That way it would build revenue by seeing more and

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That way, it would build revenue by seeing more and more patients, consistent patient & PCP
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Chapter 4 / Exercise 115
Intermediate Algebra
Tussy/Gustafson
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10TULSA MEMORIAL HEALTHCARE: A CASE STUDYrelations to keep the patient coming back, and the payer method can be consistent enough withinthe books. The Plan, SoonerCare and TMH specifically calls for each TMH provider to receive$200 per member per month, for a total annual revenue of $200 x 50,000 members x 12 months= 120 million.To stay within in budget, the 189 providers should get the Per Diagnosis methodand the 61 get paid by the Per Diem method.3)Allocation strategies:a)What proportion of the premium dollar would you allocate to the professionalservices risk pool? How would you split the professional services risk pool betweenprimary care physicians and specialists? What proportion of the premium dollarwould you allocate to the inpatient services risk pool? How would you split theinpatient services risk pool among primary care physicians, specialists, and thehospital?As shown in Table B, three scenarios are presented for consideration to the services risk pool.Scenario 1:Professional Services Risk PoolPrimary Care Physician at 40%Specialist Care Physicians at 60%Scenario 1:Inpatient Services Risk PoolPrimary Care Physician at 33%Specialist Care Physicians at 33%Hospital at 34% [rounding]Scenario 2:Professional Services Risk PoolPrimary Care Physician at 50%Specialist Care Physicians at 50%Scenario 2:Inpatient Services Risk PoolPrimary Care Physician at 33%Specialist Care Physicians at 33%Hospital at 34% [rounding]Scenario 3:Professional Services Risk PoolPrimary Care Physician at 25%Specialist Care Physicians at 75%Scenario 3:Inpatient Services Risk PoolPrimary Care Physician at 20%Specialist Care Physicians at 35%
11TULSA MEMORIAL HEALTHCARE: A CASE STUDYHospital at 45%The intent of Scenario 1 depicts somewhat of an increase risk for specialist care services,and Scenario 2 to depict an assumption of equalized risk among the organizational enterprise.Scenario 2 suggests adon’t rock the boat mentality, with the intent of shared risk and sharedreward.Realistically, historical variances would more than likely depict the risk environmentwithin Scenario 3.Scenario 3 illustrates increased levels of risk with clinical interventions forspeciality healthcare services that represents increased diagnostic costs that may not necessarilybe reimbursed, nor presents the suspected epidemiological results.Although Scenario 3 risk poolpercentiles seem drastic, in reality the allocations premiums for primary and specialist carephysician would be adjusted as shown in Table 1.The risk pool dollars can exist with theTable 1.Adjusted Premium Allocations With Scenario 3 Assumptions.Healthcare ProviderOriginalAdjustedRisk PoolPrimary Care10%8%2%Specialist18%11.7%6.3%financial budget ledgers and be reallocated to the appropriate healthcare provider (primary careor specialist care physician) with the same logic applied to Scenario 3’s hospital risk pool.

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Primary care physician, Tulsa Memorial Healthcare
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Intermediate Algebra
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Chapter 4 / Exercise 115
Intermediate Algebra
Tussy/Gustafson
Expert Verified

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