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Problem Definition

Our client is a large national health care payer (health insurance company, e.g. Aetna) exploring the launch of a new disease management program to better serve its 5 million members.

The idea is to hire and train a team of “Health Coaches” to specialize in a single disease area (e.g., heart disease, diabetes, etc.). Each coach will manage a portfolio of patients to reduce the costs of overall health expenditures (e.g., reminders to take drugs, provide limited medical advice, suggested diet, etc.). Studies show that once a month contact with each patient reduces health spending by 5%, on average.

Should our client launch the program? If so, what steps should it take?

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23.5k
Times solved
Intermediate
Difficulty
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Exhibits

Diagram 1

Diagram 2

Members 65+: Known as "Medicare Advantage", premiums funded by the government

Groups are employee sponsored plans (e.g. at McKinsey you are in a group plan)

Individual are non-groups (e.g. private contractors, unemployed etc.)

Table 1

PMPM: per member per month

Diabetic factor: in the indication of diabetes, a health coach has a factor of 4 in savings for patient treatment expenditures.