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Creating a Business Plan for a Managed Care Organization

The account manager creates a business plan for his MCO account. If the MCO contracts out its pharmacy formulary, the account manager can also choose to create a business plan for the PBM.

Typically business plans are created on a yearly basis, but the frequency varies according to business process. An account would have a number of business plans associated with it; each plan for a different period.

The first step in creating the business plan is creating the business plan record and entering overview information about the account.

This task is a step in Scenario for Managed Care.

To create an business plan for an account

1. Navigate to the Accounts screen, then the Accounts List view.
2. In the Accounts list, drill down on an account.
3. Click the Business Plans view tab.
4. Create a new record and complete the necessary fields.
5. Drill down on the business plan record.
6. Click the Account Overview view tab.

   In the Account Overview form, enter information about the account that pertains to the business plan.

   Some fields are described in the following table.

   Field	Comments
   Business Description	Use this text field to note general information about the MCO.
   Regional Plans	Use this text field make note of other business plans related to this account. For example, if this is a national business plan, this field might contain the names of regional and local business plans that are related to this national plan.
   HMO Lives	This is the number of individuals enrolled in the HMO health plans offered by the account.
   Total Lives	This is the number of individuals enrolled in all the health plans offered by the account. This field should equal the sum the other three lives fields (HMO Lives, PPO Lives, and POS Lives). This field is the same as the Total Lives field in the Accounts screen. (Click on the show more button to see this field in the Accounts form.)
   Network Phy	This is the number of physicians participating in the insurance network. This field should contain approximately the same number as the Physicians field in the Accounts screen, then the More Info view.
   Network Hosp	This is the number of hospitals belonging to the insurance network.
   PPO Lives	This is the number of individuals enrolled in the PPO health plans offered by the account.
   POS Lives	This is the number of individuals enrolled in the POS health plans offered by the account.
   Medicare	This is the number of individuals who are enrolled both in Medicare and in the health plans offered by the account.
   Medicaid	This is the number of individuals who are enrolled both in Medicaid and in the health plans offered by the account.