TROY UNIVERSITY
MASTER SYLLABUS
SORRELL COLLEGE OF BUSINESS
HSA 6684
Managed Care: Origins, Organizations, and Operations
Prerequisites
Graduate standing, HSA6682 Healthcare Planning and Management.
Description
Covers managed care programs, structures, practice models, role of physicians and other
clinicians, capitation, cost-accounting and forms of reimbursement.
Objectives
On completion of the course, the student should be able to:
1.
2.
3.
4.
5.
Describe the evolution, management, operations, functions, systems and models of
managed care and health insurance plans.
Describe financial aspects of managed care and health insurance plans, budgeting,
cost-benefit analysis, cost-accounting, reimbursement methodologies, payment
systems, pricing, incentives, risk assessment, forecasting, underwriting, and regulatory
reporting.
Propose recommendations to apply population risk assessment and the principles of
population risk management and medical home models to applicable scenarios.
Assess legal challenges and impacts of federal and state legislation, healthcare reform,
and regulations governing health insurance plans, managed-care plans, contracts, and
antitrust issues.
Evaluate applicable scenario to apply managed care and health plan strategies to meet
business objectives.
Purpose
This course explores the financial management concepts, insurance mechanisms, reimbursement,
structures and processes in managed care and in the healthcare industry to help students improve
cost-management, performance improvement, decision making and other processes in healthcare
organizations and to understand the key issues facing healthcare managers in these areas. MSM
Healthcare Management concentration requirement.
Master Syllabi are developed by the senior faculty in each business discipline. This Master Syllabus must be used as the basis for developing the
instructor syllabus for this course, which must also comply with the content specifications outlined in the Troy University Faculty Handbook.
The objectives included on this Master Syllabus must be included among the objectives on the instructor’s syllabus, which may expand upon the
same as the instructor sees fit. The statement of purpose seeks to position the course properly within the curriculum and should be consulted by
faculty as a source of advisement guidance. Specific choice of text and other details are further subject to Program Coordinator guidance.
1 August 2005
Master Syllabus: HSA 6684
2
Approved Texts (both required for course):
Kongstvedt, P. R. (2009 or current). Managed care: What it is and how it works. Sudbury, MA:
Jones and Bartlett.
Cleverley, W.O., & Cameron, A.E. (2007 or current). Essentials of Healthcare Finance (7th ed.).
Sudbury, MA: Jones and Bartlett.
Supplements
Kongstvedt, P. R. (2007 or current). Essentials of managed care (5th ed.). Sudbury, MA: Jones
and Bartlett.
Gapenski, L.C. (2009 or current). Fundamentals of Healthcare Finance. Chicago: Health
Administration Press.
Dennerll, J. T., & Davis, P. E. (2005 or current). Medical terminology: A programmed systems
approach: Revised (9th ed.). Clifton Park, NY: Thomson/Delmar Learning.
Morrisey, M.A. (2007 or current). Health insurance. Chicago: Health Administration Press.
Todd, M. K. (2009 or current). The managed care contracting handbook (2nd ed.). Productivity
Press.
Troy University Faculty Handbook (2010): Section 3.9.2.8 [extract] — essential elements of the syllabus (somewhat modified for space):
1. Course title
2. Course number +
section
3. Term
4. Instructor
5. Prerequisites
6. Office hours
7. Class days, times
8. Classroom
location
9. Office location +
e-mail address
10. Office telephone
11. Course
description,
objectives
12. Text(s)
13. Other materials
14. Grading methods, 16. General supports
criterion weights,
(computer works,
make-up policy,
writing center)
mid-term grade
17. Daily assignments,
reports
holidays, add/drop
15. Procedure, course
& open dates, dead
requirements
day, final exam
18. ADA statement
19. Electronic device
statement
20. Additional
services,
statements
21. Absence policy
22. Incomplete-work
policy
23. Cheating policy
24. Specialization
requirements
(certification,
licensure, teacher
competencies)