The Castor Collins health plan is a health maintenance program (HMO) that was found in 1999 and has grown over the years. 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. Castor Collins currently 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.
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 that requires long hours of sitting in front of a computer; the remaining five percent of the employees have positions that require physical activity. A thorough health screening was conducted by Castor Collins. Their findings were as followed, most of the employees who have sedentary positions had problems with their vision.
Twenty two percent of the employees had no history of health issues. Twenty six percent of the employees are smokers, most of them revealing that they are considered heavy smokers, although none of employees that smoke reported any respiratory complications. The remaining forty- five percent of the employees are obese. Interestingly, the obesity is due to a sedentary job, poor eating habits, and little to no physical activity. These populations of employees are at risk for severe health complications and diseases.
Constructit has 1,000 employees; 550 being male and 450 are females. The age group ranges from 26-42, and sixty percent of the employees are married. Fifty three percent of the employees have positions that require physical activity. Thirty-two percent of this group has high activity positions and twenty five percent have moderate activity positions. The remaining forty three percent of the employees have sedentary positions. The result from this groups health screening are as followed, thirty-eight percent of the employees have no preexisting health issues and are in good physical health. Ten percent of the employees are smokers. Thirty nine percent of the employees are considered obese, which is a high obesity rate. Some of the illnesses that were reported are digestive disorders, respiratory diseases, injuries, and allergies.
Analysis of both groups
It is Castor Collins job to find suitable health care plans that will benefit both companies, employees, and Castor Collins while keeping in mind to make it affordable and beneficial to all. They will need to evaluate the potential risks and assess the cost of premiums for both. All members of the team determined the best way for deciding would be best conducted by using the cost-benefit analysis system. “The cost-benefit analysis (CBA) is a set of techniques for assisting in the making of decisions that translates all relevant concerns into market (dollar) terms” (Gertzen & Allen, 2007).
The team must first consider the age, gender, and profiles of all employees. Secondly, decide the potential health risks, calculate premium and profit. Thirdly, decide what services will be covered and co-payments for these health plans. When taking into consideration the different health profiles of all employees’ obesity seemed to be an issue for both. This alone makes the population at high risk for health issues associated with obesity such as; heart diseases, strokes, and diabetes. E-editors seem to have a higher percentage of obesity and smokers putting them at a much higher risk with health issues.
After evaluating the cost and benefits that go along with providing health insurance coverage to both E-Editors and Constructit, Castor Collins financial team decided that they would only be able to provide health insurance coverage to Constructit and not E-Editors. The reason for this decision is E-Editors have a higher percentage of employees that are at risk for developing chronic diseases. The team went ahead and presented an offer to Constructit and their employees. Castor Collins can offer their employees the Castor Standard plan, which the premium to be charged will be $3,428.00. The reasoning behind choosing this plan over the Castor Enhanced and the Castor Enhanced Minor is the premiums for each employee would be significantly lower than the Enhanced and Enhance Minor plans even though each employee was willing to pay a maximum of $4,000 for their annual premium.
Also, Castor Standard does not cover preexisting health conditions, so this would be a low risk investment. Preexisting conditions can cost a company thousands of dollars and in the end not be beneficial to the company’s profits. If Castor Collins were to contemplate preexisting conditions a much higher premium may have to be considered. This is an advantage that can help keep the annual premiums down and still provide many other health coverage services. The premiums that Castor Collins will charge the employees at Constructit are much lower than anticipated, which means a lower profit return. This group is considered a lower health risk group so increasing premiums could create a possibility to make greater returns, but the outcome is still fitting.
Many hours of planning and development were considered for the final decision of adding Constructit and not E-editors as a client. The team made this decision by utilizing the CBA method and determining that Constructit would be low risk to provide health coverage too. The plan that was chosen Castor Standard will have a lower return but in the long run be beneficial to Castor Collins. The employees at Constructit will be able to afford the health coverage plan and look towards the future knowing they are insured and covered for any emergencies without draining the wallet. Castor Collins and Constructit will begin a rewarding journey that will benefit both companies in the end. The team based this decision on considering all the necessary health profiles, risks, and premiums and comparing all of the facts between both companies.
Getzen, T. E., & Moore, J. (2007). Health Care Economics: Principles and tools for the Health Care Industry. Hoboken,, NJ: John Wiley & Sons, Inc.