Master Syllabus: HSA 66841

TROY UNIVERSITY
MASTER SYLLABUS
SORRELL COLLEGE OF BUSINESS

HSA 6684
Managed Care: Origins, Organizations, and Operations

Prerequisites

Graduate standing, HSA6682 Healthcare Planning and Management.

Description

Covers managed care programs, structures, practice models, role of physicians and other clinicians, capitation, cost-accounting and forms of reimbursement.

Objectives

On completion of the course, the student should be able to:

  1. Describe the evolution, management, operations, functions, systems and models of managed care and health insurance plans.
  2. Describe financial aspects of managed care and health insurance plans, budgeting, cost-benefit analysis, cost-accounting,reimbursement methodologies, payment systems, pricing, incentives, risk assessment, forecasting, underwriting, and regulatory reporting.
  3. Propose recommendations to apply population risk assessment and the principles of population risk management and medical home models to applicable scenarios.
  4. Assesslegalchallenges and impacts of federal and state legislation, healthcare reform, and regulations governinghealth insurance plans, managed-care plans,contracts, and antitrust issues.
  5. Evaluate applicable scenario to apply managed care and health plan strategies to meet business objectives.

Purpose

This course explores the financial management concepts, insurance mechanisms, reimbursement, structures and processes in managed care and in the healthcare industry to help students improve cost-management, performance improvement, decision making and other processesin healthcare organizations and to understand the key issues facing healthcare managers in these areas. MSM Healthcare Management concentration requirement.

Approved Texts (both required for course):

Kongstvedt, P. R. (2009or current). Managed care: What it is and how it works. Sudbury, MA: Jones and Bartlett.

Cleverley, W.O.,& Cameron, A.E. (2007 or current). Essentials of Healthcare Finance (7th ed.). Sudbury, MA: Jones and Bartlett.

Supplements

Kongstvedt, P. R. (2007or current). Essentials of managed care (5th ed.). Sudbury, MA: Jones and Bartlett.

Gapenski, L.C. (2009 or current). Fundamentals of Healthcare Finance. Chicago: Health Administration Press.

Dennerll, J. T., & Davis, P. E. (2005 or current). Medical terminology: A programmed systems approach: Revised (9th ed.). Clifton Park, NY: Thomson/Delmar Learning.

Morrisey, M.A. (2007 or current). Health insurance. Chicago: Health Administration Press.

Todd, M. K. (2009 or current). The managed care contracting handbook (2nd ed.). Productivity Press.

Troy University Faculty Handbook(2010): Section 3.9.2.8 [extract] — essential elements of the syllabus (somewhat modified for space):

  1. Course title
  2. Course number + section
  3. Term
  4. Instructor
  5. Prerequisites
  6. Office hours
  7. Class days, times
/
  1. Classroom location
  2. Office location + e-mail address
  3. Office telephone
  4. Course description, objectives
  5. Text(s)
  6. Other materials
/
  1. Grading methods, criterion weights, make-up policy, mid-term grade reports
  2. Procedure, course requirements
/
  1. General supports (computer works, writing center)
  2. Daily assignments, holidays, add/drop & open dates, dead day, final exam
/
  1. ADA statement
  2. Electronic device statement
  3. Additional services, statements
  4. Absence policy
  5. Incomplete-work policy
/
  1. Cheating policy
  2. Specialization requirements (certification, licensure, teacher competencies)