...Economic Issues Simulation Paper Health maintenance organizations (HMO) are organizations that provide or organize health insurance, self-funded health care benefits plans, individuals, and other entities for the United States as a liaison with health providers or hospitals on a prepaid basis. In this simulation a virtual organization Castor Collins Health Plans presented three HMO options to two organizations. I will review one of the company’s demographics, discuss the HMO choices, explain the differences in the choices presented, and why I chose the plan I chose. The Health Maintenance Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options if the employer offers traditional healthcare options, this is way today you are given more than one option for health care. Company: Constructit Constructit consist of a 1000 employees (550 men and 450 women) ranging from ages 26 through 42 and 60 percent of them are married. Constructit has to consider in the number of employees that would covers their spouses or children for insurance coverage. Thirty-two of the workers are physical active and 25 percent are moderately physically active. There are 170 men and 210 women approximately 38 percent with no health issues. Ten percent of men and 8 percent of the women are heavy smokers. Obesity rate is also a problem with 39 percent being obese causing a heavy absenteeism for reason of high blood pressure, diabetes, heart issues, and...
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... | | |College of Natural Sciences | | |HCS/440 Version 5 | | |Economics: The Financing of Health Care | Copyright © 2010, 2007, 2005, 2004, 2002, 2000 by University of Phoenix. All rights reserved. Course Description This course provides an overview of the economics of health care. The various payers are examined, including private, state, and federal entities. Issues such as the cost effectiveness of prevention, the management of patients and their diseases, as well as the cost of treatment settings are discussed. Third party reimbursement from various sources, ranging from for-profit insurance carriers to charitable donations, are reviewed. The health care system's use of grant funding and research dollars is described. Policies Faculty and students/learners will be held responsible for understanding and adhering to all policies contained within the following two documents: • University policies: You must be logged into the student website to view this document. • Instructor policies: This document is posted in the Course Materials forum. University policies are...
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...Economic Issues Simulation Paper Introduction The Economic Issues Simulation Paper is about Castor Health Plans. This health plan was founded in 1999 as a Regional HMO in the state of Pantome. The main purpose of Health Maintenance Organizations (HMOs) is to provide health care services and health insurance to enrollees through a statewide network of hospitals and physicians. The HMOs complete this by using a capitation model in which it pays its large network of health providers. Caster Health plan has thousands of enrollees throughout the state and is looking towards increasing the amount. As a representative for the Castor my responsibilities is to maximize profit and minimize risk for the company. Other responsibilities that I would need to help with are including plenty of interaction with any new clients and formulating health plans in that would suit the client’s needs, on top of all that this would also include pricing plans and setting insurance premiums. It’s never an easy job making any sort of financial Making any types of financial and economic decisions; making decisions for a business is a lot harder because one has to realize what is and will do best in order for the business to make profits and to grow. Castor will need to choose between two types of companies it will want to help cover with their health plan. The two companies that have been put in front of their health plan company are that of Constructit or E-editor. The simulation has a couple...
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...Economic Issues Simulation Paper is about Castor Health Plans. This health plan was founded in 1999 as a Regional HMO in the state of Pantome. The main purpose of Health Maintenance Organizations (HMOs) is to provide health care services and health insurance to enrollees through a statewide network of hospitals and physicians. The HMOs complete this by using a capitation model in which it pays its large network of health providers. Caster Health plan has thousands of enrollees throughout the state and is looking towards increasing the amount. As a representative for the Castor my responsibilities is to maximize profit and minimize risk for the company. Other responsibilities that I would need to help with are including plenty of interaction with any new clients and formulating health plans in that would suit the client’s needs, on top of all that this would also include pricing plans and setting insurance premiums. It’s never an easy job making any sort of financial Making any types of financial and economic decisions; making decisions for a business is a lot harder because one has to realize what is and will do best in order for the business to make profits and to grow. Castor will need to choose between two types of companies it will want to help cover with their health plan. The two companies that have been put in front of their health plan company are that of Constructit or E-editor. The simulation has a couple of plans to chose from and on top of that it also has a customized...
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...Introduction The Economic Issues Simulation Paper is about Castor Health Plans. This health plan was founded in 1999 as a Regional HMO in the state of Pantome. The main purpose of Health Maintenance Organizations (HMOs) is to provide health care services and health insurance to enrollees through a statewide network of hospitals and physicians. The HMOs complete this by using a capitation model in which it pays its large network of health providers. Caster Health plan has thousands of enrollees throughout the state and is looking towards increasing the amount. As a representative for the Castor my responsibilities is to maximize profit and minimize risk for the company. Other responsibilities that I would need to help with are including plenty of interaction with any new clients and formulating health plans in that would suit the client’s needs, on top of all that this would also include pricing plans and setting insurance premiums. It’s never an easy job making any sort of financial Making any types of financial and economic decisions; making decisions for a business is a lot harder because one has to realize what is and will do best in order for the business to make profits and to grow. Castor will need to choose between two types of companies it will want to help cover with their health plan. The two companies that have been put in front of their health plan company are that of Constructit or E-editor. The simulation has a couple of plans to chose from and on top of that...
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...This paperwork contains HCS 440 Week 4 Individual - Economic Issues Simulation Paper General Questions - General General Questions Review the Health Care Economics Issues HMO Simulation exercise posted on your student web page. Follow the Wk 4 WEB LINK “Understanding Economic Issues for HMO’s”. This exercise is for your learning experience only. Do not post any screen short from the exercise as part of your assignment. Economic Issues Simulation Paper Prepare a 1,050- to ,1400 paper in which you present a profile of each company including the demographics of the employees, the health care risk factors (potential areas of high utilization), and the premiums the company is willing to pay. Apply each plan, Castor Standard and Castor Enhanced to each company, Constructit and E-editor, to determine which plan best meets the healthcare needs of the employees – ignore Dearden. As a representative of Castor insurance, your job is to maximize profit and minimize risk for the company. Based on your analysis of potential utilization, give at least two reasons why each plan could be selected for each company. Then select one of the two companies and state which plan you would select to sell to that company? What are the reasons for this decision? Why did you not select the other plan offered? Your paper should be organized so that each question serves as a subheading followed by the discussion, i.e. Two Reasons Why Each Plan Could Be Selected, Which...
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...Economic Issues Simulation Paper HCS440 January 13, 2014 Bruce Nave Economic Issues Simulation Paper Castor Collins is a regional health maintenance organization (HMO) that provides insurance and health care services to enrollees through its network of doctors and hospitals. Castor Collins offers several different insurance plans that would be beneficial to the employees of Constructit. The insurance plans offered vary according to services provided, cost of annual premium to employees, and utilization of services. Castor Collins has the ability to tailor an insurance plan that meets the health needs of Constructit employees at an affordable price while still brining in revenue for Castor Collins. Profile of Constructit and E-Editors Constructit is seeking a group health insurance plan and has 1,000 employees that is willing to pay a maximum of $4,000 in annual premiums. Of the 1,000 employees, 550 are men, 450 are women, and 60% of them are married. Their ages range from 26 to 42; 40% are 26-30, 31% are 31-35, 20% are 36-40, and 8% are 41-45. With a large percentage of younger employees, 38% reported having no major health risks. Reasons for absenteeism at Constructit include injuries, respiratory system diseases, digestive disorders, migraines, and allergic conditions. Some of the respiratory system diseases are attributed to the 10% of men and 8% of women who are smokers. Additionally, 43% of employees consider themselves as doing sedentary activities while 25% and...
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...Econ Economic Issues Lindsay Honea HCS/440 June 7, 2016 Christopher Clarke Economic Issues Health care economics provides theories of production, inequalities, effectiveness, regulation and competition to help keep health care running smoothly and efficiently (Getzen, 2013, p. 2-15). One key factor that health care economist are watching is medical plans provided to help cover the cost of care for individuals. These plans are put in place to help take some of the burdens off of the person while helping find affordable, reliable, quality care. Castor Collins is a health insurance group that provides insurance plans to companies to help cover their employees. In the University of Phoenix simulation (n.d.), two large organizations have come to Castor Collins to determine the right plan for their employees. As the VP of Castor Collins, it is my job to help them find the plan that fits their budget, one that is cost effective, and provides quality care. Castor Collins Health Plan is a regional HMO plan that started in 1999. This plan provides coverage to 100,000 people in its state. They are looking to increase the number of individuals that it covers. My colleagues (Helen Feuerman CEO, Jonathan Wilkes, MD, Chief Medical Officer, and Adam Hunter Executive Vice President of Planning and development) and I will be looking at options of the best way to provide this coverage for the individual, the companies who employ them, and Castro Collins (University of Phoenix, n.d...
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...Financing of Health Care Teonna Smalls HCS/440 Donna Lupinacci 05/12/2012 Introduction HMO’s and enrollees are two important players in the world of health care. Due to uncertainty on the supply and demand, moral hazard, and adverse selection, decision making for HMO’s more complex. The simulation provided me the decision making tools necessary, when making an economic decision for an HMO. Health care can be seen as a good that consumers demand and managed care firms are considered to be suppliers of both health insurance and health care. Economics tells us that rational firms make choices to maximize profits. Managed care firms incur cost when providing health care services to their enrollees and maximize their revenue by providing health insurance. Castor Collins Health Plans Castor Collins Health Plans was founded as a regional HMO in 1999. The HMO provides health insurance and health services to enrollees through its statewide network of physicians and hospitals using a capitation model to pay health care providers within the network. Currently the plan has 100,000 enrollees through the state. My responsibility as Vice President of Castor of financial planning and strategy requires me to interact with new clients and formulate health plan that will best suit their needs. In addition, I am responsible for pricing plans and setting insurance premiums. Collins has three plans to choose from, Castor Standard, which does not cover preexisting medical conditions, Castor...
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...Economic Issues Simulation HCS 440 May 30, 2011 Professor Humberto Munoz Constructit is a business organization that currently does not offer employer paid health insurance. Constructit is compromised of 1,000 people and they are willing to pay up to $4,000 per person for their annual premium. The organization consists of 550 men and 450 women ranging in age of 26 to 45 years old. Fifty-seven percent of the workers range from high activity to moderate activity level while the remaining forty-three percent are mainly in a sitting position most of times. One factor to consider when determining which type of insurance to offer the group is the amount of health risk factors that affect all the employees. Thirty-eight percent of the employees have been deemed to have no major risk factors at all; however, almost eighteen percent of the workers are smokers and thirteen and a half percent of them suffer from some form of respiratory disease or illness. One of the biggest risk factors affecting the entire group of people is obesity. Obesity affects thirty-nine percent of these workers which in turn, increases the risk for obesity related diseases and illnesses. These diseases include but not limited to heart disease, hypertension, hyperlipidemia, and diabetes. This will increase the utilization of many healthcare services including prescription drugs, diagnostic services, and outpatient office visits (University of Phoenix, 2010). Castor Collins is a regional...
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...Economic Issues Simulation HCS/440 July 9, 2014 Jonathan Foskett Economic Issues Simulation Constructlt is a company, which currently employs 1,000 individuals, 550 men and 450 women in the age group of 26-42. Approximately 60% of the group is married. The group is willing to pay up to $4,000 dollars per individual for their annual premium. Castor Collins must weigh the many considerations when deciding to insure Constructlt, the premiums employees are willing to pay, risks of providing a certain plan or service, and the expected utilization (University of Phoenix, 2014). In order to maintain a profit Castor Collins needs to take all of these aspects into consideration. Thirty-two percent of the individuals at Constructlt have a working profile, which involves significant physical activity, and only 25% have a working profile with moderate activity. When determining which insurance plan is best for Constructlt it is best to look at the health risk factors of the group. Thirty-eight percent of the group, which breaks down to 170 men and 210 women, has no major health risks. Conversely, 18% of the workers, 10% men and 8% of the women are smokers. The principal health risk factor affecting the group is obesity. Of the Constructlt group obesity affects 39% of the group. Hence, increasing the risk for obesity related diseases like high blood pressure, heart disease, and diabetes. Due to the health risk factors utilization will increase with...
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...Economic Issues Simulation Paper Name HCS/440 Economics: The Financing of Health Care February 7, 2011 Instructor Economic Issues Simulation Paper The Castor Collins health plan is a health maintenance program (HMO) that was found in 1999. The company provides health insurance coverage through a system that involves a network of physicians and hospitals. Castor Collins Heath Plan uses the capitation model to fund its large distributed group of physicians and health care organizations. Currently, Castor Collins provides health care coverage to 100,000 subscribers and would like to increase their enrollees. It is the responsibility of the Vice President along with his most trusted advisers, Helen Feuerman, Chief Financial Officer, Jonathan Wilkes, Chief Medical Officer, and Adam Hunter, Executive Vice President, Planning and Development, to reach out to new clients; two in particular, E-Editors and Constructit. E-Editors Castor Collins has a major company that is looking for health insurance coverage for their employees. The company E-Editors employs 1,600 individuals, 760 males and 840 females. The employee’s ages range from 35-54. Most of the employees with E-Editors are married so they will need to provide an affordable health care plan for their families. Looking at the kind of work involved for most of the employee’s, Castor Collins found that many of the individuals have a sedentary position. In fact, ninety-five percent of the employees at E-Editors have a position...
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...Economic Issues Simulation Paper Name HCS/440 Economics: The Financing of Health Care February 7, 2011 Instructor Economic Issues Simulation Paper The Castor Collins health plan is a health maintenance program (HMO) that was found in 1999. The company provides health insurance coverage through a system that involves a network of physicians and hospitals. Castor Collins Heath Plan uses the capitation model to fund its large distributed group of physicians and health care organizations. Currently, Castor Collins provides health care coverage to 100,000 subscribers and would like to increase their enrollees. It is the responsibility of the Vice President along with his most trusted advisers, Helen Feuerman, Chief Financial Officer, Jonathan Wilkes, Chief Medical Officer, and Adam Hunter, Executive Vice President, Planning and Development, to reach out to new clients; two in particular, E-Editors and Constructit. E-Editors Castor Collins has a major company that is looking for health insurance coverage for their employees. The company E-Editors employs 1,600 individuals, 760 males and 840 females. The employee’s ages range from 35-54. Most of the employees with E-Editors are married so they will need to provide an affordable health care plan for their families. Looking at the kind of work involved for most of the employee’s, Castor Collins found that many of the individuals have a sedentary position. In fact, ninety-five percent of the employees at E-Editors have a position...
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...Economic Issues Simulation Paper/ Constructit Ruby Medders HCS/440 March 16, 2015 Lori Geddes Economic Issues Simulation Paper/ Constructit The research was done on determining which insurance policy would be better for a striving company. My decision was to research Constructit; I will give you my reasons behind choosing this company, benefits that will help the employees of this company and why I think this was the better choice for this company. (Getzen, 2013) Profile The companies name is Constructit, it employees 1000 people. The demographics for this company is ages 26-45 years old, there are 406 people between the ages of 26-30, 314 people between the ages of 31-35, and 82 people between the ages of 41-45. The total count for this company is 550 men and 450 women and 60% of the people are married. The physical condition of the people who work for Constructit shows that 32 % of the employees are involved in great physical activity, 25% is involved in a moderate physical activity, and the rest of the employees which is 43% are involved in sedentary activities. The health risk of the employee has been rated moderately high for health risk in this group. The good part of the research showed that 35% of the group has no major health risk, although 18% of the people who work for this company are smokers. (Getzen, 2013) According to report some of the major causes of work absenteeism at Constructit are injuries, respiratory system diseases, digestive disorders...
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...Angel Gross HCS/440 Economic Issues Stimulation Paper 08/28/2014 Caryn Callahan Economic Issues Simulation Paper Introduction I am Angel Gross I am the vice president strategy and financial planning for Castor Collins Health Plan. My job description consists of on a daily basis is interacting with new patients and formulating health plans that will suit their needs also including pricing plans and setting insurance premiums. The HMO provides health insurance and health care services to enrollees through it statewide network of physicians and hospitals. Castor Collins currently has 100,000 enrollees throughout the state and is looking to increase this number. The first group constructit consist of a 1,000 people while the E-editors, comprises 1,600 people neither group has employer insurance this means that people comprising both groups will pay for they own insurance the people at constructit are willing to pay the maximum annual premium of $4,000 per person, while the people at E-editors are willing to pay a maximum annual premium of $4,500 per person. Constructit comprises 500 men and 450 women with the age group of 26 to 42 about 60 percent of the group id married. The members of E-editors comprise 760 men and 840 women in all the ages of 35 to 54 with the highest percentage of 61 percent being between 45-54 years of age. The majority of E-editors employees are listed as married. The work at E-editors is largely sedentary work sitting in front of computers...
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