Healthcare Finance

A nursing Home narrows after a while an HMO for serviceable nursing regard at $3.00 PMPM. If consumes are expected to mediocre $120 per day, what is the zenith utilization of days per 1,000 members that the nursing home can test anteriorly it begins to lavish coin?

Please parade all of your result / calculations to take reputation.

Part 2 -

Refer to the table beneath for examples 1-5. A hospital and a sanity plan are negotiating a narrow for inpatient medical–surgical care.             Calculate the amounts that would  complete the table beneath. (Please allude to stipulation 7 if expedient).

Table: Per Member Per Month (PMPM) Rate


                                    Frequency        Unit                        Frequency        Copay        Copay         Net

Category                        per 1,000      Cost        PMPM       per 1,000       Amount      PMPM       PMPM

Hospital inpatient

Medical surgical                400        $1,000         (Q1)            100               $150         (Q2) (Q3)

Use the notice from scrutinys 1 - 3 in solving scrutinys 4 and 5. Assume that you are the hospital official and that the  health    plan has offered you a capitated narrow at the PMPM objurgate that you computed in scrutiny 1. You love, at-last, that you can administer utilization improve than is reflected in the table aloft. You love the developed utilization procure be 370 per 1,000 individuals. The enumerebuke of healed lives is 25,000. Your consume per subject is $1,100. (For purposes of this example, disown ultimate consumes, subscription margins, etc.)

1. What is the PMPM objurgate?

2. What is the copay PMPM?

3. What is the NET PMPM?

4. What is the hospital’s whole fruits from this narrow?

5. Would your hospital verify a gain on this narrow?

Please parade all of your result / calculations to take reputation.

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