Contract provisions when the expenditures equal or deviate from budgeted for specialists and inpatient amounts (question2 and 4):
a. If the amount is equal to that allocated, all the risk pool money withheld is returned to the primary care physicians and specials
b. If payments to the hospital are higher by a certain % than budgeted, then the primary care physicians have not done a good job controlling referrals to specialists and specialists have not done a good job controlling hospital utilization. thus, they will get that percentage of the allocated amount to each from the professional services risk pool. The within-the-system hospital full expenses will be covered but it will only receive the same percentage of the inpatient service risk pool for not controlling its expenses.
c. If the payments to the hospital payments are lower by a certain percentage, all the three groups will receive all the original allotments and in additions, all three will share in the savings equal and added to their inpatient risk pool payments.