Draft1 updated 20Jan15 325pm
Bus Adm 757: Managed Care and Integrated Health Networks
Spring Semester 2015
Mondays 530-810 pm Lubar N130
Robert J. De Vita
Adjunct Faculty/Lecturer
Member, Advisory Councils
Lubar School of Business
And
College of Health Sciences
University of Wisconsin - Milwaukee
414.841.1742
devita@uwm.edu
“He who fights the future has a dangerous enemy.”
- Soren Kierkegaard
Office hours : By appointment immediately before Monday classes beginning @ 430 or other,
mutually agreeable times.
Course description : “Examines concepts and management of capitated and vertically
integrated health care organizations; utilization control, risk and quality assessment, benefit
design, pricing, management of clinical professionals.”
Course objectives :Our foremost objective in this course will be to “act as if” class time is IRL
( In Real Life) as in a real health care organization. We will treat being in class and the work as
if it was actually our real work. While the content will feature managed care and integrated
health networks, it will also feature how to prepare yourselves as leaders for the next versions
of both managed and integrated care.
Here’s one example: listen to this 20 minute interview of U.S. Navy Captain David Marquet by
The Healthcare Executives Network
“Captain Marquet retired from the Navy in 2009 and is now the author of Turn the Ship
Around! A True Story of Turning Followers Into Leaders. Fortune magazine called the book the
“best how-to manual anywhere for managers on delegating, training, and driving flawless
execution.” Captain Marquet’s Intent-Based Leadership model is turning around all types of
organizations—from big manufacturers to start-ups and sport teams to government.
He helps leaders build environments where people contribute and feel valued —where
everyone is a leader.
Motley Fool called Captain Marquet’s book: “One of the 12 best business books of all time.”
In this interview Captain Marquet talks about his philosophies and how they relate to
healthcare. “
Listen to the interview here. Content is very solid about fundamentals of leadership that, in my
opinion from experience, can and must be applied to health care: [note the source of the link
and see; I’m not the only health care leader who believes this].
http://healthcareexecutivesnetwork.org/2015/01/captain-david-marquet-interview/
We will simulate management team meetings, for example, with in-class breakout groups and
your project teams will be like Real Life Workgroups. And there will be similarities between
being inclass and in a real management meeting: usually highly engaged & energetic.
Sometimes boring and annoying. Just like In Real Life.
Here’s a great reference on team performance IRL:
http://mobile.nytimes.com/2015/01/04/business/corner-office-maynard-webb-yahooschairman-even-the-best-teams-can-be-better.html?_r=0
Exams & in class exercises are intended to train, condition & prepare you for the wide range of
work situations you will experience; especially given the need to learn how to adapt & adjust
so as to prevail against adversity & make the rapid changes needed given industry disruptions.
Simply put, you will :
1.
2.
3.
4.
Know/ learn content about integrated networks & managed care
Apply your learning to a series of deliverables ( see grading)
Engage & commit yourself to learning, both individually & as a class to learning together
Simplify the complexity * around you & synthesize it ----as all good health care leaders
must do
5. Learn the value of creating counter-narratives…explanations that run counter to popular
thinking….and the value of a life-long learning cohort…..your classmates as your trusted
advisors overtime.
Oliver Wendell Holmes : *I would not give a fig for the simplicity this side of complexity, but I
would give my life for the simplicity on the other side of complexity.
The basis for this quote is that you have to "complexify before you simplify" because the
simplicity that comes before knowing all of the varying, complicating factors in a situation is
really worthless, inane and naive. But, often times, the true answer is also remarkably simple:
you only have to be on the far side of complexity in order to see it clearly. And another guiding
principle gleaned from Occam’s Razor:
http://math.ucr.edu/home/baez/physics/General/occam.html
The most useful statement of the principle is
"when you have two competing theories that
make exactly the same predictions, the simpler one is the better."
Course Requirements:
It is understandable that a student might miss one or two classes due to such things as job
requirements, personal or family illness, emergencies, etc. It is expected that students will do
the following regardless of the reason for missing class:
Contact the instructor prior to the absence to discuss what will be missed and what needs to be
done to make-up the absence. In the case of an emergency (for example, being in a medical
emergency room) the student is expected to contact the instructor within 24 hours or have a
family member or friend contact the instructor.
Turn in make-up work as stipulated by the instructor.
After two absences, the student must initiate a conversation with the instructor to determine
what is required to complete the course successfully. Failure of the student to initiate this
conversation will affect the final grade and may result in withdrawal from the course.
More than three absences will result in loss of all attendance/participation points for the term
and may result in withdrawal from the course.
Late Arrival/Departure: Simply put, unless the instructor knows ahead, or there is an
emergency; arriving late to class or departing early discouraged. It is discourteous and
disruptive to your classmates and the instructor, and impairs your development of your future
leadership skills.
Participation and engagement: At University of Wisconsin – Milwaukee graduate level classes
are kept relatively small so students can actively participate in the interactive learning model
that is central to our adult learning philosophy. Students are expected to participate and
engage in a meaningful way that demonstrates their ability to think critically and apply
concepts from course assignments. It is assumed that students will listen respectfully to the
instructor and to class members. Students are expected to refrain from engaging in side
conversations while the instructor or a classmate is talking. While there will undoubtedly be
disagreements about topics of discussion, it is expected that students use critical thinking in
expressing opinions, as well as listen to others’ with respect and an eagerness to hear others’
viewpoints.
Classroom Behavior: Part of UWM’s mission is to provide an education that is respectful, safe,
and caring for all individuals. It is expected that, as UWM community members, students
contribute to this kind of learning environment. Students whose behavior is disruptive, or who
behave disrespectfully toward other students or toward an instructor, may be instructed to
leave class or be withdrawn from the course. Depending on the nature of the behavior, the
student may be expelled from the University. According to the University of Wisconsin Milwaukee Student Handbook (www.uwm.edu):
• Disruption of the educational process including behavior which inhibits or prevents faculty
and staff from carrying out their institutional functions and/or other students from learning;
• Use of illegal drugs or alcohol, or under the influence of illegal drugs or alcohol, while on
school property. Conduct contrary to responsible behavior may lead to refusal to issue a
diploma or transcript or withdrawal from the institution.
Distractions in the Classroom: Cell phones, pagers, PDA’s, and all other electronic devices are to
be silenced during class time. Text messaging will not be allowed during class. Children are not
permitted in classes. Make arrangements for childcare as well as a “first responder” in the
event of any emergencies regarding family members. If you would like to bring a guest to class,
contact the instructor prior to class.
Grading :
30 % Cases : write ups & in-class discussion for 3 HBS cases
40% Exams : mid- term & final ( in-class)
30 % Team project : write up & in-class presentation
100% Total
Grade Percentage
A
92-100%
B
83-91
C
75-82
D
66-74
F
Below 66
150 points [3 cases @ 50 pts]
200 points [2 exams @100 pts]
150 points [ 75 pts each part]
500 Total
Final grades are submitted when all work is completed.
As in-class engagement is an essential “given” for a graduate-level seminar, it is a joint
accountability for all of us. I will assess your in-class engagement using the following
resources :
1. Exercises such as Improbable Pairing--- which is rapid responses to peer questions via 2minute drills.
2. Student volunteering [or selected ]as the content expert to describe in a 5 minute
standup the takeaways from each week’s readings.
3. Your guest lecturer interactions: questions, responses, overall engagement.
These 3 resources will influence my assessment about individual student in-class performance.
Readings: Text, Cases & Articles
Health Care USA – Sulz & Young (S&Y). 8th ed.
Jones & Bartlett
ISBN: 978-1-284-o2988-8
Copyright 2014
Reinventing American Health Care - E. Emanuel MD [EE]
Public Affairs Books Group
ISBN : 978-1-61039-345-4
Copyright 2014
*Note: At the risk of making an assumption that some students may see my selection of
Dr. Emanuel’s work as a liberal bias, basically because his brother is Rahm Emanuel is
Mayor of Chicago and was formerly a high-ranking member of the Obama
Administration, please know it’s not.
I am an equal opportunity, non-partisan observer and listener. It’s just this: A. His work
was just published and B. He’s a well known oncologist at a well-known academic
medical center [U Penn], so he has some chops.
Here’s an alternative that was published after Dr. E’s, and was reviewed by the health
care economists featured in the blog, The Incidental Economist. Phil Klein is a wellpublished columnist for the conservative Washington Examiner. I will reference some of
his comments if I can snag a copy.
http://theincidentaleconomist.com/wordpress/philip-kleins-overcoming-obamacare/
Harvard cases :
Your written case analyses should answer the case questions posted on d2L. Provide 3
to 5 double spaced pages on a Word document. Use your judgment and adjust length
given the case length & complexity.
1.HBS Engaging Doctors in the Healthcare Revolution- Lee& Cosgrove
Case reprint http://hbr.org/search/R1406H . 9 pgs
June, 2014
https://cb.hbsp.harvard.edu/cbmp/content/R1406H-PDF-ENG
2. HBS Access Health CT: Marketing Affordable Care - Quelch & Norris
Case 9-514-119
29pgs
Aug.26, 2014
https://cb.hbsp.harvard.edu/cbmp/content/514119-PDF-ENG
3. HBS Steward Health Care System- Higgins & Fisher note: for profit health care
case 9-814-029 18 pgs
July 15, 2014
https://cb.hbsp.harvard.edu/cbmp/content/814029-PDF-ENG
I will upload 2 cases below to d2L
Cases for reading and discussion but not a case write up:
4.Personal experience case authored by Robert DeVita, 2012 & updated 2014 : Blue
Cross v Marshfield Clinic, 1994-95 decided by 7th Circuit Court of Appeals, Chicago, IL.
Chief Judge Richard Posner Presiding.
5.Commonwealth Fund case
Projects & presentations : as a team, you will :
1) Identify a problem facing integrated health care organizations, specifically
pertaining to managed health care
2) Create a fix to solve the problem
3) Describe / present your plan to execute the solution
Format & length of presentation : TBD
Articles- Because of rapid changes in the managed health care market, I will paste here
and post relevant, recent articles weekly e.g. one timely and major event driving
markets is that ACA Exchanges will maintain open enrollment until Feb.15. Another is
the Supreme Court decision on subsidies expected in June.
You will need to check both D2L & this Syllabus daily. I am using a JIT [Just in Time]
approach to your readings, which again, closely parallels Real Life because the half-life
of business news and ideas is so brief. This brevity of exposure is because the
market/audience for news and ideas overemphasizes the impact of trends and changes
in the short-run, while under emphasizing them in the long-run. This is more a reflection
of human behavior and today’s attention span and appetite amidst the incredible surge
of social media than the newsworthiness of content.
Guest Lecturers: The list includes both those leaders Invited& those Confirmed. Busy
schedules may require some to beg off & others to move around or be added. These
schedule changes reflect the reality of business these days.
These leaders are real life subject matter experts whom I personally know, respect &
have selected as our guests. They are community volunteers taking time away from
family, work and R&R to be with us because they care deeply about educating future
leaders.
One more clarifying point because it always comes up. To the question: Don’t the
guests just mean less work for me as instructor? Not at all—I personally work with each
guest, first contacting them and then meeting usually at least twice, and some three
times. This began last summer and continued throughout my Fall and Winter planning—
to assure they are prepared & comfortable.
Class Schedule :
Session 1- Jan.26, 2015
We will get to know one another, get acquainted with the course work & set a baseline.
 Introductions & dialog re: everyone’s personal objectives for and/or reflections
on this course.
 Review course syllabus.
 Set the baseline via review & discussion from major healthcare stakeholder
perspectives. See readings
 Conduct an exercise : Ask the expert. For today, that will be me. For the future,
each of you will take a turn.
 Think about your team project idea & with whom you’d team up
1. Text(s): EE Ch.1, 3, 4.
2.Readings:
TIE [The Incidental Economist] links to a terrific healthcare economics- specific website
run by a couple of innovative, some might say “rogue” health care economists a la the
Freakonomics guys* from several years ago.
http://theincidentaleconomist.com/wordpress/critiquing-health-care-in-the-us/
*note: Levitt and Dubner, 2005 ed.
How the Brits see the ACA doing
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60003-4/fulltext
How popular media see the ACA: Steve Brill is famous for his 26 page Time magazine
article in 2013 on the ‘charge master’….the longest Time article…..ever
How conservatives see the ACA:
http://www.thefiscaltimes.com/2015/01/14/Top-Republican-Says-He-Has-AnswerObamacare
How a famous Princeton health care economist sees Gruber and the ACA :
http://healthaffairs.org/blog/2014/12/29/rethinking-the-gruber-controversy-americansarent-stupid-but-theyre-often-ignorant-and-why/#more-43665
http://www.npr.org/blogs/health/2015/01/05/375024427/americas-bitter-pill-makescase-for-why-health-care-law-wont-work
How hospitals are faring under the ACA
http://kaiserhealthnews.org/news/how-a-states-choice-on-medicaid-expansion-affectshospitals/
How business community views health care consolidation
http://johntorinus.com/general-blog/business-and-education/wheres-transparency-uwdollars-headed-state/
Session 2 – Feb. 2
What do the following questions mean :
1. What do these terms mean to you in the real life of a health care organization
and its leadership: integrated health care, managed health care, accountable
care?
2. What are, and how do, ACOs fit in to integrated care, managed care, population
health & public health? Provide examples.
3. How do the first two points relate to your career choices and own your personal
choices when seeking health care?
1. Text: ch.1,2 S&Y + read Index references to accountable care organizations in both
S&Y & EE.
2. Readings:
-BDV’s top 7 (see D2L Word doc) re ACOs
- CommonWealth Fund :
http://www.commonwealthfund.org/~/media/files/publications/casestudy/2014/oct/1771_klein_marshfield_clinic_aco_case_study.pdf
-The Dane Difference:
Read pgs. 1-7 of the 32 pages as these are the main takeaways. What famous health
care maven appears on pg. 7’s list of names…… and why is he so famous?
http://communityadvocates.net/userimages/The%20Dane%20Difference.pdf
-Oliver Wyman: a national health care consulting company (see D2L)
PeaceHealth Board of Directors
Industry Outlook & Strategic Implications
November 21, 2014
3.Readings on the Budget Bill [aka “cromnibus”] impact on health insurance market :
CRomnibus affects QHPs (& Coops)……BDV will note similarities to Gov. Walker’s WEDC
http://healthaffairs.org/blog/2014/12/12/implementing-health-reform-beneath-thehood-of-the-cromnibus/
http://www.washingtonexaminer.com/cromnibus-and-corporate-welfare-insurerbailout-and-ex-im-provisions-in-spending-bill/article/2557195?custom_click=rss
Session 3- Feb. 9
1. Text : ch.4,5,7 S&Y
2. Readings: Copies CON text on pop health (2)
On disruptions coming in health care:
http://www.geppettoavatars.com/
http://www.commonwealthfund.org/publications/blog/2014/dec/value-basedpayment-is-spreading
Guest: Sally Lundeen PhD, Dean, UWM College of Nursing, will explore many facets of
managed care and integrated networks from the standpoint of:
-the emergence of nursing in new clinical roles
- the focus on population health
-the need for inter- professional teams
and
-the role of disruption in forging the new health care e.g. integrated primary care [premedical home].
Session 4 – Feb. 16
1. Text : Ch. 6 S&Y
2. Readings : TBD introduce VCRE. Stockdale's paradox & Tichy \ Marshall
case 1 due
HBS Engaging Doctors in the Healthcare Revolution- Lee& Cosgrove
Case reprint http://hbr.org/search/R1406H . 9 pgs
June, 2014
ttps://cb.hbsp.harvard.edu/cbmp/content/R1406H-PDF-ENG
The real “Unbroken” : Louie Zamperini
Hardiness & Pain. Never give up. If you can take it you can make it. One Moment of Pain
......a lifetime of glory.
https://m.youtube.com/watch?v=qNQHsONP4is
https://m.youtube.com/watch?v=n5OPsjiLweo
https://m.youtube.com/watch?v=mlHusz_z1wE Al Michael's. Brokaw
Guest: confirmed Susan Marshall, CEO, Backbone Institute and
Patricia J. Lenius, President, PJL & Associates
Health care is an industry in rapid transition given the resurgence of managed care &
industry integration & consolidation. Hence, health care leaders need to pay attention
to conditioning to maintain personal health, well- being & high performance while they
role model the same within their organizations.
Session 5 - Feb. 23
Guest:confirmed Larenda Mielke, Assistant Dean for Executive Education& Career
Services, UWM Lubar School of Business
“ Difficult to predict, but sure to change….. given the rapid integration and consolidation
going on within health care. ” : These are the words I used to portray the future of
health care at a Milwaukee Press Club conference panel in December, 2013. Hence, this
creates an essential challenge for health care leaders to develop their strategic
thinking skills amidst complexity and chaos. You will learn that there are proven ways to
do that.
1. Text :ch. 13 S&Y and ch.13 & CODA from EE ( Future of health care & Megatrends )
2. Readings : TBD
Session 6 – Mar. 2
Negotiating the managed care contract between potentially adversarial parties ( the
health insurance company & the health care service provider) is both an art & science.
Our focus this week is on learning firsthand about ways to apply proven leadership
practices to this endeavor.
Guest: Confirmed Alyce Katayama JD – Partner, Quarles & Brady law firm. Chair, Health
Law Practice Group. Founding Board Member & Legal Advisor to Common Ground
Healthcare Cooperative of Wisconsin.
1. Text : Ch. 8 S&Y Financing and trends
2. Readings:
http://www.forbes.com/sites/dandiamond/2015/01/11/60-minutes-just-calledobamacare-a-disaster-heres-what-they-didnt-tell-you/2/
Caution: Ed. Comments follow
Steve Brill is a reporter/columnist/ author who until two years ago knew nothing abt
health care economics except what he learned as a patient. Now---he's a pundit. An
expert. Dan Diamond is a Forbes contributor and an editor at The Advisory Board, a
national consulting company begun by very book smart Ivy Leaguers, whom, in my
opinion, never ran anything in health care, or had to make a payroll. Sorry, my Ed.
Comment turned into a Rant.
Trends in health care premium increases over time
http://www.commonwealthfund.org/~/media/files/publications/issuebrief/2015/jan/1798_schoen_state_trends_2003_2013.pdf?la=en
Session. 7- Mar 9
midterm
Group work
Session 8- Mar 16
Spring break
Session 9- Mar 23
On building a provider-centric managed health care capability for ACOs, and on
developing other vehicles and infrastructure for promoting the integration of care.
Guest : Jeff Zavada , CEO, FlagshipSails, Inc., Wi and former United Health Care
executive
Readings:
NB: this week OR next
1. Text : Ch. 6 S&Y and Ch.8 EE (Health care financing & Exchanges)
2. BX case [not for written analysis]
Session 10- Mar 30
"Health care goes retail…..so moving fast to get there is usually better "
Oliver Wyman consultant Nov. 21, 2014 Peace Healthcare board meeting
Case 2 due
HBS Access Health CT: Marketing Affordable Care - Quelch & Norris
Case 9-514-119
29pgs
Aug.26, 2014
https://cb.hbsp.harvard.edu/cbmp/content/514119-PDF-ENG
Confirmed. Guests : On the mission of a Health Insurance Cooperative ( a distinct
difference) & the role/ function of public & private health insurance exchanges : Cathy
Mahaffey, CEO & Jim Wesp, Board Chair & small business owner.
1. Text : Ch. 6 S&Y and Ch.8 EE (Health care financing & Exchanges)
2. Readings :TBD
Session 11- Apr. 6
On the case for a revitalized public health sector in American health care
Guest: Magda Peck, DSc, Founding Dean, UWM Zilber School of Public Health
1.Text : Ch.11 S&Y Public Health & Public Policy &
2.Readings: http://www.academyhealth.org/files/publications/AHRIPHinACA2014.pdf
Next:
What the Supreme Court said the first time [see Ch. Xx EE]
What the Supremes may say this June.
Duke Policy Journal
http://jhppl.dukejournals.org/content/early/2014/11/21/03616878-2867881.full.pdf
NEJM
https://pod51041.outlook.com/owa/service.svc/s/GetFileAttachment?id=AAMkADlkND
k1NGM2LWI5Y2UtNDZiMS05MmFlLTQ2MTI2ZDBiOTY1OABGAAAAAAB1XqognzGZQ6CZ
9X5o9okQBwBbHWneGtGjQrIQasfGkD8KAAAAAAEMAABbHWneGtGjQrIQasfGkD8KAAB
zhFOTAAABEgAQAEmFC6qU0ztMhgOkfWQ8Iw8%3D&X-OWACANARY=QWd6OMaKqkiut2SlVGRnr3oOldyu-dEIyxBDEq9015NP8S9-Cvj78VNT81OIo5DDFtngm_Du3A.
Gov. Walker in 2013 WSJ interview N.B. reported in Slate
http://www.slate.com/articles/news_and_politics/politics/2015/01/scott_walker_s_une
xpected_defense_of_obamacare_the_wisconsin_governor_may.html
Group work
Session 12- Apr 13
1. Text : TBD
2. Readings: TBD
Case 3 due
HBS Steward Health Care System- Higgins & Fisher note: for profit health care
case 9-814-029 18 pgs
July 15, 2014
https://cb.hbsp.harvard.edu/cbmp/content/814029-PDF-ENG
Session 13- Apr 20
On the employer’s view of health care integration, consolidation and managed health.
Guest confirmed: John Torinus, Chairman, Serigraph, Inc. West Bend, Wi. Active with
local startup community including serving as chair, BizStarts. Noted author and blogger
on public policy and the business of health care:
1. Text : TBD
2. Readings : www.johntorinus.com
Session 14 Apr 27
1. Text :
2. Readings : Case 4 on d2L
Personal experience case authored by Robert DeVita, 2012 & updated 2014 : Blue Cross
v Marshfield Clinic, 1994-95 decided by 7th Circuit Court of Appeals, Chicago, IL. Chief
Judge Richard Posner Presiding
Group work – final in class prep time for next week !
Session 15- May 4
project presentations
Guest judges Invited: Nick Desien, CEO, Ascension/Ministry Healthcare. Carrie Duda,
Senior VP, Revenue Cycle, Aurora Healthcare. Tim Masek VP Finance/Andrew Hillig, VP
Performance Improvement, Wheaton Franciscan Healthcare
1. Text : TBD
2. Readings: TBD
Session 16- May 11
final exam inclass