Prepare your write up with seven sections, including: Organizational Background, Problem Statement, Application of Tools, Findings, Interpretation & Discussion, and Recommendations, and weighted as follows:
? Application of Tools Accounting Formulas:
? Findings:
? Interpretation & Discussion:
? Recommendations:
Premium Development
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.