Unified Health

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Possible answers:

• Looking into revenue & costs of UH.
• Looking into UH's main cost components including fixed & variable.
• Understanding how the medical & non-medical costs are build up and how revenue is segmented & how revenue & costs have moved historically.

Possible answers:

• UH might be paying higher referral rates whereas HMO has negotiated better prices.
• HMO physicians might be more capable and well-rounded to treat medical conditions that UH might need a referral for.
• UH might have older or sicker patients that require outside medical treatment for a longer period.

Share additional information upon request of the candidate.

• UH has 300,000 patients in any one year.
• 25% of UH patients are 65 or older.
• In the US, cardiac patients visit a specialist 5 times a year on average.
• 25% of the population of >65 risks serious heart diseases.
• 10% of the population <65 risks serious heart diseases.

Answer:

• 25%*300,000=75,000 UH patients are 65 and older.
• That means 225,000 are 65 and younger.
• 75,000*25%=18,750 patients over 65 who risk heart diseases.
• 225,000*10%=22,500 patients under 65 who risk heart diseases.
• UH should expect ((18,750+22,500)*5)=206,250 external referral visits.

Possible answers:

• Patients could demand referrals from UH physicians.
• UH physicians are not capable enough to deal with basic cardiac issues or aren't confident enough to keep a patient at UH.
• No clear internal guidelines on when to refer a cardiac patient.
• No incentives or penalties for physicians who refer cardiac patients when it's not necessary.

Possible answers:

• UH physicians are referring cardiac patients too often and in cases where a referral might not be required. This is pushing overall costs and affecting profitability.
• Recommended to look into training UH staff to deal more with basic & minor cardiac problems.
• Recommended to define clear guidelines on when to refer cardiac patients.
• Benchmark other health providers to see how they keep their referral rates at a minimum.