36C10G19R0041-002.docx

image1.emf

Microsoft_Excel_Worksheet.xlsx

2011 A<65 P5 NRM

ATTACHMENT B

Row 2012 Model (BY11) - Scenario Z

Projected Enrollment, Utilization and VA Costs for Fiscal Year 2011

Healthcare Services Category Projections

Ages XXX, Priority XXX, Enrollee Types XXX

National

Enrollees/ Projected Average Average Projected Projected

Unique Annual Length Daily Cost Annual Annual

Type of Service Patients Admissions of Stay Census Per Service Utilization Expenditures

Projected Services Summary

AMBULATORY PRIMARY AND SPECIALTY CARE - DIAGNOSTICS AND THERAPIES $63.98 21,084,194 services $1,348,902,352

AMBULATORY PRIMARY AND SPECIALTY CARE - EVALUATION AND MANAGEMENT SERVICES $195.25 4,753,363 services $928,090,002

AMBULATORY PRIMARY AND SPECIALTY CARE - PROFESSIONAL SERVICES AND PROCEDURES $512.67 2,202,680 services $1,129,237,872

DENTAL $189.86 242,389 proced $46,019,899

INPATIENT MEDICINE AND SURGERY $3,061.82 569,000 days $1,742,174,150

LONG-TERM CARE INSTITUTIONAL $923.39 188,970 days $174,492,520

LONG-TERM CARE NON-INSTITUTIONAL $144.54 578,991 services $83,689,751

MENTAL HEALTH - INPATIENT $488.95 1,273,435 days $622,639,620

MENTAL HEALTH AND HOMELESS - OUTPATIENT $211.21 3,361,184 services $709,932,103

PHARMACY - OUTPATIENT PRESCRIPTIONS $24.39 35,111,704 scripts $856,541,241

PROSTHETICS $80.68 2,899,758 units $233,957,050

SPECIAL VA PROGRAM BEDSECTION CARE (Blind Rehab & SCI) $1,859.11 2,958 days $5,499,921

ALL MODELED BENEFITS TOTAL $7,881,176,481

ALL MODELED BENEFITS TOTAL without Long Term Care $7,622,994,211

PROXY - ALL MODELED BENEFITS TOTAL without Long Term Care (Comparable to the Base Year 2010 Model*) $7,622,289,760

Enrollment and Patient Summary

ENROLLMENT

Average Enrollment 1,211,763

Beginning of Year Enrollment 1,155,794

End of Year Enrollment 1,260,720

Unique Enrollment 1,282,081

Average Enrollment (Priority Level 1a) 0

ENROLLED PATIENTS

Unique Enrolled Patients Total 786,378

Details for Projected Services Summarized Above

AMBULATORY PRIMARY AND SPECIALTY CARE - DIAGNOSTICS AND THERAPIES

HM063_063 Radiology - General $106.47 1,374,148 proced $146,298,766

HM064_064 Radiology - CT/MRI/PET 560.72 398,630 proced 223,521,109

HM034_034 Pathology 18.94 14,708,678 proced 278,604,258

HM021_021 Cardiovascular 221.31 481,893 proced 106,646,539

HM030_030 Misc. Medical 210.55 1,166,056 proced 245,511,764

HM040_040 Office Administered Drugs 140.28 1,071,203 proced 150,263,202

HM058_058 Dialysis and Related Services 311.61 204,141 proced 63,613,440

HM036_036 Physical Medicine 93.24 688,468 visits 64,195,603

HM054_054 Chiropractic 88.29 24,042 visits 2,122,818

HM109_109 Recreational Therapy 72.99 130,054 stops 9,492,877

HM026_026 Immunizations 70.68 821,442 proced 58,056,130

HM018_018 Allergy Immunotherapy 28.32 12,828 visits 363,287

HM019_019 Allergy Testing 81.49 2,608 proced 212,560

Subtotal $63.98 21,084,194 services $1,348,902,352

AMBULATORY PRIMARY AND SPECIALTY CARE - EVALUATION AND MANAGEMENT SERVICES

HM081_081 Office Visits/Urgent Care/Physical Exams $195.25 4,753,363 visits $928,090,002

AMBULATORY PRIMARY AND SPECIALTY CARE - PROFESSIONAL SERVICES AND PROCEDURES

HM038_038 Surgery $972.01 558,129 proced $542,509,089

HM020_020 Anesthesia 365.30 77,287 proced 28,232,910

HM022_022 Consults 257.05 328,822 consults 84,522,489

HM023_023 Emergency Room Visits 561.73 484,640 visits 272,238,074

HM025_025 Hearing/Speech Exams 111.40 45,980 exams 5,122,329

HM059_059 Hearing Aid Services 167.46 24,486 visits 4,100,360

HM060_060 Prosthetic and Orthotic Services 515.14 75,841 visits 39,068,242

HM042_042 Vision Exams 193.19 272,035 exams 52,553,692

HM028_028 Maternity 1,033.85 1,483 proced 1,533,095

HM057_057 Nutritional Counseling 190.37 253,740 visits 48,304,611

HM056_056 Compensation & Pension Exams 168.30 58,640 visits 9,868,907

HM045_045 Ambulance 1,906.96 21,597 runs 41,184,075

Subtotal $512.67 2,202,680 services $1,129,237,872

DENTAL

HM841_841 Preventative and Basic Dental Services $117.08 103,680 proced $12,138,594

HM842_842 Minor Restorative Dental Services 226.16 117,186 proced 26,502,905

HM843_843 Major Restorative Dental Services 342.80 21,524 proced 7,378,400

Subtotal $189.86 242,389 proced $46,019,899

INPATIENT MEDICINE AND SURGERY

HM001_001 Medical 85,876.9 adm 4.4 $2,648.10 380,574 days $1,007,799,011

HM002_002 Surgical 28,437.0 adm 6.6 3,918.72 186,786 days 731,960,145

HM005_005 Maternity Deliveries 479.0 adm 3.0 1,482.98 1,421 days 2,106,781

HM006_006 Maternity Non-Deliveries 78.8 adm 2.8 1,400.20 220 days 308,213

Subtotal 114,871.7 adm 5.0 $3,061.82 569,000 days $1,742,174,150

*Adjusts the Total without LTC expenditures to remove the portion of Spinal Cord Injury & Disorders that was modeled as part of LTC services within the BY10 Model.

Sheet1 image2.emf

Microsoft_Excel_Worksheet1.xlsx

2011 A<65 P5 NRM

ATTACHMENT B

Row 2012 Model (BY11) - Scenario Z

Projected Enrollment, Utilization and VA Costs for Fiscal Year 2011

Healthcare Services Category Projections

Ages XXX, Priority XXX, Enrollee Types XXX

National

Enrollees/ Projected Average Average Projected Projected

Unique Annual Length Daily Cost Annual Annual

Type of Service Patients Admissions of Stay Census Per Service Utilization Expenditures

Projected Services Summary

LONG-TERM CARE INSTITUTIONAL

VA Community Living Centers (CLC)

HM000_342 Long Stay 121 $843.22 44,207 days $37,276,646

HM000_341 Short Stay 329 1,092.30 120,222 days 131,318,792

Subtotal 450 $1,025.33 164,430 days $168,595,438

Community Nursing Home (CNH)

HM332_332 Long Stay 14 $240.30 5,000 days $1,201,567

HM331_331 Short Stay 54 240.30 19,540 days 4,695,514

Subtotal 67 $240.30 24,540 days $5,897,081

LONG-TERM CARE NON-INSTITUTIONAL

HM352_352 VA Adult Day Health Care $153.46 4,180 stops $641,449

HM353_353 Community Adult Day Health Care 71.51 21,482 proced 1,536,193

HM350_350 Home-Based Primary Care 516.49 35,336 stops 18,251,021

HM357_357 Home Respite Care 82.38 6,544 proced 539,058

HM356_356 Purchased Skilled Home Care 131.74 149,938 proced 19,752,636

HM354_354 Home Hospice Care 174.76 70,161 proced 12,261,611

HM355_355 Homemaker/Home Health Aide Programs 53.93 208,207 proced 11,229,335

HM351_351 SCI&D Home Care 537.30 80 stops 43,190

HM107_107 Community Residential Care 413.98 7,576 stops 3,136,390

HM111_111 Home Telehealth 215.92 75,487 months 16,298,870

Subtotal $144.54 578,991 services $83,689,751

MENTAL HEALTH - INPATIENT

HM003_003 Acute Psychiatric 14,018.1 adm 7.6 $1,347.43 107,192 days $144,433,319

HM004_004 Acute Substance Abuse 14,424.0 adm 5.5 1,506.99 78,714 days 118,620,936

HM000_089 MH Residential Rehab 323.99 965,158 days 312,702,861

HM014_014 Comp Work Therapy/Transitional Residence (CWT/TR) 150.47 89,020 days 13,394,660

HM017_017 Sustained Treatment and Rehab (STAR I II III) 1,004.12 33,351 days 33,487,845

Subtotal $488.95 1,273,435 days $622,639,620

MENTAL HEALTH AND HOMELESS - OUTPATIENT

HM061_061 Outpatient Mental Health $260.33 716,605 visits $186,552,472

HM062_062 Psychotherapy (Ind. 45+ min / Group) 234.34 512,893 visits 120,189,237

HM033_033 Outpatient Substance Abuse 142.61 1,129,573 visits 161,090,169

HM102_102 Psychosocial Rehabilitation and Recovery Centers 112.45 160,080 stops 18,000,326

HM105_105 Mental Health Intensive Case Management (MHICM) 280.68 63,661 stops 17,868,551

HM106_106 Work Therapy 258.10 253,095 stops 65,322,980

HM108_108 MH RRTP Aftercare/Screening/Outreach 181.77 40,164 stops 7,300,767

HM103_103 Homeless 275.42 485,112 stops 133,607,600

Subtotal $211.21 3,361,184 services $709,932,103

PHARMACY - OUTPATIENT PRESCRIPTIONS

HM431_431 Prescription Drugs (Brand & Generic) $26.46 29,557,975 scripts $782,185,346

HM432_432 OTC Medication 11.66 3,461,458 scripts 40,364,315

HM433_433-HM436_436 Rx Related Supplies 16.25 2,092,271 scripts 33,991,580

Subtotal $24.39 35,111,704 scripts $856,541,241

PROSTHETICS

HM201_201 Glasses/Contacts $56.42 161,315 units $9,100,870

HM202_202 Hearing Aids 255.67 34,647 units 8,858,167

HM204_204 Oxygen 17.41 1,798,293 units 31,303,935

HM205_205 Wheelchairs 550.53 21,562 units 11,870,339

HM206_206 Medical Equipment Supplies 74.26 537,826 units 39,938,815

HM207_207 Prosthetics Artificial Limbs 590.23 1,610 units 950,365

HM208_208 Orthotics 67.30 242,514 units 16,320,535

HM209_209 Surgical Implants 1,387.40 81,606 units 113,220,807

HM203_203 VA Specialized Products 117.41 20,384 units 2,393,216

Subtotal $80.68 2,899,758 units $233,957,050

SPECIAL VA PROGRAM BEDSECTION CARE

HM010_010 Blind Rehab $1,382.95 106 days $146,266

HM011_011 Spinal Cord Injury & Disorders 1,876.77 2,853 days 5,353,655

Subtotal $1,859.11 2,958 days $5,499,921

Revenue Projections (For Use in Policy Scenario Estimates Only)

PROJECTED ANNUAL FIRST PARTY REVENUE Revenue

1 Inpatient Copay TBD

2 Long Term Care Copay TBD

3 Residential Rehab Treatment Copay TBD

4 Outpatient Basic/Specialty Copay TBD

5 Prescription Drugs Copay TBD

Other Revenue TBD

Subtotal TBD

PROJECTED ANNUAL THIRD PARTY REVENUE Revenue

1 Third Party Revenue - All Services TBD

*Adjusts the Total without LTC expenditures to remove the portion of Spinal Cord Injury & Disorders that was modeled as part of LTC services within the BY10 Model.

Sheet1