If an HMO covers 150,000 lives, expects 25 myocardial infarctions (MIs) to occur each year within the covered lives, expects a length of stay of 4.5 days for each MI, and has to pay an average of $950 per day for each day the MI patient is in the hospital, what is the PMPM costs to the health plan?
What would have to be charged to the patient or employer if the health plan has administrative costs equaling 10% of its costs and it wants a profit margin of 7%?