Question
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
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 $378 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 $335. 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 | 46,688 | 49,977 | $ | 11,148,872 | ||||||||
514 | 83,456 | 85,663 | 10,060,632 | |||||||||
1519 | 96,873 | 96,887 | 8,437,824 | |||||||||
2024 | 67,246 | 68,882 | 9,540,424 | |||||||||
2534 | 134,496 | 133,554 | 26,433,208 | |||||||||
3544 | 167,876 | 176,446 | 38,883,108 | |||||||||
4554 | 86,496 | 91,889 | 22,742,936 | |||||||||
5564 | 99,224 | 102,923 | 28,692,712 | |||||||||
6574 | 157,288 | 162,559 | 49,519,144 | |||||||||
7584 | 68,895 | 73,465 | 33,433,760 | |||||||||
85 years and older | 24,499 | 27,849 | 24,287,475 | |||||||||
1,033,037 | 1,070,094 | $ | 263,180,095 | |||||||||
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 6% 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 $360. 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.)
1. Required target cost 2. New target cost
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