VIP-MD is a health maintenance organization (HMO) located in North Carolina. Unlike the traditional fee-for-service...
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VIP-MD is a health maintenance organization (HMO) located in North Carolina. Unlike the traditional fee-for-service model that determines the payment according to the actual services used or costs incurred, VIP-MD receives a fixed, prepaid amount from subscribers. The per member, per month rate (PMPM) is determined by estimating the health care cost per enrollee within a geographic location. The average health care coverage in North Carolina costs $374 per month, which is the same amount irrespective of the subscribers age. Because individuals are demanding quality care at reasonable rates, VIP-MD must contain its costs to remain competitive. A major competitor, National Physicians, entered the North Carolina market early in the current year with a monthly premium of $331. VIP-MD wants to maintain its current market penetration and hopes to increase its enrollees in the current year. The latest data on the number of enrollees and the associated costs follow:
Age
Enrollment in Current Year
Projected Enrollment Next Year
Average Monthly Cost in Current Year
1 to 4
46,288
49,577
$ 11,148,472
5 to 14
83,056
85,263
10,060,232
15 to 19
96,473
96,487
8,437,424
20 to 24
66,846
68,482
9,540,024
25 to 34
134,096
133,154
26,432,808
35 to 44
167,476
176,046
38,882,708
45 to 54
86,096
91,489
22,742,536
55 to 64
99,624
102,523
28,692,312
65 to 74
156,888
162,159
49,518,744
75 to 84
68,495
73,065
33,433,360
85 years and older
24,099
27,449
24,287,075
1,029,437
1,065,694
$ 263,175,695
Required:
1. Calculate the target cost required for VIP-MD to maintain its current market share and profit per enrollee in the current year.
2. Costs in the health care industry applicable to VIP-MD and National Physicians are expected to increase by 7% in the coming year. VIP-MD is planning for the year ahead and is expecting all providers, including VIP-MD and National Physicians, to increase their rates by $25 to $356. Calculate the new target cost assuming again that VIP-MD wants to maintain the same profit per enrollee as in the current year.
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