Week 10: Managed Care Case Study

Question 1

Insurance health plan

Answer 1

-employer assumes ALL costs
-employee pays for coverage (FUND to pay health care claims to providers)
-employer pays insurance company into FUND for health claims to providers
-insurance profits

Question 2

fully-insured

Answer 2

-insurance assumes all costs
-employer pays per-employee premium to insurance company
-usually offered by smaller firms

Question 3

self-insured

Answer 3

-employer assumes risk
-employer acts as own insurer
-claims processed by insurance company that does negotiating and networks
-usually larger firms

Question 4

Benefits of self-insure plans

Answer 4

-control and flexibility
-allows customization vs one-size-fits all
-employer can contract w any provider
-employer does not have to pre-pay for coverage
-avoids state-mandated benefits
-potential to dec cost
-control maximizes income
-avoids state premium taxes and other fees

-not best for small firms w/o finances to meet needs

Question 5

Why is reported chronic disease at purdue less than expected?

Answer 5

-higher educated workforce
-underdiagnosing
-higher prevention screening access
-no right answer

Question 6

Purdue Healthcare Cost Split

Answer 6

-purdue 84%/16% employees
-80/20 now
-moving towards 75/25

Question 7

Purdue cost influences

Answer 7

-where u access health care
-employee entitlement
-lack of comparative pricing
-stagnant plans fostered continuation of current coverage vs looking for new options

Question 8

Purdue short-term strategies

Answer 8

-change insurance plans (3 tier premium, deductible/coinsurance arrangement, offer preventative rx at no cost, combine Rx and med deductibles)
-encourage consumerism (lab and imaging benefits, implement HealthSync (incentive for choosing lowesr. cost/highest quality, adj center for healthy living copay)
-wellness campaign (incentivize wellness outcomes, higher premiums for tobacco users)

Question 9

Purdue long-term stratgies

Answer 9

stage 1: awareness (metrics, brand, identify champions, assess funding)
-stage 2: engagement/accountability (share stories, education, partner w local providers, penalty/reward system, metrics)
-stage 3: improve and maintain: eval outcomes, assess new incentives