Question
Required information Skip to question [The following information applies to the questions displayed below.] VIP-MD is a health maintenance organization (HMO) located in North Carolina.
Required information
Skip to question
[The following information applies to the questions displayed below.]
VIP-MD is a health maintenance organization (HMO) located in North Carolina. Unlike the traditional fee-for-service model that determines the payment according to the actual services used or costs incurred, VIP-MD receives a fixed, prepaid amount from subscribers. The per member, per month rate (PMPM) is determined by estimating the health care cost per enrollee within a geographic location. The average health care coverage in North Carolina costs $376 per month, which is the same amount irrespective of the subscribers age. Because individuals are demanding quality care at reasonable rates, VIP-MD must contain its costs to remain competitive. A major competitor, National Physicians, entered the North Carolina market early in the current year with a monthly premium of $333. VIP-MD wants to maintain its current market penetration and hopes to increase its enrollees in the current year. The latest data on the number of enrollees and the associated costs follow:
Age | Enrollment in Current Year | Projected Enrollment Next Year | Average Monthly Cost in Current Year | |||||||||
14 | 46,488 | 49,777 | $ | 11,148,672 | ||||||||
514 | 83,256 | 85,463 | 10,060,432 | |||||||||
1519 | 96,673 | 96,687 | 8,437,624 | |||||||||
2024 | 67,046 | 68,682 | 9,540,224 | |||||||||
2534 | 134,296 | 133,354 | 26,433,008 | |||||||||
3544 | 167,676 | 176,246 | 38,882,908 | |||||||||
4554 | 86,296 | 91,689 | 22,742,736 | |||||||||
5564 | 99,424 | 102,723 | 28,692,512 | |||||||||
6574 | 157,088 | 162,359 | 49,518,944 | |||||||||
7584 | 68,695 | 73,265 | 33,433,560 | |||||||||
85 years and older | 24,299 | 27,649 | 24,287,275 | |||||||||
1,031,237 | 1,067,894 | $ | 263,177,895 | |||||||||
Required:
1. Calculate the target cost required for VIP-MD to maintain its current market share and profit per enrollee in the current year.
2. Costs in the health care industry applicable to VIP-MD and National Physicians are expected to increase by 8% in the coming year. VIP-MD is planning for the year ahead and is expecting all providers, including VIP-MD and National Physicians, to increase their rates by $25 to $358. Calculate the new target cost assuming again that VIP-MD wants to maintain the same profit per enrollee as in the current year.
(For all requirements, do not round intermediate calculations and round your answers to 2 decimal places.)
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