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Health Coaches Topic
Difficulty
Business situation
Intermediate
Market entry
Style
Interviewer-led (McK style)
Profitability analysis
Our client is a large national health care payer (health insurance c
e.g. Aetna) exploring the launch of a new disease management p to better serve its 5 million members.
The idea is to hire and train a team of “Health Coaches” to speciali
single disease area (e.g., heart disease, diabetes, etc.). Each coach
manage a portfolio of patients to reduce the costs of overall health
expenditures (e.g., reminders to take drugs, provide limited medical
suggestedwith diet, etc.). Studies show that once a month contact with e Master your semester Scribd Read Free Foron 30this Days Sign up to vote title reduces health spending by 5%, on average. & The New York patient Times Useful Not useful Special offer for students: Only $4.99/month.
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Should our client launch the program? If so, what steps should it tak
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Comments
The case tests the interviewee’s ability to probe and develop a custo
segmentation, digest a relatively complex chart, isolate the most critical information and determine profitability.
The data provided by both exhibits should be requested; try NOT the exhibits until need for the data is demonstrated
Strong interviewees should use common sense to make reasonable
assumptions before you provide required inputs.
Short Solution
The client should launch the Health Coaching program, and f on diabetes for the 65+ Medicare segment.
Considering other factors the client could also expand to othe
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Paragraphs highlighted in green indicate diagrams or tables that ca shared in the “Information to share” section.
Paragraphs highlighted in blue can be verbally communicated to th interviewee.
Paragraphs highlighted in orange indicate hints for you how to guid interviewee through the case.
Suggested case structure:
I. Background Here the interviewee should investigate the customer segmentation disease area and the costs per member. You're Reading a Preview Unlock full access with a free trial.
Information that can be shared if inquired: Download With Free Trial Competitive dynamics (not core to case)
With increasing health care costs, the industry is unde
pressure to innovate new products that will control sp Assume client is first to market
Past attempts to purely automate disease managemen Master your semester with Scribd Read Free Foron 30this Days Sign up to vote title yielded minimal savings & The New York Times Useful Not useful Special offer for students: Only $4.99/month.
Health Coaches
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There are no other program costs Sheet Music
II. Profitabiliy What can we get out of this chart?
Share Diagram 2 if interviewee inquires information about the clien membership segmentation and/or exposure to disease areas.
If the interviewee is not going in that direction, you can ask: “How would you segment the client’s members?”
Share Table 1 if the interviewee inquires asks for medical cost data
Try to avoid handing out Table 1 until Diagram 2 has been discu
(hint: if interviewee leads with profitability, steer him/her to first th about the customer segmentation)
You're Reading a Preview
Unlock full access with a free trial.
Which segment is likely to generate the greatest per membe Why?
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Using Diagram 2, discuss which segments and disease areas are m
important to explore.
Interviewee should choose to focus on the 65+ segment
Master your semester with Scribd (Medicare) patients are the & The New York 65+ Times
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Special offer for students: Only $4.99/month. the group members are the healthiest (younger, working).
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Interviewee should choose to focus on diabetics (Assume all are for the purposes of this case)
Diabetics make up the largest portion of sick members.
As a chronic disease is primarily brought on by behaviour, Type 2 are most likely to benefit from disease management program
Number of 65+ diabetics
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Reviewing both exhibits, the interviewee should determine if heal
coaches are profitable in each of the three segments.
Cost per Coach
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Savings for one portfolio of 65+ diabetics
Overall savings
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Recommendation Give the interviewee a moment to prepare a recommendation. The following one is a strong example:
The client should launch the health coaching program, and fi on diabetes for the 65+ Medicare segment The client should take the following steps:
Launch a pilot program to prove out assumptions (e.g., 5% c reduction, Coach portfolio capacity, etc.)
First expand to entire 65+ segment ($144M per year savings return on each Health Coach)
Consider introducing to expand to the Individual segment des being able to break-even.
This could be done due to customer retention, a moral rationale many other factors.
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Members 65+: Known as "Medicare Advantage", premiums fund the government
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Individual are non-groups (e.g. private contractors, unemploy
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PMPM: per member per month
Diabetic factor: in the indication of diabetes, a health coach has a of 4 in savings for patient treatment expenditures.
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