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HM 510

 

Health Care Delivery Systems

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Course Information

This course focuses on the major components of the Healthcare Delivery System, past and present. You will review interesting concepts from the origination of health insurance to the organization of HMO's and beyond. Multiple healthcare delivery models will be discussed including the continued and expanding growth of outpatient care and services. This course will expose any prospective or sitting manager to the many contemporary issues they need to be conversant with to be successful in their jobs.  A key focus in this course is on addressing the increasing pressure to improve the efficiency of the nation's health care system and to provide an adequate level of health care for all Americans. The course content reflects the revolutionary changes in the practice of clinical medicine, government policy, information technology, and health care cost containment. In-depth information in the areas of health care finance, health care access, managed care, and insurance and home health is also examined. Research and statistics throughout the course textbook make this course a premier reference for understanding all the services that compose the health care landscape.

Students will examine primary issues of delivery systems structures, health policy, insurance and reimbursements systems, disease management models, physician and provider reimbursement systems, ethical issues in health care, the uninsured, cost containment, quality and cost savings, clinical outcomes, as well as long-term care settings and continuums. This course provides health care managers with a comprehensive knowledge base in health care delivery systems regarding factors effecting care with in and from without of their organizations. Course Code: HM 510. Contact hours of Education = 35

Level of Complexity: Intermediate

This course is particularly designed for those who would like to become Certified as a Certified Health Care Manager by the American Institute of Health Care Professionals, Inc., however it is also offered to all health care and management professionals who may be interested in taking it.

Pre-requisite to enrolling in the continuing education program:

  1. Requisite for all Applicants for Certification: applicants/candidates for certification must meet one of the following prerequisites to enter the program: is a licensed health care professional with a current and active license to practice, which includes the following: 1.) a registered nurse currently licensed to practice nursing, 2). a licensed social worker, 3). a health care licensed professional, 4). a health care provider with a minimum of a bachelors degree, 5). a licensed counselor or psychologist, 6). holds a bachelor's degree or higher in psychology, human services, or other health related field, 7.) a health care/nurse manager/leader/charge nurse, supervisor/nurse executive, 8). a licensed allied health care professional, 9). a corporate trainer in health care, 10).  a professional health care case manager or 11). a health care manager/supervisor or consultant, 12). a licensed physician.
  2. or is currently employed in a health care setting with a minimum of five (5) years of work experience and is in a position that includes management/supervisory duties; or is in a position in which a supervisor verifies that the current position is one in which the candidate has the potential to be assigned management responsibilities or be promoted to a position of management/supervision in the future.
  3. or have been approved to enter the health care manager certification program offered by AIHCP.

Course Refund & AIHCP Policies: access here

Instructor/Course Author:  Mark C. Barabas, BS, DHA, FACHE

Link to Resume

E-mail: mcbarabas@aol.com

Instructor: Your instructor for this course is Mark C. Barabas, BS, DHA, FACHE, a Fellow in the American College of Health Care Executives. Mark has extensive experience as a Health Care Executive, including Chief Executive Officer positions and has taught health care management courses at the college level. In addition to doing consulting work, he currently conducts Acute Care, Rehab and Critical Access hospital  accreditation surveys and inspections for the Healthcare Facilities Accreditation Program (HFAP). You may access his resume above.

BOARD APPROVALS: AIHCP is an approved provider of continuing education by the Florida Board of Nursing and the District of Columbia Board of Nursing. CE Provider # 50-11975. Access information

The American Institute of Health Care Professionals (The Provider) is approved by the California Board of Registered Nurses, Provider number # CEP 15595 for 35 Contact Hours.

Course Refund & AIHCP Policies: access here

TIME FRAME: You are allotted two years from the date of enrollment, to complete this course. There are no set time-frames, other than the two year allotted time. If you do not complete the course within the two-year time-frame, you will be removed from the course and an "incomplete" will be recorded for you in our records. Also, if you would like to complete the course after this two-year expiration time, you would need to register and pay the course tuition fee again.

TEXTBOOK: There is one required Textbook for this course.

Introduction to Health Services, 7th Edition., Cengage Learning, 2007. ISBN-10: 1418012890    ISBN-13: 978-1418012892

This book may be purchased online via Amazon.com: access here

Please Note: this book is available on Amazon for rent, also in Kindle version, and there are used copies available for purchase.

You may also purchase this book at other bookstores where it is available.

You are required to order your own copy of the textbook. Please be sure to order your books as soon as possible so that you can begin your course of study.

Videos

Additional Assignments: there are Online Videos that are required for viewing for this course as well. Once enrolled into the course, students are provided with full information regarding Video Viewing and assignments. Videos are NOT required to be purchased

GRADING: You must achieve a passing score of at least 70% to complete this course and receive the 35 hours of awarded continuing education credit. There are no letter grades assigned. You will receive notice of your total % score. Those who score below the minimum of 70% will be contacted by the American Institute of Health Care Professionals and options for completing additional course work to achieve a passing score, will be presented.

COURSE EVALUATION: upon submitting your responses to the examination questions, you are required to complete the online course evaluation. Course evaluations are accessed from the online classroom. A course evaluation must be completed in order to receive the CE course certificate

Enrollment: There is open enrollment. You may register and begin this course at any time. Registration: access here

Online Classroom Resources and Tools

* Examination Access: there is link to take you right to the online examination program where you can print out your examination and work with it. All examinations are formatted as "open book" tests. When you are ready, you can access the exam program at anytime and click in your responses to the questions. Full information is provided in the online classrooms.

* Student Resource Center: there is a link for access to a web page "Student Resource Center." The Resource Center provides for easy access to all of our policies/procedures and additional information regarding applying for certification. We also have many links to many outside reference sites, such as online libraries that you may freely access.

* Online Evaluation: there is a link in the classroom where you may access the course evaluation. All students completing a course, must, without exception, complete the course evaluation.

* Faculty Access Information: you will have access to your instructor's online resume/biography, as well as your instructor's specific contact information.

* Additional Learning Materials: All course handouts are available in the online Video classrooms. All E-Learning Books are available in the classrooms for students to download.

STUDENT RESOURCE CENTER: Please access our student resource center. The Resource Center contains all of our current policies, as well as important information regarding classroom and examination accesses. Also included are trouble-shooting tips when a student has any difficulties with classroom or examination accesses. The Resource Center also provides other information regarding our continuing education and certification programs. Access to online libraries is also provided. To Access the Student Resource Center: click here.

COURSE OBJECTIVES: Upon completion of this course, you will be able to:

1. Understand the major stages in the development of the nation's health care system
2. Appreciate the many forces affecting health services of the United States
3. Understand the social, political and economic forces affecting health care
4. Describe a larger health system in terms of the various subsystems that comprise it and serve different subsections of the population
5. Explain how all parts of a health care system are related to each other and have a major impact on each other
6. Appreciate the importance of technology in health care
7. Classify health care technologies
8, Understand product development and diffusion
9. Assess the impact of technology on various health parties
10. Understand how technology assessment is conducted
11. Trace US demographic trends including births and deaths
12. Understand correlates of mortality
13. Understand disease patterns in the United States
14. Related lifestyle, behavior, and social patterns to health
15. Appreciate cancer survival trends
16. Understand issues of access to care
17. Understand national health expenditures
18. Understand governmental health care programs
19. Analyze provider reimbursement mechanisms
20. Analyze health care reform
21. Conceptualize avenues for improving health insurance plans
22. Understand the history, role and structure of health insurance
23. Appreciate the commercial health insurance industry
24. Differentiate various health insurance provisions, terms, conditions and product types
25. Understand related insurance products
26. Analyze the appropriate role of managed care in the nation's health care system
27. Understand the variety of arrangements included under the term managed care
28. Appreciate the role of all key players, especially the consumer, in managed care
29. Appreciate the challenges facing the insurance industry in the future
30. Understand the role of public health services in protecting the health of populations
31. Differentiate the levels of prevention
32. Appreciate the history of public health in the United States
33. Appreciate the roles and duties of each level of government in providing public health services
34. View public health services as a collective requirement of all participants in the health care system
35. Understand the role of ambulatory care services
36. Appreciate the evolution of ambulatory care as a distribution system
37. Outline the organizational role and control mechanisms of ambulatory care services
38. Assess the allocation of responsibilities for coordination, appropriateness and rationalization between ambulatory care and other sectors
39. Understand the role of the hospital in today's health care system
40. Understand the types of hospitals, ownership patterns, and differentiating characteristics of various hospitals
41. Understand the development of health systems and the role of hospitals in such systems
42. Follow the impact of competitive pressures and other developments on the structure and operation of hospitals and health systems
43. Understand the internal organizational structure of hospitals
44. Describe who uses long-term care and under what circumstances
45. Explain the role and scope of services included in long-term care
46. Articulate how long-term care services are organized, operated, financed, and integrated
47. Evaluate model delivery system approaches to long-term care for the future
48. Articulate national policy issues pertinent to long-term care
49. Appreciate the history of mental health
50. Assess the epidemiology of mental health
51. Understand the various settings and arrangements for delivering mental health services
52. Appreciate the financing issues in mental health
53. Assess present and future challenges in mental health
54. Understand the nature of the pharmaceutical industry
55. Understand the drug discovery process
56. Appreciate the complex legal and regulatory issues facing the industry
57. Understand the role of government and public policy with regard to pharmaceuticals
58. Appreciate the growth and changes in the composition of the health profession workforce during the twenty-first century
59. Understand the key role of physicians and osteopaths in the workforce, and account for the growth in physician supply
60. Account for the various trends and changes in dentistry, public health, nursing and pharmacy and the forces affecting these professionals
61. Comprehend the importance and potential of physician assistants and nurse practitioners in the health care system
62. Understand the various major transitions occurring in the health care workforce, with particular emphasis on current and impending shortages
63. Understand the impact of health policies on health care
64. Gain knowledge of the development of health policy in the United States
65. Appreciate the role of Government in health policy
66. Understand the key policy issues the nation faces
67. Appreciate the complexity of defining and measuring the quality of care
68. Understand how measuring and monitoring quality can result in improved outcomes
69. Define how quality is assessed and ensured
70. Appreciate the central role of public health ethical concerns in health policy and management
71. Understand ethical issues with regard to the development and distribution of and payment for, services, and with regard to the organization, management, assessment and delivery of services
72. Acquire a framework for ethical analysis of issues within health services systems
73. Understand the challenges facing the nation in each major area of health care
74. Establish criteria for a future health care system

Course Content

  • Historical evolution and overview of Health Services
  • Chronic illness implications
  • Disease vs. illness
  • Leading causes of death and lifestyle implications
  • Incidence of infectious diseases
  • Access to healthcare and trends
  • Types of access measures
  • Public Health and disease prevention
  • Governmental role in public health
  • Private sector involvement in health promotion
  • Evolution of ambulatory services
  • Levels and settings for ambulatory care
  • Ambulatory patient behavior
  • Organization of ambulatory care
  • The hospital’s role in healthcare delivery
  • Type of hospitals and their historical development
  • Vertically integrated health systems
  • Trends in hospital ownership activity
  • Community hospital organizations
  • Long-Term care continuum
  • Long-Term care settings
  • Characteristics of Nursing Homes
  • Home Healthcare
  • Financing of Long-Term care
  • Mental Health-Care settings
  • Mental Health-Care professionals
  • The structure and operation of the Pharmaceutical Industry
  • Pharmaceutical Price determination
  • Government intervention in Pharmaceutical industry-PA’s and NP’s
  • Availability of Healthcare professionals
  • Healthcare Expenditures
  • Medicare and Medicaid
  • Origins of Health Insurance
  • Benefit Structure
  • Experience rating and Community rating
  • Case Mix Index
  • HMO’s, PPO’s…
  • Managed Care Theory and Principles
  • Continuums of Insurance types
  • Provider Concerns
  • Medicare and Medicaid Managed Care
  • Health Insurance as a group benefit- funding
  • Blue Cross and Blue Shield
  • Drug, Dental, Vision, Retiree and Long-Term Care Plans
  • Disability Insurance
  • Health Insurance Industry changes
  • Health Policy and the political system
  • Federalism and Pluralism
  • Policy implementation
  • Measuring quality – benchmarking
  • Outcomes and Health status
  • Cost Containment and Quality
  • Disease Management
  • Ethical Issues in Public Health
  • Ethical issues in Healthcare
  • Government Intervention
  • Special Interest Groups
  • Adverse Selection and Moral Hazard
  • The Uninsured
  • Physician distribution, employment and expenditures
  • Physician reimbursement – trends
  • Supplier induced demand – Manipulated by physicians

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