Week 1 (j8)
Lecture - Course Overview & Lecture on Ethics
in Healthcare
“Where Did Managed Care Come From & Where Is It Going?”
- HealthCare Reform -- Relationship Between Managed Care, Health
Economics, & Healthcare Finance;
- Types of Managed Care Orgs; Integrated Delivery Systems;
Elements of Management Control & Governance
Structure;
- Budgeting, Financial Management, & Business Planning--Crucial
to Achievement of Success;
- RBRVS (resource based relative value scales);
- APCs (ambulatory patient classifications);
Debate/Term Project - Form Teams
for Issues, Debate & Project
Reading - Chapters 1-5 &
22, M.C.
Problem/Issue - Assignment #1
Week 2 (j14) Special Class Session from 1-3 p.m. @ Kinneret, 515
South Delaney Avenue, Orlando
Week 2 (j15)
Lecture - Discussion of Risk & Uncertainty & Application
to Managed Care; Open &
Closed Panel Plans; Physician Compensation
- Disease Management; Emergency Services Mgt & Utilization;
Managed Behavioral Care Svces.
Reading* - Chapters 6 -16, M.C.
Problem/Issue - Assignment #2
Week 3 (j22)
Lecture - Medical Savings Accounts
& Managed Care; Quality Management in Managed Care; Behavior Modification
in Managed Care
- Capitation Methods; Authorization Systems; Rating &
Underwriting; Member Services
Reading* - Chapters 17-21 & 23-24, M.C.
Problem/Issue - Assignment
#3
Week 4 (j29)
Lecture - Operational
Problems in Managed Care; Medicare Medicaid & Managed Care
- Regulatory & Legal Issues
Reading* - Chapters 25-30, M.C.
Problem/Issue - Assignment #4
Week 5 (f5)
Lecture -
Debates & final preparations for Term Project
Problem/Issue - Assignment #5
Week 6 (f12)
- Mock Team Presentations, Submission of Term
Project & Final Examination
1 p.m. -- Formal Presentation of Term Project to
members of governing board of Kinneret
Council on Aging
* Required Readings include daily reading of "The Wall Street Journal"
DETERMINATION OF COURSE GRADE
Your Course Grade Will be Determined in Accordance With the Following Formula:
Problem/Issues Assignments - 25%
Debate - 20%
Term Project & Team Presentation - 50%
Final Examination - 5%
A = 91 -100
B = 81 - 90
C = 71- 80
D = 61 -70
F = < 61
This course is comprised of a total of 100 points. Each point earned is
worth one percentage point.
TERM PROJECT
The class shall be divided into teams. Each team shall prepare a part of
a business plan & program strategy/design for a designated healthcare
entity, Kinneret Council on Aging. The plan will be developed on
behalf of an actual client entity which has agreed to participate in this
class directed experience. The final product will be formally presented
to the governing board of the organization.
The plan shall include at least the following sections:
I. Introduction which shall include an Assessment of decision-making apparatus
in place (or planned)
II. Plan objectives
III. Historical development of entity & past documented efforts to
address challenge(s) being faced
IV. Identification of primary & secondary target markets of entity/program
V. Identification of similar facilities in primary & secondary target
markets
VI. Analysis of Competition
VII.Patient Origin
VIII.Positioning statement (demonstrate how program is expected to impact
target market(s)
IX. Assessment of the business risk (risk of failure)
X. Marketing Strategy
XI. Presentation of implementation (Action) plan for two year period showing
elements of program (shall be integrated with plan objectives -- Item II
above)
XII. Presentation of financial plan for three year period (revenue &
expense projection & expected cash flow requirements)
XIII. Presentation of expected/predicted outcome(s)
Each team shall be expected to present their part of the Business Plan
to the client and fellow class members. Salient questions shall be
posed &, when deemed appropriate, questions also may be raised regarding
the pertinence and application of the plan assumptions. Each presentation
shall be performed extemporaneously.
To capably address the written portion of this assignment, library research
& references which document conclusions will be essential. The written
submission shall be typed and double spaced. APA methods of referencing
shall be observed. The written paper will be evaluated based upon the quality
of its content. Two separate submissions of the project are expected. In
one submission, each section of paper shall be labeled with the name of
its author (team member). Each team member shall be evaluated for completion
of their respective section(s) of the paper. No co-authorships are permitted
in completing the written portion of the Term Project. The second submission
shall include two copies of the project. This submission shall have been
edited by all team participants and will be submitted as a seamless copy
with the names of the respective team members being included as STUDENT
CONSULTANTS on the cover page.
Of the 50% of your course grade which will be derived from completion of
this assignment, 20% will be earned from the team presentation & 30%
from the written submission of each student. The completed term project
is due for submission AT THE BEGINNING OF THE WEEK 6 CLASS SESSION. LATE
SUBMISSIONS WILL NOT BE ACCEPTED. It is the responsibility of each student
to complete and submit their work as required in this syllabus.
DEBATE TOPICS
Topic #1:Resolved: managed healthcare plans provide a superior quality
of care & service when compared with any other known form of health
insurance.
Topic #2:Resolved: managed care organizations have violated the confidence
and lost the trust of an uncertain and fearful public and must now be subjected
to regulation, much like a public utility.
Topic #3:Resolved: organ donor & transplant programs should be conducted
free of any associated cost to the recipient with all expenses being borne
by society.
Topic #4:Resolved: with the 'graying' of America, the most feasible means
of providing healthcare in the new millenium will be through a regulated
program of rationing which employs as its primary criterion for eligibility
determination the age of the patient.
DEBATE GROUND RULES
1)The class will be divided into working teams.
2)The team defending a resolution will open the debate with each member
providing an opening extemporaneous statement of not more than one minute.
3)The team speaking against a resolution then will make its opening statement
with each member speaking extemporaneously for not more than one minute.
4)The floor then will be open for cross questioning with the team speaking
against the resolution (resolution opponents) having the first opportunity
to question the resolution proponents.
5)This will be followed by cross questioning alternately by each of the
resolution proponents and the resolution opponents.
6)After approximately one hour of debate, the moderator will call for the
closing statements of each team.
7)The resolution opponents will speak first with each team member offering
an extemporaneous closing statement of one minute or less.
8)The resolution proponents then will offer their closing statement with
each member speaking extemporaneously for one minute or less.
9)The class members & the instructor will evaluate the performance
of each team & will respectively vote to determine the winner of each
debate. The class members will evaluate the performance of each team while
the instructor will evaluate the performance of each individual participant.
10) A standard Debate Evaluation Form will be employed to assess the performance
of each team and the individual members.
Questions, Comments on website:
mschell@oir.ucf.edu
