Syllabus
Health Science 465
Required Textbook
Morrissey, Michael A., Health Insurance, Health Administration Press Second Edition
Compare prices for your textbooks through the University Store Price Comparison site.They will show you all of the options from the University Store plus several online options to help you find the best price
Introduction to the Course
Outcomes
Know: In this course you will identify third-party reimbursement and payment methodologies, including, but not limited to, differentiating between Medicare and Medicaid, traditional insurance, and managed care. You will also analyze the business office functions that permit a healthcare organization to maximize reimbursement and to negotiate and administrate contracts with third-party providers.
You will not study the day-to-day operations of insurers. Rather, your perspective will be that of one looking in from the outside, discovering the role that health insurance plays in the United States.
Become: The vast majority of you will not go on to be researchers, actuaries, or even insurance executives. Rather, you will buy insurance for your families and worry about coverage for your employees. This course will prepare you to make the best coverage decisions.
Most of you will work for health services providers or in organizations that provide healthcare; and your concern will be how that organization is paid by private and public insurers. This course will aid you in identifying and selecting the appropriate payer mix for your organization.
Do: As citizens, policymakers, and those in a position to influence policymakers, you will want to recognize how innovations in insurance delivery, in government policy, and in healthcare reform will affect you and your organization. This course will help you gain an intuitive knowledge of the industry which will allow you to make more-informed decisions and to cast a much more critical eye on proposed "solutions".
This course fulfills the central aims, desired skills, and core competencies of the healthcare administration program by providing:
- Healthcare Literacy: Students will learn the “insurance” structure and function and issues of the healthcare industry and related systems.
- Business Management Literacy: Students will recognize how “insurance” relates to the basics of Business Administration and Human Resource Administration of healthcare organizations.
- Quantitative Analysis: Students will develop quantitative reasoning skills that allow them to solve insurance problems addressed in the curriculum.
- Communication: Students will use written and oral communication skills and will utilize presentation software.
- Teamwork and Leadership: Through projects executed in groups, students will utilize team-building principles and exceptional leadership skills.
- Professional Ethics: Students will be encouraged to identify and eliminate any incongruities between their personal ethical tendencies and the Gospel of Jesus Christ.
Activities and Assessments
Late Work Policy
Students will automatically receive a 10 percent reduction from an assignment’s grade for each day that the assignment is late. Please note that this reduction is for each day. This late policy applies to all assignments for this course, including discussion board posts; however, late submissions for In Vivo and current event presentations will not be accepted.
Reading Quizzes (15 points each)
Because this is a 400-level course that uses a Master's-level textbook, and because we will be covering content that many of you are unfamiliar with, it is imperative that you thoroughly prepare for every lesson. In an effort to make sure that you are properly prepared, you will be given quizzes at the beginning of each lesson. The quizzes will be closed textbook. However you may use any written notes that you take while reading and preparing. The quizzes will be timed. You will have 10 minutes to complete each quiz. Please note that the supplemental reading assigned for each lesson will also be covered on quizzes.
Discussion Boards (20 Points Per week)
There will be two discussion boards each lesson in which all students will need to participate. Each discussion board will be worth 10 points for a total of 20 points per week. One discussion board will focus on the required readings while the other discussion board will allow all students to contribute to the conversation for that week's In Vivo and current event presentations. Students should provide thoughtful and substantial responses that prove critical and deep thinking in order to receive full credit. The Required Readings discussion board will not be available for students to post until they have completed the weekly preparation quiz.
Current Events (50 Points)
Each week, three students will be selected to share a current event from the healthcare industry. This current event may be in the form of a periodical handout, television news clip, video, etc. Each student will present current event information only once during the semester. During the lesson in which the student will present the collected information, they should post their findings on the "Current Events and In Vivo Presentations" discussion board on Mondays. Presenters will also be responsible for moderating the discussion involving their topic on all days the discussion board is open. During the remaining lessons of the semester when other students are assigned to present, all other class members are to engage in discussing the current events presented via the "Current Events and In Vivo Presentations" discussion board. Students will be allowed to volunteer to present—but there must be three students presenting current event information every lesson (excluding exam weeks).
In Vivo Assignment and Presentation (125 points)
Each student will work with a partner to complete a unique healthcare industry In Vivo (aka “hands on” and practical) experience. Each In Vivo fact pattern will contain case-specific guidelines for inclusion. Moreover, all papers and presentations must discuss the following: successes, difficulties, advice for others going through a similar process, and relevant health insurance terms and concepts. A portion of your grade (25 out of 125 points) will be based on your partner’s assessment of your contribution to the assignment. Your paper, presentation, and facilitation of the discussion board will be graded out of remaining 100 points.
Every student will complete this assignment once during the semester. These experiences are designed to cover a diverse range of healthcare facilities, governmental programs, and insurance/payment methods. Individually, you will write a summary (no less than two full pages) of the experience. Critical writing skills are mandatory. Working in partnerships, students will need to create a presentation (not to exceed 15 minutes) to the class regarding their experience. Partnerships will present their collected research via the "Current Events and In Vivo Presentations" discussion board on Mondays. Partnerships will also be responsible for moderating the discussion involving their topic, for all days the discussion board is open. During the remaining lessons of the semester when other students are assigned to present, all other class members are to engage in discussing the In Vivo presentations via the "Current Events and In Vivo Presentations" discussion board.
Exam #1 (100 points)
Students will complete the exam in I-Learn, but will also be required to upload all exam responses through Turnitin.com for an originality check to verify that their responses are their own work and words.
Exam #2 (100 points)
Students will complete the exam in I-Learn, but will also be required to upload all exam responses through Turnitin.com for an originality check to verify that their responses are their own work and words.
Comprehensive Final Exam (200 points)
Students will complete the exam in I-Learn, but will also be required to upload all exam responses through Turnitin.com for an originality check to verify that their responses are their own work and words.
Course Schedule
*For a detailed list of when assignments are due, please check the course Calendar.*
Lesson 01
- Course Introduction and Assignments for In Vivo and Current Events presentations
Lesson 02
- Chapter 1—History of Health Insurance in the United States
- Chapter 2—A Summary of Insurance Coverage
- Supplemental: Chosen by the instructor
Lesson 03
- Chapter 3—The Patient Protection and Affordable Care Act (ACA)
- Chapter 4—The Demand for Insurance
- Supplemental: Chosen by the instructor
- Current Events Presentations
- In Vivo Presentations: Medicaid and State Insurance Exchange
Lesson 04
- Chapter 5—Adverse Selection
- Chapter 6—Underwriting and Rate Making
- Supplemental: Chosen by the instructor
- Current Events Presentations
- In Vivo Presentations: Cost Based On Level Of Care and Home Health Care
Lesson 05
- Exam #1; Lessons 2-4
Lesson 06
- Chapter 7—Risk Adjustment
- Chapter 8—Moral Hazard
- Supplemental: Chosen by the instructor
- Current Events Presentations
- In Vivo Presentations: Urgent Care and Mental Health
Lesson 07
- Chapter 9—Utilization Management
- Chapter 10—Selective Contracting
- Supplemental: Chosen by the instructor
- Current Events Presentations
- In Vivo Presentations: Bundled Services and Workers' Compensation
Lesson 08
- Chapter 11—Managed Care Backlash, Provider Consolidation, and Monopsony Power
- Chapter 12 (Only pages 221-226)--Most Favored Nation Clauses
- Supplemental: Chosen by the instructor
- Current Events Presentations
- In Vivo Presentations: Patient Protection and Affordable Care Act (ACA)
Lesson 09
- Exam #2; Lessons 6-8
Lesson 10
- Chapter 17—Health Savings Accounts and Consumer Driven Health Plans (CDHPs)
- Chapter 18—The Small Group Market
- Supplemental: Chosen by the instructor
- Current Events Presentations
- In Vivo Presentations: Surgical Services and Free Medication
Lesson 11
- Chapter 25—Medicaid: Crowd Out and Long-Term Care Insurance
- Supplemental: Chosen by the instructor
- Current Events Presentations
- In Vivo Presentations: Children's Health Insurance Plan (CHIP) and Long-Term Care
- Video Guest Speaker: Roger Christensen
Lesson 12
- Chapter 23—An Overview of Medicare
- Supplemental: Chosen by the instructor
- Current Events Presentations
- In Vivo Presentations: Medicare
- Video Guest Speaker: Matt Hansen
Lesson 13/14
- Review and Comprehensive Final Exam