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N A T I O N A L P A C E A S S O C I A T I O N

Per Member Per Month (PMPM) Financial Benchmarking Report2015

Alexian Brothers Community Services - ChattanoogaC E N S U S 1 5 1 - 3 0 0

P E R M E M B E R P E R M O N T H ( P M P M ) F I N A N C I A L B E N C H M A R K I N G R E P O R T 2

I. Using the Reports

A. Description of the Data Set and LimitationsB. Calculation of Per Member Per Month (PMPM) DollarsC. Calculation of Expense as a Percent of Total RevenueD. Tables and Charts

II. PMPM and Percent of Income TablesSummary of Reports and Statistics Used

E. Report 1: Per-Member/Per-Month Dollar Value Report – Summary TableF. Report 2: Per-Member/Per-Month % of Total Revenue Report –

Statistics Table

III. Income and Expense, Income/Loss, Census ChartsSummary of Charts – Income, Expense, Income/Loss, Census

A. Income Charts Chart 1: Your Income SourcesChart 2: All Programs’ Income SourcesChart 3: All Income PMPM and %Chart 4: PACE - Medicare PMPM and %Chart 5: PACE - Medicaid PMPM and % Chart 6: PACE - Other PMPM and %Chart 7: Other Income PMPM and %

B. Expense Charts Chart 9: Your Top 5 Expenses Chart 10: All Programs’ Top 5 ExpensesChart 8: Expenses - All Chart 9: PACE CenterChart 10: Primary CareChart 11: Adult Day Care

Chart 12: Community Primary CareChart 13: Community Adult Day CareChart 14: Social ServicesChart 15: TherapyChart 16: Home CareChart 17: MealsChart 18: TransportationChart 19: Outpatient SpecialistChart 20: PharmacyChart 21: DME and SuppliesChart 22: Labs and DiagnosticsChart 23: Nursing HomeChart 24: HospitalChart 25: Sub-Acute RehabilitationChart 26: Assisted Living/Residential CareChart 27: AdministrativeChart 28: MarketingChart 29: InsuranceChart 30: DepreciationChart 31: FacilityChart 32: Other Expense

C. Income/Loss Chart Chart 35: Income/Loss PMPM and %

D. Census ChartChart 36: PACE Center Average Enrollment by ZIP Code

Appendices:

A. Per Member Per Month (PMPM) Cost Category Definitions and Specifications

B. Per Member Per Month (PMPM) Frequently Asked Questions about Data Entry

Table of Contents


A. Description of the Data Set and Limitations

The Data Set:The income and expense data presented in the following reports and charts were submitted to the National PACE Association by its member PACE programs. The data represent the income and expense of only fully capitated (i.e. capitated for Medicare and Medicaid) programs.

The submitted data was evaluated for internal consistency to assure that:

the total income reported equaled the sum of the values for each of the income categories reported

the total expenses reported equaled the sum of the values for each expense category

The net income or loss reported equaled the difference between the total income reported and the total expenses reported

Limitations:Beyond the tests for internal consistency for reported values that were significant outliers, an attempt was made to verify with the PACE program that submitted the information that the reported value was correct. In several cases, this resulted in adjustments to the data in consultation with the submitting program. In other cases, the outlier result was either accurate or could not be resolved because of data gaps.

For outlier results reflecting a gap in data, there were two common reasons:

For some programs, costs for the “PACE Center” category could not be accurately allocated across this category’s two subcategories: “Adult Day Center” and “Primary Care.” As a result, one of the two subcategories may have been assigned a disproportionately high amount of cost and the other a disproportionately low amount of cost. Extremely low values in either subcategory probably do not reflect true cost experience. The “PACE Center” category which rolls up the two subcategories is a more reliable indicator of cost experience.

Internally “contracted” costs incurred by some PACE programs for services provided by another component of the program’s sponsoring organization

could not be fully accounted for or isolated. As a result, in some cost categories, such as transportation or adult day care, the reported experience may underestimate the actual cost of providing these services.

As a result of these data gaps, the median value for all programs is likely to be a more reliable comparison than the mean (or average) which can be skewed by a single missing or inappropriately low value. Also, when considering the minimum value reported in a category, allowances should be made for the possibility that the value reflects a data gap rather than actual experience.

B. Calculation of Per Member Per Month (PMPM) DollarsTo calculate the PMPM for a revenue or expense item, the value reported for that item is divided by the total member months. Member months are months of service for each enrolled PACE participant. Each month of a participant’s enrollment in a PACE program is equal to one member month of service. For example, if a participant was enrolled in a PACE program for nine months from March through December, this participant would contribute nine member months to the program’s total number of member months.

Member months were not reported separately for Medicare, Medicaid or other payers; therefore, the income PMPM results for each of these payers reflect the average across all PACE participants rather than the average for just those participants covered by a particular payer.

C. Calculation of Income and Expense as a Percent of Total RevenueTo calculate income and expense as a percent of total revenue, each income or expense category’s value is divided by the value reported for total revenue. This percent represents the percentage of total income that is either:

derived from a particular income source, e.g. Medicare or Medicaid expended in a particular expense category, e.g. Social Work

D. Reports and Charts

I. Using the Reports


The two reports provided present the underlying data used to create the charts that follow.

The first report, ‘Per-Member/Per-Month Dollar Value,’ presents your program’s PMPM dollar value information for each revenue and expense item.

The second report, ‘Per-Member/Per-Month % of Total Revenue,’ presents your program’s PMPM percent of total revenue value information for each revenue and expense item.

In both reports, your program’s reported values are presented in the first column to the right of the item description. In addition to your own program’s value, the reports also contain information to help you compare both the dollar amount and percent of total revenue your program derives from specific revenue sources or expends on specific expense categories to other programs. The additional reported values on each report present a range of statistics for each income and expense category.

The statistics presented on the reports include:

Minimum » The lowest value reported across all the programs

1st Quartile » 25% of the programs reported a result that is below the 1st quartile value

while 75% reported a result that is above

Median » 50% of the programs reported a result that is below the median value

and 50% reported a result that is above the median value. The median is a measure of the central value, or typical result, reflected across all programs

3rd Quartile » 75% of the programs reported a result that is below the 3rd quartile

value, while 25% reported a result above

Maximum » The highest value reported across all programs

Mean » The average across all programs, including reported values of zero

Standard Deviation » It measures the distribution of reported results below and above the

mean. Assuming a normal distribution of results, you would expect 66% of all results to be within plus or minus one standard deviation from the mean. For example, the mean for All Revenue is $5,401 and the standard deviation is $906. We would expect 66% of all programs to have an All Revenue result between $4,495 ($5,401 - $906) and $6,307 ($5,401 + $906). You would expect 99% of all results to be within plus or minus two standard deviations from the mean.

Observations » The number of individual programs that contributed data that were

used in the calculation of the statistical values reported for the specific measure item

II. Reports


The charts are presented in two sets: Income Charts and Expense Charts. At the beginning of each set, two pie charts represent your program’s experience and the experience of all programs combined. The Income pie charts show the sources of income for your program

and for all programs as a percent of total income. The Expense pie charts show the top 5 expenses plus all remaining expenses for your program and all programs combined. These pie charts can help you compare your program’s income sources and top 5 expense categories to other programs.

Note: The Expense pie chart expresses expense categories as a percent of total expenses, not as a percent of total revenue. All other charts express the expense category’s value as a percent of total revenue.

A. Income ChartsFollowing the pie charts in the Income section, a bar graph depicts the range of experience reported across all programs as well as your program’s own result for total income. The first chart “Income: Total PMPM” shows your total income PMPM. In this chart and all other charts, the result for your program is plotted on the graph in relation to your program’s reported dollar value as it compares to the value being reported for the minimum, 1st quartile, median, 3rd quartile, and maximum results for the benchmarking item. You can use these results to compare your program to other programs. Subsequent bar graphs in the Income section show your income PMPM for each particular source (e.g. Medicare) as well as the percent of your total income derived from the source. In the charts showing both the PMPM (in bars) and the percent of income (in a line), the axis on the left is used to read the PMPM dollar value and the axis on the right is used to read the percent of income value.

B. Expense ChartsFollowing the pie charts in the Expense section, a series of bar and line graphs present the PMPM dollar values and percent of income values for each of the expense categories. Your program’s result is plotted on the graph in relation to your programs reported dollar value as it compares to the value being reported for the minimum, 1st quartile, median, 3rd quartile, and maximum results for the benchmarking item. Similar to the income charts, the axis on the left is used to read the bars reflecting the PMPM dollars and the axis on the right is used to read the line reflecting the percent of income expended.

C. Income/Loss ChartThe Income/Loss chart follows the same format as the income and expense charts. This chart shows values indicating a net loss below the line and programs with a net income above the line. The bars correspond to the left axis indicating PMPM dollars and the line corresponds to the right axis indicating percent of revenue.

D. Census ChartsThe first of the census charts presents a graphic representation of PACE program enrollment and physical location in relation to ZIP Code on a national level. Your program’s values for Member Months and Average enrollment are displayed at the top the page. The key to the left of the map displays six value ranges representing average enrollment with corresponding symbols. The symbols are plotted on the map area representing PACE programs with an average enrollment that falls within the listed range. The number shown to the left of the map key reports the number of individual PACE programs that are being plotted for a particular enrollment range.

III. Income and Expense, Income/Loss, Census Charts


Per Member Per Month (PMPM) Cost Category Definitions

1. Functional Cost Categories Generally, costs are reported by function (e.g. PACE Center) rather than by input or resource (e.g. RN salaries).

Each functional cost category should include all expenses directly associated with the function (e.g. salaries, supplies).

General and administrative costs should be reported in the designated cost categories for these items (see Item Reference numbers 29-33 below) rather than allocated across all categories.

2. Allocation of Staff Expense Staff expenses should be allocated to one of the expense items as appropriate.

For staff expenses, include the following: salary, benefits (to include health insurance, pension, workmen’s compensation, employee transportation assistance, parking, uniforms), taxes, employee recognition, professional development expenses, productive and nonproductive time, and professional licenses paid by the organization.

An individual staff member’s expense may be allocated across multiple cost categories if the individual contributes to multiple functions.

3. Complete Transmittal In order to transmit a complete set of cost information, you must provide all of the required items. If you have incurred no expenses in a cost item, enter 0.

4. Cost Item Specifications The table below provides specific information on the costs to be assigned to each of the Per Member Per Month cost categories. The Item Reference Number in the table refers to the item’s number in the related data entry screen (the Excel spreadsheet).

Appendix A


Per Member Per Month (PMPM) Cost Category Specifications

Cost Category SpecificationsItem Ref. # Item Specification

1 Year-Ending Date for Data Transmitted The last day of the period for which income and expenses are being reported

2 Number of days in reported period Total number of days in the period for which income and expenses are being reported

3 Enrollment Total number of participants enrolled in the PACE program at the year-ending date

4 Member Months - All Total number of member months for the period being reported

5 Income - All Total income for the PACE program

6 PACE - Medicare Income received from Medicare for the provision of PACE services

7 PACE - Medicaid Income received from Medicaid for the provision of PACE services

8 PACE - OtherIncome received from sources other than Medicare or Medicaid (e.g. private pay) for the provision of PACE services

9 Income - Other Income not related to the delivery of PACE services (e.g. foundation grants, interest income)

10 Expenses - All Total of all expenses related to the PACE Program, as detailed below in items 11 – 31 below

11 PACE Center Sum of Primary Care (item # 12) and Adult Day (# 13) below

12 Primary Care – PACE Center based

Medical DirectorPrimary Care Physician(s) in Clinic or HomeNurse Practitioner in Clinic or HomeNursing Staff in Clinic or Day Center who provide Primary Care (Note: not home care nursing)Clinic Administrative StaffMedical RecordsMedical Records Staff

13 Adult Day Care – PACE Center

PACE Day Center Staff - allPACE Day Center Staff – AssistantsPACE Day Center SupervisorRecreational Therapy - ProgramRecreational Therapy - ContractedLaundry



14 Contracted, Off-site Primary CareContracted, Primary Care Costs of Physicians, Nurse Practitioners, and Nurses for delivering Primary Care in a location other than a PACE Center or Participant’s Home.

15 Contracted, Off-site Adult Day Care Contracted, Adult Day Care costs for services in a location other than a PACE Center

16 Social Services Social Work staff - all

17 Therapy

Occupational Therapy - ProgramOccupational Therapy - ContractedSpeech Therapy - ProgramSpeech Therapy - ContractedPhysical Therapy - ProgramPhysical Therapy - ContractedTherapy Provided Under Contract – Other (Note – do not include Recreational Therapy, see # 12 above)Therapy - Other

18 Home Care

Home Care – NursingHome Care – Personal AssistanceLifeline MonitoringHome Care - Other

19 Meals

FoodPlates and CutleryStaffContracted ServiceMeals - Other

20 Transportation

Outsourced Transportation Costs (incl. Ambulance for non-inpatient)Van Fleet: Van Leasing, Van Repairs, Van Maintenance, Auto Gas and OilTransportation Staff – Drivers, Assistants, OtherOther



21 Outpatient Specialist

AudiologyDentistryOptometryPodiatrySurgeryPathologyRadiologyOutpatient DialysisPsychiatry/PsychologyOther

22 Pharmacy

Prescription DrugsOver the Counter DrugsDispensing/AdministrativePharmacistOther

23 DME and Supplies Durable Medical EquipmentSupplies: Clinic Supplies, Day Center Supplies, Therapy Supplies, Other SuppliesOther

24 Labs and Diagnostics Lab CostsOther Diagnostic Service Costs (e.g. x-ray, MRI)Other

25 Nursing Home Short Stay/Respite Long Stay/Permanent PlacementOther



26 Hospital

AmbulanceEmergency RoomIntensive Care UnitMedical/SurgicalInpatient Rehabilitative (Acute Care Stay)Inpatient DialysisInpatient PsychiatricOther

27 Sub-Acute Rehabilitation Sub-Acute Rehabilitative Care/Skilled Nursing FacilitySub-Acute Rehabilitative Care/HospitalSub-Acute Rehabilitative Care/Other Place of Service

28Assisted Living/Residential Care

PACE HousingFoster Care/Group HomeResidential Care/Assisted LivingICF (>30 days)Other

29 Administrative

Admissions and Eligibility StaffProgram Management StaffTravelPostage and CourierPhotocopying and PrintingBank ChargesAccounting ServicesBooks and SubscriptionsManagement Support ServicesInformation SystemsLicensing FeesLegal FeesTranslation ServicesAdministrative SuppliesOther



30 MarketingMarketing StaffMarketing Expenses

31 InsuranceLiability InsuranceStop-loss InsuranceFacility Related Insurance

32 Depreciation

EquipmentBuildingVehiclesInformation Systems/Computers

33 Facility

PACE Center Rent/MortgagePACE Center Utility CostsFacility MaintenanceEquipment MaintenanceMaintenance StaffOther

34 Other Expense Expenses not specified above (please describe in Notes section)

35 Income (Loss) from operations Total Revenues minus Total Expenses

36

Medical Loss Ratio (MLR) Note: LISTED on the % of Total Revenue Report Only

Medical Loss Ratio is the ratio of the value of medical services provided to the amount of the premiums paid (Items 11-28 / Item 5)


Per Member Per Month (PMPM) Frequently Asked Questions about Data EntryPMPM Item # Subject Question Answer

multiple Employee Benefits How do I assign Employee Benefits expenses?

Assign employee benefits expenses to the cost item that the staff’s salary is associated with; you can prorate your total Employee Benefits expenses using the proportion of your total salaries that is assigned to different cost items

multiple FICA How do I assign FICA expenses? assign these expenses to the cost item that the staff’s salary is associated with; you can prorate your total FICA expenses using the proportion of your total salaries that is assigned to different cost items

26 Inpatient Specialist How do I assign inpatient specialists costs?

Assign inpatient specialists costs to the Hospital item (# 26)

33 Interest Expense How do I assign interest expense incurred by the program for cash flow/short term borrowing?

Assign interest expense for cash flow/short term borrowing to the Other expense item (# 33) and include a note explaining this

multiple, 31 Minor equipment How do I assign minor equipment expenses?

Assign minor equipment expenses to the expense item with which it is associated (e.g. Adult Day Care # 13) if the equipment is not depreciable; if the equipment is depreciable, assign the annual depreciation expense to the Depreciation expense item (# 31)

19 Nutritionist How do I assign Nutritionist Expense? Assign nutritionist expenses to the Meals item (# 19); this item will be re-titled to be “Meals and Nutrition”

26 Outpatient Hospital Services

How do I assign outpatient hospital service expenses?

Assign outpatient hospital service expenses to the Hospital expense item (# 26)

33 Pastoral Care How do I assign pastoral care staff costs?

Assign pastoral care staff costs to the Other expense item (# 33) and include a note explaining this

32 Phone How do I assign phone costs? Assign phone costs to the Facility item (# 32)

multiple Professional Development

How do I assign Professional Development (e.g. seminars, travel to conferences, registration fees) expenses?

Assign professional development expenses to the cost item that the staff’s salary is associated with; you can prorate your total Professional Development expenses using the proportion of your total salaries that is assigned to different cost items

23 Prosthetics How do I assign prosthetic expenses? Assign prosthetic expenses to the DME/Supplies expense item (# 23)

Appendix B

Audit Year(FinancialData)

Item # Chart # Category Your Value $ Minimum $ 1st Quartile $ Median $ 3rd Quartile $ Maximum $ # of POs (n)

2015 5 3 REVENUE - ALL

6 4 Revenue - Medicare

7 5 Revenue - Medicaid

8 6 Revenue - PACE Other

9 7 Revenue - Other

10 10 EXPENSES - ALL

11 11 Expenses - PACE Center

12 12 Expenses - PACE Center : Primary Care

13 13 Expenses - Day Center

14 14 Expenses - Community Primary Care

15 15 Expenses - Community Adult Day Care

16 16 Expenses - Social Services

17 17 Expenses - Therapy

18 18 Expenses - Home Care

19 19 Expenses - Meals

20 20 Expenses - Transportation

21 21 Expenses - Outpatient Specialist

22 22 Expenses - Pharmacy

23 23 Expenses - DME and Supplies

24 24 Expenses - Labs and Diagnostics

25 25 Expenses - Nursing Home

26 26 Expenses - Hospital

27 27 Expenses - Sub-Acute Rehabilitation

28 28 Expenses - Assisted Living / Residential Care

29 29 Expenses - Administrative

30 30 Expenses - Marketing

31 31 Expenses - Insurance

32 32 Expenses - Depreciation

33 33 Expenses - Facility

34 34 Expenses - Other

35 35 INCOME (LOSS)

23$8,339.00$6,731.50$6,440.00$5,824.00$2,155.00$22,403,861.00

23$3,774.00$3,315.50$2,818.00$2,492.50$1,004.00$11,884,496.00

23$4,295.00$3,656.50$3,297.00$2,882.50$1,084.00$10,418,336.00

23$412.00$220.50$84.00$1.50$0.00$42,779.00

23$135.00$90.50$39.00$1.00$0.00$58,250.00

23$8,052.00$6,716.50$6,246.00$5,564.00$1,843.00$19,962,095.00

23$1,369.00$904.50$744.00$641.00$200.00$2,320,998.00

23$697.00$554.00$466.00$349.00$111.00$2,029,564.00

23$718.00$400.50$272.00$202.00$0.00$291,434.00

23$288.00$0.00$0.00$0.00$0.00

23$146.00$0.00$0.00$0.00$0.00

23$191.00$132.00$109.00$89.00$35.00$449,811.00

23$337.00$229.50$177.00$153.50$95.00$717,214.00

23$2,199.00$831.00$513.00$334.00$61.00$1,080,806.00

23$214.00$165.50$129.00$98.50$41.00$534,394.00

23$669.00$440.50$365.00$253.50$165.00$1,610,390.00

23$799.00$392.50$312.00$261.50$92.00$1,039,980.00

23$1,093.00$824.00$699.00$586.00$242.00$2,225,267.00

23$187.00$122.00$86.00$50.00$0.00$181,192.00

23$143.00$66.00$48.00$28.00$0.00$134,682.00

23$1,355.00$821.50$585.00$298.50$55.00$2,387,400.00

23$1,300.00$871.50$540.00$350.00$156.00$1,420,459.00

23$346.00$98.50$0.00$0.00$0.00

23$881.00$202.50$139.00$22.00$0.00$528,885.00

23$1,513.00$887.50$740.00$605.50$271.00$4,062,916.00

23$574.00$86.00$60.00$35.50$0.00$391,545.00

23$141.00$50.00$35.00$13.00$0.00$24,726.00

23$171.00$108.50$86.00$62.50$12.00$364,804.00

23$740.00$229.50$183.00$130.50$19.00$486,628.00

23$757.00$154.00$21.00$0.00$0.00

23$793.00$406.50$262.00($81.00)($1,589.00)$2,441,765.00

H4402 | PMPM Dollars ($) | Report

Audit Year(FinancialData)

Item # Chart #Category Your Result % Minimum_% 1st Quartile_% Median_% 3rd Quartile_% Maximum_% # of POs_%)

2015 5 3 REVENUE - ALL

6 4 Revenue - Medicare

7 5 Revenue - Medicaid

8 6 Revenue - PACE Other

9 7 Revenue - Other

10 10 EXPENSES - ALL

11 11 Expenses - PACE Center

12 12 Expenses - PACE Center : Primary Care

13 13 Expenses - Day Center

14 14 Expenses - Community Primary Care

15 15 Expenses - Community Adult Day Care

16 16 Expenses - Social Services

17 17 Expenses - Therapy

18 18 Expenses - Home Care

19 19 Expenses - Meals

20 20 Expenses - Transportation

21 21 Expenses - Outpatient Specialist

22 22 Expenses - Pharmacy

23 23 Expenses - DME and Supplies

24 24 Expenses - Labs and Diagnostics

25 25 Expenses - Nursing Home

26 26 Expenses - Hospital

27 27 Expenses - Sub-Acute Rehabilitation

28 28 Expenses - Assisted Living / Residential Care

29 29 Expenses - Administrative

30 30 Expenses - Marketing

31 31 Expenses - Insurance

32 32 Expenses - Depreciation

33 33 Expenses - Facility

34 34 Expenses - Other

35 35 INCOME (LOSS)

36 36 MEDICAL LOSS RATIO (MLR)

23100.00%100.00%100.00%100.00%100.00%100.00%

2353.00%49.00%46.00%42.00%28.00%53.05%

2372.00%54.00%51.00%48.00%45.00%46.50%

236.00%4.00%2.00%0.00%0.00%0.19%

232.00%1.00%0.00%0.00%0.00%0.26%

23128.00%101.00%96.00%94.00%86.00%89.10%

2324.00%16.00%11.00%9.00%6.00%10.36%

2311.00%9.00%7.00%6.00%3.00%9.06%

2312.00%7.00%4.00%3.00%0.00%1.30%

235.00%0.00%0.00%0.00%0.00%0.00%

232.00%0.00%0.00%0.00%0.00%0.00%

233.00%2.00%2.00%1.00%1.00%2.01%

235.00%4.00%3.00%3.00%2.00%3.20%

2329.00%13.00%9.00%6.00%1.00%4.82%

234.00%2.00%2.00%2.00%1.00%2.39%

238.00%7.00%6.00%4.00%3.00%7.19%

2310.00%6.00%5.00%4.00%2.00%4.64%

2316.00%12.00%11.00%10.00%6.00%9.93%

233.00%2.00%1.00%1.00%0.00%0.81%

232.00%1.00%1.00%1.00%0.00%0.60%

2321.00%14.00%9.00%5.00%1.00%10.66%

2322.00%12.00%8.00%7.00%3.00%6.34%

235.00%2.00%0.00%0.00%0.00%0.00%

2314.00%3.00%2.00%0.00%0.00%2.36%

2319.00%15.00%12.00%10.00%7.00%18.13%

2310.00%1.00%1.00%1.00%0.00%1.75%

232.00%1.00%1.00%0.00%0.00%0.11%

233.00%2.00%1.00%1.00%0.00%1.63%

2313.00%4.00%3.00%2.00%1.00%2.17%

2313.00%2.00%0.00%0.00%0.00%0.00%

2314.00%6.00%4.00%-1.00%-28.00%10.90%

2390.00%82.00%76.00%73.00%65.00%65.31%

2015

Revenue - Medicare Revenue - Medicaid Revenue - PACE Other Revenue - Other

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

Your Results_%

53.05%

46.50%

0.19% 0.26%

H4402 | Chart 1 | Your Revenue Sources

2015

Revenue - Medicare Revenue - Medicaid Revenue - PACE Other Revenue - Other

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

Avg. Your Results_%

44.51%

51.94%

2.98%1.33%

Chart 2 | Average Revenue Sources for All Orgs

2015REVENUE - ALL

Your Result_$ Minimum $ 1st Quartile $ Median $ 3rd Quartile $ Maximum $

$0.00

$1,000.00

$2,000.00

$3,000.00

$4,000.00

$5,000.00

$6,000.00

$7,000.00

$8,000.00

Value

$6,688.00

$2,155.00

$5,824.00

$6,440.00

$6,731.50

$8,339.00

H4402 | Chart 3 | Revenue - ALL | PMPM Dollars ($)

2015Revenue - Medicare

Your Result_$ Minimum $ 1st Quartile_$ Median $ 3rd Quartile $ Maximum $

$0.00

$1,000.00

$2,000.00

$3,000.00

$4,000.00

Value

$3,548.00

$1,004.00

$2,492.50

$2,818.00

$3,315.50

$3,774.00

H4402 | Chart 4 | Revenue - Medicare | PMPM Dollars ($)

Audit Year (Financial Data) / Category

2015Revenue - Medicare

Your Result % Minimum_% 1st Quartile_% Median_% 3rd Quartile_% Maximum_%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

Value

53.05%

28.00%

42.00%

46.00%49.00%

53.00%

H4402 | Chart 4 | Revenue - Medicare | Percent (%) of Total Revenue

2015Revenue - Medicaid

Your Results_$ Minimum $ 1st Quartile $ Median $ 3rd Quartile $ Maximum $

$0.00

$1,000.00

$2,000.00

$3,000.00

$4,000.00

Value

$3,110.00

$1,084.00

$2,882.50

$3,297.00

$3,656.50

$4,295.00

H4402 | Chart 5 | Revenue - Medicaid | PMPM Dollars ($)

2015Revenue - Medicaid


0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Value

46.50% 45.00%48.00%

51.00%54.00%

72.00%

H4402 | Chart 5 | Revenue - Medicaid | Percent (%) of Total Revenue

2015Revenue - PACE Other


$0.00

$100.00

$200.00

$300.00

$400.00

Value $220.50

$412.00

$13.00

$84.00

$0.00 $1.50

H4402 | Chart 6 | Revenue - PACE Other | PMPM Dollars ($)

2015Revenue - PACE Other


0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

Value

0.19%0.00% 0.00%

2.00%

4.00%

6.00%

H4402 | Chart 6 | Revenue - PACE Other | Percent (%) of Total Revenue

2015Revenue - Other


$0.00

$50.00

$100.00

Value

$135.00

$17.00

$39.00

$90.50

$0.00 $1.00

H4402 | Chart 7 | Revenue - Other | PMPM Dollars ($)

2015Revenue - Other


0.00%

0.50%

1.00%

1.50%

2.00%

Value

0.26%

0.00% 0.00% 0.00%

1.00%

2.00%

H4402 | Chart 7 | Revenue - Other | Percent (%) of Total Revenue

Audit Year (Fin..Category Chart #

2015 Expenses -Administrative

29

Expenses - NursingHome

25

Expenses -Pharmacy

22

Expenses - PACECenter : PrimaryCare

12

Expenses -Transportation

20

Expenses - Hospital 26

18.13%

10.66%

9.93%

9.06%

7.19%

6.34%

H4402 | Chart 8 | Your Top 6 Expense Categories by Percent (%) of Total Expense

Audit Year (Fi..Category Chart #

2015 Expenses -Administrative

29

Expenses - Pharmacy 22

Expenses - Home Care 18

Expenses - Hospital 26

Expenses - NursingHome

25

Expenses - PACE Center: Primary Care

12

12.33%

10.98%

9.68%

9.59%

9.12%

7.32%

Chart 9 | Mean of All Orgs | Top 6 Expense Categories by Percent (%) of Total Expense

2015EXPENSES - ALL


$0.00

$2,000.00

$4,000.00

$6,000.00

$8,000.00

Value

$5,959.00

$1,843.00

$5,564.00

$6,246.00$6,716.50

$8,052.00

H4402 | Chart 10 | Expenses - ALL | PMPM Dollars ($)

2015EXPENSES - ALL


0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

140.00%

Value

101.00%

128.00%

89.10% 86.00%94.00% 96.00%

H4402 | Chart 10 | Expenses - ALL | Percent (%) of Total Revenue

2015Expenses - PACE Center


$0.00

$200.00

$400.00

$600.00

$800.00

$1,000.00

$1,200.00

$1,400.00

Value

$1,369.00

$693.00

$200.00

$641.00

$744.00

$904.50

H4402 | Chart 11 | Expenses - PACE Center | PMPM Dollars ($)

2015Expenses - PACE Center


0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

Value

10.36% 11.00%

16.00%

24.00%

6.00%

9.00%

H4402 | Chart 11 | Expenses - PACE Center | Percent (%) of Total Revenue

2015Expenses - PACE Center : Primary Care


$0.00

$200.00

$400.00

$600.00

Value

$606.00

$111.00

$349.00

$466.00

$554.00

$697.00

H4402 | Chart 12 | Expenses - PACE Center : Primary Care | PMPM Dollars ($)

2015Expenses - PACE Center : Primary Care


0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

Value

11.00%

9.06%

3.00%

6.00%

7.00%

9.00%

H4402 | Chart 12 | Expenses - PACE Center : Primary Care | Percent (%) of Total Revenue

2015Expenses - Day Center


$0.00

$200.00

$400.00

$600.00

Value

$202.00

$272.00

$400.50

$718.00

$87.00

$0.00

H4402 | Chart 13 | Expenses - Day Center | PMPM Dollars ($)

2015Expenses - Day Center


0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

Value

12.00%

1.30%

0.00%

3.00%

4.00%

7.00%

H4402 | Chart 13 | Expenses - Day Center | Percent (%) of Total Revenue

2015Expenses - Community Primary Care


$0.00

$50.00

$100.00

$150.00

$200.00

$250.00

$300.00

Dollars_$ PMPM

$288.00

$0.00 $0.00 $0.00 $0.00

H4402 | Chart 14 | Expenses - Community Primary Care | PMPM Dollars ($)

2015Expenses - Community Primary Care


0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

Value

0.00% 0.00% 0.00% 0.00% 0.00%

5.00%

H4402 | Chart 14 | Expenses - Community Primary Care | Percent (%) of Total Revenue

2015Expenses - Community Adult Day Care


$0.00

$50.00

$100.00

$150.00

Value

$146.00

$0.00 $0.00 $0.00 $0.00

H4402 | Chart 15 | Expenses - Community Adult Day Care | PMPM Dollars ($)

2015Expenses - Community Adult Day Care


0.00%

0.50%

1.00%

1.50%

2.00%

Value

0.00% 0.00% 0.00% 0.00% 0.00%

2.00%

H4402 | Chart 15 | Expenses - Community Adult Day Care | Percent (%) of Total Revenue

2015Expenses - Social Services


$0.00

$50.00

$100.00

$150.00

$200.00

Value

$134.00

$109.00

$132.00

$191.00

$35.00

$89.00

H4402 | Chart 16 | Expenses - Social Services | PMPM Dollars ($)

2015Expenses - Social Services


0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

Value

2.01%

1.00% 1.00%

2.00% 2.00%

3.00%

H4402 | Chart 16 | Expenses - Social Services | Percent (%) of Total Revenue

2015Expenses - Therapy


$0.00

$100.00

$200.00

$300.00

Value

$214.00

$153.50$177.00

$229.50

$337.00

$95.00

H4402 | Chart 17 | Expenses - Therapy | PMPM Dollars ($)

2015Expenses - Therapy


0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

Value

3.20%

2.00%

3.00% 3.00%

4.00%

5.00%

H4402 | Chart 17 | Expenses - Therapy | Percent (%) of Total Revenue

2015Expenses - Home Care


$0.00

$500.00

$1,000.00

$1,500.00

$2,000.00

Value

$2,199.00

$323.00 $334.00

$513.00

$831.00

$61.00

H4402 | Chart 18 | Expenses - Home Care | PMPM Dollars ($)

2015Expenses - Home Care


0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

Value

13.00%

29.00%

4.82%

1.00%

6.00%

9.00%

H4402 | Chart 18 | Expenses - Home Care | Percent (%) of Total Revenue

2015Expenses - Meals


$0.00

$50.00

$100.00

$150.00

$200.00

Value

$160.00

$129.00

$165.50

$214.00

$41.00

$98.50

H4402 | Chart 19 | Expenses - Meals | PMPM Dollars ($)

2015Expenses - Meals


0.00%

1.00%

2.00%

3.00%

4.00%

Value

2.39%

1.00%

2.00% 2.00% 2.00%

4.00%

H4402 | Chart 19 | Expenses - Meals | Percent (%) of Total Revenue

2015Expenses - Transportation


$0.00

$100.00

$200.00

$300.00

$400.00

$500.00

$600.00

$700.00

Value

$481.00

$165.00

$253.50

$365.00

$440.50

$669.00

H4402 | Chart 20 | Expenses - Transportation | PMPM Dollars ($)

2015Expenses - Transportation


0.00%

2.00%

4.00%

6.00%

8.00%

Value

7.19%

3.00%

4.00%

6.00%

7.00%

8.00%

H4402 | Chart 20 | Expenses - Transportation | Percent (%) of Total Revenue

2015Expenses - Outpatient Specialist


$0.00

$200.00

$400.00

$600.00

$800.00

Value

$310.00$261.50

$312.00

$392.50

$799.00

$92.00

H4402 | Chart 21 | Expenses - Outpatient Specialist | PMPM Dollars ($)

2015Expenses - Outpatient Specialist


0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

Value

10.00%

4.64%

2.00%

4.00%

5.00%

6.00%

H4402 | Chart 21 | Expenses - Outpatient Specialist | Percent (%) of Total Revenue

2015Expenses - Pharmacy


$0.00

$200.00

$400.00

$600.00

$800.00

$1,000.00

$1,200.00

Value

$1,093.00

$664.00

$242.00

$586.00

$699.00

$824.00

H4402 | Chart 22 | Expenses - Pharmacy | PMPM Dollars ($)

2015Expenses - Pharmacy


0.00%

5.00%

10.00%

15.00%

Value

10.00%11.00%

12.00%

16.00%

9.93%

6.00%

H4402 | Chart 22 | Expenses - Pharmacy | Percent (%) of Total Revenue

2015Expenses - DME and Supplies


$0.00

$50.00

$100.00

$150.00

$200.00

Value

$122.00

$187.00

$54.00 $50.00

$86.00

$0.00

H4402 | Chart 23 | Expenses - DME and Supplies | PMPM Dollars ($)

2015Expenses - DME and Supplies


0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

Value

0.81%

0.00%

1.00% 1.00%

2.00%

3.00%

H4402 | Chart 23 | Expenses - DME and Supplies | Percent (%) of Total Revenue

2015Expenses - Labs and Diagnostics


$0.00

$50.00

$100.00

$150.00

Value

$143.00

$40.00

$28.00

$48.00

$66.00

$0.00

H4402 | Chart 24 | Expenses - Labs and Diagnostics | PMPM Dollars ($)

2015Expenses - Labs and Diagnostics


0.00%

0.50%

1.00%

1.50%

2.00%

Value

0.60%

0.00%

1.00% 1.00% 1.00%

2.00%

H4402 | Chart 24 | Expenses - Labs and Diagnostics | Percent (%) of Total Revenue

2015Expenses - Nursing Home


$0.00

$200.00

$400.00

$600.00

$800.00

$1,000.00

$1,200.00

$1,400.00

Value

$1,355.00

$713.00

$298.50

$585.00

$821.50

$55.00

H4402 | Chart 25 | Expenses - Nursing Home | PMPM Dollars ($)

2015Expenses - Nursing Home


0.00%

5.00%

10.00%

15.00%

20.00%

Value

10.66%

14.00%

21.00%

1.00%

5.00%

9.00%

H4402 | Chart 25 | Expenses - Nursing Home | Percent (%) of Total Revenue

2015Expenses - Hospital


$0.00

$200.00

$400.00

$600.00

$800.00

$1,000.00

$1,200.00

$1,400.00

Value

$1,300.00

$424.00

$156.00

$350.00

$540.00

$871.50

H4402 | Chart 26 | Expenses - Hospital | PMPM Dollars ($)

2015Expenses - Hospital


0.00%

5.00%

10.00%

15.00%

20.00%

Value 12.00%

22.00%

6.34%

3.00%

7.00%8.00%

H4402 | Chart 26 | Expense - Hospital | Percent (%) of Total Revenue

2015Expenses - Sub-Acute Rehabilitation


$0.00

$100.00

$200.00

$300.00

Value

$346.00

$98.50

$0.00 $0.00 $0.00

H4402 | Chart 27 | Expenses - Sub-Acute Rehabilitation | PMPM Dollars ($)

2015Expenses - Sub-Acute Rehabilitation


0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

Value

0.00% 0.00% 0.00% 0.00%

2.00%

5.00%

H4402 | Chart 27 | Expenses - Sub-Acute Rehabilitation | Percent (%) of Total Revenue

2015Expenses - Assisted Living / Residential Care


$0.00

$200.00

$400.00

$600.00

$800.00

Value

$158.00 $139.00$202.50

$881.00

$22.00$0.00

H4402 | Chart 28 | Expenses - Assisted Living / Residential Care | PMPM Dollars ($)

2015Expenses - Assisted Living / Residential Care


0.00%

5.00%

10.00%

15.00%

Value

14.00%

2.36%

0.00% 0.00%

2.00%3.00%

H4402 | Chart 28 | Expenses - Assisted Living / Residential Care | Percent (%) of Total Revenue

2015Expenses - Administrative


$0.00

$500.00

$1,000.00

$1,500.00

Value

$1,213.00

$1,513.00

$271.00

$605.50

$740.00

$887.50

H4402 | Chart 29 | Expenses - Administrative | PMPM Dollars ($)

2015Expenses - Administrative


0.00%

5.00%

10.00%

15.00%

20.00%

Value

18.13%

10.00%

12.00%

15.00%

19.00%

7.00%

H4402 | Chart 29 | Expenses - Administrative | Percent (%) of Total Revenue

2015Expenses - Marketing


$0.00

$100.00

$200.00

$300.00

$400.00

$500.00

$600.00

Value

$117.00

$574.00

$35.50$60.00

$86.00

$0.00

H4402 | Chart 30 | Expenses - Marketing | PMPM Dollars ($)

2015Expenses - Marketing


0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

Value

10.00%

1.75%

0.00%

1.00% 1.00% 1.00%

H4402 | Chart 30 | Expenses - Marketing | Percent (%) of Total Revenue

2015Expenses - Insurance


$0.00

$50.00

$100.00

$150.00

Value

$141.00

$13.00

$35.00

$50.00

$7.00$0.00

H4402 | Chart 31 | Expenses - Insurance | PMPM Dollars ($)

2015Expenses - Insurance


0.00%

0.50%

1.00%

1.50%

2.00%

Value

0.11%0.00% 0.00%

1.00% 1.00%

2.00%

H4402 | Chart 31 | Expenses - Insurance | Percent (%) of Total Revenue

2015Expenses - Depreciation


$0.00

$50.00

$100.00

$150.00

Value

$109.00 $108.50

$171.00

$12.00

$62.50

$86.00

H4402 | Chart 32 | Expenses - Depreciation | PMPM Dollars ($)

2015Expenses - Depreciation


0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

Value

0.00%

1.00% 1.00%

2.00%

3.00%

1.63%

H4402 | Chart 32 | Expenses - Depreciation | Percent (%) of Total Revenue

Audit Year (Financial Data) / Category

2015Expenses - Facility


$0.00

$200.00

$400.00

$600.00

$800.00

Value

$145.00 $130.50$183.00

$229.50

$740.00

$19.00

H4402 | Chart 33 | Expenses - Facility | PMPM Dollars ($)

2015Expenses - Facility


0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

Value

13.00%

2.17%

1.00%

2.00%

3.00%

4.00%

H4402 | Chart 33 | Expenses - Facility | Percent (%) of Total Revenue

2015Expenses - Other


$0.00

$200.00

$400.00

$600.00

$800.00

Value

$154.00

$757.00

$21.00$0.00 $0.00

H4402 | Chart 34 | Expenses - Other | PMPM Dollars ($)

2015Expenses - Other


0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

Value

13.00%

0.00% 0.00% 0.00% 0.00%

2.00%

H4402 | Chart 34 | Expenses - Other | Percent (%) of Total Revenue

2015INCOME (LOSS)


($1,500.00)

($1,000.00)

($500.00)

$0.00

$500.00

$1,000.00

Value

($1,589.00)

($81.00)

$729.00

$262.00$406.50

$793.00

H4402 | Chart 35 | Income (Loss) | PMPM Dollars ($)

2015INCOME (LOSS)


-30.00%

-20.00%

-10.00%

0.00%

10.00%

Value

-28.00%

10.90%14.00%

-1.00%

4.00%6.00%

H4402 | Chart 35 | Income (Loss) | Percent (%) of Total Revenue

2015MEDICAL LOSS RATIO (MLR)


0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Value

65.31% 65.00%

73.00%

76.00%

82.00%

90.00%

H4402 | Chart 36 | Medical Loss Ratio (MLR)

Enrollment154

200

250

300

national pace ass o ci a ti o n per member per ......d. tables and charts ii. pmpm and percent of...

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