The American legal system

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1. Write a 4 page APA Style paper describing the American legal system. Describe the branches of our government, the types of laws, and our court system.

2. Answer the following questions for a, b, c and d

Ulysses S. Grant (USG) is a nonprofit HMO that is preparing a premium bid for Stewart Martha Inc. (SMI), a major employer in USG’s service area with 2,500 members. USG uses the cost approach to estimate primary care physician’s costs for SMI’s members. On average, each member makes two visits to a primary care physician per year, and each primary care physician can handle 2,000 patient visits per year. Total compensation per primary care physician is $150,000 per year.

a. SMI has obtained primary care bids from other HMOs in the other area and has told USG that it can have the primary care contract for a PMPM premium of $13.00. Should USG accept the contract? Suppose that each member makes 2.6 visits to a primary care physician per year. Should USG accept the contract?

b. Suppose that the average of two visits to a primary care physician per year is a weighted average of two groups of SMI members–a small group with a chronic disease that requires a higher frequency of visits and a large group without a chronic disease that requires a lower frequency of visits:

Number

Average primary care visits per year

Members without chronic disease

2,400

1.58

Members with chronic disease

100

12.08

Total

2,500

2.00

Compare the primary care cost per member per month of the group of SMI members without a chronic disease to the group with a chronic disease. What information do these two numbers provide?

c. The primary care physicians believe they are overworked and underpaid. Their association is demanding that the total compensation per primary care physician be increased and the expected workload of each primary care physician be reduced. Management believes that the following settlements are possible:

Total comp per MD per year

Visits per MD per year

Best case

$160,000

1,900

Most likely case

$170,000

1,800

Worst case

$180,000

1,700

Should USG still accept the contract?

d. Suppose USG decides to submit a premium bid to MSI of $40 PMPM for both primary and specialty physicians. The primary care physicians will be paid $13 PMPM; the specialty physicians will be paid on a discounted fee-for-service basis. To create proper incentives, USG establishes a professional services risk pool equal to 15 percent of the budget for specialist physicians. After reconciliation at the end of the year, any funds left in the risk pool are evenly split among all primary care physicians. If the actual payments to the specialist physicians total $720,000 during the year, what would a primary care physician’s actual PMPM be after reconciliation at the end of the year?

 
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