Copperline Healthcare Case

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copperline.xlsx
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CASE30

CASE 30 Student Version Copyright 2010
5/10/11 By FACHE
COPPERLINE HEALTHCARE
Capitation and Risk Sharing
This case requires students to examine the issues involved with payment allocation and risk sharing
within a Physician Hospital Organization (PHO).
The model calculates the dollar distributions to each provider category and the budgeted and actual
total reimbursement for the PHO's primary care physicians, specialist physicians, and hospital.
In addition, the model provides the calculations for two illustrative risk pools.
The model consists of a complete base case analysis--no changes need to be made
to the existing MODEL-GENERATED DATA section. However, all values in the student
version INPUT DATA section have been replaced with zeros. Thus, students must determine
the appropriate input values and enter them into the model. These cells are colored red.
When this is done, any error cells will be corrected and the base case solution will appear.
Note that the model does not contain any risk analyses, so students will have to create
their own if required by the case. Furthermore, students must create their own graphics
(charts) as needed to present their results.
INPUT DATA: KEY OUTPUT:
PMPM payment from the Plan $0 Total Budgeted Reimbursement
Primary care physicians:
Number of members 0 Premium allocation $0
Professional services risk pool 0
Allocation of premium dollar (%): Inpatient services risk pool 0
PHO administration / overhead 0.0% Total $0
Paid to within-system physicians: Specialist care physicians:
Primary care 0.0% Premium allocation $0
Specialists 0.0% Professional services risk pool 0
Ancillary services 0.0% Inpatient services risk pool 0
Administration / profit 0.0% Total $0
Paid to within-system hospital 0.0% Within-system hospital:
Paid for prescription drugs 0.0% Premium allocation $0
Paid to out-of-system providers 0.0% Inpatient services risk pool 0
Professional services risk pool 0.0% Total $0
Inpatient services risk pool 0.0%
Total premium dollar 0.0% Total Actual Reimbursement
Primary care physicians:
Distribution of professional services risk pool: Actual payment $0
Primary care physicians 0% Professional services risk pool 0
Specialist care physicians 0% Inpatient services risk pool 0
Total 0% Total $0
Specialist care physicians:
Distribution of inpatient services risk pool: Actual payment $0
Primary care physicians 0% Professional services risk pool 0
Specialist care physicians 0% Inpatient services risk pool 0
Hospital 0% Total $0
Total 0% Within-system hospital:
Actual payment $0
Sensitivity analysis: Inpatient services risk pool 0
Suppose actual payment differs from premium Total $0
allocation by the percentages below:
Specialists 0%
Hospital 0%
MODEL-GENERATED OUTPUT:
Sensitivity analysis:
Allocation of Premium: Results if Actual Payment Differs from Premium Allocation
PHO administration / overhead $0 PHO administration / overhead $0
Paid to within-system physicians: Paid to within-system physicians:
Primary care 0 Primary care 0
Specialists 0 Specialists 0
Ancillary services 0 Ancillary services 0
Administration / profit 0 Administration / profit 0
Paid to within-system hospital 0 Paid to within-system hospital 0
Paid for prescription drugs 0 Paid for prescription drugs 0
Paid to out-of-system providers 0 Paid to out-of-system providers 0
Professional services risk pool 0 Professional services risk pool 0
Inpatient services risk pool 0 Inpatient services risk pool 0
Total premium dollar $0 Total revenue $0
Professional Services Risk Pool:
Budgeted payments for specialists $0
Actual payments for specialists $0
Variance from budget $0
Risk pool starting amount $0
Remainder in pool $0
Risk pool allocation
Primary care physicians $0
Specialists $0
Inpatient Services Risk Pool:
Budgeted payments for inpt services $0
Actual payments for inpt services $0
Variance from budget $0
Risk pool starting amount $0
Remainder in pool $0
Risk pool allocation
Primary care physicians $0
Specialists $0
Hospital $0
END