Question

A national health insurance plan was concerned about its ability to influence the use of health services by its plan members. A review of utilization patterns suggested a high level of both overutilization of certain health services and underutilization of other health services. The patterns identified could be correlated with both inefficient use of services resulting in poor health outcomes and unnecessarily high costs to the health plan.

The plan administrators developed a pilot program for addressing inappropriate utilization of services and began by focusing on substance abuse services. By examining existing patterns of utilization and plan member characteristics, they were able to identify segments of the population that were at risk for substance abuse or that were already substance abusers. The research indicated the characteristics of those most at risk in terms of their demographic attributes and psychographic cluster (i.e., Mosaic segment). Plan administrators were able to develop materials targeting subsets of the plan population with information designed to resonate with their demographic and lifestyle attributes. This approach led to much better communication with targeted plan members and, ultimately, more efficient use of services and reduced health plan costs.

1. Did plan administrators gather useful information and use the information collected to develop effective communication materials? Why or why not? Could they have done anything differently to improve their outcomes?

Answer 1

The Plan Administrators has gathered the information about the population which are either the substance abuse, the disturbing demographic and lifestyle attributes, so that they able to communicate with the targeted members or population. The gathering information about the population and communication diameter would not able to solve the problems of inefficient use of services which is resulting in poor health outcomes and unnecessarily high costs of the health plan.

To solve the problems, the Plan Administrators must go through the (a) requirements towards the efficient use of the health services, (b) availability of the services to the areas where maximum members are concentrated. The problem of the high costs of health plan can be solved through (1) least cost of health care materials and affordable and qualified health care officer, (2) Placement of the Health care centers at the concentrated members of plan, so that per capita health care cost is achieved.