Career Development and Lifestyle Planning
Innovation in Health Care Delivery2 CreditsBU.550.620.XX[NOTE: Each section must have a separate syllabus.][Day & Time / ex: Monday, 6pm-9pm][Start & End Date / ex: 3/24/15-5/12/15][Semester / ex: Fall 2016][Location / ex: Washington, DC]InstructorToby Gordon, Sc.D.Contact InformationPhone Number: 410-234-9432E-mail Address: tgordon@jhu.eduOffice Hours[Day(s)/Times]Required Texts & Learning MaterialsTextbookShi, L., & Singh, D. (2013). Essentials of the U.S. Health Care System (3rd ed.). Burlington, MA: Jones & Bartlett Learning.ArticlesAsch, D. A., Terwiesch, C., Mahoney, K. B., & Rosin, R. (2014). Insourcing health care innovation. N Engl J Med, 370(19), 1775-1777. Asch, D. A., & Volpp, K. G. (2012). What business are we in? The emergence of health as the business of health care. N Engl J Med, 367(10), 888-889. 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. Berwick, D. M. (2003). Disseminating innovations in health care. JAMA: Journal of the American Medical Association, 289(15), 1969. Blumenthal, D., & Hsiao, W. (2015). Lessons from the east--China's rapidly evolving health care system. New England Journal of Medicine, 372(14), 1281. 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. Chokshi, D. (2015). How primary care can handle 15 million newly insured patients. The Atlantic. 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. Edwards, J. N., Silow-Carroll, S., & Lashbrook, A. (2011). Achieving efficiency: Lessons from four top-performing hospitals. The Commonealth Fund, (July). 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. Gordon, T. (2013). Quality of care in the United States: The US experience in defining and measuring quality.?. In R. Kray, C. Koch & P. Sawick (Eds.), Qualit?t in der medizin dynamisch denken versorgung-- forschung-- markt (1st ed., pp. 95). Wiesbaden: Springer Gabler. 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. Iglehart, J. K. (2015). The expansion of retail clinics -- corporate titans vs. organized medicine. New England Journal of Medicine, 373(4), 301. Lepore, J. (2014). The disruption machine. The New Yorker.Reddy, K. S. (2015). India's aspirations for universal health coverage. New England Journal of Medicine, 373(1), 1. Schumann, J. (2015). ?The doctor is out: Young talent is turning away from primary care. The Atlantic. 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. Ware, J. E., Brook, R. H., Davies, A. R., & Lohr, K. N. (1981). ?Choosing measures of health status for individuals in general populations. American Journal of Public Health, 71(6), 620. Wieczner, J. (2013). Pros and cons of concierge Medicine. Wall Street Journal.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. Harvard Business School Press (HBSP) MaterialsBohmer & Knoop, 2006, “The Challenge Facing the U.S. Healthcare Delivery System” (606096)Dyer, Gregersen & Christensen, The DNA of Disruptive Innovators: The Five Discovery Skills That Enable Innovative Leaders to "Think Different" (8369BC)Herzlinger, Kindred, & McKinley, 2014, “Philips-Visicu” (313015)Jain, Porter, Akrouh, & Daly, 2010, Ledina Lushko: Navigating Health Care Delivery (710459)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)Course DescriptionThis course provides an overview of the healthcare delivery system in the US 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 healthcare services. The course considers the paradox of the American healthcare delivery system, and how large expenditures on healthcare 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 Carey Business School’s general learning goals and objectives, visit the Teaching & Learning@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 & RubricsAssignmentCourse Learning Objective(s)WeightClass Participation1, 2, 3, 4, 520%Homework Assignments1, 2, 3, 4, 530%Team Assignment1, 2, 3, 4, 510%Examination1, 2, 3, 4, 540%Total100%Class ParticipationThe 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 classesStudents 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.Homework Assignments (5 points each)Assignments will be based on assigned readings and cases to help prepare you for class, encourage critical analysis of the readings and critical thinking about managerial challenges, and assess content knowledge. The assignments will be posted on Blackboard through Turnitin and must be submitted through Turnitin. Assignments are due prior to the start of class. Points will be deducted for late assignments. Team Assignment (10 points)Students will be assigned to teams for a team assignment requiring research, analysis and decision-making based on a real world issue. The assignment should be submitted in a Word document, minimum of 7 pages, not to exceed 10 pages double-spaced, APA style.ExaminationAn examination will be given in class 8. 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.SessionDateTopicReadingsAssignments Due1Healthcare Systems: Getting Behind the NumbersDyer 2011Asch 2012Fuchs, 2013Woolf, 2013*Shi, 2013: Chapters 1, 2Homework 1 2The Cost ConundrumBlumenthal 2015Bohmer & Knoop, 2006, “The Challenge Facing the U.S. Healthcare Delivery System” (606096)Coye 2001Gawande, 2009Reddy 2015*Shi, 2013: Chapter 6,5, 12Homework 23Access to Care, and Quality and the Triple Aim*Shi, 2013: Chapters 4, 7Chokshi, 2015Schumann, 2015Wieczner, 2013Gawande, 2011*Gordon, 2013Consumer Reports, 2013*Ware 1981Berwick, Nolan 2008Homework 34Innovation and Disruption in Health CareGuest Speaker*Lepore, 2014Asch, 2014Berwick 2003*Gawande, A. 2012Hwang and Christensen, 2008Homework 4Team Assignment5Innovation in Provider Strategies: Industry Consolidation; Payer-Provider IntegrationShi, 2013: Chapter 8,9Porter & Teisberg, 2014, “The Cleveland Clinic: Growth Strategy 2014” (709473)Casale, 2007Shah, 2013Homework 56Innovation in Provider Strategies: Services Lines and Centers of ExcellenceShi, 2013: Chapter 10, 14Edwards 2011Porter & Jain, 2013, “The University of Texas MD Anderson Cancer Center: Interdisciplinary Cancer Care” (708487)Ledina Lusko Span 2015Homework 67Innovation in Producer StrategiesHerzlinger, Kindred, & McKinley, 2014, “Philips-Visicu” (313015)Herzlinger 2006 Iglehart (2015)Homework 78ExamCarey 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.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 ServicesJohns Hopkins University and the Carey Business School are committed to making all academic programs, support services, and facilities accessible. To determine eligibility for accommodations, please contact the Disability Services Office at time of admission and allow at least four weeks prior to the beginning of the first class meeting. Students should contact Priscilla Mint in the Disability Services Office by phone at 410-234-9243, by fax at 443-529-1552, or by email. Honor Code/Code of ConductAll students are expected to view the Carey Business School Honor Code/Code of Conduct tutorial and submit their pledge online.?Students who fail to complete and submit the pledge will have a registrar’s hold on their account. Please contact the student services office via email 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.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 InclusionStudent Success CenterInclement 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.Homework Session 1Complete the Discovery and Delivery Skills self-assessment in the Dyer chapter and report your score. Discuss whether the score is consistent with how you would rate your innovation DNA.Dyer 2011Review 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.Session 2What 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?Compare the challenges in McAllen,Texas to those described in the India or China readings (pick one) with respect to improving cost, access or quality(pick one).Reddy 2015, Blumenthal 2015Session 3Discuss the causes of primary care shortage in the US and offer potential solutions. Contrast the US approach to primary care to any other country. Cite references Shi, 2013: Chapters 4,7, Consumer Reports, 2013, Chokshi, 2015, Schumann, 2015Is concierge medicine an innovation with respect to the primary care shortage? Why or why not?Wieczner, 2013Identify 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 Nolan 2008Why do you think the US does not have a single payer system? List at least 5 reasons why not.Session 4Team assignment: For the assigned country, provide a background description of the country’s health system and its healthcare delivery challenges. Identify and describe innovations in healthcare delivery that can be exported from the US to the selected country and/or imported to the US from the selected country. Asch, 2014, Berwick, 2003, *Gawande, A. 2012Hwang and Christensen, 2008Session 5Porter & 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?List the key success factors for hospitals to improve value from the Edwards 2011 reading Casale, 2007, ShahList 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?Session 6Ledina LuskoPorter & Jain, 2013, “The University of Texas MD Anderson Cancer Center: Interdisciplinary CancerDiscuss Ledina Lusko’s course of treatment. Does it typify aspects of US care, or could this course of treatment happened anywhere. In retrospect, what could she or her family have done differently?Why 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? Session 7Herzlinger, Kindred, & McKinley, 2014, “Philips-Visicu” (313015)Herzlinger 2006 Apply the Herzlinger model of the 6 Forces to the VISICU case.What effect did the forces have on VISICU ?What kind of innovation in the Herzlinger framework is the “hospital-to- home”—technology, integrator, or consumer-facing?Evaluate the business model options and recommend actions. Should Philips offer services or only technology?RUBRICS1. Class Participation Self-assessment RubricCircle the value that best captures your in-class participation, and provide evidence in the comments section. High-quality comments have one or more of the following properties:Offer a different and unique, but relevant, perspective based upon analysis and theoryHelp move the discussion and analysis forwardBuild upon the comments of classmatesTranscend the “I feel” syndrome: that is, include some evidence or logicLink relevant concepts to current events or personal work experiences012345Did not participateEngaged listener 1+ comments per class2+ comments2+ high quality commentsJustificationInstructor comment2. Homework Grading will be based on points earned per question (as assigned by the instructor), scored based on content and depth of response. 3. Team assignment (Scale-5-Strongly agree, 4-Agree, 3-Neither agree or disagree, 2-Disagree, 1-Strongly disagree)Quality of Presentation (50%)The presentation was well-organized; time was appropriately allocated to cover the material.The presentation effectively engaged the audience.The verbal communications were clear. Speakers were articulate, and explained concepts well.The slides were visually clear and conveyed the information clearly, with tables and charts used to summarize information. The slides were graphically pleasing.All members of the team actively participated.The team appeared professional and interacted in a professional manner with the client.Proper attribution was given to sources and participants.Quality of Presentation Material (Content) (50%)The content included all required components in a thorough yet concise mannerStrong evidence of primary and secondary market research, Outstanding analysis and synthesis of dataConclusions and recommendations were well-supported by the research and analysisDetailed appendices were included to support the presentation materials4. Examination will be scored based on assigned points per question. ................
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