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Model with Questions, Student Version                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               

This case requires students to examine the issues involved with payment allocation and risk sharing
within a Physician Hospital Organization (PHO). The model calculates the dollar distributions to each
provider category and the budgeted and actual total reimbursement for the PHO’s primary care
physicians, specialist physicians, and hospital. In addition, the model provides the calculations for two
illustrative risk pools.

The model consists of a complete base case analysis–no changes need to be made to the existing
MODEL-GENERATED DATA section. However, values in the INPUT DATA section of the student
spreadsheet have been replaced by zeros. Students must select appropriate input values and enter
them into the cells with values colored red. After this is done, any error cells will be corrected and
the base case solution will appear. The KEY OUTPUT section includes the most important output
from the MODEL-GENERATED DATA section.


PMPM payment from the Plan $0 Total Budgeted Reimbursement
Primary care physicians:
Number of members 0 Premium allocation $0
Professional services risk pool 0
Allocation of premium dollar (%): Inpatient services risk pool 0
PHO administration / overhead 0.0% Total $0
Paid to within-system physicians: Specialist care physicians:
Primary care 0.0% Premium allocation $0
Specialists 0.0% Professional services risk pool 0
Ancillary services 0.0% Inpatient services risk pool 0
Administration / profit 0.0% Total $0
Paid to within-system hospital 0.0% Within-system hospital:
Paid for prescription drugs 0.0% Premium allocation $0
Paid to out-of-system providers 0.0% Inpatient services risk pool 0
Professional services risk pool 0.0% Total $0
Inpatient services risk pool 0.0%
Total premium dollar 0.0% Total Actual Reimbursement
Primary care physicians:
Distribution of professional services risk pool: Actual payment $0
Primary care physicians 0% Professional services risk pool 0
Specialist care physicians 0% Inpatient services risk pool 0
Total 0% Total $0
Specialist care physicians:
Distribution of inpatient services risk pool: Actual payment $0
Primary care physicians 0% Professional services risk pool 0
Specialist care physicians 0% Inpatient services risk pool 0
Hospital 0% Total $0
Total 0% Within-system hospital:
Actual payment $0
Sensitivity analysis: Inpatient services risk pool 0
Suppose actual payment differs from premium Total $0
allocation by the percentages below:
Specialists 0%
Hospital 0%


            Sensitivity analysis:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   

Allocation of Premium: Results if Actual Payment Differs from Premium Allocation
PHO administration / overhead $0 PHO administration / overhead $0
Paid to within-system physicians: Paid to within-system physicians:
Primary care 0 Primary care 0
Specialists 0 Specialists 0
Ancillary services 0 Ancillary services 0
Administration / profit 0 Administration / profit 0
Paid to within-system hospital 0 Paid to within-system hospital 0
Paid for prescription drugs 0 Paid for prescription drugs 0
Paid to out-of-system providers 0 Paid to out-of-system providers 0
Professional services risk pool 0 Professional services risk pool 0
Inpatient services risk pool 0 Inpatient services risk pool 0
Total premium dollar $0 Total revenue $0

Professional Services Risk Pool:
Budgeted payments for specialists $0
Actual payments for specialists $0
Variance from budget $0
Risk pool starting amount $0
Remainder in pool $0
Risk pool allocation
Primary care physicians $0
Specialists $0

Inpatient Services Risk Pool:
Budgeted payments for inpatient services $0
Actual payments for inpatient services $0
Variance from budget $0
Risk pool starting amount $0
Remainder in pool $0
Risk pool allocation
Primary care physicians $0
Specialists $0
Hospital $0


Sample Answer

Compelling correspondence is essential to the achievement all things considered but since of the changing idea of the present working environments, successful correspondence turns out to be more troublesome, and because of the numerous impediments that will permit beneficiaries to acknowledge the plan of the sender It is restricted. Misguided judgments.In spite of the fact that correspondence inside the association is rarely completely open, numerous straightforward arrangements can be executed to advance the effect of these hindrances.

Concerning specific contextual analysis, two significant correspondence standards, correspondence channel determination and commotion are self-evident. This course presents the standards of correspondence, the act of general correspondence, and different speculations to all the more likely comprehend the correspondence exchanges experienced in regular daily existence. The standards and practices that you learn in this course give the premise to additionally learning and correspondence.

This course starts with an outline of the correspondence cycle, the method of reasoning and hypothesis. In resulting modules of the course, we will look at explicit use of relational connections in close to home and expert life. These incorporate relational correspondence, bunch correspondence and dynamic, authoritative correspondence in the work environment or relational correspondence. Rule of Business Communication In request to make correspondence viable, it is important to follow a few rules and standards. Seven of them are fundamental and applicable, and these are clear, finished, brief, obliging, right, thought to be, concrete. These standards are frequently called 7C for business correspondence. The subtleties of these correspondence standards are examined underneath: Politeness Principle: When conveying, we should build up a cordial relationship with every individual who sends data to us.

To be inviting and polite is indistinguishable, and politeness requires an insightful and amicable activity against others. Axioms are notable that gracious “pay of graciousness is the main thing to win everything”. Correspondence staff ought to consistently remember this. The accompanying standards may assist with improving courtesy:Preliminary considering correspondence with family All glad families have the mystery of progress. This achievement originates from a strong establishment of closeness and closeness. Indeed, through private correspondence these cozy family connections become all the more intently. Correspondence is the foundation of different affiliations, building solid partners of obedient devotion, improving family way of life, and assisting with accomplishing satisfaction (Gosche, p. 1). In any case, so as to keep up an amicable relationship, a few families experienced tumultuous encounters. Correspondence in the family is an intricate and alluring marvel. Correspondence between families isn’t restricted to single messages between families or verbal correspondence.

It is a unique cycle that oversees force, closeness and limits, cohesiveness and flexibility of route frameworks, and makes pictures, topics, stories, ceremonies, rules, jobs, making implications, making a feeling of family life An intelligent cycle that makes a model. This model has passed ages. Notwithstanding the view as a family and family automatic framework, one of the greatest exploration establishments in between family correspondence centers around a family correspondence model. Family correspondence model (FCP) hypothesis clarifies why families impart in their own specific manner dependent on one another ‘s psychological direction. Early FCP research established in media research is keen on how families handle broad communications data. Family correspondence was perceived as an exceptional scholastic exploration field by the National Communications Association in 1989. Family correspondence researchers were at first impacted by family research, social brain science, and relational hypothesis, before long built up the hypothesis and began research in a family framework zeroed in on a significant job. Until 2001, the primary issue of the Family Communication Research Journal, Family Communication Magazine, was given. Family correspondence is more than the field of correspondence analysts in the family. Examination on family correspondence is normally done by individuals in brain science, humanism, and family research, to give some examples models. However, as the popular family correspondence researcher Leslie Baxter stated, it is the focal point of this intelligent semantic creation measure making the grant of family correspondence special. In the field of in-home correspondence, correspondence is normally not founded on autonomous messages from one sender to one beneficiary, yet dependent on the dynamic interdependency of data shared among families It is conceptualized. The focal point of this methodology is on the shared trait of semantic development inside family frameworks. As such, producing doesn’t happen in vacuum, however it happens in a wide scope of ages and social exchange.

Standards are rules end up being followed when performing work to agree to a given objective. Hierarchical achievement relies significantly upon compelling correspondence. So as to successfully impart, it is important to follow a few standards and rules. Coming up next are rules to guarantee powerful correspondence: clearness: lucidity of data is a significant guideline of correspondence. For beneficiaries to know the message plainly, the messages ought to be sorted out in a basic language. To guarantee that beneficiaries can without much of a stretch comprehend the importance of the message, the sender needs to impart unmistakably and unhesitatingly so the beneficiary can plainly and unquestionably comprehend the data.>

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