Required Textbook

Morrissey, Michael A., Health Insurance, Health Administration Press Second Edition.

The course materials are available in the Course Materials List.

Students can compare prices for their textbooks through the University Store Price Comparison site. This will show them all of the options from the University Store plus several online options to help them find the best price available.

Introduction to the Course

Note: This course code has changed from HS 465 to HCA 395. You may occasionally see references to the old course code or title.

Outcomes

Know: In this course students will identify third-party reimbursement and payment methodologies, including, but not limited to, differentiating between Medicare and Medicaid, traditional insurance, and managed care. Students 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.

Students will not study the day-to-day operations of insurers. Rather, their perspective will be that of one looking in from the outside and discovering the role that health insurance plays in the United States.

Become: The vast majority of students will not go on to be researchers, actuaries, or even insurance executives. Rather, students will buy insurance for their families and worry about coverage for their employees. This course will prepare students to make the best coverage decisions.

Most students will work for health services providers or in organizations that provide healthcare, and their concern will be how that organization is paid by private and public insurers. This course will aid them in identifying and selecting the appropriate payer mix for their organization.

Do: As citizens, policymakers, and those in a position to influence policymakers, students will want to recognize how innovations in insurance delivery, in government policy, and in healthcare reform will affect them and their organization. This course will help students gain an intuitive knowledge of the industry, which will allow them to make better-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 the following:

• Healthcare Literacy
  • Students will learn the insurance structure, functions 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 will 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. 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.  Quizzes and Exams will also not be accepted late.  

Reading Quizzes (15 Points Each)

Due to this being a 400-level course that uses a master's-level textbook, a lot of content will be covered that many students are unfamiliar with, it is imperative that students thoroughly prepare for every week. In an effort to make sure that students are properly prepared, they will be given quizzes at the beginning of each week. The quizzes will be closed textbook. However, students may use any written notes that they take while reading and preparing. The quizzes will be timed. Students will have 10 minutes to complete each quiz. Please note that the supplemental reading assigned for each week will also be covered on quizzes.

Discussion Boards (20 Points Per Week)

There will be two discussion boards each week in which all students will need to participate. Each discussion board will be worth 10 points for a combined 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 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 week in which the student will present the collected information, they should post their findings on the In Vivo and Current Event 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 weeks 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 In Vivo and Current Event Presentations discussion board. Students will be allowed to volunteer to present—but there must be three students presenting current event information every week (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 each students' grade (25 out of 125 points) will be based on their partner’s assessment of their contribution to the assignment. Each students' paper, presentation, and facilitation of the discussion board will be graded out of the 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, students 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 In Vivo and Current Event 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 weeks 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 In Vivo and Current Event 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.

Week 01

• Course Introduction and assignments for In Vivo and Current Event Presentations

Week 02

• Chapter 1: History of Health Insurance in the United States
• Chapter 2: A Summary of Insurance Coverage
• Supplemental: Chosen by the instructor

Week 03

• Chapter 3: The Patient Protection and Affordable Care Act (ACA)
• Chapter 4: The Demand for Health Insurance
• Supplemental: chosen by the instructor
• Current Events Presentations
• In Vivo Presentations: Medicaid and state insurance exchange

Week 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 healthcare

Week 05

• Exam #1: covering weeks 2–4

Week 06

• Chapter 7: Risk Adjustment
• Chapter 8: Moral Hazard and Prices
• Supplemental: chosen by the instructor
• Current Events Presentations
• In Vivo Presentations: Urgent care and mental health

Week 07

• Chapter 9: Utilization Management (UM)
• Chapter 10: Selective Contracting
• Supplemental: chosen by the instructor
• Current Events Presentations
• In Vivo Presentations: Bundled services and workers' compensation

Week 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 (PPACA)

Week 09

• Exam #2: covering weeks 6–8

Week 10

• Chapter 17: Health Savings Accounts and Consumer-Directed Health Plans (CDHP)
• Chapter 18: The Small-Group Market
• Supplemental: chosen by the instructor
• Current Events Presentations
• In Vivo Presentations: Surgical services and free medication

Week 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

Week 12

• Chapter 23: An Overview of Medicare
• Supplemental: chosen by the instructor
• Current Events Presentations
• In Vivo Presentations: Medicare
• Video Guest Speaker: Matt Hansen

Week 13/14

• Review and Comprehensive Final Exam

Additional Information

Honor Code

Following the Honor Code is of great importance as you strive to be a disciple of Christ. Academic honesty and integrity is expected of all BYU-I students. To copy another's work from the Internet, a book, or from any other source and claiming it to be your own work, is plagiarism. Read the official definitions of plagiarism and cheating from the Academic Honesty portion of the Honor Code. Each case of plagiarism or cheating will be dealt with by the instructor. When working on a group project, you have the responsibility to assure that others in the group do not plagiarize. Any academic dishonesty issue will be referred to the BYU-I Dean of Students, if necessary. Even though you are taking this course online, BYU-Idaho's Dress and Grooming standards still apply. By adhering to the Honor Code you will create a learning environment, "consistent with the ideals and principles of The Church of Jesus Christ of Latter-day Saints." (Honor Code webpage)

Tutoring

Tutoring options for online students are available through the Academic Support Centers. There are tutors available to help you with your writing questions and there might be course-specific tutoring available. Check the Academic Support Centers for more details.

University Policies

Students with Disabilities

Brigham Young University-Idaho is committed to providing a working and learning atmosphere that accommodates qualified persons with disabilities. If you have a disability and require accommodations, please contact the Disability Services Office at (208) 496-9210 or visit their website and follow the Steps for Receiving Accommodations. Reasonable academic accommodations are reviewed for all students who have qualified documented disabilities. Services are coordinated with students and instructors by the Disability Services Office.

This course may require synchronous meetings. If you are currently registered with the Disability Services Office and need an interpreter or transcriber for these meetings, please contact the deaf and hard of hearing coordinator at (208) 496-9219.

Other University Policies

Student Honor and Other Policies

Please read through the document called University Policies. It gives important information about the following topics:

• Student Honor
  • Academic Honesty
  • Student Conduct
    • Sexual Harassment
• Student with Disabilities
• Complaints and Grievances
• Copyright Notice

Go to the Student Resources module to review further resources and information.

Disclaimer

This syllabus and the course schedule may be changed at any time prior to or during the semester as the need arises based upon circumstances. Any changes will be available to view on the course documents.