Purdue Managed Care Case Study Flashcards
True or False?
If I have health insurance, all of my medical expenses will be covered?
False
- premium
- deductible
- copay
True or False?
Employers typically pay 25-30% of total annual salary for benefits?
True
True or False?
People need health insurance because health care is expensive?
True; and unpredictable
Overview of Fully vs Self Insured Health Plans
Self Insured (Purdue)
- Employee –> $$$ –> Employer
- can be used to save money
- can still pay anthem to administrate claims
Fully Insured
- Employee –> $$$ –> Employer –> $$$ –> Insurance
- set price annually
- insurance assumes the risk and manages everything
- insurance desires to make a profit
Fully vs Self Insured Health Plans
Fully Insured:
- insurance company assumes the risk
- employer pays per-employee premium to insurance company
- SMALLER EMPLOYERS
Self-Insured:
- employer assumes the risk
- employer acts as there own insurer
- claims can still be managed and processes by insurance company
- LARGER EMPLOYERS
Benefits of Self-Insured Plans
- allows customization of plans vs one size fits all
- employer is free to contract with any provider
- employer does not have to pre-pay for coverage
- avoids state mandated benefits’
- level of control maximizes income
- avoids state health insurance taxes & other fees
Disease State Prevalance at Purdue
- disease state prevalence is much lower at Purdue compared to national prevalence
Why?
- may not utilize HC services
- highly educated & healthier
Outlier
- MS & Leukemia are similar to normal because they require access to HC system –> major issues
Purdue Prevention Screening Rates
“mediocre”
Purdue Healthcare Expenditure 2004-2010
- HC expenditure drastically increased from 2004-2010 and was unsustainable
- results in less money for faculty salaries, student services or that money must come from somewhere else like tuition
MUST BE WILLING TO DO UNPOPULAR THINGS TO SOLVE
Purdue Healthcare Cost Split
- Before 2014: 84/16
- 2014: 80/20 mandate
INDUSTRY STANDARDS: 75/25
Geographical Influence on Purdue Cost
- employees have entitlement to choose location & procedures
- lack of information on comparative pricing
- stagnant plans fostered continuation of current coverage
Purdue’s Benefits Compared to Peer Universities
- Purdue was spending much more on benefits compared to other universities (exception of CDHP)
General Strategies to decrease cost
- increase housing costs for students
- corec access for employees
- incentivize preventative care
- choose in network providers
- increase students; decrease faculty
Pharmacy Strategies to decrease cost
- do not cover nonessential meds
- switch to generic meds
- increase adherence
- increase follow-up and monitoring
Purdue’s Short Term Strategies
Changed Insurance Plan
- 2-tier premium structure
- deductible/coinsurance arrangement
- offer free generic preventative meds
- combined Rx and medical deductibles
Encouraged Consumerism
- develop lab and imaging benefits
- implement Cashlight Rewards
- adjust Center for Healthy Living copay
- incentivize improving wellness outcomes
