Managed Care Symposium

Doctorate of Philosophy in Health Care Administration

HCA 800

Breyer State University
Instructor: Dominick L. Flarey, Ph.D., MBA, RN,CS, CNAA, FACHE

SYLLABUS

COURSE OVERVIEW: This is a ten-semester hour doctoral level course in the Doctor of Philosophy in Health Care Administration Degree Program. This course will provide doctoral students with an intensive study of all aspects of managed health care. Students will conduct readings from an authoritative text and develop a comprehensive learning portfolio. The learning portfolio will guide the study and knowledge acquisition of a broad base of important information and application in all dimensions of managed care, from the provider perspective to the industry perspective. Students will also select one focused area of interest related to managed health care and produce a scholarly paper following independent research/study of the focused topic. Full information for the learning portfolio project and the scholarly paper, including instructions, are provided to students upon official enrollment into this course.

TIME-FRAME: You are allotted ten weeks of time to complete this course. An extension of up to five additional weeks is generally approved.

TEXTBOOKS: There is one required textbook for this course.

Book 1: Essentials of Managed Care (4th edition). Peter R. Kongstvedt. Boston; Jones and Bartlett Publishers: 2003. ISBN # 763739839.

GRADING: Your final grade will be based on the grading of the learning portfolio and the scholarly paper. Grading criteria are presented to you upon official enrollment into the course.

COMMUNICATION: You are encouraged to communicate with me. I am available as a teacher, coach, and mentor to assist you in meeting your goals for this course. Primarily, communication is through e-mail. However, I am also available for conversation by telephone if you would like. Our classroom for this course has a "chat" room. I am also very willing to meet with you one-on-one in the chat room at your request. From time to time, depending on how many students are enrolled in this course at a particular time, we will have some scheduled group chats. You will receive more detailed information at the time such chat sessions are scheduled. Please keep my e-mail address handy so that you can contact me whenever necessary.

ABOUT YOUR INSTRUCTOR: Dominick L. Flarey, Ph.D., DCH, MBA, RN,CS,FACHE- professor of nursing and President of Breyer State University. He is a certified Adult Nurse Practitioner, Certified Psychiatric-Mental Health Nurse, and a Board Certified Clinical Hypnotherapist. He has published extensively in peer reviewed journals and has authored /co-authored seven texts in nursing. He speaks nationally on many clinical and administrative topics related to nursing, including case management, health care administration and managed health care, psychiatric-mental health, and health care law and ethics. Dr. Flarey is also certified in Nursing Administration Advanced, and is a Fellow in the American College of Health Care Executives. He is also on the faculty at Canyon College . He is the author and co/author/editor of seven texts in nursing and health care administration and the past editor -in-chief of JONA's Health Care Law, Ethics and Regulation.

COURSE OBJECTIVES: Upon completion of this course, you will be able to:

1). Define and discuss the history and evolution of managed care.
2). Discuss federal statutes related to managed health care.
3). Define and discuss the major types of managed health care structures.
4). Identify and discuss various models of managed care within defined structures.
5). Discuss how each model of care operates as well as advantages/disadvantages.
6). Review and comment on the economics of health care delivery in the age of managed care
7). Discuss physician practice management and contemporary models of such.
8). Define and discuss major issues of the governance of provider structures in managed care"
9). Discuss the most pressing legal and ethical issues related to managed health care.
10). Define and discuss the concept and models of integrated delivery systems.
11). Discuss the process of provider credentialing.
12). Define and discuss programs of quality assurance and quality improvement related to care delivery in managed care environments.
13). Discuss capitation, how it is structured and the economic issues associated with it.
14). Define key characteristics of advanced managed care systems.
15). Discuss the "hospitalist" approach to acute care delivery.
16). Define and discuss disease management.
17). Examine models of case management used today in managed health care delivery.
18). Contrast disease management and case management.
19). Discuss the operations and goals of utilization review processes.
20). Explain the NCAQ accreditation process.
22). Discuss HEDIS.
23). Examine the federal statute HIPPA and its implications for health care delivery today.
24). Discuss Medicare program and models of managed care.
25). Discuss State funded managed care models.
26). Define and discuss consumer rights and protections in managed care environments today.
27). Examine and discuss advanced managed care systems.
28). Select a focused topic in managed health care and conduct independent study/research.
29). Prepare a scholarly paper/presentation on a focused topic related to managed health care.

CLASSROOM: You will utilize the online virtual classroom for this course to access all information and instructions for all requirements for this course.

PREREQUISITES: You must have completed HCA 725 and HCA 750 to register for this course.

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