Assume that an HMO's capitation payment to PCPs is $20 PMPM, but 15% of this...
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Assume that an HMO's capitation payment to PCPs is $20 PMPM, but 15% of this amount is placed in the PCP risk pool. The budgeted amount for specialty and hospital costs is $40 PMPM. The purpose of the risk pool is to encourage the PCPs to take actions that cause realized specialty and hospital costs to be less than those budgeted. Cost is measured by the amount the HMO spends on each physician's referral. There are three PCPs: Physician A, Physician B, and Physician C. Assume that each physician has 1,000 patients. Suppose Physician A's actual referral costs are $500,000, Physician B's are $540,000, and Physician C's are $620,00. Finally, suppose that no PCP will receive any funds from the risk pool if it is empty at the end of the year, but if there are referral funds left in the risk pool at the end of the year, they will be divided equally among the three physicians. Choose, the correct combination of Physicians that will receive funds back from the risk pool at the end of the year: None of the physicians All of the physicians Physicians A and B Only physician C
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