Graduate Council
New, Modified or Deleted Course Form
This form has many drop-down menus. To activate the menu, click on the “Choose an item.” and click the arrow to
the right.
1. Please complete this form and save the file as the subject and course number without spaces (ex: PSYC648).
2. Send it as an email attachment to Jennifer Bazaz (jbazaz@gmu.edu); remember to add any related documents (for
new courses, please include the catalog description with catalog credit format, e.g. 3:2:1 and the course syllabus).
3. Bring the signed original of this form to the Graduate Council meeting for our files. We will forward it on to the
Registrar’s Office for implementation.
-FOR COURSE CHANGES, PLEASE ONLY LIST THE MODIFICATIONS BEING MADE____________________________________________________________________________________________________
Request for a: New Course
Unit: CHHS Department: Health Administration and Policy
Subject and Course Number (if applicable, include cross listing): HAP 652 Course Title:
Essentials of Health Insurance and Managed Care
Effective Term: (new/modified courses only): fall 2009
Credit Hours: (Fixed)
3
OR (Var.)
to
Final Term (deleted courses only):
For Labs or RCT:
or
Grade Type: Regular Graduate
Repeat Status: NR * Only use RD or RT when the course can be repeated for credit.
Total number of hours allowable for this course to be taken (must complete for RD or RT courses):
Schedule Type Code(s):
First code: LEC Second code (only for courses w/LAB or RCT component): Choose an item.
Prerequisite or Corequisite: None
Please Note: For modified courses - review prerequisite or corequisite for necessary changes. For deleted courses review other courses to correct prerequisites that list the deleted course.
Description of Modification (if applicable- please be specific!):
Special Instructions (major/college/class code restrictions, if applicable):
Submitted by/Contact Person: PJ Maddox pmaddox@gmu.edu
_______________________________________________________________________________________________________________________
Signatures:
Department/Unit Approval: ____
___________Date: 4-3-09
Grad Council Member: _____________________________________________________________Date:
Provost Office: _____________________________________________________________Grad Council Approval Date:
Please type into the chart those units outside of your own that may be impacted by this:
- Each of these units must approve this change prior to it being submitted to the Grad Council for
approval.
UNIT APPROVER’S
UNIT APPROVER’S
NAME
SIGNATURE
UNIT NAME
DATE
GEORGE MASON UNIVERSITY
College of Health and Human Services
Department of Health Administration and Policy
Course Number:
HAP 652 3:3:0
Course Title:
Essentials of Health Insurance and Managed Care
Course Placement:
Graduate Elective
Faculty:
Dr. Peter Kongsvedt
Course Description:
Survey course in US health insurance and managed care. Provides an
overview of the different types of health insurers and managed care organizations, with content on
sales and marketing, provider network management and reimbursement, medical and quality
management, claims processing, member services, IT and operational finance. Policy, laws and
regulations affecting the industry will also be addressed.
Course objectives:
Upon completion of this course the student will be able to:
1. Understand the historical roots of health care cost inflation and health insurance and managed
care, including market sectors and their characteristics;
2. Differentiate the different types of managed care health plans and provider arrangements
(including Medicare and Medicaid managed care)
3. Analyze managed care contracting arrangements, physician reimbursement and hospital/facility
contracting models
4. Articulate different methodologies and approaches for conducting managed medical care
service utilization and cost analysis;
5. Selectively employ strategies to ensure health plan quality and compliance with regulatory
oversight (including accreditation);
6. Articulate essential operations and challenges in the management of health plans including plan
sales and marketing, legal and regulatory standards, billing and enrollment, claims processing
and member services);
7. Discuss the requirement for essential IT infrastructure for mandated standards, electronic data
interchange and IT support of the enterprise
Required textbook(s):
Kongstvedt, Peter R., Essentials of Managed Health Care, Fifth Edition, Jones and Bartlett Publishers,
2007.
Course Requirements:
Students are required to attend class on time and participate fully. Prior to class students will complete
all assigned class readings and journal articles. Course assignments including writing two short issue
papers and prepare and prepare a final issues paper (meeting instructor format guidelines) and will and
presentation in class.
Course Evaluation:
Student grades will be derived based upon the following class expectations and deliverables:
1. Short paper #1 (5 pages): 15%
2. Short paper #2 (5 pages): 15%
3. Final paper and presentation: 50%
o Paper (15-20 pages in length) 30%
o Presentation 20%
4. Class participation: 20%
5. Instructor Grading Scale:
6. 93-100%= A
90- 92 %= A88- 89 %= B+
83- 87 %= B
80- 82 %= B78- 79 %= C+
73- 77 %= C
70- 72 %= C68- 69 %= D+
63- 67 %= D
60- 62 %= D59% ... = F
A: Excellent performance; sharp insight; articulate; superior writing ability; able to relate material to
previous experience and learning; an example for others to follow.
B: Good performance; active listener and participant; articulates thoughts clearly; accomplishes more than
minimum requirements; solid performance.
C: Satisfactory performance; accomplishes minimum requirements; communicates at generally acceptable
level; satisfactory understanding of concepts at basic level.
F: Quality and quantity of work and participation is below average and unacceptable.
Teaching methods/strategies:
Lectures, class discussion and student presentations.
Student Attendance and Participation
Class attendance is expected; if you are unable to be at class, it is your responsibility to inform the course
instructor and to identify a strategy to meet the learning objectives for that day.
Please complete all required reading and written assignments by the specified date. Assignment guidelines
specify the date the work is due; if you are unable to meet the deadlines, it is your responsibility to negotiate
another date well in advance of the deadline. Failure to submit work on the due (or negotiated) date will result
in a 5-point penalty for each day late.
Written Assignments
All written assignments will be graded using the following criteria:
70% ON CONTENT. Content will be judged by relevance (critical issues are identified by student);
level of analysis (strong, demonstrates depth and critical approach); manifests original thoughts; factual
information demonstrates accuracy.
30% ON MECHANICS. Mechanics will be judged according to the following: grammar and style;
organization and flow; presentation (important for construction of papers and bibliographic
documentation). Papers should use font no larger than 12 point, and margins should be 1" on top and
bottom; left and right margins should be 1.5". All papers should be double-spaced. American
Psychological Association (APA) style for bibliographic references, style, etc should be followed. The
APA writing guidelines may be found at: http://apastyle.apa.org/
On-time electronic mail submission via Word format is required for all written assignments, unless
approved otherwise by the instructor.
Students are expected to use standard English in all course communications.
Course/topical outline:
Class 1: Understand the historical roots of health insurance and managed care
Class 2: Understand the different market sectors and their characteristics (including Medicare and
Medicaid managed care)
Class 3: Understand the different types of health plans and their key differences
Class 4: Understand common myths and realities in health insurance and managed care
Class 5: Understand physician contracting, network operations issues and different forms of
physician reimbursement under managed care
Class 6: Understand hospital and facility contracting, network issues and different forms of hospital
and facility reimbursement under managed care
Course 7: Understand the causes of health care cost inflation and emerging policy solutions
Class 8: Understand how utilization and medical costs are measured and performed
Class 9: Understand quality measurement and management, including health plan measurement
and accreditation
Class 10: Understand health plan sales & marketing, including legal and regulatory issues
Class 11: Understand how health plans perform basic operations, including billing & enrollment,
claims processing and member services
Class 12: Understand the basic IT issues, including mandated standards, electronic data
interchange, informatics and analysis, and IT support of the enterprise as well as federal policy and
regulations.
Class 13: Student Presentations
Honor code:
“To promote a stronger sense of mutual responsibility, respect, trust, and fairness among all members
of the George Mason University community and with the desire for greater academic and personal
achievement, we, the student members of the university community, have set forth this honor code:
Student members of the George Mason University community pledge not to cheat, plagiarize, steal, or
lie in matters related to academic work” (George Mason University Catalo).
Individuals with disabilities:
George Mason University is committed to complying with the Rehabilitation Act of 1973 and the
Americans with Disabilities Act of 1990 by providing reasonable accommodations for disabled
applicants for admission, students, applicants for employment, employees, and visitors. Applicants for
admission and students requiring specific accommodations for a disability should contact the Disability
Resource Center at 703-993-2474, or the Equity Office at 703-993-8730. Applicants for employment
and employees should contact Human Resources at 703-993-2600 or the Equity Office. Students and
employees are responsible for providing appropriate documentation and requesting reasonable
accommodation in a timely manner (George Mason University Catalog).