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SU_MHC6305_W3_A2_Burns_C.DOCBay Pines Medical Centers 1
PAGE
RUNNING HEAD: Bay Pines Medical Centers
Cymberly Burns
Bay Pines Medical Centers
MHC6305
South University
Dr. M. Kadrie
Since there’s a 20% reduction while utilization or a 10% cost reduction, therefore the total cost of medical averages to be $17,000 x $1,230.30 = $20,915,100.
Therefore, by adding a 10% profit the total premium of $20,915,100 / 0.90 = $23,239,000.
Because the per member per month is basis, totals averages are $23,239,000 / $50,000 / 12 = $38.73.
Rating on the average the population will be utilizing $425 x $50 = $21,250 per inpatient a day that will total cost will be $21,250 x $1, 367 = $29,048,750.
10% total for the premium that is reserved for the profit. This will make 0.90 x the total premium = $29,048,750.
PMPM (Per member Per month) rate
|
Service Category |
Annual usage per member (a) |
Average medical cost (b) |
Administrative expenses (c) |
Total rate (d=b + c) |
Capitation rate PMPM (d x a) / 12 |
|
General |
0.15 |
1,500.00 |
166.67 |
1,666.67 |
20.83 |
|
Surgical |
0.13 |
1,800.00 |
200.00 |
2,000.00 |
20.83 |
|
Psychiatric |
0.07 |
700.00 |
77.78 |
777.78 |
4.54 |
|
Alcohol/Drug Abuse |
0.04 |
500.00 |
55.56 |
555.56 |
1.76 |
|
Maternity |
0.04 |
1,500.00 |
166.67 |
1,666.67 |
5.83 |
|
|
|
|
|
|
53.79 |
Calculated utilization rates reduced by 10 percent
|
Service Category |
Annual usage per member (a) |
Average medical cost (b) |
Administrative expenses (c) |
Total rate (d=b + c) |
Capitation rate PMPM (d x a) / 12 |
|
General |
0.14 |
1,500.00 |
166.67 |
1,666.67 |
18.75 |
|
Surgical |
0.11 |
1,800.00 |
200.00 |
2,000.00 |
18.75 |
|
Psychiatric |
0.06 |
700.00 |
77.78 |
777.78 |
4.08 |
|
Alcohol/Drug Abuse |
0.03 |
500.00 |
55.56 |
555.56 |
1.58 |
|
Maternity |
0.04 |
1,500.00 |
166.67 |
1,666.67 |
5.25 |
|
|
|
|
|
|
48.41 |
Calculated utilization rates reduced by 20 percent
|
Service Category |
Annual usage per member (a) |
Average medical cost (b) |
Administrative expenses (c) |
Total rate (d=b + c) |
Capitation rate PMPM (d x a) / 12 |
|
General |
0.12 |
1,500.00 |
166.67 |
1,666.67 |
16.67 |
|
Surgical |
0.10 |
1,800.00 |
200.00 |
2,000.00 |
16.67 |
|
Psychiatric |
0.06 |
700.00 |
77.78 |
777.78 |
3.63 |
|
Alcohol/Drug Abuse |
0.03 |
500.00 |
55.56 |
555.56 |
1.41 |
|
Maternity |
0.03 |
1,500.00 |
166.67 |
1,666.67 |
4.67 |
|
|
|
|
|
|
43.05 |
Average service cost reduced by 10 percent.
|
Service Category |
Annual usage per member (a) |
Average medical cost (b) |
Administrative expenses (c) |
Total rate (d=b + c) |
Capitation rate PMPM (d x a) / 12 |
|
General |
0.15 |
1,350.00 |
150.00 |
1,500.00 |
18.75 |
|
Surgical |
0.13 |
1,620.00 |
180.00 |
1,800.00 |
18.75 |
|
Psychiatric |
0.07 |
630.00 |
70.00 |
700.00 |
4.08 |
|
Alcohol/Drug Abuse |
0.04 |
450.00 |
50.00 |
500.00 |
1.58 |
|
Maternity |
0.04 |
1,350.00 |
150.00 |
1,500.00 |
5.25 |
|
|
|
|
|
|
48.41 |
Premium of both utilization and cost reductions
|
Service Category |
Annual usage per member (a) |
Average medical cost (b) |
Administrative expenses (c) |
Total rate (d=b + c) |
Capitation rate PMPM (d x a) / 12 |
|
General |
0.14 |
1,350.00 |
150.00 |
1,500.00 |
16.88 |
|
Surgical |
0.11 |
1,620.00 |
180.00 |
1,800.00 |
16.88 |
|
Psychiatric |
0.06 |
630.00 |
70.00 |
700.00 |
3.68 |
|
Alcohol/Drug Abuse |
0.03 |
450.00 |
50.00 |
500.00 |
1.43 |
|
Maternity |
0.04 |
1,350.00 |
150.00 |
1,500.00 |
4.73 |
|
|
|
|
|
|
43.60 |
Reference:
Miller, Max (2017). Bay Pines Medical Center
Retrieved from http://www.chegg.com/homework-help/questions-and-answers/75-bay-pines-medical
