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You have recently joined New England HMO as a marketing analyst. The HMO has been approached by a consortium. Your task is to develop the bid presentation to be made to the consortium.

Download and read the scenario. Download and use thespreadsheet for analysis.

Present your analysis as a 3-page report in a Word document formatted in APA style. Develop the bid presentation as a 6'7 slide PowerPoint presentation.

Name your documents as: LastnameFirstInitial_W1_A5.doc and LastnameFirstInitial_W1_A5.ppt.
For example, if your name is John Smith, your documents will be named SmithJ_W1_A5.doc and SmithJ_W1_A5.ppt.



Premium Development Case Study         A?© 2007 South University
New England HMO              
Select the appropriate input values and enter them in cells containing hyphens or zeroes. Once you do this, the base case solution will appear.
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 acute care, nursing home care, and inpatient mental heatlh care; cases per member for inpatient surgery; and visits per member for emergency room care.
Inflation adjustment 0.0%   PMPM bid $ 31.08    
Administrative expense percent 0.0%   Premium rates:      
Profit/reserves percent 0.0%   Single   $ -    
        Family   $ -    
PMPM Calculation:              
    Historical Historical Base Copay Adjustment Factors Adjusted Inflation Adjusted
    Cost Data Utilization PMPM Cost Cost Utilization PMPM Cost PMPM Cost
I. Medical Expenses              
Facility Services:              
Acute   $ - 0.0000 $ - 0.0000 0.0000 $ -  
Skilled nursing - 0.0000 - 0.0000 0.0000 -  
Mental health - 0.0000 - 0.0000 0.0000 -  
Substance abuse     0.41 1.0000 1.0000 0.41  
Surgical procedures - 0.0000 - 0.0000 0.0000 -  
Emergency room - 0.0000 - 0.0000 0.0000 -  
Outpatient procedures     3.43 1.0000 1.0000 3.43  
Total facility services PMPM amount   $ 3.84     $ 3.84 $ 3.84
Physician Services:              
Primary care     $ - 0.0000 0.0000 $ -  
Specialist care              
Office visits     - 0.0000 0.0000 -  
Surgical services     9.00 0.9544 1.0000 8.59  
All other services     23.67 0.8659 0.9100 18.65  
Total physician services PMPM amount         $ 27.24 $ 27.24
Total medical PMPM amount             $ 31.08
II. Other Expenses              
Administrative           $ -  
Reserves             -  
Total other expenses           $ - $ -
Total PMPM amount             $ 31.08
III. Premium Rates              
    Single Family          
  Rate factor 0.000 0.000          
  Monthly premium rate $0.00 $0.00

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