The medical director of a large health insurer, 100,000 enrollees with premium income of $500,000,000...
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Finance
The medical director of a large health insurer, 100,000 enrollees with premium income of $500,000,000 has a preventive care budget of $10,000,000 (2% of total premium income). Given the list of preventive care services (ranked in declining order of cost effectiveness below and located in the Problem 9.1 tab in the BudgetCh09.xls file), their prices, and the number of eligible members who could benefit from each service (assume only 40% of eligible will partake of preventive care offerings), what services should be offered or where should the medical director draw the line?
Effect- | # of |
| |||
iveness | Program | Price | Patients |
| |
1 | Daily Aspirin Use, discussion | $20 | 10,000 |
| |
2 | Smoking cessation, discussion | $30 | 23,000 |
| |
3 | Colorectal cancer screening | $18 | 40,000 |
| |
4 | Hypertension screening | $50 | 40,000 |
| |
5 | Influenza immunization | $5 | 22,000 |
| |
6 | Problem drinking screening & counseling | $30 | 8,000 |
| |
7 | Vision screening | $50 | 100,000 |
| |
8 | Cervical cancer screening | $125 | 25,000 |
| |
9 | Breast cancer screening | $100 | 25,000 |
| |
10 | Chlamydia screening | $58 | 14,000 |
| |
11 | Calcium supplements, discussion | $20 | 50,000 |
| |
12 | Folic acid supplements | $20 | 50,000 |
| |
13 | Obesity screening and counseling | $50 | 33,000 |
| |
14 | Depression screening | $50 | 24,000 |
| |
15 | Hearing screening | $150 | 50,000 |
| |
16 | Injury prevention counseling (0-4) | $50 | 1,600 |
| |
17 | Osteoporosis screening | $225 | 23,000 |
| |
18 | Cholesterol screening-high risk | $53 | 60,000 |
| |
19 | Diabetes screening | $63 | 7,000 |
| |
Source: | Priorities Among Effective Clinical Preventive Services, Results of a | ||||
Systematic Review and Analysis, Maciosek MV, Coffield AB, | |||||
Edwards, NM, Flottemesch, TJ, Goodman, MJ, and Solberg LI, | |||||
Am J Prev Med, 2006; 31(1), 52-61. |
If your solution does not use all available funds, develop alternatives that will. How many preventative services can be delivered to members?
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