Case Study

You have just been hired as the director of strategic planning for a health plan that insures 30% of the residents in a metropolitan area of 500,000. Most of those insured by this health plan are employed by large companies in the metropolitan area, and these companies pay for their employees’ health insurance. The health plan leaders and the employers both recognize that their business model depends on their success in addressing behavioral risk factors that play a critical role in the prevention and management of chronic diseases, the containment of health care costs, and the enhancement of employee productivity.

In your new role, you are asked to create a comprehensive plan for addressing these behavioral risk factors—by improving both the clinical care provided and the plan’s community-based efforts. Specifically, you want to develop strategies to reduce the levels of tobacco use, unhealthy diet, and physical inactivity. In constructing your plan, consider the following questions:

1.What mix of interventions would you need to consider that might change enrollee behavior, provider behavior, and community policies and environments and maximize the cost-effectiveness of this plan?

2.What is the evidence that these interventions would work?

3.What would be the implementation challenges of the plan?

Main textbook: Knickman, J. R., & Kovner, A. R. (2015). Jonas and Kovner’s health care delivery in the United States (11th ed.). New York, NY: Springer Publishing. ISBN-13: 978-0-8261-2527-9
 
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