Case Study: Star Memorial Hospital/Newport Healthcare - Capitation and Risk Sharing. This case permits students to examine the issues involved with payment allocation and risk sharing within an integrated delivery organization (PHO). Although there are many quantitative elements to the case, there also are numerous qualitative issues that merit discussion.
Q1. What reimbursement method would you recommend for each of the following providers (Primary Care Physicians; Specialists; Hospital and Other services)? Justify your answers.
Q2. What allocation of premium dollars do you recommend for each provider? Justify your recommendations.
Q3. Should all the physician hospital organization's (PHO) physicians participate in the contract, or should subpanels be formed?