- This Case Illustrates The Development Of A Premium Rate By A Managed Care Plan For Submission Of A Bid To Furnish Health 1 (139.95 KiB) Viewed 27 times
- This Case Illustrates The Development Of A Premium Rate By A Managed Care Plan For Submission Of A Bid To Furnish Health 2 (35.42 KiB) Viewed 27 times
- This Case Illustrates The Development Of A Premium Rate By A Managed Care Plan For Submission Of A Bid To Furnish Health 3 (76.67 KiB) Viewed 27 times
health coverage is limited to 60 days
Copays are as follows:
Acute inpatient care $150 per admission
Mental health inpatient care $150 per admission
Inpatient surgical services $150 per procedure
Emergency care $ 25 per visit
Primary physician care $ 15 per visit
Specialist physician care $ 10 per visit plus $10 PCP copay
2. For High Cost Premium Plan:
Mental health coverage is limited to 90 days.
There are no copays with this plan
3. For Low Cost Premium Plan
Mental health coverage is limited to 30 days.
Copays are as follows:
Acute inpatient care $250 per admission
Mental health inpatient care $250 per admission
Inpatient surgical services $250 per procedure
Emergency care $ 50 per visit
Primary physician care $ 25 per visit
Specialist physician care $ 20 per visit plus $20 PCP copay.Please
DO NOT alter the cells in the spread sheet. The sheet will
automatically calculate the answer.
This case illustrates the development of a premium rate by a managed care plan for submission of a bid to furnish healthcare services to employees of a buyer consortium. The historical cost input data for facilities services is the per diem reimbursement rate for npatient acute care, the daily cost for skilled nursing facility care, the daily cost for inpatient mental health care, the per case cost for hospital-based surgery, and the per visit cost for emergency room services. The historical utilization input data for facilities services is days per member for acute care, nursing home care, and inpatient mental health care; cases per member for inpatient surgery; and visits per member for emergency room care. The model consists of a complete base case analysis--no changes need to be made to the existing MODEL-GENERATED DATA section. However, values in the INPUT DATA section of the student spreadsheet have been replaced by zeros. Students must select appropriate input values and enter hem into the cells with values colored red. After this is done, any error cells will be corrected and he base case solution will appear. The KEY OUTPUT section includes the most important output rom the MODEL-GENERATED DATA section.
INPUT DATA: KEY OUTPUT: $ 31.08 Inflation adjustment Administrative expense percent Profit/reserves percent 0.0% 0.0% 0.0% PMPM bid Premium rates: Single Family A A $ $
OTHER INPUT AND MODEL-GENERATED DATA: PMPM Calculation: Historical Cost Data Historical Base Utilization PMPM Cost Copay Adjustment Fackdjustflation Adjusted Cost P PMPM Cost $ 1. Medical Expenses Facility Services: Inpatient: Acute Skilled nursing Mental health Substance abuse Surgical procedures Emergency room Outpatient procedures 0.0000 $ 0.0000 0.0000 0.41 0.0000 0.0000 0.0000 1.0000 0.0000 0.0000 1.0000 0.0000 # 0.0000 # 0.0000 # 1.0000 # 0.0000 # 0.0000 1.0000 0.0000 0.0000 # # 3.43 Total facility services PMPM amount $ 3.84 # $ 3.84 $ 0.0000 0.0000 # Physician Services: Primary care Specialist care Office visits Surgical services All other services 9.00 23.67 0.0000 0.9544 0.8659 0.0000 1.0000 0.9100 # # # Total physician services PMPM amount # $ 27.24 Total facility and physician services PMPM amount $ 31.08 II. Other Expenses Administrative Reserves # # Total other expenses # $ Total PMPM amount $ 31.08 III. Premium Rates Family Rate factor Monthly premium rate Single 0.000 $0.00 0.000 $0.00