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There are 4 modules in this course
This course will review the drivers of healthcare cost and solutions that have been proposed to address cost, quality and value of health care. Many point blame for high costs on payment models that pay healthcare providers for every service they provide to patients, essentially paying more for volume and service intensity. This is called a Fee for Service (FFS) payment model. Some solutions, arguably the more sustainable solutions, are the combined strategies of new payment models, care management, insurance plan designs, consumer engagement tools, and technology.
Using that information we will explore various situations, showcasing coordinated care and payment strategies that can be implemented to improve patient health and the cost of delivery of healthcare services.
By the end of this course, the learner should be able to:
1. Identify the drivers and trends of healthcare spending from the perspective of various stakeholders, including medical providers, insurers, government and private purchasers and payments
2. Critically assess the impact of strategic and financial approaches that have been put in place by the ACA and the various modifications.
3. Evaluate how healthcare payment models currently work and the new direction that value-based payment is taking.
4.Identify how financial and non-financial metrics can be appropriately combined to improve a healthcare stakeholders’ value proposition.
This week's focus will be on understanding the various stakeholders in healthcare. We will review the "math" surrounding healthcare costs and how it can fluctuate. Healthcare drivers will be reviewed to identify trends. As you move through the weekly material, I encourage you to think about the impact that the drivers have on the delivery of the healthcare services.
I Thought we were done with this: Insurance Markets
Module 2•4 hours to complete
Module details
This week we will describe the various elements which underline health insurance within the United States. For example, third party payment structures and risk pooling, to name a few. This week we will focus some time on the Affordable Care Act (ACA) which is a very complex piece of legislation. Special attention will be made on provisions of the ACA that impact insurance markets, financing, healthcare costs, and payment models.
Selection Impact on Risk Pools and Premium Costs•4 minutes
Background on U.S. Health Insurance•3 minutes
Affordable Care Act•5 minutes
Access to Insurance•4 minutes
Interview with Mark Guanya: Part 1•17 minutes
Medicare Changes•3 minutes
Insurance Sources•4 minutes
Benefits•4 minutes
Article Introduction: "The Bitter Pill"•3 minutes
1 reading•Total 30 minutes
The Bitter Pill•30 minutes
3 assignments•Total 95 minutes
Week 2 Quiz (Graded)•35 minutes
Check Your Knowledge•30 minutes
Check Your Knowledge•30 minutes
3 discussion prompts•Total 50 minutes
Week 2 General Discussion•10 minutes
Purchasing Insurance•20 minutes
Article Discussion•20 minutes
Value-Based Payment Models
Module 3•5 hours to complete
Module details
This week will continue to "follow the money". We will focus much of our attention on the shortcomings of a Fee-for-Service payment model. Our attention will shift to alternative payment models that have been implemented, allowing for certain comparisons to be made. Lastly, we will review some results that have been achieved because of the new payment models. This week I will leave you by asking, If we know that the Fee-for-Service payment model is dysfunctional, why is it continuously used?
Contractual Reforms to Address Cost and Trend•3 minutes
Managed Care•4 minutes
Article Introduction: Dealing with Medical Practice Variations•3 minutes
Fee-for-Service Payment Models•6 minutes
Bundled Payments•4 minutes
Healthcare Differences•7 minutes
Medical Homes•4 minutes
Capitation or Salary•4 minutes
Reference Pricing and the Consumer•3 minutes
What Drives Results?•5 minutes
Interview with Mark Guanya: Part 2•24 minutes
2 readings•Total 75 minutes
Dealing with Medical Practice Variations: A Proposal for Action•30 minutes
CMS Vignettes•45 minutes
3 assignments•Total 95 minutes
Week 3 Quiz (Graded)•35 minutes
Check Your Knowledge•30 minutes
Check Your Knowledge•30 minutes
3 discussion prompts•Total 30 minutes
Week 3 General Discussion•10 minutes
Article Discussion•10 minutes
Consumer Engagement•10 minutes
Evolving Integrated Models: Putting It All Together
Module 4•4 hours to complete
Module details
This week we shift our focus from reviewing current payment models and strategies to applying some of the models and concepts to "real-world" scenarios. We will use fictitious examples, as well as published articles to bring together all of the concepts. As with most things, there is not one single answer to solving the healthcare cost, quality, and value problems. I encourage you to think "outside of the box" and as always, "follow the money!"
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Learner reviews
4.6
56 reviews
5 stars
71.42%
4 stars
21.42%
3 stars
3.57%
2 stars
1.78%
1 star
1.78%
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M
MN
5·
Reviewed on Apr 12, 2022
Excellent instructorGave the course 5 stars, however one thing I would point out is that some articles are not available without paid subscriptions to the source newspapers.
O
OO
5·
Reviewed on May 5, 2020
The energy the Professor brings into the course is amazing.
A
AC
4·
Reviewed on Nov 3, 2020
It is a good course. you will get the idea of healthcare payment model.
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