Payment Plcy Implic Med Care

2 Credits · Level: Graduate

This course examines the effects of third-party coverage on the organization and delivery of medical care. It is presumed that the student already has a basic understanding of the financing of medical care, including a basic understanding of medical care reimbursement. This course undertakes a deeper understanding of the consequences associated with the manner in which financial risk is pooled and implications of the approaches taken to reimburse and pay health care providers. This course will trace the origins and examine the limits of emerging approaches in “pay for performance,” value-based purchasing,” “shared savings,” “bundled payments,” “medical homes,” “Accountable Care Organizations,” as well as various forms of managed care. This course will also examine how reimbursement or payment policies have been used to affect the organization and delivery of health care in general, improve the quality of care, and attempt to ensure that resources are expended efficiently and effectively. Students who take this course should be in a stronger position to help develop reimbursement methods for payers, negotiate or lobby for changes in existing reimbursement methods on behalf of providers, or advocate for the use of coverage and reimbursement policies to help alter the organization and delivery of medical care.