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HAMBA I - Structure and Economics of the US Health PDF

Level: 500

Course Description

Healthcare systems are complicated structures beholden economically and legally to many different stakeholders and policies. When those factors change, they have consequences. Aspiring managers must be able to make informed decisions about what to do in the face of change. By the end of this course, aspiring healthcare system managers will be prepared to analyze the economic impact of policy changes on their institutions and tackle challenges such as hospital mergers, new payment models, regulated drug prices, and Medicaid insurance bids. Learn more at rize.pub/HAMBA-I.

Prerequisites

• None, although a basic understanding of economics [e.g. previous undergraduate class] would be beneficial, as this course deals with the understanding the economic impact of policies on healthcare systems.

Course Topics

• US Healthcare System Structure and Economics: Understanding the structure and economics of the US healthcare system is crucial for navigating regulatory landscapes, making informed financial decisions, and driving organizational success.
  • The US healthcare system is one of the largest and most complex industries, offering vast opportunities for innovation and leadership. Understanding its structure opens doors to significant influence and career advancement.
  • CMS, Medicare, Medicaid, and the ACA control trillions of dollars in funding and impact millions of lives. Knowledge of their roles and interactions is essential for driving strategic initiatives and negotiating contracts.
  • Application of economic principles to understand roles and interactions
• Social Determinants of Health (SDoH)
  • Adverse social factors can lead to higher healthcare utilization and costs, while preventive care and targeted interventions can result in significant savings and improved health outcomes. For aspiring managers, understanding SDoH helps optimize resource allocation, develop equitable funding models, and enhance overall economic productivity and stability within the healthcare system.
• Healthcare Payment Models
  • Students will explore various payment models, including traditional fee-for-service and emerging value-based care, which can can offer a positive trajectory for financially struggling providers. Understanding payment models is a major factor in any healthcare system’s financial sustainability.
  • By analyzing the impacts of different payment models, managers can implement payment strategies that enhance care efficiency and patient satisfaction, ultimately driving competitive advantage.
• Healthcare Policy and Regulations
  • Policies can dramatically affect operational and financial outcomes. Staying ahead of regulatory changes enables proactive management and strategic planning, avoiding costly compliance issues.
  • By learning to predict the impact of policy changes on different stakeholders within the healthcare system, managers can position an organization to adapt swiftly and capitalize on new opportunities, providing a significant competitive edge.
• Insurance Fundamentals: Understanding insurance fundamentals is vital for administrators to manage costs, negotiate with insurers, and design benefits that attract and retain employees.
  • Basics of health insurance, including different types of plans
  • Effective risk management and underwriting strategies can significantly lower insurance costs and improve financial stability, enhancing the organization's bottom line.
• Consolidation and Integration of Healthcare Systems: Understanding hospital mergers and financial challenges helps managers make the right strategic decisions that ensure their institution's viability and growth, especially as the COVID-19 pandemic has exacerbated financial strains by increasing operating costs and reducing patient volumes. In 2023, with 65 announced hospital deals, managers need to navigate complex regulatory landscapes and integrate operations effectively to achieve economies of scale, improve care coordination, and maintain competitive advantage.
  • Examination of mergers and acquisitions in healthcare
  • Benefits and challenges of consolidation
  • Strategies for successful integration of healthcare systems

Here are some examples of professional questions in healthcare management this course will help prepare you to consider:

• Two hospitals are considering merging. Would such a merger be good for the hospitals, as well as for patients and payers?
• An insurance company is proposing a new “at-risk” payment model for a health system. What risks to the system would this represent?
• Medicare now regulates the prices of certain pharmaceutical products. What effects would this have on drug manufacturers and pharmacy benefit managers?
• A state Medicaid program has put out a request for proposals for insurers to bid on providing health insurance for Medicaid beneficiaries. What aspects of the bid should an insurer focus on?