HPAM - NYU Wagner Graduate School of Public Service



HPAM-GP/EXEC-GP 1830.001 Introduction to Health Policy and ManagementFall 2019Instructor InformationProf. Jacob Victory Email: jov200@nyu.eduOffice Hours: By appointment and immediately after each classCourse InformationClass Meeting Times: Wednesdays, 6:45pm - 8:25pmClass Location: 194 Mercer Street, Room 203Course DescriptionThis core specialization course in the NYU Wagner MPA: Health Policy and Management program explores major topics in the study of health and health care delivery. We will discuss determinants of health, the social distribution of health and disease, and health disparities; the organization and financing of the U.S. health care system, its historical context, the roles and behaviors of its key actors, and its comparison to health systems of other nations; the quality, cost and accessibility of health care services; and health care delivery system improvement and reform. We will examine these themes using a multidisciplinary approach that employs sociological, political, economic and ethical perspectives on health and disease, the health care system, and the challenges of meeting the varied (and often conflicting) needs and motivations of health care system stakeholders. The objective of this course is to build understanding of fundamental ideas, issues and problems in health policy and management and thereby to provide a strong foundation for future studies and careers in the health care field.Course and Learning ObjectivesAssignments and participation in class and case study discussion in this course will be used to assess progress against the competencies listed below. No student will receive a B or higher without demonstrating satisfactory progress toward mastery of each competency. The level of competency expected to be achieved is denoted in brackets according to the following key and the following mechanism of how the competency will be assessed.[1] = Basic: Foundational understanding of knowledge/skill/competency.[2] = Intermediate: Student demonstrates greater depth of understanding of this knowledge/skill/competency and can use this ability to analyze a problem.[3] = Advanced: Student demonstrates expertise in this knowledge/skill/competency and can use this ability to evaluate, judge, and synthesize information.At the conclusion of this course, students will be prepared to:Describe the organization, financing and performance of the U.S. health care delivery systemIdentify determinants of health and explain the impact on the distribution of health and diseaseDefine the roles of key stakeholders – providers, government and private payers, employers, regulators, patients – and describe their incentives and behaviorCompare the U.S. health care system to the organization and financing models abroadExplain fundamental concepts of health care payment and performance measurementDefine key health policy developments over the past 50 years and explain their significanceAnalyze strengths, weaknesses and feasibility of policy and management approaches that aim to promote health, prevent disease and improve health services delivery and assess the impact of these approaches on quality, access, cost and equity goalsLearning Assessment TableProgram CompetencyCorresponding AssignmentsLevel of Competency Expected to Be Achieved via the AssignmentThe ability to assess population and community health needs from a public service perspectiveCase Study Discussion, Class Participation2The ability to examine social and behavioral determinants of health and understand how health systems can address the needs of vulnerable populationsCase Study Discussion, Class Participation2The ability to understand how policy and delivery processes work, and to consider the demographic, cultural, political and regulatory factors involved in and influencing health policy and management decision-makingIndividual Memo, Team Memo, Class Participation2The ability to understand and apply legal and ethical principles to managerial and leadership decisions affecting health care organizationsCase Study Discussion, Class Participation2The ability to measure, monitor and improve safety, quality, access and system/care delivery processes in health care organizationsClass Participation, Case Study Discussion, Team Memo1The ability to draw implications and conclusions to develop an evolving vision that results in long-term organizational viabilityIndividual Memo, Team Memo, Case Study Discussion3The ability to communicate and interact productively (via listening, speaking and writing) on matters of healthcare with a diverse and changing industry, work force and citizenryCase Study Discussion, Class Participation3The ability to present convincingly to individuals and groups the evidence to support a point of view, position or recommendationCase Study Discussion, Class Participation3Class ReadingsStudents should arrive to class prepared to participate in the discussion of these themes based on their critical analysis of assigned readings. TextbookKovner, A. and Knickman, J., ed. (2015) Health Care Delivery in the United States (11th Edition). New York: Springer Press. Other Required ReadingsAssigned weekly readings that are not included in the required textbook will be posted on NYU Classes.Written RequirementsIn addition to attending and participating in classes, students are required to complete one memo (due October 23, 2019, and written by the individual student) and a final research memo and presentation (due on December 11, 2019, and written and presented by student groups of at least four in each group). Instructions for written assignments are included at the end of this syllabus and also be discussed in class. Grading information is provided at the end of this syllabus.Course SessionsA. Population HealthWeek 1 (9/4): Introduction: Health, Disease, and CommunityTopicsOverview of course Definitions of health and disease Relationship between health and medical care Required readings From Health Care Delivery in the United StatesKnickman, J. and Kovner, T. Chapter 1: The Challenge of Health Care Delivery and Health Policy pp. 3-12.Dangremond, C. Chapter 2: A Visual Overview of Health Care Delivery in the United States pp. 13-27.Posted on NYU ClassesSchroeder, S. 2007. We Can Do Better: Improving the Health of the American People. New England Journal of Medicine 357: 1221-1228. Colgrove, J. 2002. The McKeown Thesis: A Historical Controversy and Its Enduring Influence. American Journal of Public Health 92(5): 725-729. Gawande, A. 2011. Cowboys and Pit Crews: 2011 Commencement Address at Harvard Medical School. The New Yorker, posted May 26.Week 2 (9/11): Epidemiologic Measures and Determinants of HealthTopicsRelationships between socioeconomic status, race/ethnicity, gender and health Population health inequalities and social justice implications Required readings From Health Care Delivery in the United StatesRusso, P. Chapter 5: Population Health, pp. 79-94.Posted on NYU ClassesAdler, N. and Rehkopf, D. 2008. U.S. Disparities in Health: Descriptions, Causes and Mechanisms. Annual Review of Public Health 29: 235-252. Marmot, M. 2005. Social Determinants of Health Inequalities. The Lancet 365: 1099-1104. Williams, D. and Jackson, P. 2005. Social Sources of Racial Disparities in Health. Health Affairs 24(2): 325-334.Week 3 (9/18): Public Health Policy and ManagementTopicsPublic health infrastructure Prevention and health promotion frameworks Health behavior Policy approaches to improving public health Required readings From Health Care Delivery in the United StatesLeviton, L., Kuehnert, P.L., and Wehr, K., C. Chapter 6: Public Health: A Transformation for the 21st Century, pp. 99-112. Cassidy, E., Trujillo, M., and Orleans, C. T., Chapter 7: Health and Behavior, pp, 119-142.Posted on NYU ClassesRoberts, M. and Reich, M. 2002. Ethical Analysis in Public Health. The Lancet 359(9311): 1055-1059. Robert Wood Johnson Foundation Commission to Build a Healthier America 2009. Beyond Health Care: New Directions to a Healthier America. Executive Summary and Introduction, pp. 9-25.B. Organization of the U.S. Health Care SystemWeek 4 (9/25): U.S. Health Policy and ReformTopicsHistorical development of health care delivery system Government role in health care system Comparative health systems Models of delivery and payment in other developed nations Required readings From Health Care Delivery in the United StatesSparer, M., and Thompson, F.J., Chapter 3: Government and Health Insurance: The Policy Process pp. 29-49Posted on NYU ClassesBlendon, R. and Benson, J. 2001. Americans’ Views on Health Policy: A Fifty-Year Historical Perspective. Health Affairs 20(2): 33-46. Starr, P. 2011. Remedy and Reaction: The Peculiar American Struggle Over Health Care Reform. New Haven, CT: Yale University Press. Introduction. Rothman, David, J. 1993. A Century of Failure: Health Care Reform in America. Duke University. Journal of Health Politics & Law 18(2): 271-286.Week 5 (10/2): Health Care FinancingTopicsFundamental characteristics of health care markets Medicare, Medicaid/CHIP and private insurance Spending growth in the U.S. Managed care and cost containment Implications of 2010 Patient Protection and Affordable Care Act (PPACA) Required readings From Health Care Delivery in the United StatesKnickman, J. Chapter 11: Health Care Financing, pp. 231-249. Calabrese, T., and Safian K., Chapter 12: Health Care Costs and Value, pp. 253-269. Appendix: Major Provisions of the Patient Protection and Affordable Care Act of 2010, pp. 343-361Knickman, J.R., and Kovner, A. R., Chapter 16: The Future of Health Care Delivery and Health Policy, pp. 334-341.Posted on NYU ClassesBodenheimer, T. 2005. High and Rising Health Care Costs, Part 1: Seeking an Explanation. Annals of Internal Medicine 142(10): 847-854. Cutler, D. 2010. Analysis and Commentary: How Health Care Reform Must Bend the Cost Curve. Health Affairs 29(6): 1131-1135.Week 6 (10/9): Comparative Health SystemsTopicsComparative health systemsModels of delivery and payment in other developed nationsRequired readings From Health Care Delivery in the United StatesGusmano, M., and Rodwin, V., Chapter 4: Comparative Health Systems, pp. 53-71.Posted on NYU ClassesMurray, C. and Frenk, J. 2000. A Framework for Assessing the Performance of Health Systems. Bulletin of the World Health Organizations 78(6): 717-731.Davis, K., Schoen, C. and Stremekis, K. 2010. Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally. 2010 Update. Commonwealth Fund, Pub. No. 1400.Weisz, D., Gusmano, M., Rodwin, V., and Neuberg, L. 2008. Population Health and the Health System: A Comparative Analysis of Avoidable Mortality in Three Nations and Their World Cities. European Journal of Public Health 18(2): 16-172.Please Watch Film:Sick Around the World at 7 (10/16): Providers and Organization of CareTopicsAcute and ambulatory care delivery Evolving organizational formsRequired readings From Health Care Delivery in the United StatesLandry, A. Y., Cathleen O.E., Chapter 9: Organization of Medical Care, pp. 183-209Posted on NYU ClassesBodenheimer, T. 2007. Coordinating Care—A Perilous Journey through the Health Care System. The New England Journal of Medicine 358(10): 1064-1071. Rittenhouse, D. 2009. Primary Care and Accountable Care: Two Essential Elements of Delivery System Reform. New England Journal of Medicine 361(24): 2301-2303.Week 8 (10/23): Medical Professionals and the Health Care WorkforceMEMO #1 DUE TODAYA paper copy of the completed Memo #1 is due before the start of Week 8’s class session. This memo must also be emailed to the instructor before the start of the last class icsHistorical and emerging roles for physicians and health professionals Health care labor markets Professionalization and power in organized medicineRequired readings From Health Care Delivery in the United StatesSpetz, J., and Chapman S. A., Chapter 10: Health Workforce, pp. 213-224Posted on NYU ClassesGoodman, C. and Fisher, E. 2008. Physician Workforce Crisis? Wrong Diagnosis, Wrong Prescription. New England Journal of Medicine 358(16): 1658-1661.Peterson, M. 2001. From Trust to Political Power: Interest Groups, Public Choice, and Health Care. Journal of Health Politics, Policy and Law 26(5): 1145-1163. Weisz, G. et al. 2007. The Emergence of Clinical Guidelines. The Milbank Quarterly 85(4): 691-727.Week 9 (10/30): Patient Decision-Making and the Provider-Patient RelationshipTopicsRole of the patient in the health care system Patient preferences and informed patient decision-making Provider?patient relationship Consumer-directed care and patient demand for and use of informationRequired readings Posted on NYU ClassesHibbard, J. and Cunningham, P. 2008. How Engaged Are Consumers in Their Health and Health Care, and Why Does It Matter? Center for Studying Health System Change, Research Brief No. 8 (October). Mechanic, D. 1998. The Functions and Limitations of Trust in the Provision of Medical Care. Journal of Health Politics, Policy and Law 23(4): 661-686. Sepucha, K. and Mulley, A. 2009. A Perspective on the Patient’s Role in Treatment Decisions. Medical Care Research and Review 66(1 suppl): 53S-74S. Arnold, S. and Scanlon, D. 2009. Realizing True Consumer-Directed Health Care: What the Policy Community Needs. Medicare Care Research and Review 66 (1 suppl): 3S-8S.C. Health Care System Performance, Challenges, and DebatesWeek 10 (11/6): Meeting Changing Population NeedsTopicsChronic disease management Long-term care End-of-life issuesRequired readings Posted on NYU ClassesBodenheimer, T., Wagner, E., Grumbach, K. 2002. Improving Primary Care for Patients with Chronic Illness: The Chronic Care Model, Part 2. Journal of the American Medical Association 288: 1909-1914. Gawande, A. 2010. Letting Go: What Should Medicine Do When It Can’t Save Your Life? The New Yorker August 2 issue. Kane, R. and Kane, R. 2001. What Older People Want from Long-Term Care, and How They Can Get It. Health Affairs 20(6): 114-127. Kaye, H., Harrington, C. and LaPlante, M. Long-Term Care: Who Gets It, Who Provides It, Who Pays, and How Much? Health Affairs 29(1): 11-21.Week 11 (11/13): Improving Quality of CareTopicsSafety and quality of U.S. health care delivery Measuring, regulating and improving quality and patient safety Challenges of quality improvement and adverse event reduction in health care Quality improvement frameworks and interventionsRequired readings From Health Care Delivery in the United StatesClancy, C. and Fraser I., Chapter 13: High Quality Health Care, pp. 273-293Posted on NYU ClassesLandrigan, C. et al. 2010. Temporal Trends in Rates of Patient Harm Resulting from Medical Care. New England Journal of Medicine 363: 2124-2134.Week 12 (11/20): Managing New Medical TechnologyTopicsExpanding use of pharmaceutical and medical devices in health care Treatment benefits versus monetary costs associated with medical innovation Role of pharmaceutical/biotech industry in health care systemRequired readings From Health Care Delivery in the United StatesKropf, R. Chapter 15: Health Information Technology, pp. 311-326Posted on NYU ClassesCutler, D. and McClellan, M. 2001. Is Technological Change in Medicine Worth It? Health Affairs 20(5): 11-29. Gilsdorf, J. 2004. As Drug Marketing Pays Off, My Mother Pays Up. Health Affairs 23(1): 208-212. Steinman, M., Landefeld, S. and Baron, R. 2012. Industry Support of CME – Are We At a Tipping Point? New England Journal of Medicine 366(12): 1069-1071.11/27: NO CLASS DUE TO THANKSGIVING RECESSWeek 13 (12/4): Expanding Access and Reducing Disparities in Access and TreatmentTopicsBarriers to care for vulnerable patient populations The uninsured and underinsured in the U.S. Implications of 2010 Patient Protection and Affordable Care ActRequired readings From Health Care Delivery in the United StatesGarcel, J.M., Ward, E.A., and Rodriguez L.J., Chapter 8: Vulnerable Populations: A Tale of Two Nations, pp. 149-175.Posted on NYU ClassesAyanian, J. et al. 2000. Unmet Health Needs of Uninsured Adults in the United States. Journal of the American Medical Association 284(16): 2061-2069. Hurley, R. et al. 2007. Community Health Centers Tackle Rising Demands and Expectations. Center for Studying Health System Change, Issue Brief No. 116 (December). Fuchs, V. 2009. Health Reform: Getting the Essentials Right. Health Affairs 28(2): w180-w183.Week 14 (12/11): Team Final Paper & Presentation Due TodayTeam final project and presentationsA paper copy, and an electronic version emailed to the instructor, of the completed Memo #2 and presentations are due before the start of Week 14’s class session. Teams will be presenting their paper and topic to the entire class. Each team will have five minutes to present this presentation.Written Requirements and GradingIn addition to attending and participating in class meetings, all students are required to submit the following written assignments by the following deadlines. Final grades will be calculated accordingly:GradingThis class will not be graded on a curve. The grading rubric will be shared prior to each assignment. This course follows the NYU Wagner School’s general policy guidelines on incomplete grades, academic honesty and plagiarism. It is the student’s responsibility to become familiar with these policies. All students of this class are expected to pursue and meet the highest standards of academic excellence and integrity.Incomplete gradesAcademic IntegrityAcademic integrity is a vital component of Wagner and NYU. All students enrolled in this class are required to read and abide by Wagner’s Academic Code. All Wagner students have already read and signed the?Wagner Academic Oath. Plagiarism of any form will not be tolerated and students in this class are expected to?report violations to me.?If any student in this class is unsure about what is expected of you and how to abide by the academic code, you should consult with me.Grading BreakdownMemo 1: Individual (due 10/12): 30%Final Paper (Memo 2): Teams of Four (due 12/11): 40%Presentation of Memo 2: Team (due 12/11): 5%Class Participation: 25%Class Participation (25% of class grade)This course depends on active and ongoing participation by all class participants. Participation starts with reading all course materials and listening to each other and the instructor during class sessions. Class participants are expected to read and discuss the weekly readings on a weekly basis.You will not earn the 25% of your grade for class participation simply by attending classes.While attendance is a large component, to fully earn the 25% for class participation, students must come prepared to engage and speak in the class each week that the class meets as a group. To “engage,” each student must listen to all points of view, share his/her thoughts on at least one subject or discussion raised within each class, critique thoughts (in a respectful, reflective and thoughtful manner), ask questions, and/or promote thoughtful dialogue with class participants. My lectures are frequently very interactive with students in the class and I have the right to call on any member of the class at any time. It is always my goal to know every student’s name.I encourage you to take the class participation requirement very seriously, as I certainly do and want to see that you are fully engaged in the course subject during each class each week. (If, for some reason, you have not read the class readings and feel unprepared to respond to being called on in a class, please let me know. It is understandable that this may be the case on rare occasion. If this, however, becomes a regular or frequent happening, your participation grade/percentage will be severely affected.) As other instructors have noted, please note that the quality and quantity of participation can be, but are not necessarily, correlated.Lateness PolicyPlease submit assignments on time. Both assignments must be emailed to me (jov200@nyu.edu) immediately before the class session on the day they are due. A paper copy must also be presented to the instructor at the start of each class that each assignment is due. Extensions will be granted only in case of emergency. This is to respect those who abide by class deadlines. Papers and presentations submitted late and without extensions will be penalized, as will papers that do not follow explicit directions relayed in class and/or via this syllabus. The instructor will subtract five points for each day the assignment is late. Please note that if a paper copy is not submitted to me at the beginning of the class in which it is due, it is considered a late submission.NYU’s Calendar Policy on Religious HolidaysNYU’s Calendar Policy on Religious Holidays states that members of any religious group may, without penalty, absent themselves from classes when required in compliance with their religious obligations. Please notify me in advance of religious holidays that might coincide with exams to schedule mutually acceptable alternatives.Henry and Lucy Moses Center for Students with Disabilities at NYUAcademic accommodations are available for students with disabilities. Please visit the Moses Center for Students with Disabilities (CSD) website and click on the Reasonable Accommodations and How to Register tab or call or email CSD at (212-998-4980 or mosescsd@nyu.edu) for information. Students who are requesting academic accommodations are strongly advised to reach out to the Moses Center as early as possible in the semester for assistance.Written AssignmentsGeneral Guidelines for MemosPlease see the NYU Writing Center Guide to Writing Memos, posed on the course Sakai site, for memo composition guidelines. Citations are required for each paper. It is acceptable to use a reference page listing the footnotes and sources; in fact, this is preferred. If relevant, appropriate exhibits (not included in page length) are acceptable but not required. All written work should be double-spaced (except where explicitly noted) in 12-point Times New Roman font with 1” margins on each page. The memo and paper must be printed and written on one side of each sheet and not printed on both sides.Memo 1 (Individual)Due October 23, 2019 (Week 8)You are the Chief Operating Officer of a large healthcare system, composed of acute, long term care, and community based organizations in addition to long term care managed care plans. Given your current studies in health policy and management, the Chief Executive Officer of this large healthcare system has requested that you prepare a high-level briefing for the system’s Board of Directors in which you describe: (a) Three significant factors that have contributed to dramatic growth in health care spending over the past 50 years; and (b) How health care payment and delivery models are transforming to promote greater accountability for both cost and quality in the health care system. 1) Please also include an analysis of two of the most promising reimbursement or care delivery models or approaches you have noted in your memo that show potential or have already shown results in constraining cost growth and maintaining or improving quality, as well as: 2) At least four limitations or open questions that accompany each new reimbursement and care delivery model you identify that are intended to promote “accountable care.” The memo must be four pages in length. Please include references to course readings, as well as any relevant outside sources that support your analysis after the fourth page. Citations and a reference page (not included in the page length) are required. Please note that any paper without citations to support the memo’s key points will have 15 points automatically deducted from the total points.Memo 2: Team-based Project(With at least four student partners per team/memo)Due December 11, 2019 (Week 14)12-page research paper and a 5-minute presentation (in PowerPoint format)Instructions: In a five-student team (some team may vary in the number of student partners due to class size), please prepare a 12-page research paper on the topics that follow:Please prepare a 12-page research paper in which you focus on one dimension of performance of the U.S. health care delivery system. You must choose one topic in these three areas: quality, cost or access. You must have this area of performance approved, as a group, by the course instructor before you start any core work on preparing your paper and presentation. The performance area must be clearly stated, in a complete sentence, and must have a quantitative factor, rate, or ranking (or other factors to clearly delineate performance). This complete sentence must be presented to the instructor by email or in person prior to the writing of the full paper. (This is requested to ensure that groups are on the right track and have the full approval of the instructor.) Once approved, the topic must be clearly stated in the beginning of your paper.You must focus on performance in a defined within one of these categories. Some suggested topics may be quality of care for chronically-ill elderly patients, cost-effectiveness of new medical technologies, or access to specialized care for low-income populations. Many other topics in these three areas are also acceptable.In this final paper, please examine:How performance on this dimension is influenced specifically by the 1) organization, 2) financing of health care in the U.S., as well as the 3) behavior of key health system stakeholders; What must be improved or reformed to achieve performance gains in your selected area, specifically by noting at least one policy and one delivery system reform for your performance area; andAt least three implications and/or open questions per each reform you note of your analysis for performance area.In your analysis, please consider all stakeholders relevant to your specified focus—providers, payers and purchasers, patients, communities, policy-makers, and other groups that play a role in performance in your focal area—and be sure to examine at least three implications and/or open questions for reform at both the policy and delivery system levels that you clearly describe in your paper.Please include references to course readings as well as any relevant outside sources that support your analysis. Citations and a references page (not included in page length) are required. In addition to your paper, please prepare a five-minute presentation (roughly 5-7 slides in PowerPoint or a similar format) that clearly communicates key points of your research report as succinctly as possible. For example, a general template might include a title slide, a slide that summarizes current performance or trends in your selected performance area and significance of the topic, a slide that describes key health care system factors that you identified to contribute to the problem, and a slide that highlights your analysis of required changes or reforms necessary to achieve performance improvement. Your papers and presentations are due December 11, 2019. The slide presentation will be presented during class. It will be responsibility of each team’s identified “lead” to submit the final paper and presentation on behalf of the team. This lead must be identified to the course instructor. Presentations will be given by each group and each student partner must be part of the presentation; these presentations will be conducted on the last class session (December 11, 2019). The order in which the teams present will be drawn at random. Please bring hard copies of your PowerPoint presentations to the last class, printed in “full page” single-sided mode, so that they can be distributed in class. If on the occasion the class runs out of time, or for any reason (e.g., class size, or time limitations, etc.) that likely will not allow every team to present, grading will be based exclusively on the slides and papers that you submit and not on the in-class delivery.Please note that your memo must be 12 pages in length. Any paper without citations to support the memo’s key points will have 15 points automatically deducted from the total points.I welcome you to this class and look forward to our interactions, your thorough and active engagement, your thoughts and our mutual learning. ................
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