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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. The 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.
8 hours, 45 minutes
11
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 class members (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.Required Textbook:Â Kongstvedt PR, editor. Essentials of Managed Health Care, 4th edition. Bartlett & Jones, 2001. Full Reading List:Â Includes required readings and additional suggested readings.
Other Resources
» Managed Care Fact Sheet
Reference information, statistics, and key terms in the field
» Medical Management Tools
The potential array of medical management approaches within managed care organizations
» Quiz Study Guide
Key content areas to review for each of the course's three quiz.
Course Currilcum
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- Lecture 1: Overview of Insurance/Managed Care Principles and History 00:55:00
- Lecture 2: HMOs and Integrated Delivery Systems 00:55:00
- Lecture 3: Risk, Capitation, and other Financial Issues 00:55:00
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- Lecture 4: PPOs and CDHPs and other non-HMO models 00:55:00
- Lecture 6: Quality & Accountability I 00:55:00
- Lecture 10: MC & Public Policy I: Medicare & Medicaid Managed Care 00:55:00
- Lecture 11: MC & Public Sector Plans II : Medicaid and Health Reform for Uninsured 00:00:00
- Lecture 12: Managed Care in a Global Context 00:55:00
- Managed Care and Health Insurance Assignments 00:30:00
