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Copperline's Risk Pools

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Please provide assistance answering the problems in the attached file on Copperline Company with regards to its risk pools.

See the attached file.

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The solution discusses the Copperline's risk pools.

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See the attached file.

1. a. Primary care physicians can be paid through capitation. It would encourage physicians to transfer patients to other providers and it reduces the risk on a single provider.

b. Specialists can be paid using discounted fee-for-service basis marked at a certain reimbursement percentage.

c. Hospitals should be paid on a per-diem basis. It would result in lower costs to the physician hospital organization (PHO) in the long run and help in better management of hospital utilization.

d. Since other services form a smaller proportion of overall care plans, they can be paid using a fee each service.

2. The allocation method is different from that of typical allocation, as it incorporates risk pools. PHO administration/overhead and payments to physicians within the system should be allocated a higher proportion than that recommended by consultants. Administration/profit should also be allocated higher premiums. Special allocations can be brought down to create a risk-sharing arrangement with a PHO. A separate risk pool for professional and inpatient services should be created to encourage ...

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