Finance Case Study
Finance Case Study
You have recently joined New England HMO as a marketing analyst. The HMO has been approached by a consortium. Your task is to develop the bid presentation to be made to the consortium.
Download and read the scenario. Download and use the spreadsheet for analysis.
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Present your analysis as a 3-page report in a Word document formatted in APA style. Develop the bid presentation as a 6’7 slide PowerPoint presentation.
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| Premium Development Case Study | A?© 2007 South University | |||||||
| New England HMO | ||||||||
| Select the appropriate input values and enter them in cells containing hyphens or zeroes. Once you do this, the base case solution will appear. | ||||||||
| 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 acute care, nursing home care, and inpatient mental heatlh care; cases per member for inpatient surgery; and visits per member for emergency room care. | ||||||||
| KEY INPUT: | KEY OUTPUT: | |||||||
| Inflation adjustment | 0.0% | PMPM bid | $ 31.08 | |||||
| Administrative expense percent | 0.0% | Premium rates: | ||||||
| Profit/reserves percent | 0.0% | Single | $ – | |||||
| Family | $ – | |||||||
| OTHER INPUT AND MODEL-GENERATED DATA: | ||||||||
| PMPM Calculation: | ||||||||
| Historical | Historical | Base | Copay Adjustment Factors | Adjusted | Inflation Adjusted | |||
| Cost Data | Utilization | PMPM Cost | Cost | Utilization | PMPM Cost | PMPM Cost | ||
| I. Medical Expenses | ||||||||
| Facility Services: | ||||||||
| Inpatient: | ||||||||
| Acute | $ – | 0.0000 | $ – | 0.0000 | 0.0000 | $ – | ||
| Skilled nursing | – | 0.0000 | – | 0.0000 | 0.0000 | – | ||
| Mental health | – | 0.0000 | – | 0.0000 | 0.0000 | – | ||
| Substance abuse | 0.41 | 1.0000 | 1.0000 | 0.41 | ||||
| Surgical procedures | – | 0.0000 | – | 0.0000 | 0.0000 | – | ||
| Emergency room | – | 0.0000 | – | 0.0000 | 0.0000 | – | ||
| Outpatient procedures | 3.43 | 1.0000 | 1.0000 | 3.43 | ||||
| Total facility services PMPM amount | $ 3.84 | $ 3.84 | $ 3.84 | |||||
| Physician Services: | ||||||||
| Primary care | $ – | 0.0000 | 0.0000 | $ – | ||||
| Specialist care | ||||||||
| Office visits | – | 0.0000 | 0.0000 | – | ||||
| Surgical services | 9.00 | 0.9544 | 1.0000 | 8.59 | ||||
| All other services | 23.67 | 0.8659 | 0.9100 | 18.65 | ||||
| Total physician services PMPM amount | $ 27.24 | $ 27.24 | ||||||
| Total medical PMPM amount | $ 31.08 | |||||||
| II. Other Expenses | ||||||||
| Administrative | $ – | |||||||
| Reserves | – | |||||||
| Total other expenses | $ – | $ – | ||||||
| Total PMPM amount | $ 31.08 | |||||||
| III. Premium Rates | ||||||||
| Single | Family | |||||||
| Rate factor | 0.000 | 0.000 | ||||||
| Monthly premium rate | $0.00 | $0.00 | ||||||
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