Instructor

Offered By

Department of Health Policy and Management

Description

Presents an overview of major issues related to the design, function, management, regulation, and evaluation of health insurance and managed care plans. Provides a firm foundation in basic concepts pertaining to private and public sector health insurance/benefit plans, both as provided by employers and government agencies such as Medicaid and Medicare. Key topics include population care management techniques, provider payment, organizational integration, quality and accountability, cost-containment, and public policy. The course makes extensive use of outside experts Course is relevant for management- or policy-oriented students who will be working in, or interrelating with, public and private (both for-profit and not-for-profit) health insurance plans and organized delivery systems such as HMOs and hospital/physician "integrated" delivery systems. Course is also relevant to students who will be researching and analyzing these systems. Although the emphasis is placed on the US, the material is applicable to international students who are interested in financing and organization of highly developed medical care delivery systems in other nations.

Syllabus

Course Description

Presents an overview of major issues related to the design, function, management, regulation, and evaluation of health insurance and managed care plans. Provides a firm foundation in basic concepts pertaining to private and public sector health insurance/benefit plans, both as provided by employers and government agencies such as Medicaid and Medicare. Key topics include population care management techniques, provider payment, organizational integration, quality and accountability, cost-containment, and public policy. The course makes extensive use of outside experts Course is relevant for management- or policy-oriented students who will be working in, or interrelating with, public and private (both for-profit and not-for-profit) health insurance plans and organized delivery systems such as HMOs and hospital/physician integrated delivery systems. Course is also relevant to students who will be researching and analyzing these systems. Although the emphasis is placed on the US, the material is applicable to international students who are interested in financing and organization of highly developed medical care delivery systems in other nations.

Course Objectives

The goal of this class is to provide an overview of major issues related to the design, function, management, regulation, and evaluation of health insurance programs and managed care organizations, including HMOs. 

The focus will be on both private and public sector programs. The emphasis will be placed on the US , though the course should be of relevance to organized health care programs in other nations.

The main learning objective of this course is to increase the effectiveness of classmembers (appropriate to their educational program) as managers, policy analysts, public health advocates, or researchers/evaluators working with or within these types of organizations.

Specifically, students will be able to better function as managers, policy analysts or evaluators dealing with the following health insurance/ managed care issue areas:

- Finance and organization
- Network structure
- Medical management
- Quality monitoring and improvement
- Special need populations
- Mental health
- Pharmacy benefits.

Prerequisites

Introduction to Health Policy (300.600) or Introduction to the US Healthcare System (300.651)

Readings

Textbook: Kongstvedt PR, editor. Essentials of Managed Health Care, 4th edition. Bartlett & Jones, 2001

Course Requirements

• Three short in-class quizzes based on required readings and lecture material for all preceding classes (not including that day). 25% of grade.
• A 3- to 5-page discussion paper (homework assignment #1) on a topic/issue of greatest interest to the student. 25% of grade.
• A final paper (homework assignment #2). Students may select from one of several standard assignments or develop a special customized paper that directly relates to the course content. The final paper format is an applied action-oriented briefing or research protocol in the 10- to 15-page range. 50% of grade

  Schedule

  SESSION #	TOPIC	ACTIVITIESa
  1	Overview of Insurance/Managed Care Principles and History	Lecture 1 - Jonathan Weiner
  2	HMOs and Integrated Delivery Systems	Lecture 2 - Jonathan Weiner
  3	Risk, Capitation, and other Financial Issues	Lecture 3 - Jonathan Weiner
  4	PPOs and CDHPs and other non-HMO models	Lecture 4 - Jonathan Weiner Discussion of Assignment 1
  5	Medical Management in IPA/Network HMOs	Lecture 5 - Bernie Manscheim, Coventry Health Care
  6	Quality & Accountability I	Lecture 6 - David Bodycombe, Jonathan Weiner Quiz 1
  7	Medical Management in Group/Staff HMOs	Lecture 7 - Amy Phillips, Kaiser Permanante Mid-Atlantic
  8	Organizational and Provider Network Challenges in an Academic Integrated System	Lecture 8 - Patty Brown & Robert Kritzler, Johns Hopkins Healthcare
  9	Quality & Accountability II	Lecture 9 - Sarah Scholle, National Committee for Quality Assurance Assignment 1 due
  10	MC & Public Policy I: Medicare & Medicaid Managed Care	Lecture 10 - Jonathan Weiner Quiz 2
  11	MC & Public Sector Plans II : Medicaid and Health Reform for Uninsured	Lecture 11 - Jonathan Weiner Discussion of Assignment 2
  12	Managed Care in a Global Context	Lecture 12 - Hugh Waters & Jonathan Weiner
  13	Ethical Issues in Managed Care & Health Insurance	Case study presented by Ingrid Burger Final paper topic due
  14	Pharmaceuticals: PBMs & Medicare Part D	Lecture 14 - Alan Lyles Quiz 3
  15	Managed Behavioral/Mental Health Services	Lecture 15 - Steven Sharfstein, Sheppard Pratt
  16	Developing Trends in Managed Care (Selected by Class)	Lecture 16 - Jonathan Weiner   Assignment 2 due