Career Development and Lifestyle Planning



Innovation in Health Care Delivery2 CreditsBU.550.520.XX [NOTE: Each section must have a separate syllabus.][Day & Time / ex: Monday, 6pm-9pm][Start & End Dates / ex: 3/24/15-5/12/15][Semester / ex: Fall 2016][Location / ex: Washington, DC]Instructor[Full Name]Contact Information[Email Address][Phone Number, (###) ###-#### (Optional)]Office Hours[Please specify the day and time of the 2 hours that will be dedicated to office hours each week. For evening classes, faculty may wish to hold their office hours by phone or email. While faculty are permitted to state “and by appointment,” office hours should not be held exclusively by appointment.]Required Texts & Learning MaterialsTextbookShi, L., & Singh, D. (2016). Essentials of the U.S. Health Care System (4th ed.). Burlington, MA: Jones & Bartlett Learning.Harvard Business School Press (HBSP) Materials Bohmer & Knoop, 2006, “The Challenge Facing the U.S. Healthcare Delivery System” (606096)Porter & Jain, 2013, “The University of Texas MD Anderson Cancer Center: Interdisciplinary Cancer Care” (708487)Porter & Teisberg, 2016, “Cleveland Clinic: Transformation and Growth 2015” (709473)ArticlesBakaeen, F. G., Blaustein, A., & Kibbe, M. R. (2014). Health care at the VA: Recommendations for change. Jama, 312(5), 481.Berry LL, Mate KS. Essentials for improving service quality in cancer care. Healthcare (2016)Berry, L. L., & Mirabito, A. M. (2010). Innovative healthcare delivery. Business Horizons, 53(2), 157.Berwick, D. M. (2003). Disseminating innovations in health care. JAMA: Journal of the American Medical Association, 289(15), 1969. Berwick, D., Nolan, T., & Whittington, J. (2008). The triple aim: Care, health, and cost, 27, no.3 (2008):759-769. Health Affairs, 27(3), 759. Casale, A. S., Paulus, R. A., Selna, M. J., Doll, M. C., Bothe, A., Jr, McKinley, K. E., et al. (2007). "ProvenCareSM": A provider-driven pay-for-performance program for acute episodic cardiac surgical care. Annals of Surgery, 246(4), 613. Coye, M. J. (2001). No Toyotas in health care: Why medical care has not evolved to meet patients’ needs. Health Affairs, 20(6), 44. A doctor's office that's all about you. (2013). Consumer Reports, 78(7), 20. Fisher, E. S., McClellan, M. B., Bertko, J., Lieberman, S. M., Lee, J. J., Lewis, J. L., et al. (2009). Fostering accountable health care:Moving forward in medicare. Health Affairs, 28(2), w219. Fuchs, V. (2013). How and why US health care differs from that in other OECD countries. JAMA: Journal of the American Medical Association, 309(1), 33. Gawande, A. (2009). The cost conundrum. New Yorker, 85(16), 36. Gawande, A. (2011). The hot spotters. New Yorker, 86(45), 40. Gawande, A. (2012). Big med. New Yorker, 88(24), 52. Herzlinger, R. E. (2006). Why innovation in health care is so hard. Harvard Business Review, 84(5), 58. Hwang, J., & Christensen, C. (2008). Innovation in health care delivery: A framework for business-model innovation. Health Affairs, 27(5), 1329. Jacobson, J. O., Rotenstein, L. S., & Berry, L. L. (2016). New diagnosis bundle: Improving care delivery for patients with newly diagnosed cancer. Journal of Oncology Practice / American Society of Clinical Oncology, 12(5), 404-406.Kizer, K. W., & Jha, A. K. (2014). Restoring trust in VA health care. The New England Journal of Medicine, 371(4), 295.Lepore, J. (2014). The disruption machine. The New Yorker.McClellan, M., Kent, J., Beales, S. J., Cohen, S. I., Macdonnell, M., Thoumi, A., et al. (2014). Accountable care around the world: A framework to guide reform strategies. Health Affairs (Project Hope), 33(9), 1507. Powers, B. W., & Chaguturu, S. K. (2016). ACOs and high-cost patients. The New England Journal of Medicine, 374(3), 203. Powers, B. W., & Chaguturu, S. K. (2016). ACOs and high-cost patients. The New England Journal of Medicine, 374(3), 203.Shah, N. R., & Chokshi, D. A. (2013). Should health care systems become insurers? JAMA: Journal of the American Medical Association, 310(15), 1561. Span, P. (2015, April 14). They're all just trying to help. The New York Times, pp. 3. Wennberg, J., & Gittelsohn. (1973). Small area variations in health care delivery. Science (New York, N.Y.), 182(4117), 1102.Woolf S.H., Aron L.Y. The US Health Disadvantage Relative to Other High-Income Countries: Findings From a National Research Council/Institute of Medicine Report. JAMA. 2013; 309(8):771-772. Course DescriptionThis course provides an overview of the health care delivery system in the United States as compared to other models internationally, and explores the drivers of change that are creating opportunities for innovation and improvements in the cost, quality, and access dimensions of health care services. The course considers the paradox of the American health care delivery system, and how large expenditures on health care have not resulted in best outcomes due in part to issues of cost, access, and quality.Prerequisite(s)NoneLearning ObjectivesBy the end of this course, students will be able to: Analyze how the United States health care system performs in comparison with other countries.Evaluate the historic and current drivers of change in the organization and delivery of health care in the Unites States, and the strategic implications.Evaluate the roles and relationships of key stakeholders in the organization and delivery of health care in the United States.Create strategies to achieve value in the delivery of health care services and current strategies in the provider, payer, and producer sectors.To view the complete list of Carey Business School’s general learning goals and objectives, visit the Carey website.Attendance Attendance and class participation are part of each student’s course grade. Students are expected to attend all scheduled class sessions. Each class will include opportunities for teams to work together. Failure to attend class will result in an inability to achieve the objectives of the course. Regular attendance and active participation are required for students to successfully complete the course.Assignments AssignmentCourse Learning Objective(s)WeightClass Participation1, 2, 3, 428%Homework1, 2, 314%Team Project415%Peer Evaluation43%Examination1, 2, 3, 440%Total100%Students may earn up to 100 points total. Grades will be assigned according to class rank by points, with no more than the top 25% of students earning a grade of A or A-.Class Participation (28%)Students may earn up to 4 points per class for each week except for the final exam week.The success of the course depends on the active engagement of all participants. Students are expected to have read the articles and cases before attending class and to take a proactive stance with respect to class contributions. Each week students will participate in interactive learning exercises based on application of concepts from the assigned readings. Review questions are included in the course calendar to guide preparation. Students should prepare responses to these questions prior to class so as to fully participate in the small group activities. While the instructor may sometimes use cold calling, students should not expect this to be sufficient for opportunities to make substantive contributions. Discussions are to be directed to the class rather than the instructor. Students are expected to be actively engaged in discussions about the assigned readings and cases, and make comments or contributions that raise the level of discourse. Students will complete a self-evaluation after each class and document their contributions that support the evaluation. The instructor will review the assessment, provide feedback to the student and revise the grade if necessary.Grading Rubric01*2*34This score is rareAbsent or did not participateEngaged listener for most of the class Participated in group activities and class discussion Was fully prepared for and engaged in discussion and activities. Was an engaged listener when other groups were presentingProvided outstanding leadership and participation in class exercises. Made insightful comments that advanced the discourse.*Students who appear engaged in non-class related activities on laptops and mobile devices will be dropped a level of participation Homework (14%)Each assignment is worth 2 points.Homework questions are listed in the course schedule in the syllabus. They are drawn from the study questions that are also in the schedule. Homework must be submitted via Turnitin prior to the start of class. Students should direct any issues with submission via Turnitin to carey.blackboard@jhu.edu. Grading Rubric2 - Demonstrates outstanding understanding of the material as evidenced by response to questions posed; provides thorough and complete answers that reference the assigned materials. 1 - Demonstrates limited understanding of the material as evidenced by response to questions posed.0 - Did not submit by the deadline, the start of class, and/or did not submit via Turnitin.Team Project (15%)Teams may earn up to 15 points for the assignment.Students will work in teams on an assignment requiring research, analysis, and decision-making based on a real-world health care delivery system issue. Teams will make 15-minute presentations of their projects. Grading Rubric - PresentationScale: 3-Strongly agree, 2-Agree, 1-Neither agree or disagree, 0-DisagreeScoring will be based on a weighted total (% weight times scale score, scaled to 15 points) The problem/issue was clearly stated. (5%)The research methods were appropriate to the issue/problem. (5%)There was strong evidence of primary market research. (5%)There was strong evidence of thorough and comprehensive secondary research. (5%)There was outstanding analysis and synthesis of data. (10%)The conclusions and recommendations were well-supported by the research and analysis. (10%)The conclusions and recommendations were practical, thorough, and likely to be feasible. (10%)Detailed appendices were included to support the presentation materials. (10%)The presentation was well-organized; time was appropriately allocated to cover the material. (5%)The presentation effectively engaged the audience. (5%)The verbal communications were clear. Speakers were articulate, and explained concepts well. (5%)The slides were visually clear and conveyed the information clearly, with tables and charts used to summarize information. The slides were graphically pleasing. (10%)All members of the team actively participated. (5%)The team appeared professional and interacted in a professional manner with the client. (5%)Proper attribution was given to sources and participants. (5%)Peer Evaluation (3%)Team members may earn up to 3 points based on peer evaluation.Each team member will evaluate the other team members on level of participation and contributions. Criteria to consider include team meeting attendance, timely response to communications, completion of agreed-upon work on schedule, and contribution to the quality of the final product.Scores for peers must average 10. Team members may not receive the same score.Cut and paste this table and submit it by email to the instructor.Team MemberPointsTeam member 1Team member 2Team member 3Etc.TotalAverage10Individual points will be assigned based on each person’s average as follows:12 or higher = 3 points9 to 11 = 2 pointsBelow 9 = 1 point= 0 pointsExamination (40%)The final exam will be consist of short answer questions drawn from the study questions and material covered in class.GradingThe grade of A is reserved for those who demonstrate extraordinarily excellent performance. The grade of A- is awarded only for excellent performance. The grade for good performance in this course is a B+/B. The grades of D+, D, and D- are not awarded at the graduate level. Please refer to the Carey Business School’s Student Handbook for grade appeal information. Tentative Course Calendar**The instructors reserve the right to alter course content and/or adjust the pace to accommodate class progress. Students are responsible for keeping up with all adjustments to the course calendar.WeekTopicReadingStudy Questions for In-class ExercisesDue1Health Care Systems: Getting Behind the NumbersOECD materials (on BBD)Fuchs, 2013Woolf, 2013Shi, 2016: Ch. 1: Major Characteristics of U.S. Health Care Delivery Ch. 2: Foundations of U.S. Health Care Delivery OECD materialsShi, Ch. 1Review the WHO definition of health. What is your definition of health? Review the WHO definition of a health care system (look at the website) and the Shi definition in Ch 1. How should the performance of health care system be measured? Develop five explicit measuresUsing the OECD materials on BBD, select the five OECD metrics that most closely match the criteria that you would use to pick the country with the best health care system (see OECD spreadsheet). Identify the country that best matches your criteria. Sources to consider include the OECD data and World Bank.What are the three basic models of national health systems?Shi, Ch. 2What are Social Determinants of Health? FuchsWhat are the three reasons why United States expenditures on health differ from other OECD countries?WoolfWhat factors explain why the United States has a health disadvantage compared to other wealthy nations?Homework 1List five measures of health system performance.List five criteria for selection of the country with the best health care system.Identify the country that best matches your criteria.2The Cost ConundrumMust read:Gawande, 2009Bohmer & Knoop, 2006Shi, 2016: Ch. 12: Cost, Access, and Quality Recommended:Wennberg, 1973Coye, 2001What best explains the high level of expenditures in McAllen, Texas? Who are the stakeholders and what are their interests in McAllen, Texas?What circumstances led to or contributed to the situation in McAllen, Texas? Is what happened in McAllen unique to the US? Why or why not? What are the five challenges described by Bohmer?What are the three primary responses to the challenge of U.S. health care proposed by Bohmer?Homework 2Go to the Dartmouth Atlas of Healthcare websiteReview the page description in the “Data by Region” tab.Go to Tools, and then select “Benchmarking.” Create and run a report of your own choosing based on a topic you are interested in. Download the report in Excel and submit it via Turnitin. Be prepared to discuss the report in class.3Access to CarePayment for Health Care in the U.S.; Affordable Care Act BriefingMust read:Berry, 2010Berwick, 2008Consumer Reports, 2013Gawande, 2011Ch. 3: Historical Overview of U.S. Health Care DeliveryCh. 6: Financing and Reimbursement MethodsRecommended:Ch. 4: Health Care Providers and Professionals Kizer, 2014Bakaeen, 2014Identify attributes of the U.S. health care delivery system that may have contributed to the significant medical or health conditions of patients described in the Gawande article, The Hotspotters. What innovations as discussed in the Hot Spotters might improve the value of health care services? What is the Triple Aim?Why do you think the United States does not have a single payer system? Who are the primary payers for health care services in the United States?What changes are occurring in the United States with respect to primary care?Homework 3Discuss whether or not the United States can achieve the Triple Aim without a single payer system? What are the barriers and how can they be removed?Do not exceed one page double-spaced. Use APA formatting rules.4Innovation and Disruption in Health CareInnovation in Provider Strategies: Services Lines and Centers of ExcellenceMust read:Berry, 2016Berwick, 2003Herzlinger, 2006Hwang and Christensen, 2008Porter & Jain, 2013, “The University of Texas MD Anderson Cancer Center: Interdisciplinary Cancer Care” (708487)Reference:Jacobson, 2016Lepore, 2014Berry, 2016Gawande, 2012Why is multidisciplinary care important in cancer? How is value created for patients? How does integration of care actually take place at MD Anderson? What are the supporting mechanisms? What factors have allowed the head and neck center (and other MCCs) to be successful at MD Anderson? What business model is MD Anderson employing, per the Hwang article?What are the elements required for a successful disruptive integration?What are the barriers to innovation in health care according to Herzlinger?Homework 4Discuss and compare the recommendations in the Berry article to the MD Anderson Cancer Center model.Do not exceed one page double-spaced. Use APA formatting rules.5Innovation in Provider Strategies: Industry ConsolidationMust read:Fisher, 2009Porter & Teisberg, 2014, “The Cleveland Clinic: Growth Strategy 2015” (709473)Shah, 2013Span, 2015Ch. 9: Managed Care and Integrated SystemsWhat is the Cleveland Clinic’s overall strategy for improving value for patients? Identify the critical components and their rationale.Where has the Clinic made the most progress? What are the areas for improvement? Identify the Clinic’s various approaches to growing its practice. Which growth initiatives should the Clinic expand and why?Homework 5Compare the Cleveland Clinic approach to achieving value to the Triple Aim as proposed by Berwick et al.Do not exceed one page double-spaced. Use APA formatting rules.6Innovation through Payer–Provider Integration: Accountable CareMust read:Casale, 2007McClellan, 2014Powers, 2016Ch. 14: The Future of Health Services DeliveryList and describe four factors that contributed to Geisinger’s success with ProvenCareSM.List and describe the three advantages and three disadvantages for a provider (hospital and/or physician group) becoming an insurer.What are the pros and cons of offering warranties for health care services for a provider in the United States?Homework 6What are the likely market effects and risks for a provider organization such as a hospital system in becoming insurers?7Project PresentationsSubmit the team PPT prior to class8ExaminationSelf-Assessment of ParticipationName:01*2*34WeekAbsent or did not participateEngaged listener for most of the class Participated in group activities and class discussion Was fully prepared for and engaged in discussion and activities. Was an engaged listener when other groups were presentingProvided outstanding leadership and participation in class exercises. Made insightful comments that advanced the discourse. This score is rare.1234567Carey Business SchoolPolicies and General InformationBlackboard SiteA Blackboard course site is set up for this course. Each student is expected to check the site throughout the semester as Blackboard will be the primary venue for outside classroom communications between the instructors and the students. Students can access the course site at . Support for Blackboard is available at 1-866-669-6138.Course EvaluationAs a research and learning community, the Carey Business School is committed to continuous improvement. The faculty strongly encourages students to provide complete and honest feedback for this course. Please take this activity seriously; we depend on your feedback to help us improve. Information on how to complete the evaluation will be provided toward the end of the course.Disability ServicesAll students with disabilities who require accommodations for this course should contact Disability Services (carey.disability@jhu.edu or 410-234-9243) at their earliest convenience to discuss their specific needs. If you have a documented disability, you must be registered with Disability Services to receive accommodations.?Please note that accommodations are not retroactive.?Therefore it is strongly encouraged that you identify your needs to Disability Services as early as possible.Honor Code/Code of ConductThe Carey community believes that honesty, integrity, and community responsibility are qualities inherent in an exemplary citizen. The objective of the Carey Business School Honor Code is to create an environment of trust among all members of the academic community while the qualities associated with success are developed in students. All students are expected to view the Carey Business School Honor Code/Code of Conduct tutorial and submit their pledge online.?Please contact the student services office at carey.students@jhu.edu if you have any questions.Students are not allowed to use any electronic devices during in-class tests. Calculators will be provided if the instructor requires them for test taking. Students must seek permission from the instructor to leave the classroom during an in-class test. Test scripts must not be removed from the classroom during the test.Student Success CenterThe Student Success Center offers free online and in-person one-on-one and group coaching in writing, presenting, and quantitative courses. The center also offers a variety of workshops and exam study sessions, and provides a list of self-guided resources. Most of the tutors are current Carey students. For more information or to book an appointment, please visit the Student Success Center website. Other Important Academic Policies and ServicesStudents are strongly encouraged to consult the Carey Business School’s Student Handbook and Academic Catalog and Student Resources for information regarding the following items:Statement of Diversity and InclusionInclement Weather PolicyCopyright StatementUnless explicitly allowed by the instructor, course materials, class discussions, and examinations are created for and expected to be used by class participants only.?The recording and rebroadcasting of such material, by any means, is forbidden. Violations are subject to sanctions under the Honor Code. ................
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