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7 . 5 . Bay Pines Medical Center estimates that a capitated population of 5 0 , 0 0 0 would have the following base
Bay Pines Medical Center estimates that a capitated population of
would have the following base case utilization and total cost
characteristics:
In addition to medical costs, Bay Pines allocates percent of
the total premium total capitated revenue for administration
reserves.
a What is the PMPM rate that Bay Pines must set to cover medical
costs plus administrative expenses?
b What would be the rate if a utilization management program
were to reduce utilization within each patient service category by
percent? By percent?
c Return to the initial base case utilization assumption. What rate
would be set if the average cost on each service were reduced by
percent?
d Assume that both utilization and cost reductions were made.
What would the premium hes
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