Health System Financial Report

One of the key elements of healthcare is to determine your payor mix. Whether you are in direct service (i.e. outpatient care, hospital, dental, behavioral health, surgery) or support service (i.e. pharmacy, radiology, medical equipment), you need to understand what mix your payors are and how they reimburse. These models are important to the sustainability of your care model.

Utilizing the sample health system financial report, please analyze the following items:
• What is the current payor mix for the organization?
• What do you see is the typical reimbursement for each payor (you can use estimates based on monthly and YOY data)?
• What would happen if the payor mix shifted 5% more for TriCare? Medicaid?
• Based on your analysis and outside research, why do you think that some practices will limit the amount of payors that are not private companies (i.e. Medicaid, Medicare, TriCare, uninsured)?
• Is it ethical that organizations limit payors or target patients with certain insurance carriers?

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