 9 114

57 AmeriHealth 57 3,411 528 1,820 1,047 14 54

Lehigh/Capital MCOs 566 7,009 3,047 20,088 1,911 49 254

American Indian or

Alaskan Native

51 Gateway 17 22 41 59 7 1 0

52 United 11 22 12 32 3 0 1

53 Aetna 5 13 17 32 16 1 0

54 UPMC 3 26 9 13 4 2 0

57 AmeriHealth 1 54 9 27 36 3 2

Lehigh/Capital MCOs 37 137 88 163 66 7 3

Asian

51 Gateway 33 183 319 1,511 12 0 1

52 United 41 122 141 574 2 0 1

53 Aetna 9 127 120 298 51 1 6

54 UPMC 15 112 47 231 0 2 13

57 AmeriHealth 8 305 103 217 109 0 4

Lehigh/Capital MCOs 106 849 730 2,831 174 3 25

White

51 Gateway 3,626 7,184 8,543 8,669 750 161 430

52 United 3,660 4,391 2,463 3,641 528 285 593

53 Aetna 1,028 3,816 2,898 3,424 6,497 729 930

54 UPMC 1,086 5,196 1,266 1,948 348 535 3,397

57 AmeriHealth 1,234 14,142 3,727 2,485 9,276 666 1,517

Lehigh/Capital MCOs 10,634 34,729 18,897 20,167 17,399 2,376 6,867


51 Gateway 203 6,087 1,302 5,830 75 0 9

52 United 531 2,550 471 1,807 47 5 10

53 Aetna 87 1,567 318 1,040 573 12 15

54 UPMC 87 2,093 204 623 34 0 44

57 AmeriHealth 104 22,390 471 1,178 1,386 16 12

Lehigh/Capital MCOs 1,012 34,687 2,766 10,478 2,115 33 90


Pacific Islander

51 Gateway 4 4 16 29 0 0 0

52 United 1 13 5 14 1 0 0

53 Aetna 1 13 8 8 9 0 0

54 UPMC 4 17 4 5 1 0 2

57 AmeriHealth 2 32 6 8 11 0 3


Unknown

51 Gateway 102 422 491 1,136 46 0 2

52 United 151 292 193 545 31 0 3

53 Aetna 57 288 244 407 349 4 2

54 UPMC 48 343 83 294 21 0 28

57 AmeriHealth 59 1,205 229 375 694 3 11

Lehigh/Capital MCOs 417 2,550 1,240 2,757 1,141 7 46

MCO TOTAL

51 Gateway 4,143 15,335 12,195 28,103 984 165 463

52 United 4,642 8,141 3,777 10,315 673 294 635

53 Aetna 1,244 6,572 3,985 7,663 8,169 766 991

54 UPMC 1,290 8,453 1,777 4,357 443 548 3,598

57 AmeriHealth 1,465 41,539 5,073 6,110 12,559 702 1,603

TOTAL 12,784 80,040 26,807 56,548 22,828 2,475 7,290

Racial/Ethnic

information is self-

reported by consumers

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 03/08/18 .

13


Lehigh/Capital cont.

Racial/Ethnic

information is self-

reported by consumers.

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

Black or African

American

51 Gateway 1,913 612 3,003 1,844 41 2,422 23,896

52 United 1,276 112 801 343 8 3,860 11,684

53 Aetna 345 85 487 338 32 1,213 6,870

54 UPMC 941 143 798 305 9 947 5,421

57 AmeriHealth 3,314 166 4,256 2,529 15 2,271 19,482

Lehigh/Capital MCOs 7,789 1,118 9,345 5,359 105 10,713 67,353

American Indian or

Alaskan Native

51 Gateway 41 10 32 29 3 63 325

52 United 28 0 9 6 0 48 172

53 Aetna 13 3 3 11 4 36 154

54 UPMC 30 1 13 9 0 31 141

57 AmeriHealth 56 6 50 67 1 65 377

Lehigh/Capital MCOs 168 20 107 122 8 243 1,169

Asian

51 Gateway 928 118 337 192 8 212 3,854

52 United 315 24 125 52 2 253 1,652

53 Aetna 77 16 68 57 5 111 946

54 UPMC 367 17 149 59 2 70 1,084

57 AmeriHealth 725 63 632 484 1 193 2,844

Lehigh/Capital MCOs 2,412 238 1,311 844 18 839 10,380

White

51 Gateway 14,613 9,520 15,470 7,491 3,431 15,632 95,520

52 United 5,889 1,240 3,748 1,854 591 12,196 41,079

53 Aetna 2,102 1,306 1,722 1,532 646 4,956 31,586

54 UPMC 5,904 1,322 3,631 1,804 288 4,592 31,317

57 AmeriHealth 15,270 1,747 26,540 15,283 931 8,636 101,454



51 Gateway 4,455 3,531 2,823 2,979 75 2,734 30,103

52 United 2,518 415 615 383 21 4,593 13,966

53 Aetna 534 424 292 277 18 932 6,089

54 UPMC 1,530 414 597 371 12 932 6,941

57 AmeriHealth 8,694 1,204 4,464 4,792 21 2,857 47,589

Lehigh/Capital MCOs 17,731 5,988 8,791 8,802 147 12,048 104,688

Native Hawaiian or


51 Gateway 14 14 29 10 0 17 137

52 United 18 5 24 5 0 39 125

53 Aetna 4 3 4 4 0 12 66

54 UPMC 3 0 18 8 0 9 71

57 AmeriHealth 37 4 45 30 0 22 200


Unknown

51 Gateway 1,220 412 493 362 44 587 5,317

52 United 598 72 239 132 14 709 2,979

53 Aetna 215 78 107 98 19 353 2,221

54 UPMC 733 92 235 143 3 372 2,395

57 AmeriHealth 1,720 160 889 684 21 609 6,659

Lehigh/Capital MCOs 4,486 814 1,963 1,419 101 2,630 19,571

MCO TOTAL

51 Gateway 23,184 14,217 22,187 12,907 3,602 21,667 159,152

52 United 10,642 1,868 5,561 2,775 636 21,698 71,657

53 Aetna 3,290 1,915 2,683 2,317 724 7,613 47,932

54 UPMC 9,508 1,989 5,441 2,699 314 6,953 47,370

57 AmeriHealth 29,816 3,350 36,876 23,869 990 14,653 178,605

TOTAL 76,440 23,339 72,748 44,567 6,266 72,584 504,716


14


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


35 UPMC 20 107 102 435 42 5,046 2

36 Gateway 0 17 30 43 6 3,630 1

37 AmeriHealth 6 23 35 33 8 1,274 0

56 Aetna 1 22 20 42 2 2,451 0

New West MCOs 27 169 187 553 58 12,401 3


Native

35 UPMC 2 3 10 28 12 108 2

36 Gateway 0 1 0 2 0 26 5

37 AmeriHealth 1 2 6 1 1 11 0

56 Aetna 0 1 0 0 0 43 1

New West MCOs 3 7 16 31 13 188 8

Asian

35 UPMC 8 14 56 46 6 1,439 1

36 Gateway 0 5 3 0 0 223 1

37 AmeriHealth 0 2 7 1 0 169 0

56 Aetna 0 6 5 1 1 116 0

New West MCOs 8 27 71 48 7 1,947 2

White

35 UPMC 825 4,007 10,140 11,626 3,420 24,110 529

36 Gateway 40 737 1,294 953 425 9,361 91

37 AmeriHealth 95 524 1,910 992 276 4,151 78

56 Aetna 43 566 1,726 1,146 270 6,590 52

New West MCOs 1,003 5,834 15,070 14,717 4,391 44,212 750


35 UPMC 5 43 59 86 14 1,681 3

36 Gateway 0 9 13 8 4 914 1

37 AmeriHealth 1 6 14 8 1 318 0

56 Aetna 0 3 14 8 2 561 2

New West MCOs 6 61 100 110 21 3,474 6


Pacific Islander

35 UPMC 0 2 2 1 0 21 0

36 Gateway 0 0 0 0 0 8 0

37 AmeriHealth 0 0 0 0 0 4 0

56 Aetna 0 1 0 3 0 6 0

New West MCOs 0 3 2 4 0 39 0

Unknown

35 UPMC 2 43 65 111 19 375 0

36 Gateway 0 4 8 10 2 139 0

37 AmeriHealth 0 5 17 8 2 69 0

56 Aetna 0 1 18 12 2 114 0

New West MCOs 2 53 108 141 25 697 0

MCO TOTAL

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

36 Gateway 40 773 1,348 1,016 437 14,301 99

37 AmeriHealth 103 562 1,989 1,043 288 5,996 78

56 Aetna 44 600 1,783 1,212 277 9,881 55

TOTAL 1,049 6,154 15,554 15,604 4,515 62,958 769


15


Northwest cont.

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


35 UPMC 66 75 1,789 11 193 45 7,933

36 Gateway 7 5 702 0 29 11 4,481

37 AmeriHealth 6 9 474 17 27 6 1,918

56 Aetna 3 11 459 0 30 9 3,050

New West MCOs 82 100 3,424 28 279 71 17,382


Native

35 UPMC 10 17 15 4 15 15 241

36 Gateway 2 1 4 0 4 1 46

37 AmeriHealth 2 0 7 4 4 3 42

56 Aetna 0 4 3 0 2 4 58

New West MCOs 14 22 29 8 25 23 387

Asian

35 UPMC 18 19 90 2 26 7 1,732

36 Gateway 2 1 20 0 3 0 258

37 AmeriHealth 2 9 15 0 5 5 215

56 Aetna 0 1 13 1 1 1 146

New West MCOs 22 30 138 3 35 13 2,351

White

35 UPMC 6,509 6,133 11,780 1,781 6,898 4,646 92,404

36 Gateway 893 283 3,017 21 820 658 18,593

37 AmeriHealth 328 1,228 1,702 1,311 1,042 737 14,374

56 Aetna 396 675 1,624 61 987 489 14,625

New West MCOs 8,126 8,319 18,123 3,174 9,747 6,530 139,996


35 UPMC 35 37 200 11 60 33 2,267

36 Gateway 2 4 39 1 10 4 1,009

37 AmeriHealth 1 9 40 9 9 2 418

56 Aetna 4 3 29 1 11 5 643

New West MCOs 42 53 308 22 90 44 4,337


Pacific Islander

35 UPMC 0 3 9 1 2 2 43

36 Gateway 0 0 1 0 0 0 9

37 AmeriHealth 0 0 0 1 1 1 7

56 Aetna 0 0 0 0 1 0 11

New West MCOs 0 3 10 2 4 3 70

Unknown

35 UPMC 29 26 161 25 58 18 932

36 Gateway 2 0 43 0 8 7 223

37 AmeriHealth 4 3 34 13 7 2 164

56 Aetna 2 0 34 1 5 3 192

New West MCOs 37 29 272 39 78 30 1,511

MCO TOTAL

35 UPMC 6,667 6,310 14,044 1,835 7,252 4,766 105,552

36 Gateway 908 294 3,826 22 874 681 24,619

37 AmeriHealth 343 1,258 2,272 1,355 1,095 756 17,138

56 Aetna 405 694 2,162 64 1,037 511 18,725

TOTAL 8,323 8,556 22,304 3,276 10,258 6,714 166,034


16


Northeast

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


41 AmeriHealth NE 43 224 111 28 74 12 846 1,975

44 Geisinger 64 104 242 92 218 19 2,554 4,543

50 Aetna 56 47 156 23 70 11 684 1,387

New East MCOs 163 375 509 143 362 42 4,084 7,905

American Indian or

Alaskan Native

41 AmeriHealth NE 6 18 3 3 5 2 21 29

44 Geisinger 11 6 16 4 11 2 67 45

50 Aetna 6 2 9 0 5 2 19 10

New East MCOs 23 26 28 7 21 6 107 84

Asian

41 AmeriHealth NE 22 18 69 8 15 1 210 116

44 Geisinger 22 16 148 17 44 8 986 413

50 Aetna 5 3 100 1 10 6 188 89

New East MCOs 49 37 317 26 69 15 1,384 618

White

41 AmeriHealth NE 2,791 6,669 2,280 1,108 1,338 701 4,959 10,207

44 Geisinger 4,552 2,488 5,645 4,884 6,606 1,546 22,927 31,055

50 Aetna 3,416 881 2,096 720 952 608 3,837 5,943

New East MCOs 10,759 10,038 10,021 6,712 8,896 2,855 31,723 47,205


41 AmeriHealth NE 32 256 62 17 54 80 1,015 5,415

44 Geisinger 26 111 112 68 146 140 3,925 8,043

50 Aetna 23 60 59 14 37 56 671 1,334

New East MCOs 81 427 233 99 237 276 5,611 14,792


Pacific Islander

41 AmeriHealth NE 0 0 4 2 1 0 3 8

44 Geisinger 1 0 2 0 3 0 16 36

50 Aetna 3 1 5 0 2 0 12 7

New East MCOs 4 1 11 2 6 0 31 51

Unknown

41 AmeriHealth NE 29 115 58 13 21 20 216 317

44 Geisinger 37 48 113 60 75 16 782 730

50 Aetna 35 26 49 15 19 11 168 178

New East MCOs 101 189 220 88 115 47 1,166 1,225

MCO TOTAL

41 AmeriHealth NE 2,923 7,300 2,587 1,179 1,508 816 7,270 18,067

44 Geisinger 4,713 2,773 6,278 5,125 7,103 1,731 31,257 44,865

50 Aetna 3,544 1,020 2,474 773 1,095 694 5,579 8,948

TOTAL 11,180 11,093 11,339 7,077 9,706 3,241 44,106 71,880

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 908 46 2,481 14 162 350 392 43

44 Geisinger 2,129 88 2,333 36 416 333 538 88

50 Aetna 218 44 1,146 7 208 122 181 21

New East MCOs 3,255 178 5,960 57 786 805 1,111 152

American Indian or

Alaskan Native

41 AmeriHealth NE 10 3 38 1 8 16 15 1

44 Geisinger 23 4 43 5 10 20 20 4

50 Aetna 3 1 19 1 6 4 9 1

New East MCOs 36 8 100 7 24 40 44 6

Asian

41 AmeriHealth NE 20 5 177 5 14 16 50 19

44 Geisinger 72 17 200 19 53 51 73 7

50 Aetna 11 10 64 7 12 11 14 9

New East MCOs 103 32 441 31 79 78 137 35

White

41 AmeriHealth NE 4,126 2,028 8,830 294 2,690 1,948 7,741 1,065

44 Geisinger 12,624 4,390 7,543 1,460 9,409 4,306 13,252 2,791

50 Aetna 1,289 1,573 2,675 275 3,100 1,008 2,842 838

New East MCOs 18,039 7,991 19,048 2,029 15,199 7,262 23,835 4,694


41 AmeriHealth NE 88 35 2,414 8 179 305 573 23

44 Geisinger 187 63 2,178 34 410 333 653 81

50 Aetna 30 26 924 5 142 149 147 12

New East MCOs 305 124 5,516 47 731 787 1,373 116


Pacific Islander

41 AmeriHealth NE 7 1 34 0 1 6 7 0

44 Geisinger 4 3 12 2 8 5 7 2

50 Aetna 1 1 9 1 3 0 2 1

New East MCOs 12 5 55 3 12 11 16 3

Unknown

41 AmeriHealth NE 42 10 528 2 43 86 127 12

44 Geisinger 105 18 469 16 130 141 195 36

50 Aetna 20 3 267 7 36 59 34 20

New East MCOs 167 31 1,264 25 209 286 356 68

MCO TOTAL

41 AmeriHealth NE 5,201 2,128 14,502 324 3,097 2,727 8,905 1,163

44 Geisinger 15,144 4,583 12,778 1,572 10,436 5,189 14,738 3,009

50 Aetna 1,572 1,658 5,104 303 3,507 1,353 3,229 902

TOTAL 21,917 8,369 32,384 2,199 17,040 9,269 26,872 5,074



18


Northeast cont.

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


41 AmeriHealth NE 2 12 82 52 46 10 7,913

44 Geisinger 5 36 21 182 125 34 14,200

50 Aetna 8 12 17 49 36 6 4,509

New East MCOs 15 60 120 283 207 50 26,622

American Indian or

Alaskan Native

41 AmeriHealth NE 0 2 15 0 3 0 199

44 Geisinger 1 8 1 4 15 4 324

50 Aetna 0 1 1 1 4 4 108

New East MCOs 1 11 17 5 22 8 631

Asian

41 AmeriHealth NE 1 2 14 4 14 2 802

44 Geisinger 0 15 6 20 31 14 2,232

50 Aetna 0 0 0 1 5 1 547

New East MCOs 1 17 20 25 50 17 3,581

White

41 AmeriHealth NE 135 1,095 5,792 831 1,551 737 68,916

44 Geisinger 491 4,465 963 2,428 5,366 3,296 152,487

50 Aetna 136 936 552 693 1,102 606 36,078

New East MCOs 762 6,496 7,307 3,952 8,019 4,639 257,481


41 AmeriHealth NE 0 16 44 25 41 12 10,694

44 Geisinger 2 32 17 95 112 24 16,792

50 Aetna 0 8 13 17 27 4 3,758

New East MCOs 2 56 74 137 180 40 31,244


Pacific Islander

41 AmeriHealth NE 0 0 1 0 1 0 76

44 Geisinger 0 0 0 0 6 0 107

50 Aetna 0 0 0 0 2 0 50

New East MCOs 0 0 1 0 9 0 233

Unknown

41 AmeriHealth NE 4 7 25 5 20 10 1,710

44 Geisinger 1 31 16 30 65 29 3,143

50 Aetna 1 4 6 5 16 2 981

New East MCOs 6 42 47 40 101 41 5,834

MCO TOTAL

41 AmeriHealth NE 142 1,134 5,973 917 1,676 771 90,310 44 Geisinger 500 4,587 1,024 2,759 5,720 3,401 189,285 50 Aetna 145 961 589 766 1,192 623 46,031

TOTAL 787 6,682 7,586 4,442 8,588 4,795 325,626



19

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

Southeast

09 Bucks 15 Chester 23 Delaware 46 Montgomery 51 Philadelphia Southeast

Other/Unknown

42 United 23 31 23 31 96 204

43 Aetna 23 13 17 35 73 161

45 Health Partners 15 22 19 34 144 234

47 Keystone 61 24 57 106 207 455

Southeast MCOs 122 90 116 206 520 1,054

Non-Hispanic

42 United 5,149 9,676 8,639 8,368 48,574 80,406

43 Aetna 6,582 6,083 10,122 10,410 32,188 65,385

45 Health Partners 10,540 2,492 7,932 10,819 148,552 180,335

47 Keystone 35,866 18,127 65,792 48,806 219,479 388,070

Southeast MCOs 58,137 36,378 92,485 78,403 448,793 714,196

Hispanic

42 United 632 3,305 474 1,298 6,532 12,241

43 Aetna 570 1,170 546 869 4,258 7,413

45 Health Partners 1,631 342 753 1,313 68,460 72,499

47 Keystone 4,431 4,268 3,788 6,284 28,132 46,903

Southeast MCOs 7,264 9,085 5,561 9,764 107,382 139,056

TOTAL 65,523 45,553 98,162 88,373 556,695 854,306



20


Southwest

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

Other/Unknown

31 Gateway 53 0 3 0 3 8 1 1

32 United 35 1 2 0 2 2 5 5

34 UPMC 181 5 9 4 12 23 9 18

59 Aetna 24 0 2 1 0 4 1 1

Southwest MCOs 293 6 16 5 17 37 16 25

Non-Hispanic

31 Gateway 57,966 1,000 11,075 694 6,024 5,292 3,579 3,963

32 United 20,114 492 2,157 1,099 3,615 1,122 5,002 9,064

34 UPMC 99,454 9,970 13,008 5,830 13,439 14,300 14,953 19,381

59 Aetna 7,673 429 1,306 688 2,033 911 2,680 807

Southwest MCOs 185,207 11,891 27,546 8,311 25,111 21,625 26,214 33,215

Hispanic

31 Gateway 850 12 135 6 77 98 73 36

32 United 425 2 53 8 53 32 108 66

34 UPMC 2,368 80 165 75 185 289 158 183

59 Aetna 207 3 39 7 35 21 36 21

Southwest MCOs 3,850 97 392 96 350 440 375 306

TOTAL 189,350 11,994 27,954 8,412 25,478 22,102 26,605 33,546



21


Southwest cont.

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

Other/Unknown

31 Gateway 1 0 0 1 10 5 86

32 United 2 2 1 0 4 23 84

34 UPMC 2 6 4 4 15 33 325

59 Aetna 0 3 0 0 4 5 45

Southwest MCOs 5 11 5 5 33 66 540

Non-Hispanic

31 Gateway 827 2,436 6,875 1,778 5,578 11,162 118,249

32 United 3,343 1,719 1,449 2,767 5,005 7,657 64,605

34 UPMC 3,342 8,765 8,546 6,503 18,320 31,324 267,135

59 Aetna 381 544 764 1,038 1,367 2,017 22,638

Southwest MCOs 7,893 13,464 17,634 12,086 30,270 52,160 472,627

Hispanic

31 Gateway 5 26 59 19 93 109 1,598

32 United 19 26 31 26 90 110 1,049

34 UPMC 24 85 178 62 287 368 4,507

59 Aetna 1 15 11 12 40 34 482

Southwest MCOs 49 152 279 119 510 621 7,636

TOTAL 7,947 13,627 17,918 12,210 30,813 52,847 480,803



22


Lehigh/Capital

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

Other/Unknown

51 Gateway 2 15 13 16 4 0 0

52 United 4 11 11 20 0 0 0

53 Aetna 5 13 7 15 9 0 0

54 UPMC 0 14 4 6 5 1 1

57 AmeriHealth 3 26 8 7 25 0 0


Non-Hispanic

51 Gateway 3,859 8,245 11,311 21,878 901 164 455

52 United 3,769 5,266 3,395 8,492 635 292 624

53 Aetna 1,097 4,752 3,759 6,699 7,530 752 980

54 UPMC 1,148 5,992 1,623 3,757 414 545 3,553

57 AmeriHealth 1,309 15,906 4,671 4,790 10,642 685 1,594


Hispanic

51 Gateway 282 7,075 871 6,209 79 1 8

52 United 869 2,864 371 1,803 38 2 11

53 Aetna 142 1,807 219 949 630 14 11

54 UPMC 142 2,447 150 594 24 2 44

57 AmeriHealth 153 25,607 394 1,313 1,892 17 9

Lehigh/Capital MCOs 1,588 39,800 2,005 10,868 2,663 36 83

TOTAL 12,784 80,040 26,807 56,548 22,828 2,475 7,290



23


Lehigh/Capital cont.

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

Other/Unknown

51 Gateway 27 5 11 11 1 15 120

52 United 7 5 9 6 2 18 93

53 Aetna 4 2 7 10 1 9 82

54 UPMC 34 3 16 14 0 4 102

57 AmeriHealth 37 3 49 33 1 21 213

Lehigh/Capital

MCOs 109 18 92 74 5 67 610

Non-Hispanic

51 Gateway 18,042 9,196 10,197 8,447 3,520 18,698 114,913

52 United 7,632 1,292 3,142 2,225 620 16,346 53,730

53 Aetna 2,669 1,365 1,684 1,922 705 6,513 40,427

54 UPMC 7,620 1,388 3,526 2,083 304 5,833 37,786

57 AmeriHealth 19,019 1,730 18,330 16,746 972 11,111 107,505

Lehigh/Capital

MCOs 54,982 14,971 36,879 31,423 6,121 58,501 354,361

Hispanic

51 Gateway 5,115 5,016 11,979 4,449 81 2,954 44,119

52 United 3,003 571 2,410 544 14 5,334 17,834

53 Aetna 617 548 992 385 18 1,091 7,423

54 UPMC 1,854 598 1,899 602 10 1,116 9,482

57 AmeriHealth 10,760 1,617 18,497 7,090 17 3,521 70,887

Lehigh/Capital

MCOs 21,349 8,350 35,777 13,070 140 14,016 149,745

TOTAL 76,440 23,339 72,748 44,567 6,266 72,584 504,716



24


Northwest

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

Other/Unknown

35 UPMC 0 3 3 6 0 24 0

36 Gateway 0 1 0 0 0 3 0

37 AmeriHealth 0 1 0 1 0 2 0

56 Aetna 0 0 0 3 0 3 0

New West MCOs 0 5 3 10 0 32 0

Non-Hispanic

35 UPMC 837 4,180 10,361 12,206 3,477 30,687 536

36 Gateway 39 769 1,341 1,006 435 12,983 94

37 AmeriHealth 100 556 1,964 1,033 281 5,567 78

56 Aetna 43 589 1,756 1,197 272 9,087 54

New West MCOs 1,019 6,094 15,422 15,442 4,465 58,324 762

Hispanic

35 UPMC 25 36 70 121 36 2,069 1

36 Gateway 1 3 7 10 2 1,315 5

37 AmeriHealth 3 5 25 9 7 427 0

56 Aetna 1 11 27 12 5 791 1

New West MCOs 30 55 129 152 50 4,602 7

TOTAL 1,049 6,154 15,554 15,604 4,515 62,958 769



25


Northwest cont.

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

Other/Unknown

35 UPMC 5 1 23 3 5 6 79

36 Gateway 0 0 2 0 1 0 7

37 AmeriHealth 0 0 9 1 1 1 16

56 Aetna 2 0 2 0 1 0 11

New West MCOs 7 1 36 4 8 7 113

Non-Hispanic

35 UPMC 6,591 6,234 13,843 1,809 7,163 4,737 102,661

36 Gateway 905 291 3,786 21 863 667 23,200

37 AmeriHealth 342 1,251 2,236 1,346 1,076 751 16,581

56 Aetna 402 692 2,139 63 1,024 507 17,825

New West MCOs 8,240 8,468 22,004 3,239 10,126 6,662 160,267

Hispanic

35 UPMC 71 75 178 23 84 23 2,812

36 Gateway 3 3 38 1 10 14 1,412

37 AmeriHealth 1 7 27 8 18 4 541

56 Aetna 1 2 21 1 12 4 889

New West MCOs 76 87 264 33 124 45 5,654

TOTAL 8,323 8,556 22,304 3,276 10,258 6,714 166,034



26


Northeast

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

Other/Unknown

41 AmeriHealth NE 6 4 6 2 1 1 14 10

44 Geisinger 4 3 13 5 3 2 47 33

50 Aetna 6 3 8 1 0 0 10 10

New East MCOs 16 10 27 8 4 3 71 53

Non-Hispanic

41 AmeriHealth NE 2,881 6,734 2,519 1,148 1,431 724 5,905 11,688

44 Geisinger 4,646 2,581 6,139 5,033 6,859 1,575 26,094 35,082

50 Aetna 3,511 937 2,393 758 1,028 626 4,646 7,224

New East MCOs 11,038 10,252 11,051 6,939 9,318 2,925 36,645 53,994

Hispanic

41 AmeriHealth NE 36 562 62 29 76 91 1,351 6,369

44 Geisinger 63 189 126 87 241 154 5,116 9,750

50 Aetna 27 80 73 14 67 68 923 1,714

New East MCOs 126 831 261 130 384 313 7,390 17,833

TOTAL 11,180 11,093 11,339 7,077 9,706 3,241 44,106 71,880




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 14 0 2 2 2 1

44 Geisinger 10 0 20 0 3 20 5 5

50 Aetna 2 0 11 0 2 4 1 3

New East MCOs 16 1 45 0 7 26 8 9

Non-Hispanic

41 AmeriHealth NE 5,083 2,052 11,727 306 2,786 2,254 7,872 1,119

44 Geisinger 14,882 4,443 10,251 1,526 9,672 4,596 13,578 2,890

50 Aetna 1,534 1,586 3,977 299 3,269 1,134 2,974 868

New East MCOs 21,499 8,081 25,955 2,131 15,727 7,984 24,424 4,877

Hispanic

41 AmeriHealth NE 114 75 2,761 18 309 471 1,031 43

44 Geisinger 252 140 2,507 46 761 573 1,155 114

50 Aetna 36 72 1,116 4 236 215 254 31

New East MCOs 402 287 6,384 68 1,306 1,259 2,440 188

TOTAL 21,917 8,369 32,384 2,199 17,040 9,269 26,872 5,074



28


Northeast cont.

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

Other/Unknown

41 AmeriHealth NE 0 0 1 1 3 0 75

44 Geisinger 0 1 0 4 2 4 184

50 Aetna 0 2 0 0 1 0 64

New East MCOs 0 3 1 5 6 4 323

Non-Hispanic

41 AmeriHealth NE 139 1,124 5,914 847 1,575 756 76,584

44 Geisinger 485 4,502 1,015 2,561 5,492 3,325 167,227

50 Aetna 142 945 580 724 1,125 616 40,896

New East MCOs 766 6,571 7,509 4,132 8,192 4,697 284,707

Hispanic

41 AmeriHealth NE 3 10 58 69 98 15 13,651

44 Geisinger 15 84 9 194 226 72 21,874

50 Aetna 3 14 9 42 66 7 5,071

New East MCOs 21 108 76 305 390 94 40,596

TOTAL 787 6,682 7,586 4,442 8,588 4,795 325,626



29

Mandatory February 2018 PLAN MAKE UP BY AGE GROUP AND GENDER

SOUTHEAST

42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

< 21 Yrs

Female 22,068 17,336 60,595 115,636 215,635 Male 22,924 18,631 61,472 124,171 227,198 Total 44,992 35,967 122,067 239,807 442,833

22-45 Yrs


46-64 Yrs


Over 64

Yrs

Female 376 277 1,041 1,631 3,325 Male 261 151 573 934 1,919 Total 637 428 1,614 2,565 5,244

TOTAL 92,851 72,959 253,068 435,428 854,306

SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

< 21 Yrs


22-45 Yrs


46-64 Yrs


Over 64

Yrs

Female 148 67 423 33 671 Male 81 41 275 24 421 Total 229 108 698 57 1,092

TOTAL 119,933 65,738 271,967 23,165 480,803



LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL

< 21 Yrs

Female 45,319 19,894 11,656 11,679 49,080 137,628

Male 47,855 20,705 12,390 12,681 51,725 145,356

Total 93,174 40,599 24,046 24,360 100,805 282,984

22-45 Yrs

Female 30,879 13,523 9,995 9,653 35,792 99,842

Male 15,030 8,210 7,157 6,495 17,416 54,308

Total 45,909 21,733 17,152 16,148 53,208 154,150

46-64 Yrs

Female 11,372 4,958 3,377 3,594 14,229 37,530

Male 8,043 4,104 3,185 3,078 9,505 27,915

Total 19,415 9,062 6,562 6,672 23,734 65,445

Over 64

Yrs

Female 444 157 106 105 585 1,397

Male 210 106 66 85 273 740

Total 654 263 172 190 858 2,137

TOTAL 159,152 71,657 47,932 47,370 178,605 504,716

NORTHWEST

35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

< 21 Yrs

Female 26,652 6,221 3,841 4,652 41,366

Male 28,443 6,500 4,071 4,795 43,809

Total 55,095 12,721 7,912 9,447 85,175

22-45 Yrs

Female 21,080 4,915 3,505 3,677 33,177

Male 12,701 3,349 2,753 2,832 21,635

Total 33,781 8,264 6,258 6,509 54,812

46-64 Yrs

Female 9,540 1,927 1,476 1,480 14,423

Male 6,996 1,682 1,472 1,257 11,407

Total 16,536 3,609 2,948 2,737 25,830

Over 64

Yrs

Female 80 12 14 16 122

Male 60 13 6 16 95

Total 140 25 20 32 217

TOTAL 105,552 24,619 17,138 18,725 166,034


31


NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

< 21 Yrs Female 22,711 48,135 11,317 82,163

Male 23,915 50,636 11,963 86,514

Total 46,626 98,771 23,280 168,677

22-45 Yrs Female 18,768 38,356 9,224 66,348

Male 10,986 22,024 6,781 39,791

Total 29,754 60,380 16,005 106,139

46-64 Yrs Female 7,752 16,965 3,594 28,311

Male 5,911 12,683 3,048 21,642

Total 13,663 29,648 6,642 49,953

Over 64 Yrs Female 183 302 61 546

Male 84 184 43 311

Total 267 486 104 857

TOTAL 90,310 189,285 46,031 325,626


Mandatory February 2018 PLAN MAKE UP BY AGE GROUP

SOUTHEAST

42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

< 21 Yrs 44,992 35,967 122,067 239,807 442,833

22-45 Yrs 32,550 26,726 84,341 128,182 271,799

46-64 Yrs 14,672 9,838 45,046 64,874 134,430

Over 64 Yrs 637 428 1,614 2,565 5,244

TOTAL 92,851 72,959 253,068 435,428 854,306

SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

< 21 Yrs 63,777 34,184 132,845 9,674 240,480

22-45 Yrs 37,555 21,635 90,276 9,529 158,995

46-64 Yrs 18,372 9,811 48,148 3,905 80,236

Over 64 Yrs 229 108 698 57 1,092

TOTAL 119,933 65,738 271,967 23,165 480,803

LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL

< 21 Yrs 93,174 40,599 24,046 24,360 100,805 282,984

22-45 Yrs 45,909 21,733 17,152 16,148 53,208 154,150

46-64 Yrs 19,415 9,062 6,562 6,672 23,734 65,445

Over 64 Yrs 654 263 172 190 858 2,137

TOTAL 159,152 71,657 47,932 47,370 178,605 504,716


33

Mandatory February 2018 PLAN MAKE UP BY AGE GROUP

NORTHWEST

35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

< 21 Yrs 55,095 12,721 7,912 9,447 85,175

22-45 Yrs 33,781 8,264 6,258 6,509 54,812

46-64 Yrs 16,536 3,609 2,948 2,737 25,830

Over 64 Yrs 140 25 20 32 217

TOTAL 105,552 24,619 17,138 18,725 166,034

NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

< 21 Yrs 46,626 98,771 23,280 168,677

22-45 Yrs 29,754 60,380 16,005 106,139

46-64 Yrs 13,663 29,648 6,642 49,953

Over 64 Yrs 267 486 104 857

TOTAL 90,310 189,285 46,031 325,626


34

HealthChoices Enrollment 2nd Quarter 2017 AID CATEGORY DISTRIBUTION

Southeast

Newly Eligible (45+) 10%

Newly Eligible (19-44)

22%

SSI & HH 16%

TANF/HB/MAGI (Ages 0-20)

42%

B&CC <1% TANF/HB/MAGI

(Ages 21+) 10%

Northwest



22%

SSI & HH 18%


41%

B&CC <1%

TANF/HB/MAGI (Ages 21+)

10%

Southwest B&CC <1%


11%


21%

Newly Eligible (45+) 11%SSI & HH

18%


40% Lehigh/Capital


B&CC <1%

Newly Eligible(19-44)

21%

SSI & HH 15%


45%


10%

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

(Ages 21+) 10%

35


22%

Newly Eligible(45+) 10%

SSI & HH 15%


42%

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.

HealthChoices Enrollment February 2018 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.

February 2018

Zone Percentage

Southeast 91.0%

Southwest 92.9%

Lehigh/Capital 92.3%

Northwest 94.8%

Northeast 92.2%

Total 92.2%

Source: Maximus

36

Medical Assistance Transportation Program

37

Based on Data Submitted by Each County

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 ... · 47 keystone 4,187 3,026 4,416 7,156 29,753...

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