MANAGED CARE AND HEALTH INSURANCE Syllabus
Course Learning Objectives
Upon successfully completing this course, students will be able to:
- Better function as managers, policy analysts or evaluators addressing the following health insurance/ managed care issue areas:
- Health care finance and organization
- Integrated delivery systems / networks
- Medical "care management"
- Health care reform and policy
- Quality monitoring and improvement
- Special need populations
- Health information technology / Electronic health records
- Mental /Behavioral health
- Ethics of coverage and resource allocation
The Managed Care and Health Insurance course presents an overview of major issues related to the design, function, management, regulation, and evaluation of health insurance and managed care plans. The course 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 and the new Affordable Care Act (ACA). Key topics include population care management techniques, provider payment, organizational integration, quality and accountability, cost-containment, and public policy. The 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 Health Maintenance Organizations (HMOs), Accountable Care Organizations (ACOs) and hospital/physician “integrated” delivery systems (IDSs). This course will also be relevant to students who will be researching and analyzing these systems. The course makes use of experts from within the Johns Hopkins Health System and elsewhere as guest lecturers.
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. It is also relevant to students who will be researching and analyzing these systems.
Methods of Assessment
1) There will be 3 very short (10 minutes or less) quizzes based on readings and lecture. (20% of grade)
2) Assignment #1: A 3-5 page discussion paper on a topic/issue of greatest interest to the student. (25% of grade)
3) Assignment #2: Final - Students may select from one of several standard assignments or work with course faculty to develop special customized paper that directly relates to course content. The format for the assignment will be an applied action-oriented briefing paper or research protocol in the 10-15 page range. (55% of grade)
PrerequisitesThis course is intended for students with some basic knowledge of the US health care system. 300.651 or a similar courses or consent of instructor.
Required Text: Essentials of Managed Care, P. Kongstvedt (edt). Sixth Edition. Jones and Bartlett, 2013.
There will also be required journal articles for most class sessions. The articles and their URLs are noted on the syllabus which can be found in the course library.
Please see the course Session for a full list of dates and items for this course.
Academic Ethics Code
Students enrolled in the Bloomberg School of Public Health of The Johns Hopkins University assume an obligation to conduct themselves in a manner appropriate to the University's mission as an institution of higher education. A student is obligated to refrain from acts which he or she knows, or under the circumstances has reason to know, impair the academic integrity of the University. Violations of academic integrity include, but are not limited to: cheating; plagiarism; knowingly furnishing false information to any agent of the University for inclusion in the academic record; violation of the rights and welfare of animal or human subjects in research; and misconduct as a member of either School or University committees or recognized groups or organizations.
- Overview of Insurance / Managed Care Principles and History
- HMOs and other MCOs
- Risk, Capitation, P4P and other Financial Issues
- "Accountable" and "Integrated" Care
- Medical Management –1 (Group/Staff HMO context)
- Medical Management – 2 ((IPA / PPO context)
- MC and Public Policy 1: Health Reform
- MC & Public Policy 2: Medicare
- MC & Public Sector Plans 3 : Medicaid Managed Care
- An Academic IDS - Management Issues & Provider / MCO Interactions
- Ethical Issues in Managed Care & Health Insurance
- Quality & Performance Monitoring
- Health IT: impact on population health and managed care
- Managed Behavioral/Mental Health Services
- Pharmaceuticals: PBMs & Medicare Part D
- Health Care Transformation: Developing Trends in Managed Care
Disability Support ServicesIf you are a student with a documented disability who requires an academic accommodation, please contact the Office of Student Life Services at 410-955-3034 or via email at email@example.com.