Imagine you are the VP of Human Resources for a large health system. One of your biggest responsibil Show more Imagine you are the VP of Human Resources for a large health system. One of your biggest responsibilities is to oversee the provision of health care benefits for the systems employees and their families.

Imagine you are the VP of Human Resources for a large health system. One of your biggest responsibil Show more Imagine you are the VP of Human Resources for a large health system. One of your biggest responsibilities is to oversee the provision of health care benefits for the systems employees and their families.

In fact behind employee salaries health benefits is the biggest line item in the systems budget. Your CFO is worried about next years budget and has approached you with a need to reduce spending on health benefits or at least cut down on the increase in spending as much as possible. Your group is self-insured and currently uses your local BC/BS provider as a third party administrator (TPA). Your group of 10000 employees has 20000 covered lives (or members) and currently uses only the BC/BS PPO plan. Your current utilization profile looks like this: Cost Cat. Measure units/ year $/svc Inpatient Adm/1000/yr 80 $ 15000 Outpatient Svcs/1000/yr 4000 $ 300 Professional Vis/1000/yr 5000 $ 288 Ancillary svcs /1000/yr 500 $ 480 Pharmacy Script/member 15 $ 48 BC/BS has given you guidance about next years likely trends. They expect both unit prices ($/svc) and utilization (units per year) to increase by 5% per year. They have suggested two alternate delivery models for your employees that could save you money: Narrow-network HMO Using your own system as the basis for a narrower network option you could continue to offer essentially the same benefit structure as you currently do. The limited choice of providers would deliver your benefits with no rise in utilization (you would still incur the 5% rise in unit price) High Deductible Health Plan (HDHP) In this choice you would continue to use the BC/BS large network but your employees would be given a $5000 deductible. The size of the deductible means that your employees would decrease their utilization of services by 5%. Neither alternative is especially attractive to your employees. Therefore youll need to plan to put incentives in place in the form of greater premium contribution and/or HSA funding. Unfortunately its not as simple as a single dollar amount per employee. For the HMO it will cost $30 per year to convince the first 500 employees to switch $60 for the next 500 etc. For the HDHP youll need to do better (people really dont like high-deductible plans). For this plan it will cost $60 for the first 500 employees to switch $120 for the second 500 etc. Your job from the available facts calculate the current years spending by category and in total. Then calculate the expected spending next year assuming no changes are made to the plan. Finally show the optimal mix of PPO HMO and HDHP members in order to minimize total expense to the health system. Keep in mind the incentives given to employees to choose a lower cost option should be considered a cost. Show less

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