AHIP AHM-530 Exam - Topic 5 Question 17 Discussion

Question

The Foxfire Health Plan, which has 20,000 members, contracts with dermatologists on a contact capitation basis. The contact capitation arrangement has the following features:

Foxfire distributes the money in the contact capitation fund once each quarter and the distribution is based on the point totals accumulated by each dermatologist.

Foxfire's per member per month (PMPM) capitation for dermatology services is $1.

The dermatologist receives 1 point for each new referral that is not classified as a complicated referral and 1.5 points for each new referral that is classified as complicated.

During the first quarter, Foxfire's PCPs made 450 referrals to dermatologists and 100 of these referrals were classified as complicated. One dermatologist, Dr. Shareef Rashad, received 42 of these referrals; 6 of his referrals were classified as complicated. Statements that can correctly be made about Foxfire's contact capitation arrangement include:

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A) that the value of each referral point for the first quarter was $120

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B) that the value of Foxfire's contact capitation fund for dermatologists for the first quarter was $20,000

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C) that the payment that Foxfire owed Dr. Rashad for the first quarter was $6,120

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D) all of the above