HCS 440 Economic Issues Simulation Paper L Taylor

Topics: Health care, Health economics, Health insurance Pages: 6 (1078 words) Published: May 24, 2015


Economic Issues Simulation Paper
Leah Taylor
HCS/440
March 2, 2015
Jonathan Foskett
Economic Issues Simulation Paper
Castor Collins Health Plans is an HMO that was found in the state of Pantome in 1999. As like other HMO companies, Castor Collins Health Plans provides health insurance and health care services to enrollees through a statewide network of physicians and hospitals. This company has a total of 100,000 enrollees. Castor Collins Health Plans are looking to increase the number of enrollees in the company. My mission is to increase the number of enrollees. As the Vice President of strategy and financial planning, my role is interacting with new clients and formulating health plans that will fulfill the needs of the new clients. As a representative of Castor Insurance, my job is to maximize profit and minimize risk for the company. Based on my analysis of potential utilization, I will provide at least two reasons why each plan could be selected. Then I will state which plan I would select to sell to my chosen company to increase the number of enrollees. I will also provide the reasons for my decision and why I did not select the other plans offered. With the help of my colleagues, I look forward to helping the company increase the number of enrollees in the future. My colleagues are Helen Feuerman, Jonathan Wilkes, and Adam Hunter. Helen is the chief financial officer at Castor Collins Health Plans and she is in charge of the financial operations of the company. Her job consists of accounting, budgeting, forecasting, underwriting and actuarial, financial analysis, financial planning, and risk management. With her credentials of having a certification in Public Accountant and Chartered Life Underwriter, she plays a huge role within the company. Helen has been with Castor Collins Health Plans for seven years. Dr. Jonanthan Wilkes is the chief medical officer at Castor Collins Health Plans. His job consists of working with utilization management and clinical services. He has been an important aspect of the company by being the chief advisor and strategic planner on the medical aspect of the delivery of health care services. Dr. Jonathan Wilkes has been with Castor Collins Health Plans since 2002. Adam Hunter is the Executive Vice President of planning and development at Castor Collins Health Plans. He is in charge of new product development and corporate affiliations. Adam Hunter has been an important aspect of the company by helping the company gain new enrollees and ensuring that they are satisfied with the health plans that the HMO offers. Constructit and E-Editors are groups of individuals in which are seeking health insurance from Castor Collins Health Insurance Company. Constructit consists of 1,000 people whereas E-Editors consists of 1,600 people. The individuals at Constructit are willing to pay a maximum premium of $4,000 per person and E-Editors are willing to pay a maximum premium of $4,500 per person. The Castor Standard plan does not cover preexisting conditions, the risks and returns in this plan are low. A comparison of the expected utilization and the returns from providing Castor Standard to this group shows that the risks that I have accepted are high. The earnings from the Castor Standard Plan is not sufficient to cover them. Choosing another plan or not insuring the group would have potentially mitigated the risks. The option that I could have taken was not to insure the group at all, but any earnings are better than none for the company. The group that I believe is the best for Castor Collins Health Plans is E-Editors. E-Editors is willing to pay a higher premium up to $4500, in which my company can earn $5.58 million. I have chosen to set them up with the Castor Standard Plan because the Castor Enhanced Plan and Castor Customized Plan would have increased the premium over their maximum amount they are willing to pay for a premium. The maximum amount that E-Editors are willing...

References: University of Phoenix. (2015). Economic Issues Simulation Paper. Retrieved from University of
Phoenix, HCS440 website.
University of Phoenix. (2015). Understanding Economic Issues for HMOs [Multimedia].
Retrieved from University of Phoenix, HCS440 website.
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