4
HEALTH CARE ADMINISTRATION PROGRAM
CALIFORNIA STATE UNIVERSITY, LONG BEACH
SYLLABUS - JANUARY 2009
Course Title: HCA 537 – MANAGED CARE - 3 UNITS
Instructor: Jean Klein, MBA
Phone: (949) 916-9937
E-mail:
Office Hours: Available after class, by e-mail or Phone
Required Textbook: Kongstvedt, Peter R., Essentials of Managed Health Care, Fifth Edition, Jones and Bartlett Publishers, 2007.
Recommended Kongstvedt, Peter R., The Managed Health Care Handbook, Fifth Edition,
References: Aspen Publishers, Inc., 2007.
Marcinko, David Edward, Dictionary of Health Insurance and Managed Care, Springer Publishing Company, 2006
Managed Care Glossary of Terms: http://www.pohly.com/terms.html
PURPOSE OF COURSE
The purposes of this course are to prepare people to enter the managed care field and to orient managers to the organization and administration of health maintenance organizations, preferred provider organizations and related enterprises. Both relationships to the health care marketplace and operational aspects of managed health systems will be covered. The assessment of managed health care is a very dynamic field which is evolving continually. In an effort to incorporate the most up to date information possible, journal articles will be a feature of this class. Additionally, students will be expected to develop a real-world projection of health care into the twenty-first century.
EXPECTED OUTCOMES
Upon completion of the course, each student should be able to:
1. Identify the different models of health care organizations
2. Describe impact of Federal HMO Act on health care delivery
3. Describe Health Care State Statutes and Federal Regulations
4. Identify essential aspects of provider contracts and compensation arrangements
5. Describe the components of a marketing plan for a managed care system
6. Identify problems of financial management in an HMO
7. Design a competitive health care product taking into account benefits and costs
8. Describe how premium rates are set under different rating systems
9. Analyze industry trends and their implications
10. Differentiate case management from disease management
11. Identify components of utilization review and quality
12. Identify some of the common operational problems of Managed Care
CLASS SCHEDULE Requirements Due
Week 1: Class Overview – Managed Care Process Model
Week 2: Chapters 1-2: Introduction to Managed Health Care
Week 3: Chapters 5-6: Health Care Delivery System – Physicians
Week 4: Chapter 7-8: Hospitals - Compensation – Performance-Based Incentives
Week 5: Chapter 9: Managing Medical-Surgical Utilization
Week 6: Chapters 10, 11, 14: Disease Management – Case Management Opinion Paper Due
Week 7: Chapter 15: Quality Management
Week 8: Chapter 16: Data Analysis and Profiling in Health Care
Week 9: Chapter 21: Sales and Marketing
Week 10: Mid-Term
SPRING BREAK RECESS
Week 11: Chapter 23: Accreditation and Performance Measurement
Week 12: Chapters 24-25: Financial Management, Rate Setting & Product Design
Week 13: Chapter 26, 29: Common Operational Problems, Medicare, Global
Week 14: Chapter 33: State Regulations - Student Reports Research Paper Due
Week 15: Student Reports Research Paper Due
Week 16: FINAL EXAM
STUDENT RESPONSIBILITIES AND EVALUATION
ATTENDANCE
Students are required to attend and be prepared for each session by having read the assigned materials. Attendance is expected at each class session. However, under serious and compelling circumstances, an absence may be excused. It is then the responsibility of the student to bring himself/herself up to date on the class material. Laptop computers are not to be in use during class (other than for presentations).
DROPS
It is the responsibility of the student to file for drop status if he or she desires. The program director generally does not sign drop forms after the third week. No instructor drop will be filed.
DISABLED STUDENT ASSISTANCE
Please notify the instructor if you need specific accommodations.
CHEATING AND PLAGIARISM
It is the policy of the faculty and administration to deal effectively with the student who practices cheating or plagiarism. One or more of the following academic actions are available to the faculty member who finds a student has been cheating or plagiarizing: (a) Review -- no action, (b) An oral reprimand with emphasis on counseling toward prevention of further occurrences; (c) A requirement that the work be repeated; (d) Assignment of a score of zero (0) for the specific demonstration of competence, resulting in the proportional reduction of final course grade; (e) Assignment of a failing final grade; (f) Referral to the Office of Judicial Affairs for possible probation, suspension, or expulsion.
EXAMS
As a traditional grading system is required for evaluation of student performance in this course, there will be a midterm and final exam. No make up exams will be given unless you have made arrangements with the instructor prior to the exam. Partial credit will be given for evidence of correct reasoning, but not for “effort.”
JOURNAL DISCUSSION/OPINION PAPER
Review a Managed Health Care journal or article. Write an opinion paper of the article (4-5 pages double spaced computer written). The paper should include an overview of the material presented and your opinions or thoughts on the subject matter, as if you were discussing the topic with another health care colleague. Present recommendations on your issue and include sourced references. Please number all papers, staple in the upper-left hand corner, and put your name and the date on the paper.
RESEARCH POSITION PAPER & ORAL PRESENTATION
For this class, one (1) position paper is required. The position paper, should include your view of a particular problem or issue in managed health care from careful consideration of professional literature on the subject. The papers should include four major components:
1. A description and significance of the managed health care problem or issue chosen;
2. The question to be addressed;
3. Your position or proposed solution; and
4. Support for your position (including references).
This can be done in about 5-7 double-spaced pages of text, and should be turned in on the day of your class presentation. You will be required to present your position paper to the class in a 15 minute oral presentation. Audio/visual aids may be used in this presentation.
PAPER REQUIREMENTS AND GRADING
Papers will be graded using an evaluation criteria for specific key areas. A scale of one to five will be used to evaluate how well the paper followed the criteria based on: format, content, spelling, organization and structure.
CLASS PARTICIPATION
Participation in classroom discussions is important. It is evident who attends and contributes and who does not. Participation will be computed into the final grade for the course.
BASIS OF SEMESTER GRADE
The exams and papers will have the following weights in the computation of a final letter grade:
Midterm 35%
Final 35%
Journal Opinion Paper (4-5 pgs.) 10%
Research Position Paper (5-7 pgs.) 10%
Oral Presentation 5%
Class Participation 5%
TOTAL: 100%
JOURNALS RELATED TO MANAGED CARE
AAHP (American Association of Health Plans) Journal
Business and Health
California Medicine
Group Practice Journal
Health Affairs
Health Care Financial Management
Health Care Financing Review
Health Care Financing Topics
Inquiry
JAMA (Journal of American Medical Association)
Journal of Politics, Policy and Law
Journal of Risk and Insurance
Medical Care
Medical Interface
Milbank Memorial Fund Quarterly
Modern Health Care
MANAGED CARE ORGANIZATION
American Association of Health Plans
1129 20th Street NW, Suite 600
Washington, DC 20036-3421
Phone: (202) 778-3200 or (202) 778-3239, Fax: (202) 331-7487, Web: http://www.aahp.org
Health plan association representing over 1,000 health plans throughout the country. Provides information on Managed Care Organization educational programs, health care delivery, research, services, and products.
ON-CAMPUS COMPUTER ASSISTANCE
The CSULB Technology Help Desk is now available for students. Help is available on a wide range of computer issues including: BeachBoard, Windows and Mac OS, CSULB Internet Accounts, Remote Connectivity, Microsoft Desktop Applications, Anti-Virus, Internet and Web related topics. Visit us on the web at http://helpdesk.csulb.edu or contact the THD by phone at 562-985-4959 or send Email to .
The Writer's Resource Lab helps students with all sorts of writing assignments. It provides personalized writing tutorial assistance and group tutorial sessions and workshops. Schedule an appointment with a tutor by calling during office hours: (562) 985-4329
Office hours are posted at: http://www.csulb.edu/colleges/cla/departments/english/wrl/
Note: It's easy to obtain an appointment early in the semester, much harder toward the end.