Copperline Healthcare Case

I need the attached case problems ansswered as well as the attached spreadsheet completed. Thanks

 

CASE3

0

Budgeted Reimbursement

physicians:

0

$0

0

0

$0

:

Primary care 0.0% Premium allocation $0

0.0%

0

0.0%

0

0.0%

$0

0.0%

0.0% Premium allocation $0

0.0% Inpatient services risk pool 0

Professional services risk pool 0.0% Total $0
Inpatient services risk pool 0.0%

0.0%

:

$0

Primary care physicians 0% Professional services risk pool 0
Specialist care physicians 0% Inpatient services risk pool 0
Total 0% Total $0

Actual payment $0

Primary care physicians 0% Professional services risk pool 0
Specialist care physicians 0% Inpatient services risk pool 0

0% Total $0

Total 0% Within-system hospital:
Actual payment $0

Inpatient services risk pool 0

Total $0

Specialists 0%

0%

Sensitivity analysis:
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

$0

$0

$0

$0

$0

$0

$0

Specialists $0

$0

$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

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

Primary care

Number of members

Premium allocation

Professional services risk pool

Allocation of premium dollar (%):

Inpatient services risk pool

PHO administration / overhead

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0%

Total

Paid to within-system physicians:

Specialist care physicians

Specialists

Professional services risk pool

Ancillary services

Inpatient services risk pool

Administration / profit

Total

Paid to within-system hospital

Within-system hospital:

Paid for prescription drugs

Paid to out-of-system providers

Total premium dollar

Total Actual Reimbursement

Primary care physicians

Distribution of professional services risk pool:

Actual payment

Specialist care physicians:

Distribution of inpatient services risk pool:

Hospital

Sensitivity analysis:

Suppose actual payment differs from premium

allocation by the percentages below:

Hospital

MODEL-GENERATED OUTPUT:

Allocation of Premium:

Results if Actual Payment Differs from Premium Allocation

Total revenue

Professional Services Risk Pool:

Budgeted payments for specialists

Actual payments for specialists

Variance from budget

Risk pool starting amount

Remainder in pool

Risk pool allocation

Primary care physicians

Inpatient Services Risk Pool:

Budgeted payments for inpt services

Actual payments for inpt services

END