Premium Rate Case Study
Not what you're looking for?
Complete Case 5: Blue Pointe Healthcare:
Assist with writing a case review that addresses premium development. That include quantitative and qualitative factors, conclusions and recommendations.
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.
This model differs from most models in that much of the input data required is in the MODEL-
GENERATED DATA section. All input values in the student version have been replaced with zeros.
Thus, students must enter the appropriate input data into the red cells containing a zero or hyphen.
When this is done, any error cells will be corrected and the base case solution will appear. However, the model does not contain any scenario analyses, so students will have to create their own if necessary. Furthermore, students must create their own graphics output (charts) as needed to present their results.
Note that the historical cost input data for facilities services is the per deim reimbursement rate for inpatient 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.
Purchase this Solution
Solution Summary
The solution discusses the premium rate case study.
Solution Preview
Development
Qualitative Factor:
Blue Pointe Healthcare premium development cover two different categories of expenses one is the cost of proving required health care services and the other is administration cost and cost of reserves. The organization has adopted multistep approach to set its premium and these steps include:
(i) Estimation of base per member per month (PMPM) for each of the plan's covered benefit. This base PMPM cost is basically developed using the historical utilization and cost data. For ...
Education
- MBA, Indian Institute of Finance
- Bsc, Madras University
Recent Feedback
- "I've posted a similar question for another course. It's post 657940, and it's a practice problem that I'd like to use for the final exam. Your help will be greatly appreciated. "
- "thank you!"
- "Thank you again Jayant. You are super fast. "
- "Thank you Jayant. You are appreciated. "
- "Again, thank you Jayant. You are wonderful. "
Purchase this Solution
Free BrainMass Quizzes
Writing Business Plans
This quiz will test your understanding of how to write good business plans, the usual components of a good plan, purposes, terms, and writing style tips.
Marketing Research and Forecasting
The following quiz will assess your ability to identify steps in the marketing research process. Understanding this information will provide fundamental knowledge related to marketing research.
Employee Orientation
Test your knowledge of employee orientation with this fun and informative quiz. This quiz is meant for beginner and advanced students as well as professionals already working in the HR field.
Transformational Leadership
This quiz covers the topic of transformational leadership. Specifically, this quiz covers the theories proposed by James MacGregor Burns and Bernard Bass. Students familiar with transformational leadership should easily be able to answer the questions detailed below.
MS Word 2010-Tricky Features
These questions are based on features of the previous word versions that were easy to figure out, but now seem more hidden to me.