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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 $360 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 $317. 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 44,888 48,177 $ 11,147,072
514 81,656 83,863 10,058,832
1519 95,073 95,087 8,436,024
2024 65,446 67,082 9,538,624
2534 132,696 131,754 26,431,408
3544 166,076 174,646 38,881,308
4554 84,696 90,089 22,741,136
5564 98,424 101,123 28,690,912
6574 155,488 160,759 49,517,344
7584 67,095 71,665 33,431,960
85 years and older 22,699 26,049 24,285,675
1,014,237 1,050,294 $ 263,160,295

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 7% 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 $342. Calculate the new target cost assuming again that VIP-MD wants to maintain the same profit per enrollee as in the current year.

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