Week 4 Assignment
Part I
Consider the four health plans below with an eye to choosing one to offer to the company’s employees. Assume that the health plans and their annual per employee premiums are as follows:
| Health Plan | Premium, Individual | Premium, Family |
| Aetna Health | $4,555 | $11,428 |
| MetroPlus | $4,267 | $10,540 |
| Empire | $4,217 | $10,767 |
| Oxford | $6,029 | $13,417 |
The employer will pay 80% of the premium for individual coverage, and the employee will pay the remaining 20% as well as the entire additional premium for family coverage. (The premiums listed above, while realistic in magnitude, are hypothetical and computed solely for the purpose of this project.) All of the plans are managed care plans. Assume that the benefit package is the same across all plans, so there is no difference between them in what services are covered.
In addition to the above data, click here to access the latest report for ‘Health Plan Comparison in New York State’. Review the online report and incorporate relevant information into your evaluation.
You can view the various categories of measures on which health plans are rated (e.g., Access to Care, Adult Living with Illness, etc.). Click each link for a summary chart that presents the performance (usually as a percentage score) of each plan in the group on the relevant measures and how each plan compares to regional and statewide scores.
Provide an analysis that outlines the plan you selected and why. Generally, you would select the plan with the highest score, but if you chose a plan with a lower score, explain why. Include the following elements in your analysis:
- Explain which factors (e.g., price and/or performance measures) were most important to your choice of plan and how you derived the weights for each factor you used.
- Indicate, on a scale of 1 to 10, how comfortable or confident you are that you made the right choice, with 10 being most confident.
Part II
You need to use the multi-attribute utility (MAU) technique to respond to the following questions. Although the technique can be performed with pencil and paper, it is recommended you use a Microsoft Excel to do the various calculations involved.
Click the following links to access the information on using the MAU technique:
- MAU Model
- MAU Example
- Compare your level of confidence at the time you completed Part I to your confidence level for Part II, when you used this decision aid.
- Was it helpful? What were its advantages and disadvantages?
Did it make the decision harder to make or easier to justify?
Resource:
Hahn, W.J., Seaman, S.L., & Bikel, R. (2012). Making decisions with multiple attributes. Retrieved from http://gbr.pepperdine.edu/2012/08/making-decisions-with-multiple-attributes-a-case-in-sustainability-planning/.
To support your work, use your course and textbook readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Submission Details:
- Your assignment should be addressed in a 2- to 3-page document.
- Submit your documents to the Submissions Area by the due date assigned.
Sample Answer
Part 1
Making a choice for a health insurance plan for a company is a crucial decision. A number of surveys have revealed that health insurance is the most important benefit that employees take into account when making the decision to take up a new job or remain in their current job. In today’s environment, managers confront difficult decisions on a day-to-day basis and need to consider an increasingly wide range of criteria in the decision-making process. Therefore, healthcare managers must consider various factors when selecting a health plan for their employees, including cost, coverage, type of plan, their employees, and the competition.
From the options provided in this scenario, i.e., Aetna Health, MetroPlus, Empire, and Oxford, I would settle for MetroPlus. This is mainly because the benefits offered by MetroPlus stood out, and this would be beneficial for the employees. The most important factor that influenced my decision was the price because the plan appears to be affordable, especially for the family package. MetroPlus outperforms all other New York health insurance plans in the state quality incentive rankings.
MetroPlus provides a variety of services for healthy living, which depicts how much the company’s healthcare insurance plans care about the wellbeing of their clients. Individuals who are eligible for MetroPlus include those living in Brooklyn, Bronx, Queens, and Staten Island. MetroPlus Health Plan has different plans, including Enhanced Health and Recovery Plan (HARP), Child Health Plus, Fully Integrated Duals Advantage (FIDA), and Essential Plan. The Enhanced (HARP) plan is a managed care plan that manages physical and mental health as well as substance use services in a comprehensive and integrative way for adults with behavioral health needs (MetroPlusHealth, 2021). The Child Health Plus plan is especially attractive as the coverage comes at no cost, and it covers children under the age of 19 who do not qualify for Medicaid (MetroPlusHealth, 2021).
The FIDA plan is a program administered jointly by the federal Centers for Medicare & Medicaid Services (CMS) and the NY State Department of Health and is designed to incorporate care for NY residents who have both Medicaid and Medicare (MetroPlusHealth, 2021). The Essential plan offers all the covered benefits provided by the New York State Health and American Rescue Plan. The plan does not have a monthly premium and no cost for vision and dental services. Furthermore, it provides all the essential benefits, including mental health, emergency care, prescription drugs, emergency care, among others (MetroPlusHealth, 2021).
One of the key factors that influenced my decision to settle on MetroPlusHealth is that the health plan scored above 90 percent of state benchmarks. This includes care related to hypertension, diabetes, mental illness, and substance abuse disorders. MetroPlusHealth plan attributes its streamlined process of collaborating with NYC Health and health facilities as well as its community providers to education, exchanging data, member support, and working to bring members in for care, particularly those with the highest needs or those classified as most immediate.
The NY State quality incentive program is based on the measurement and reporting from medical care in the previous calendar year. A plan’s ranking and score in the program serve as an indicator of the quality of care offered to MetroPlusHealth’s members relative to all plans in the care market managed by Medicare. The data that was assessed takes into consideration national standards of care, consumer input, and assessment as well as state-specific measures. On a scale of 1 to 10 on how confident I am with the choice I selected, I would give myself 7.5 as I feel that although the health plans are effective, some of the things can be done in a different way.
PART II
After using the multi-attribute utility (MAU) technique, my level of confidence dropped to 7. After responding to the questions in the decision aid, it was clear that I did not consider various important variables, including space, rent, and location. The decision aid is helpful as it shows the different criteria that must be taken into account when making a decision related to procuring a healthcare plan. The major advantage of MAUT is that it considers uncertainty, and it can have a utility assigned to it, which is not a quality that is accounted for in other techniques. Also, it is comprehensive and takes into account and incorporates the preferences of each consequence at every stage of the method. Nonetheless, as much as this amount of accuracy is convenient, it can result in numerous potential disadvantages. A large volume of input is also necessary at every stage of the procedure so as accurately record the preferences of the decision-maker, and this makes the technique quite data intensive. It might not be possible to acquire this level volume of data and level of input for every decision-making problem. Also, the decision makers’ preferences need to be precise, handing specific weights to each of the consequences, and this calls for stronger assumptions at each phase. It might be difficult to apply this precisely, and it can be relatively subjective.
