Saint Joseph's University

HSV 551 Managed Health Care

Understand the elements of managed care for better practice management.

Format: Online
Duration: 8 weeks
Credits: 3 credits

Managed Health Care (HSV 551) introduces the fundamental concepts of managed care, including current and evolving models, terminology, and differences among insurers and payers. The course focuses on financial incentives to restrain health care costs and the role of utilization review, peer review, and provider review.

Managed Health Care Coursework

Through literature review, discussion and research, the HSV 551 coursework explores the progression of managed care through the historical and evolutional development of the field, its major components, and operating principles to specific health care delivery strategies and approaches. Weekly research papers written using peer-reviewed articles will help assess your comprehension of a variety of managed care topics.

Up for Discussion

Learn from your instructor and peers via interactive discussion forums that can include a number of intriguing and current health topics like the example below.

Why is the element of control so central and critical for the process of managed care?

What You’ll Learn in Managed Health Care

Throughout the Managed Health Care course, you’ll cover the broad terrain of this important third party industry in the United States. In the beginning, you’ll examine the origins and development of managed care as it is practiced today in American health care. You’ll study the major components of managed care, how such functions operate and are related to provider services and operations, employer purchasers, and employee/subscriber populations. Through class discussion and independent research, you’ll seek answers to questions of managed care’s impact and significance to the various stakeholder groups within the managed care environment.

As the course progresses, you’ll move from the social and economic impacts of managed care to the technologies and applications of how managed care and health insurance companies go about their business. Operational areas such as contracting, service delivery, infrastructure, physician relationships, disease management, plan design, and other technical/business areas are presented for analysis and review. This allows you time to fully explore each of these areas, understand what they represent, how they function, and what role they play in the larger managed care environment.

Because the third party industry and especially managed care is such a rapidly changing field, this course tracks the latest developments and trends in the field. Government policy, marketplace dynamics, and the Internet have shaped these trends. This provides you information that can be utilized directly in your workplaces. It also helps you recognize what long-term changes may be present in the future of the managed care and health insurance fields in this country.

As the course concludes, you’ll be equipped with insight and knowledge about managed care that will provide genuine understanding of both the operational components of the field, as well as the relationship and impact of managed care on all constituents, users, purchasers, regulators, and providers.

Course Topics

Over the eight-week duration of the course, you’ll be introduced to new topics and weekly themes. Sample weekly topics may include:

  • Origins, history, core elements, and operating principles of managed care
  • Integrated delivery systems and types of managed care plans
  • Provider roles, functions, payment systems, and behavior
  • Medical management, utilization, quality, and case management systems
  • Disease management and impact of ACA on utilization of disease management
  • Consumerism, network development, and contract negotiation
  • Technology and information technology for managed care
  • Medicare/Medicaid managed care, employers’ interest, and regulation

Course Learning Objectives

All Managed Health Care coursework provides you with a comprehensive review of managed care, from its simple infancy to its complex future. Upon completion of the course, you will have an academically and experientially enriched background to:

  • Understand the historical roots and evolutionary path managed care has taken that has significantly contributed to how it is structured and operates today.
  • Gain insight, knowledge, and information about the various aspects and components of managed care and health insurance which compose this third party industry in American health care.
  • Learn what the impact and significance the managed care movement has had on its major stakeholder groups from patients and end users to providers and the federal government.
  • Appreciate the contributions managed care has made in terms of health care quality, health care delivery, and overall service.
  • View what are the current trends and future directions in the managed care field which would suggest newer realities for the health care industry in general over the next several years.

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To learn more about the online Master of Science in Health Administration curriculum from Saint Joseph’s University, call (866) 758-7670 to speak with a program manager or request more information below.

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