Cooper-Pearson case study
Cooper-Pearson case study
Healthcare benefits play a big part in employee satisfaction and retention, though many organizations do not see the importance, according to a recent survey conducted by insurance company MetLife. More than three-quarters of employees who say they have good healthcare benefits also report high job satisfaction, and 71 percent of those workers are loyal to their employers. Conversely, only about one-fourth of staff members who are dissatisfied with their benefits are happy and loyal to their organization. I have been given the task to research different medical insurance plans to assist Cooper-Pearson in selecting an insurance program for their marketing company. My aim is to provide them with enough details to make an informed decision on the different managed care plans.
This information will allow them to provide their employees with a compensation package that is both affordable and desirable. Once an attractive compensation plan is in place; we expect the retention rate to improve and the recruitment of quality employees to increase. The primary differences between the HMO plan and the PPO plan is that you are required to have a primary care physician within the primary care network that you are assigned to. You don’t have the option of visiting a physician outside of the network. You must have a referral from your physician to see a medical specialist and the specialist must be within the approved network. HMO plans normally cost less than a PPO but you may have a higher co-payment with a HMO plan.
The PPO provides more information to the insured concerning cost sharing in or out of the network (Kongstvedt, 2007, p 25). According to (“benefithouse.com”, 2011), an indemnity plan allows you to use a medical provider of your choice to receive medical care. You must pay an annual deductible for the coverage before the insurance repayment takes effect. Once the deductible is paid then the plan will pay a percentage of your medical coverage and you pay the remaining balance.
There is a cap on how much the insured has to pay towards his or her coverage with an indemnity plan. The company spends a lot of time recruiting young men and women directly out of college and are willing to provide them with a good salary to join the company. Most people who are directly out of college don’t have families and don’t focus on medical benefits. Their priorities are on making a good salary. However, over time as they begin to have families and or health issues, they come to the realization that the company doesn’t have an adequate health plan. This can lead to stress which can produce other health issues further complicating matters.
It is important for this company to go with a managed care plan that has a customer focus approach. This will encourage current and future employees that the company believes in investing in quality medical care, as employees are there foremost priority. The goal is to have an understanding on what type of medical coverage is most important to the employee and use the information as a way to measure the quality provided in the managed care programs. It is common for the insured to play a key role in decisions concerning their healthcare. They are more apt to accept the cost sharing when they feel they are getting a choice on the type of care received. Once the managed care plan is made available to the employees, the desired result is to see an improvement in retention and recruitment.
A possible negative impact could be an increase of cost for both the employer and the employee. However, creating an incentive plan such as a wellness program with an employee bonus could encourage a healthier lifestyle which could lead to fewer visits to a provider. Possibly cutting healthcare costs for the company and the employees. The managed care industry is increasingly using physician credentialing when seeking health care providers. The credentialing process must be conducted in a manner that meets the goals of the managed care program. When it comes to managed –care physician credentialing, it is primarily performed to protect patients. It is one of the most effective controls in medicine today and probably ranks right up there with residency training as a key to quality. Credentialing is also performed to protect the hospital and medical staff in case a patient is (or believes he/she has been) injured. Corporate negligence cases often allege that the hospital did not perform the credentialing function well.
Good credentialing practices allow one’s hospital to easily demonstrate that you dotted all of the i’s and crossed all of the t’s. There’s no question that if a hospital and its credentials committee do their jobs well, it becomes very difficult for a plaintiff attorney to demonstrate negligent credentialing. Employee benefit plans are dynamic. They need to be adapted to changing economic, business, demographic, and other forces that affect these plans and the business community. Otherwise, they can rapidly become outdated and unnecessarily expensive. The Prescription Drug component of the Employee Benefit program is a critical element of an employer-sponsored health and productivity benefit program.
Understanding the organization’s position in relation to other employer-sponsored programs can help one measure the pharmacy benefit plan(s) relative to the employer marketplace. It also can help one compete effectively in attracting and retaining high-quality employees, managing prescription drug plan costs and developing appropriate strategies to respond to the challenges of the current economic environment. Finally, health insurance helps protect an individual or family from financial loss for costs incurred because of sickness or injury. According to the U.S. Census Bureau, an estimated 85 percent of all Americans have some form of health insurance. Roughly half of all Americans with coverage get it through their employer or their spouse’s employer. There are a number of reasons why it makes good business sense for employers to offer insurance benefits to their employees and their families.
1. Kongstvedt, P. Essentials of Managed Health Care, 5th Edition. 2007. Jones and Bartlett: Sudbury, MA.
2. Benefit House, What is Indemnity Health Insurance, 2011. Retrieved 14 September, 2012 from 3. http://www.benefithouse.com/insurance/health/indemnity.html 4. https://www.bucksurveys.com/bucksurveys/Surveys/PrescriptionDrugBenefit/tabid/81/Default.aspx 5. http://smallbusiness.chron.com/importance-health-insurance-company-17225.html
University/College: University of Arkansas System
Type of paper: Thesis/Dissertation Chapter
Date: 4 January 2017
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