Managed Health Care

Masters in Business Administration

MBA 601

Breyer State University
Instructor: Mark C. Barabas, BS in BA, DHA

SYLLABUS

COURSE OVERVIEW: This course is designed to provide you with the comprehensive concepts of Managed Care. You will review the formative years of Managed Care and study various theories, concepts and models as they relate to Managed Care. The types of Managed Care Organizations and different provider payment models are the building blocks of you developing a Managed Care knowledge base so you can make appropriated management decisions when working in Health Care Delivery. The Insurance Function, in addition to organizational models will be reviewed at length. The understanding of Capitation and other compensation models is vital to your ability to apply the theory of Managed Care to your local market dynamics. Utilization review, Quality and Provider contracting are discussed from the management perspective. Negotiation tactics and changing provider behavior are important components of the course material. Market trends in Medicare and Medicaid Managed Care contracting and development are reviewed from their origination through the current practice.

The financial implications of Case Management, Disease Management and Pharmacy Benefit Management are covered in the course. MCO's relations with Behavioral Health Providers, Home Care, Subacute and Hospice providers are reviewed. Physician behavior, Reimbursement Systems and Information Systems are discussed. Claims processing and Managed Care trends are explained.

Chapters 1 - 28, 32 - 42 and 55, 56, and 57, will be covered in this course

TEXTBOOK: There is one required textbook for this course.

Book 1: The Managed Health Care Handbook. Peter R. Kongstvedt, ASPEN, 4th Edition. 2001: ISBN # 0-8342-1726-0.

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TIME FRAME: This is a four-semester hour course. This course is allotted ten weeks of time You must complete all of the requirements for the course successfully by the end of the ten-week period. The first day of week one will begin the day that you register for the course, or the day which you notify me that your textbook has arrived and you are ready to begin your studies. Please be cognizant of the time frame. It is rare that extensions of time are permitted, unless you have good justification. Upon successful completion of this course, you will be awarded four semester hours of credit.

WRITTEN ASSIGNMENTS: You will complete a learning portfolio of questions, a Research paper and a final exam to earn your grade. You will be required to draw on your work, life, and managed care experiences in completing your assignments.

Your Research paper must be written on a current Managed Care topic. It must include a bibliography of current articles. The topic may be presented to your instructor when you complete Chapter 28 from your Learning Portfoloio. The expected length of your paper is 5 - 10 pages.

GRADING: The learning portfolio is graded on a Pass/Fail basis. The case study and the open book final exam will be graded based on the following scale:

90-100%    = A
80-89%      = B
70-79%      = C
Below 70% = Fail

INSTRUCTOR: The instructor for this course is Mark C. Barabas, CHE, BS in BA, DHA.

Current, CEO, Mercy Suburban Hospital , Mercy Health System. Former, Hospital COO
Former, Adjunct faculty @ Youngstown State University and Lebanon Valley College .
Former, Chair of the Board for two national Health Care Organizations.
Current, Editorial Board JONA's Healthcare, Law, Regulation and Ethics Journal and frequent contributor of published articles.
Winner of the Graduate Literary Award from the University of Toronto Department of Healthcare Administration for 2001.
Current and former member of numerous non-profit community organizations Board of Trustees.
Hospital Accreditation Administrative Surveyor for the Healthcare Facility Accreditation Program.
See Breyer State website "Faculty" for more information.

INSTRUCTOR AVAILABILITY: Upon registration, you will be given my email address. I am available periodically through email, so please email me any questions that may occur. That is why I am here. I will do everything to help you as much as possible. Please do not wait until the end of the class to try to get help. It will be too late. Anytime your grade falls below C, I will try to contact you about it. If I do not, please do not hesitate to contact me through email.

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

1). Learn the basic concepts of Managed Care Theory.
2). Review the History of Managed Care.
3). Study Multiple Managed Care models.
4). Determine the Managed Care model in your local market.
5). Review the different types of Managed Care Organizations.
6). Study various payment models for Managed Care providers.
7). Understand the Insurance function of Managed Care.
8). Learn how to apply Managed Care reimbursement models to management decision making.
9). Study provider reimbursement models including capitation.
10). Understand Quality and Utilization applications in Managed Care.
11). Review negotiating tactics in Managed Care.
12). Discuss concepts in changing provider behavior.
13). Study market trends in Medicare and Medicaid managed Care.
14). Review the strategies of Managed Care Network Development.
15). Understanding the components of Integrated Healthcare Delivery Systems and how they work.
16). Review of Governance models in Managed Care.
17). Discuss the role of Community Health Centers in Managed Care.
18). Study the role of Alternative Medicine as it relates to Managed Care.
19). Review basic Medical management Concepts in Managed Care.
20). Understand the Clinical Service Authorization process.
21). Learn the role of the Emergency Department and Ancillary Services in Managed Care.
22). Study Case Management's impact on Managed Care.
23). Discuss Core Competencies of Disease Management.
24). Review Prescription Drug Systems and Benefits in Managed Care.
25). Understand the role of Behavioral Health, Home Care, Subacute Care and Hospice providers in Managed Care.
26). Study the systems of Provider Profiling in MCO's.
27). Review approaches to Physician Behavior change in Managed Care.
28). Discuss methods of Patient Behavior Change in MCO's.
29). Understand MCO information systems and E-Commerce requirements.
30). Comprehensively review Claims and Benefits Administration Systems.
31). Discuss Member Services and Consumer Affairs as they related to the Sales and Marketing Approach of MCO's.

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