Bay Pines Medical Center estimates that a capitated population of 50,000 would have the following base case utilization and total cost characteristics:

Service Category

Inpatient Days

per 1,000 Enrollees

Average Cost

per Day

General

150

$1,500

Surgical

125

$1,800

Psychiatric

70

$700

Alcohol/Drug Abuse

38

$500

Maternity

42

$1,500

Total

425

$1,367

In addition to medical costs, Bay Pines allocates 10 percent of the total premium for administration/reserves.

On the basis of your data analysis, respond to the following:

• What is the PMPM rate that Bay Pines must set to cover medical costs plus administrative expenses?
• What would be the rate if a utilization management program were to reduce utilization within each patient service category by 10 percent? And by 20 percent?
• Consider the initial base case utilization assumption. What rate would be set if the average cost on each service were reduced by 10 percent?
• Assume that both utilization and cost reductions were made. What would the premium be?