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Course description Health Care Management is a course for students interested in better understanding health care management tools in an era of reform. The course looks at various methods for addressing universal access to health care, quality of care and health care costs. The course also examines consumers’ experiences with the health care system and explores ways to improve this experience. Through case studies, critical evaluation, readings and assignments, this course will assess progress toward health care reform in the US and in Vermont from different stakeholders’ perspectives. The distinct strategic and leadership challenges faced by managers in healthcare organizations will be examined through the lenses of consumers, employers, practitioners, insurers, regulators, and public policymakers. Real world examples of the tools being used to create universal access in Vermont will be examined critically and assessed for broader replication nationally. Health Care Management: Course objectives Upon completion of this course, students should be able to demonstrate an ability to: 1. Assess the performance of the American health care system and the state of Vermont on cost, quality, access and the consumer experience. 2. Evaluate the use and relative effectiveness of health care management tools and strategies. 3. Articulate the challenges and opportunities associated with reforming the health care system nationally and locally. 4. Discuss the different approaches to managing costs and quality from the perspective of different stakeholder groups within the private, non-profit, and public sectors. 5. Discuss the differences between the performance of health systems in industrialized nations outside of the US and the United States. 6. Critically examine and craft a persuasive argument for changes needed in the United States health Care system. 7. Critically examine the health care management tools in practice and how well they are addressing cost, access, and quality. Course Methods This is an online graduate course that will entail a variety of teaching methods including, power point presentations, written lectures, case studies and discussion board.
Course Requirements Students will be evaluated based on the following:
Paper 1: Op-Ed Piece: Health Care Management Tools Identify one of the health care management decisions made by the state or federal government in the past three years. Critically examine the issue being addressed by two or more stakeholders. Lay out a forceful argument for why or why not the decision will help to achieve the objectives of universal access, lowering costs or objectives and propose a new way of managing health access, quality or cost. The paper should be no more than 750 words. Extra credit will be given to anyone getting their op-ed piece published. Paper 2: Stakeholder Perspective, Problem Introduction and “Hassle Map” This paper is an opportunity for students to share a personal perspective on the health care system from one or more stakeholders’ perspectives. It is also designed to select an issue from the list of health care management and policy issues being explored at the federal or state level being addressed through federal or state health care reform. Student should write about a personal experience (or an experience of someone they know) related to a problem with health care quality, access or cost. The paper should identify the problem; identify who is affected by the problem, the stakeholder group they represent and identify a desired or acceptable outcome for the problem to be resolved. The paper should also include a diagram of a “hassle map” that documents visually the patient’s experience with the health care system and the breakdowns in management, process, communication s or systems that created the problem. The papers should describe the root causes of the ‘hassles” or breakdowns for the consumer and then describe a health care reform proposal at the state of federal level that is designed to address that problem. The paper should be no more than five pages, double spaced. Final Project: Real World Management Project The final project will take place of a final examination. The final project is a real world health care management assignment that will require the development of a critical analysis of a health care management issue within the Affordable Care Act. Students may select a topic from the following list or suggest a topic of their own. The topics include: Financing the Affordable Care Act (ACA) Implementation of the ACA Drivers of Premium Variations in the ACA Outreach to the Uninsured ACA Impacts on the Delivery of Care Information Technology and the ACA State by State Variations in the ACA The Future of the ACA 2
The Politics of Obamacare A Consumer’s Perspective on the ACA A Health Care Provider Perspective on the ACA As part of this assignment, two “real world” activities related to the topic must be completed. These can include: A visit to a clinic for the uninsured, an educational seminar on the Affordable Care Act hosted by the state of Vermont or another organization, sitting in on legislative testimony on the Affordable Care Act (Vermont Health Connect), an interview with someone involved in the implementation of the Affordable Care Act. A list of these activities will be provided by the professor at the beginning of the semester. This paper should be no longer than ten pages, double spaced. Discussion Board Each week three discussion questions will be posted. Each student is required to make a total of three posts to two of the discussion questions weekly. This will include an initial post in response to the discussion question along with two responses to your classmates postings. The discussion contributes to 30% of your final grade and is a very important aspect of this course.
Determination of Grade Your grade will be determined as follows: Paper 1: Op-Ed Piece Paper 2: Stakeholder Perspective Class Discussion Posts Final Project
Percentage of Grade 20 % 20% 30% 30%
Blackboard This course will be taught on Blackboard, all materials (aside from Textbook) will be available through Blackboard. The site will also include the class roster and contact information for all students, guidelines for presentations, weekly assignments and periodic announcements. All students are expected to be able to access Blackboard. For more information about how to use Blackboard, go to https://bb.uvm.edu/webapps/portal/frameset.jsp or contact email@example.com for assistance.
Required Text and Readings The required text for this course is: Greenwald, Howard, Health Care in the United States, Organization, Management and Policy, 2010, John Wiley and Sons. The course also has a series of articles and cases assigned for each module which will be 3
posted on blackboard at the beginning of the semester. Dates Module Readings and Learning Activities Assignments
Section 1 – Understanding Reform
Module 1: Introduction to Course Objectives, Reform Content, Stakeholders and Management Tools This week we will introduce the course, Please post responses to two of objectives and expectations of students. the following discussion We will begin to understand the particular questions: challenges facing leaders of health care organizations in terms of managing access, 1. What are the varying and cost and quality. We will examine sometimes, competing challenges surrounding the experience of interests of stakeholder consumers and introduce the concept of a groups in the current “hassle map.” We will discuss the healthcare marketplace? sometimes varying on, sometimes 2. How do the perspectives competing interests of stakeholder groups we bring impact our in the current health care marketplace and choice of management how the perspectives we bring impact our tools? experience and choice of management 3. From the standpoint of a tools. healthcare consumer define the major problem Lecture: in the U.S. for cost, quality and access. What grade Introduction to Stakeholders and would you give the U.S. Management Tools Health Care System and why? View video: If Air Travel Were Like Health Care http://www.youtube.com/watch?v=5J67xJKp B6c
Readings: 1. Chapter 1: Understanding Health Care (pages 4-18) and Chapter 2: The US Health Care System: Features, Development and Controversies (pages 19 – 39 ); Course Textbook
Module 2: History of Reform Week 2 This week we will discuss an overview of the health care system in the United States. This overview will provide a historical context for the course and why tools to manage health care costs, access, and quality are in use by managers in health care organizations today. Please post responses to two of the following discussion questions: 1. What are the important threats to access, quality and costs in today’s reform? 2. Are there historical “lessons learned” that we should keep in mind for current healthcare reform? 3. Reflecting upon the historical turning points and the evolution of the US health care system and thinking of the challenges of today, what are the similarities from the past and common themes that are still present today? Are we at a turning point now?
Lecture: History of Reform
View video: CNN Money- 60 years to Obama’s Health Reform http://money.cnn.com/video/news/2012/06 /27/n-60-years-to-Obamacare.cnnmoney/ Readings: 1. Chapter 3: Major Health Problems in Modern Society (pages 41 – 70); Course Textbook 2. National Health Insurance, “A Brief History of Reform Efforts in the US”, Kaiser Family Foundation, March 2009 http://kaiserfamilyfoundation.files.w ordpress.com/2013/01/7871.pdf Module 3: National Reform (PPACA) Week 3 This week we will discuss an overview of the Patient Protection and Affordable Care Act (PPACA). This week will focus on providing an overview of the objectives of reform and the changes in the health care insurance market. An analysis of how reforms are playing out nationally will be discussed as well as how national politics may shape or influence the future of 5
Please post responses to two of the following discussion questions: 1. How will federal health reform impact consumer experiences? 2. How will reform play out for different market
reform. We will also review access in health care in the United States. An overview of the uninsured and the regulatory and insurance market tools that are in place to protect consumers and expand access to insurance coverage will be provided. Lecture: The Affordable Care Act 101 Old World/new World of Health Insurance Readings: 1. PPACA PRIMER BCBSA EXCHANGE TOOLKIT 2. Wanamaker, Seize the ACA: The Innovator’s Guide to the Affordable Care Act, Clayton Christensen Institute for Disruptive Innovation, 2013. http://www.christenseninstitute.org/ wpcontent/uploads/2013/09/Seize_the _ACA_midres.pdf View Video:
segments and states? 3. What improvements did PPACA have on the U.S. health care system? What gaps remain? What is the relationship between implementation of ACA and the potential impact of the law?
Health Reform Explained Video: "Health Reform Hits Main Street http://www.youtube.com/watch?v=3Ilc5xK2_E Module 4: Vermont Reforms (Act 48/Single Payer) Week 4 This week we will discuss Vermont state reforms including Act 48 and potential future steps for Vermont’s Health Care System. Please post responses to two of the following discussion questions: 1. What are the health care management implications of the Hsiao Report: short and long?
Lecture: Vermont History of Reform and
Outlook for the Future
BCBSVT: Vermont's Health Benefit Exchange http://www.youtube.com/watch?v=ujhYXC9VkCs Q: Plans on Vermont Health Connect http://www.youtube.com/watch?v=slh5FsBFmw s
2. Can a state like Vermont achieve single payer on its own? 3. What are the obstacles to implementing “single payer healthcare” in Vermont? What are the opportunities?
Readings: 1. Care (pages 71-97); Course Textbook 2. Hsiao Report (Executive Summary) 1/19/10 3. Act 48 Summary http://hcr.vermont.gov/sites/hcr/file s/ACT%2048%20one%20page%20su mmary%20June%2014.pdf 4. Wright, L., Pre-Existing Conditions, Vermont Life, 2013. 5. Strategic Plan for Vermont Health Reform http://hcr.vermont.gov/sites/hcr/file s/2013/Strategic%20Plan%20Revised %20July%202012.pdf Module 5: International Models
Lecture: International Health Care Systems View Video: Sick Around the World http://video.pbs.org/video/1050712790/ Readings: 1. Reid, T., 5 Myths About Health Care Around the World, The Washington Post, Sunday, August 23rd, 2009. http://articles.washingtonpost.com/200908-23/opinions/36874710_1_governmentrun-insurance-health-care-medical-insurance
Please post responses to two of the following discussion questions: 1. What management tools are in place in other countries that aren’t in place in the US system? 2. Is there more than one version of single payer? 3. What are some of the things that distinguish the US health system from health systems in other industrialized nations? Paper 1: Op Ed Piece is due at end of the week
Section 2 – Stakeholder Perspectives
Module 6: Healthcare Providers and other Healthcare Professionals Week 6 This week we will review reimbursement Please post responses to two of methodologies and tools that are in use and the following discussion contemplated for future use to improve questions: quality of care and mitigate growth in 1. What are unintended health costs. consequences of the fee for service Lecture: reimbursement system? Payment reform, past, present and 2. What options are future. there for reforming the reimbursement Review Video: system? James Robinson: Payment Reform - Lessons from 3. From the perspective the US of health care http://www.youtube.com/watch?v=kmnJ_ppproviders what are the gLM advantages of a fee for service system? What needs to change Readings: 8
1. Chapter 6: The Healthcare Labor Force (pages 139-165); course textbook 2. Chapter 5: Health Care Organizations (pages 104 – 137); course textbook 3. Kaplan, Robert and Porter, Michael, How to solve the Cost Crisis in Health Care, Harvard Business Review, September 2011 Module 7: Insurers Week 7 This week we will review the tools in use by insurance companies to manage healthcare costs and their effectiveness, consequences and discuss approaches for the future. Lecture: Health Cost Management Tools from the Insurer Perspective View Video: Whistleblower- Insurance Companies Abusing ACA- Health Action http://www.youtube.com/watch?v=zTCcXVk 0MOg Readings: 1. Chapter 7: Health Care Organizations (pages 171-201); Course Textbook 2. Berkto, John, Health Insurance Market Rating Practices, RAND Testimony to the Senate Finance Committee, September, 2008. http://www.rand.org/content/dam/rand/pu bs/testimonies/2008/RAND_CT315.pdf
to move to alternate financing models?
Please post responses to two of the following discussion questions: 1. What are some obstacles to managing healthcare costs? 2. How have the tools used by insurers to manage costs changed as the result of PPACA? 3. From the perspective of health insurers is it possible to balance a positive consumer experience and cost management? How can insurance companies learn from other industries? What makes them different?
Module 8: Consumers Week 8 This week we will discuss the emergence of a retail market for healthcare and an overview of the management tools in place to address rising costs and consumer satisfaction, along with their relative effectiveness. We will also introduce the concept of a Hassel Map which is a required part of Paper 2: Stakeholder Perspectives. Lecture: The evolving retail market Consumer driven health care Hassle mapping View Video: How the Affordable Care Act (Obama Care) affects young people http://www.youtube.com/watch?v=coj2hM PmKXw Please post responses to two of the following discussion questions: 1. How is the retail marketplace for healthcare transforming cost, access and quality? 2. What are the obstacles to disruptive innovation in health care delivery?
Paper 2: Stakeholder Perspective paper Due at end of the week
Readings: 1. Chapter 9: Impact of Innovation: Utilization, Cost and Quality of Care (pages 234-254); course textbook 2. Kaiser Family Foundation, Health Care Costs, A Primer, 2012 http://kaiserfamilyfoundation.file s.wordpress.com/2013/01/767003.pdf
3. Variation in Health Care Spending: Target Decision Making, Not Geography http://iom.edu/Reports/2013/Va 10
riation-in-Health-Care-SpendingTarget-Decision-Making-NotGeography.aspx?utm_medium=e tmail&utm_source=Institute 4. Christensen, Clayton, Will Disruptive Innovations Cure Health Care?, Harvard Business Review, 2000. http://hbr.org/web/extras/insightcenter/health-care/will-disruptiveinnovations-cure-health-care
Section 3 – Health Care Management Tools
Module 9: Delivery System Reform (ACO’s) Week 9 This week will be an overview of the current provider payment system and emerging models for paying for value and paying for quality through the use of Accountable Care Organizations. We will also discuss lessons learned from deployment of pay for quality tools in the US. Tools to manage the quality of patient populations, patients with chronic disease, and control unwanted variation in health care. Lecture: Accountable Care Organizations View Video: Dr. Elliot Fisher- Accountable Care- It’s All About the Relationships http://www.youtube.com/watch?v=xHJuCaC b4xc Please post responses to two of the following discussion questions: 1. Can we shift the paradigm by paying for outcomes instead of paying for services? 2. What is the ACO model? How is it different from what we have today? 3. What are some of the major challenges and opportunities related to ACO development?
Readings: 1. Bebinger, Martha, Mission Not Yet Accomplished? Massachusetts Contemplates Major Moves on Cost Containment, Health Affairs, Volume 28, number 25, September/October, 2009 http://content.healthaffairs.org/cont ent/28/5/1373.full 2. Gawunde, Atul, “The Cost Conundrum,”The New Yorker, June 1,2009 http://www.newyorker.com/reportin g/2009/06/01/090601fa_fact_gawan de Module 10: End of Life Care Week 10 This week we will discuss issues in end of life care. We will discuss the current model of delivering end of life care in the US and its costs and consequences. We will also discuss consumer satisfaction and preferences and approaches for the future. Lecture: End of Life Care View Video: Stephen Kiernan- Let’s Talk About Alternatives http://www.youtube.com/watch?v=FEDi-QqtQg&list=PL4749BC66B2DBDD74&index= 4 Readings: 1. Randall Krakauer, Claire M. Spettell, Lonny Reisman, and Marcia J.Wade, Opportunities To Improve The Quality Of Care For Advanced Illness, An Aetna pilot program shows how it can be done. 12 Please post responses to two of the following discussion questions: 1. How much do we spend on care at the end of life? What are the drivers of these costs? 2. How can we transform this model in the future? 3. Describe the obstacles and opportunities of moving toward a compassionate model of end of life care?
Module 11: Wellness, Condition Management and Consumer Engagement Week 11 This week we will review the tools being Please post responses to two of used by employers and their employees to the following discussion engage consumers in wellness and questions: condition management. We will discuss the 1. How successful have effectiveness of wellness programs as a cost different wellness control tool and ideas for improving this techniques been? model in the future. 2. What impact is the growth in health care costs having on Lecture: business? 3. What is the potential Wellness, Condition Management value of health, wellness and Consumer Engagement and condition management programs for employers? What View Video: are some potential measures of return on Retail Health Clinics investment for these http://www.youtube.com/watch?v=3suprograms? _YVQXCQ Readings: Chapter 10: Health Promotion and Disease Prevention (pages 255-287); Course Textbook 2. Huscamp, H., Rosenthal, M., Health Risk Appraisals: How Much Do They Influence Employee’s Behavior? Health Affairs, Volume 28. Number 5, September/October, 2009 http://content.healthaffairs.org/content/28/ 5/1532.long 3. Employee Benefit Research Institute, Health Care Access a problem regardless of Plan Type, June , 2013 http://www.ebri.org/pdf/PR1030.19June13.Notes-Hlth.pdf 1.
Module 12: Government, Policy and Politics Week 12 This week we will discuss the politics of healthcare in the United States. Please post responses to two of the following discussion questions: Lecture: 1. Does the policy-making Government, Policy and Politics process in the United States, emphasizing the View Video: action of self-interested coalitions, bypass a New York Times- Politics: Health Care broader “public interest”? Reform: Then and Now 2. Should privatization in http://www.youtube.com/watch?v=2xti_3BK CIE application of U.S. health policy be reduced? 3. What lessons for the Readings: future can be learned from 1. Chapter 11: Government, Policy and past reform efforts, both Politics in Health Care (pages 289successful and 321); Course Textbook unsuccessful? Module 13: Looking Ahead Week 13 This week we will discuss what the future of health care in the U.S. could look like. Please post responses to two of the following discussion questions: Lecture: 1. Would Americans benefit The Future of The US Healthcare from adopting expenditure System caps or expenditure targets such as those used in some non-U.S. systems? View Video: 2. To what extent can persons newly insured under Keith Humphries- The Future of Health Care in America: New Hopes, New Fears Medicaid expect the same http://www.youtube.com/watch?v=Pr87zTL1 quality of care as those who knE are privately insured? 3. What health-care related Readings: controversies might be 1. Chapter 12: Choices for the Future expected to develop in the (pages 324-339); Course Textbook near future? 14
Module 14: Final Paper Due Week 14 This week your Final Papers will be due. As part of your Final Project grade please read and provide a two page critique of a peers paper.
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