Answered step by step
Verified Expert Solution
Link Copied!

Question

1 Approved Answer

I need to show my work on this, like formulas used if any... Group Number: Group Project i Mini Case I Payments to Providers All

I need to show my work on this, like formulas used if any...
image text in transcribed
Group Number: Group Project i Mini Case I Payments to Providers All America HMO pays its primary care physicians (PCPs) by capitation. but a percentage of the total capitated amount is withheld and distributed to individual PCPs based on aggregate PCPPerformance. The financial goal of importance to All America is to achieve total actual specialty care and hospital costs less than budgeted. To this end, All America provides a financial incentive to its PCPsto encourage careful referral of patients to these services.The financial incentive is based on the referral gain or loss, defined as the difference between the actual and budgeted specialty care and hospital cost. More specifically, All America uses the following risk-sharing rules: If there is a total referral zain. then all orthe total withhold is returned to the PCPs If a total referral loss withhold, then the difference (withhold-referral loss)is returned to the PCPs based on the number of patients per PCP If a total referral loss >total nithhold. then none of the withhold is returned to the PCPs Last year, All America's capitation payment to the PCPs was S20 PMPM, but 15 percent of this amount was placed into the PCPrisk pool. The budgeted amount for specialty and hospital costs was S50 PMPM. At the end of the year, the following data were recorded for the four All America PCPs: Dr Smith Dr Barney Dr Wells Dr Fargo patients Number of 1.600 Actual referral costs $504.000 $470.000 S590.000 S880.000 a. Calculate the total compensation of each PCP at the end of the year. b. Was each of the PCPs fairly compensated? What incentives does this single risk pool based on aggregate PCP perform present to the individual PCPs? What should be investigated to assess ance the fairness of the PCP compensation? ANSWER PCP capitation payment PMPM PCP withhold rate Specialty hospital budget PMPM Number of months per year Dr Smith Dr Barney Dr Wells Dr Fargo Total Number of patients IJ600 Annual capitation payment Withhold nitial allocation Budgeted referral costs Actual referral costs $470.000 Referral gain (loss) Withhold returned Total compensation

Step by Step Solution

There are 3 Steps involved in it

Step: 1

blur-text-image

Get Instant Access to Expert-Tailored Solutions

See step-by-step solutions with expert insights and AI powered tools for academic success

Step: 2

blur-text-image_2

Step: 3

blur-text-image_3

Ace Your Homework with AI

Get the answers you need in no time with our AI-driven, step-by-step assistance

Get Started

Recommended Textbook for

Practical Guide To Commercial And Industrial Energy Auditing

Authors: Mtijan M Kamara

1st Edition

1717257321, 978-1717257321

More Books

Students also viewed these Accounting questions

Question

Calculate the future value of an ordinary annuity.

Answered: 1 week ago

Question

1. Let a, b R, a Answered: 1 week ago

Answered: 1 week ago

Question

What advice would you provide to Jennifer?

Answered: 1 week ago

Question

What are the issues of concern for each of the affected parties?

Answered: 1 week ago