U.S. Health Care System: On-site Syllabus



The U.S. Health Care System: Past, Present, and Future2 CreditsBU.550.620.XX[NOTE: Each section must have a separate syllabus.][Day & Time / ex: Monday, 6pm-9pm][Start & End Dates / ex: 8/20/18–10/15/18][Semester / ex: Fall 2018][Location / ex: Washington, DC]Instructor[Full Name]Contact Information[Email Address][Phone Number, ###- ###-#### (Optional)]Office Hours[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, 2014, “The Cleveland Clinic: Growth Strategy 2014” (709473)ArticlesBerry, 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. Health Affairs, 27(3), 759–769.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. 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., & Skinner, J. S. (2009). Fostering accountable health care: Moving forward in Medicare. Health Affairs, 28, w219–w231.Frean, M., Gruber, J., & Sommers, B. D. (2016). Disentangling the ACA’s coverage effects—Lessons for policymakers.?New England Journal of Medicine,?375, 1605–1608.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. McClellan, M., Kent, J., Beales, S. J., Cohen, S. I., Macdonnell, M., Darzi, A. (2014). Accountable care around the world: A framework to guide reform strategies. Health Affairs (Project Hope), 33, 1507.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. Woolf, S.H., & Aron, L.Y. (2013). The US health disadvantage relative to other high-income countries: Findings from a National Research Council/Institute of Medicine Report. JAMA, 309(8), 771–772. Course DescriptionThis course provides an overview of the health care delivery system in the United States, and explores the drivers of change over time that shape the organization and delivery of healthcare services and opportunities for innovation and improvements in the cost, quality, and access dimensions of health care services. The course considers the paradox of the U.S. 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 ObjectivesAt the conclusion of the course, students will understand the following:How the United States healthcare system performs in comparison with other countries.The historic and current drivers of change in the organization and delivery of healthcare in the US, and the strategic implications.The key stakeholders in the organization and delivery of healthcare in the US, their relationship to each other.The role of innovation in meeting stakeholder objectives, and applications of innovative business models in the organization and delivery of healthcare.Strategies to achieve value in the delivery of healthcare services and current strategies in the provider, payer and producer sectors.To view the complete list of the 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. Excessive absence will result in loss of points for team participation. Regular attendance and active participation are required for students to successfully complete the course.Assignments & RubricsAssignmentLearning ObjectivesWeightClass Participation1, 2, 3, 4, 521%Quizzes1, 2, 3, 4, 520%Team Assignment1, 2, 3, 4, 525%Peer Evaluation1, 2, 3, 4, 5 4%Examination1, 2, 3, 4, 530%Total100%Class Participation 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. 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.There will be small group breakout assignments in most classes, so active participation is assumed. Students will earn three points for being present and engaged; two points for partial participation, one point for no participation, and no points if class is missed. The lowest class score will be dropped. Quizzes There will be six quizzes consisting of questions drawn from the study questions provided in the syllabus for each week of class. Quizzes will be graded based on assigned points per question. Each quiz is worth four points. The lowest score will be dropped.Team ProjectStudents will work in teams on an assignment requiring research, analysis and decision-making based on a real world healthcare delivery innovation.The $10 million challengeTeams will be randomly assigned. Each team has $10 million to invest in a company or start-up with an innovative idea or approach to an issue facing the US healthcare system, for example cost, access, quality, equity, or quality. Investment could be in the form of stock purchase in an existing company, an angel investment, private equity investment, etc. Teams will make 10 minute presentations in class, followed by ten minutes of questions and answers.Required contentIdentify the specific issue or problem to be addressed, e.g. prevent hospital readmissions for congestive heart failureProvide background and context for the issue or problem Develop at last five criteria for the selection of an investment target, e.g company has a working prototype in place, under study in a pilot, strong management teamUsing these criteria, identify three to five potential investment targets by company name, and provide a summary chart of which criteria each target reachesSelect one investment target, and justify the selection.Explain the company’s business model, and how you think your investment will help the company develop, implement and disseminate its innovationProvide a three to five-year forecast of relevant milestones the company must achieve, e.g. production development, improvement, and other related topicsIdentify potential barriers to success, e.g. problems related to bringing the product to market, competitor actions, regulatory considerationsGrading Rubric Each student in the group receives the same grade as the rest of the group.CriteriaNot Good Enough0 ≤ score ≤ 69Adequate70 ≤ score ≤ 79Good80 ≤ score ≤ 89Excellent90 score ≤100WeightedScoreThe problem/issue was clearly stated. 5%The research methods were appropriate to the issue/problem. 5%There was strong evidence of thorough and comprehensive research. 10%There was outstanding analysis and synthesis of data.20%The conclusions and recommendations were practical, thorough, and likely to be feasible, and were well supported by the research and analysis.25%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. Proper attribution was given to sources and participants.10%Total Score (Maximum: 100 points, to be scaled to Examination The final exam will consist of about 30 multiple choice and short answer questions drawn from course readings, slides and team projects.GradingThe grade of A is reserved for those who demonstrate extraordinarily excellent performance as determined by the instructor. The grade of A- is awarded only for excellent performance. The grades of B+, B, and B- are awarded for good performance. The grades of C+, C, and C- are awarded for adequate but substandard performance.?The grades of D+, D, and D- are not awarded at the graduate level (undergraduate only). The grade of F indicates the student’s failure to satisfactorily complete the course work.?Please note that for?Core?and?Foundation?courses, a?maximum of 25% of students may be awarded an A or A-; the grade point average of the class should not exceed 3.3. For?Elective?courses, a maximum of 35% of students may be awarded an A or A-; the grade point average of the class should not exceed 3.4. (For classes with 15 students or fewer, the class GPA cap is waived.)Tentative Course CalendarThe 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.SessionDateTopicReadings and Study Questions1Healthcare Systems: Getting Behind the NumbersThis module is the on-ramp to the course, focusing on why and how the U.S. health care system is different from other nations (in terms of structure, measures, and quantitative results) and why it matters. Quiz 1Fuchs, 2013Woolf, 2013OECD spreadsheet posted on BlackboardShi, 2013: Chapters 1, 2Review the OECD spreadsheet posted on Blackboard and the assigned readings which will provide background and help you prepare a more in-depth response.Asch 2012, Fuchs, 2013, Woolf, 2013, Shi 2013 ch. 1,2What is your definition of health? What should be the primary objectives of a healthcare system?Select four OECD metrics that you would use to pick the country with the best healthcare system (see OECD spreadsheet). Provide a rationale for your selections.Identify the OECD country that best matches your criteria Describe three other measures, either from the OECD list or elsewhere, to assess the performance of a healthcare system.2The Cost ConundrumThis module looks at who the stakeholders are in the U.S. health care system, and how and why their wants and needs vary. This module also explores the incentives and disincentives to lower costs and improve quality of care in the United States, and it illustrates the fragmentation and lack of centralized oversight of the system. Particular attention is paid to regional variation.Quiz 2Gawande, 2009Bohmer & Knoop, 2006, “The Challenge Facing the U.S. Healthcare Delivery System” (HBS 606096)Shi, 2013: Chapter 5, 12What best explains the high level of expenditures in McAllen Texas? Who are the stakeholders and what are their interests in McAllen Texas?Gawande, 2009What circumstances led to or contributed to the situation in McAllen Texas? Is what happened in McAllen unique to the US? Why or why not? Bohmer & Knoop 2006, Coye 2001, Shi ch 5What innovations are evidenced in the Gawande reading? How could the business goals of entrepreneurs in McAllen be reconciled with what is best for the community overall?3Access to Care; Quality and the Triple AimThis module looks at how the U.S. health system works (and doesn’t work) in terms of patient access to providers of care, and the rules for coverage eligibility and access to care by payor.Quiz 3Gawande, 2011Consumer Reports, 2013Berwick 2008*Shi, 2013: Chapters 4,11Identify attributes of the US healthcare delivery system that may have contributed to the significant medical or health conditions of patients described in the Gawande article, The Hotspotters. Gawande, 2011What innovations as discussed in the Hot Spotters might improve the value of healthcare services? How do they relate to achievement of the Triple Aim?Berwick, 2008Payment for Healthcare in the USAffordable Care Act BriefingThis module explores why the United States does not have a single payor health care system or universal coverage despite attempts to provide it at key moments in U.S. history. It then looks at the goals and mandates of the Affordable Care Act of 2010. Shi, Ch. 3, 6Why do you think the US does not have a single payer system? List at least 5 reasons why not.Frean, 20164Innovation and Disruption in Health CareIn this module and the next two,, the focus shifts to opportunities for innovation in health care delivery in areas such as organization of care, payment models, payor–provider integration and medical technology. We introduce Christenson’s framework for Disruptive Innovation.Herzlinger, 2006Hwang and Christensen, 2008Berwick, 2003Berry, 2010Innovation in Provider Strategies: Services Lines and Centers of ExcellenceQuiz 4Porter & Jain, 2013, “The University of Texas MD Anderson Cancer Center: Interdisciplinary Cancer Care” (HBS 708487)Gawande, 2012Why is multidisciplinary care important in cancer? How is value created for patients? What is the structure of the head and neck center? What activities, specialists, and facilities are included in the center? What activities are shared across multiple centers? Why? How does integration of care actually take place? What are the supporting mechanisms? What factors have allowed the head and neck center (and other MCCs) to be successful at MD Anderson? In light of trends towards vertical integration in healthcare, how can MD Anderson forward or reverse integrate to shore up its position?5Innovation in Provider Strategies: Industry ConsolidationQuiz 5Porter & Teisberg, 2014, “The Cleveland Clinic: Growth Strategy 2014” (HBS 709473)Shah, 2013Shi, 2013: Chapter 8,9Porter & Teisberg, 2014,Cleveland ClinicWhat 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?6Innovation through Payer-Provider Integration ; Accountable CareQuiz 6Shi, 2013: Chapter 10, 14Casale, 2007Span, 2015Fisher, 2009McClellan, 2014Casale, 2007, ShahList the key success factors for hospitals to improve value from the Edwards 2011 reading List 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 US?7Project Presentations8ExamCarey Business School Policies 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.Disability Support ServicesAll students with disabilities who require accommodations for this course should contact Disability Support Services at their earliest convenience to discuss their specific needs. If you have a documented disability, you must be registered with Disability Support Services (carey.disability@jhu.edu or 410-234-9243) to receive accommodations. For more information, please visit the Disability Support Services webpage.Academic Ethics PolicyCarey expects graduates to be innovative business leaders and exemplary global citizens. The Carey community believes that honesty, integrity, and community responsibility are qualities inherent in an exemplary citizen. The objective of the Academic Ethics Policy (AEP) is to create an environment of trust and respect among all members of the Carey academic community and hold Carey students accountable to the highest standards of academic integrity and excellence.It is the responsibility of every Carey student, faculty member, and staff member to familiarize themselves with the AEP and its procedures. Failure to become acquainted with this information will not excuse any student, faculty, or staff from the responsibility to abide by the AEP. Please contact the Student Services office if you have any questions. For the full policy, please visit the Academic Ethics Policy webpage.Student Conduct CodeThe fundamental purpose of the Johns Hopkins University’s regulation of student conduct is to promote and to protect the health, safety, welfare, property, and rights of all members of the University community as well as to promote the orderly operation of the University and to safeguard its property and facilities. As members of the University community, students accept certain responsibilities which support the educational mission and create an environment in which all students are afforded the same opportunity to succeed academically. Please contact the Student Services office if you have any questions. For the full policy, please visit the Student Conduct Code webpage.Student Success CenterThe Student Success Center offers free online and in-person one-on-one and group coaching in writing, presenting, and quantitative courses. For more information on these services and others, or to book an appointment, please visit the Student Success Center website.Other Important Policies and ServicesStudents are encouraged to consult the Student Handbook and Academic Catalog and Student Services and Resources for information regarding other policies and services.Copyright 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 Academic Ethics Policy. ................
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