What primary care rate (PMPM) will Families First propose to ABC Company?
Problem 3 Problem 2 Problem 1 UNDERSTANDING HEALTHCARE FINANCIAL MANAGEMENT PROBLEM 1 PROBLEM 2 Age Band Males Females 20-29 30-39 40-49 50-59 60+ Number of Average primary care visits per year ANSWER Each primary care physician can handle about 3,000 patient visits per year, for which he or she is paid Families First is a managed care plan that has been asked to submit a premium bid to ABC Company, a large males females ABC Company Number of patients Actual referral costs Dr Smith Dr Barney Dr Wells Dr Fargo All America HMO pays its primary care physicians (PCPs) by capitation, but a percentage of the total Last year, All America’s capitation payment to the PCPs was $20 PMPM, but 15 percent of this amount was the end of the year, the following data were recorded for the four All America PCPs: the PCP compensation? manufacturer in its service area. The premium bid includes the primary care for all of the ABC employees. average primary care utilization rates from its own databases. This information is shown below: $180,000. What primary care rate (PMPM) will Families First propose to ABC Company? ABC has provided information about the age and gender of its employees, and Families First has identified placed into the PCP risk pool. The budgeted amount for specialty and hospital costs was $50 PMPM. At a. Calculate the total compensation of each PCP at the end of the year. b. Were each of the PCPs fairly compensated? What incentives does this single risk pool based on aggregate PCP performance present to the individual PCPs? What should be investigated to assess the fairness of returned to the PCPs based on the number of patients per PCP If a total referral loss total withhold, then none of the withhold is returned to the PCPs If a total referral gain, then all of the total withhold is returned to the PCPs
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