PUAD 5058



PPD 600

MANAGEMENT OF MANAGED CARE ORGANIZATIONS

Summer 2010

INSTRUCTOR: BILL GIL, CEO

Facey Medical Foundation

11165 Sepulveda Blvd.

Mission Hills, CA 91345

Phone: (818) 837-5707 Fax: (818) 365-6964

Email: bgil@

Office Hours by Appointment

Classes:

Friday, May 21, 2010 (1 p.m. to 9 p.m.)

Saturday, May 22, 2010 (9 a.m. to 5 p.m.)

Friday, June 18, 2010 (1 p.m. to 9 p.m.)

Saturday, June 19, 2010 (9 a.m. to 5 p.m.)

Total Units: Two (2)

COURSE DESCRIPTION

This course provides students an understanding of the different aspects of managed care. It places an emphasis on its practical applications in the field of ambulatory care. This course will examine the organizational structure and interactions of physician organizations, hospitals, and health plans. Lectures and case studies will be presented examining operational issues as they relate to the challenge of balancing the managed care equation.

PPD 600 will review the transition of the industry from a fee-for-service cottage industry, to the complex managed care arena of today. Managed care’s challenge to control cost places a larger burden on physician organizations and their relationships with payers and hospitals. This course will provide future managers an understanding of the economic forces in play, and what role management plays in resolving this challenge.

READING ASSIGNMENTS

Kongstvedt, Peter R. Essentials of Managed Health Care, Fifth Edition, Jones and Bartlett Publishers, 2007. Note: the entire text must be read by the first class session.

Handouts will be distributed at the first session, to be read by the fifth session. This includes a Glossary of Terms, Acronyms, and articles.

COURSE REQUIREMENTS, EVALUATION, AND GRADING

CLASS PARTICIPATION (20%)---Students must attend class and be prepared. They must participate in discussion, questioning and all other class activities.

EXAMINATION (40%)---There will be an exam on Saturday morning, June 19, 2010. It will cover information from the text and handouts, plus material covered in class. A calculator may be used.

EITHER A GROUP PROJECT OR FINAL PAPER (40%)--Groups of two or three students will be formed during the first weekend of class to complete a group project. Alternatively, a student can opt to prepare an individual paper. In both cases, the student(s) will select a health care organization to study, focusing on one specific aspect directly relating to managed health care. The project or paper should include an assessment of the strategies, related operational issues and relative success of the chosen managed health care organization. A key aspect should delineate the impact of managed heath care on the studied organization.

The group project should entail some data collection. To the extent possible, data from public sources should be incorporated into the analyses presented in the project. The projects will be presented during the second weekend of the course (June 18-19).

The paper will consist of an executive summary, five pages of analysis, support documentation, references, notes and exhibits. The paper will be due on the final day of the course, June 19 at 9 am. .

The instructor’s assessment of the group project or individual paper will be based on the level of detail of the identification and examination of the organization’s strategies and operations, and the comprehensiveness of the analysis of the selected organization. Again, the key point must be the relationship and impact managed health care has on the organization.

COURSE OBJECTIVES

Understand the economics of managed care and the pressure placed on the different organizations. This includes the financial impact of prepaid and capitated contracts.

Identify the different models of health maintenance organizations, physician organizations, and other health care delivery systems.

Understand the importance of governance, leadership and corporate ethics in managed care. This will relate to the management of and by physicians.

Analyze essential aspects of managed care contracts and also Information Systems’ role.

Assess the current and future economic environment of managed care for all organizational types, health plans, physician organizations, and hospitals. Understand strategic imperatives required of these organizations.

Understand the competitive forces in the market place and identify core characteristics of successful health care organizations.

This course will provide students the opportunity to better understand this arena to allow the student to decide the strategic value of pursuing a career in this managed care field. Class speakers from the managed care industry will present in class and provide a balance between the academics and practical sides of managed care.

COURSE OUTLINE

Friday, May 18, 2010

This day will provide an overview of the course, text and subject matter. We will deal with a macroeconomic view of the managed care field. We will examine physician organizations in a more microeconomic level. We will look at the strategic imperatives facing today’s capitated, delegated model. Groups will be formed to begin planning the group projects.

Issues covered will include:

The evolving world of managed care

Economics of managed care and capitation

Physician organizations and their structural differences

Types of physician organizations and their variances

Governance and leadership

Empowerment of an organization

Societal effect of a physician organization and managed care contracting

The interest of the individual vs. the interest of the organization

Physician compensation and behavior

Management of physician organizations and the differences between lay management and physician leadership

Saturday, May 19, 2010

We will address the “nuts and bolts” of capitation, including how the HMO dollar is split. We will also look at the Hospital environment and its role in managed care.

This Session will examine the marketplace from the HMO point of view, as we evaluate the current hospital, physician organization, and health plan environment, and their respective tolerance for delegating and assuming financial risk.

Topics covered will include:

Health Maintenance Organizations (HMOs)

The HMO arena---products, benefits, and market consolidation

Past, present, and future of managed care

Cost control---accountable healthcare vs. patient rights

Medicare Risk---is there a future?

Contract negotiations: preparation, negotiation, and implementation

Friday, June 18, 2010

Improvement in patient satisfaction, turning an organization from Physician-centric to Patient-centric. We will examine how the industry has put greater emphasis on quality and patient satisfaction measures.

“Life in the trenches”. A look at organizational issues in a managed care group. This will include all aspects of medical group operations.

We will review Hospital strategy pertinent to managed care. Critical to this issue is the Hospitals’ decision whether to accept risk via capitation, or remain on a per-diem relationship with the health plans.

Hospitals’ role in managed care: past, present, and future

Managed care statistics and their role in rate setting and contract negotiations

The specialist’s role and the independent practitioner’s role in managed care

Other issues include:

Corporate compliance for physician organizations

Labor issues in managed care

Financial issues in the managed care arena

Fee-for-service billing, a full review

Strategic development of organized delivery systems

Operational issues in physician organizations

Saturday, June 19, 2010

This day will begin with the examination. The exam will cover all materials presented through June 1st and the text and handouts. It will account for 40% of the final grade.

The remainder of this day will focus on the Group Project Presentations. Groups will present to the class, followed by discussion of these Projects. Groups should bring handouts to distribute to the audience. Groups are also asked to post their presentations on the course Blackboard once class is over.

Group Project Presentations will be completed, including discussion. There will be a review of the course and an evaluation of the professor.

FINAL PAPERS (for those who select this option) will be collected at the start of class. Electronic copies of the papers should also be submitted to the course Blackboard. Instructions for submitting the paper will be posted on the Assignment page of the Blackboard.

Professor: Bill Gil, President and CEO, Facey Medical Foundation

Bill Gil is the President and Chief Executive Officer of Facey Medical Foundation, a large, not-for-profit healthcare foundation. Facey has been a healthcare provider for more than 80 years, with over 125 physicians, providing care for more than 180,000 patients. Nearly 85% of Facey’s business comes from capitated, delegated managed care contracts.

Mr. Gil is an experienced healthcare executive with 20 years experience as an executive in the healthcare field. He has specialized in the managed care arena, mostly as a senior executive with physician organizations. Mr. Gil has also served as CEO of a heath plan.

Mr. Gil holds an MBA from Pepperdine University. He has been a featured speaker at numerous healthcare programs across the nation, and served as guest lecturer at several universities.

Academic Integrity

Violations of academic integrity standards will be treated seriously. The following is from section 10.0 of the USC publication SCampus:

Examples of academic dishonesty include the following:

• Cheating on an exam

• Plagiarism

• Submitting a paper written by or obtained from others including prior students in a course

• Using a paper or essay in more than one class without the instructor’s express permission

• Changing academic records outside of normal procedures and/or petitions

• Using another person to complete homework assignments or take-home examinations without the knowledge and consent of the instructor

• Resubmitting returned and corrected academic work under the pretense of grader evaluation error when, in fact, the work has been altered from its original form

Please note that the University has made an online software tool for detecting plagiarism available to faculty. The software, “Turnitin,” detects unoriginal or copied material based on comparison to internet sources, journals, other student papers, and other documents stored in Turnitin’s worldwide database.

Section 11.00 in SCampus outlines behavior violating university standards and appropriate sanctions.

Please review these policies and ensure that you understand them.

Academic Accommodations Based on a Disability

Any student requesting academic accommodations based on a disability must register with Disability Services and Program (DSP) each semester. A letter of verification for approved accommodations can be obtained from DSP, located in STU301, open 8:30 AM to 5:00 PM Monday – Friday, phone number (213) 740-0776. The letter must be given to the instructor as early in the semester as possible.

-----------------------

Because the functions of a university depend on honesty and integrity among members, the university expects from its students a higher standard of conduct than the minimum required to avoid disciplinary action.



................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download