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Rina Vertes
This course will review the drivers of healthcare cost and solutions that have been proposed to address cost, quality and value of health care. Many point blame for high costs on payment models that pay healthcare providers for every service they provide to patients, essentially paying more for volume and service intensity. This is called a Fee for Service (FFS) payment model. Some solutions, arguably the more sustainable solutions, are the combined strategies of new payment models, care management, insurance plan designs, consumer engagement tools, and technology.
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This course will review the drivers of healthcare cost and solutions that have been proposed to address cost, quality and value of health care. Many point blame for high costs on payment models that pay healthcare providers for every service they provide to patients, essentially paying more for volume and service intensity. This is called a Fee for Service (FFS) payment model. Some solutions, arguably the more sustainable solutions, are the combined strategies of new payment models, care management, insurance plan designs, consumer engagement tools, and technology.
Read more
This course will review the drivers of healthcare cost and solutions that have been proposed to address cost, quality and value of health care. Many point blame for high costs on payment models that pay healthcare providers for every service they provide to patients, essentially paying more for volume and service intensity. This is called a Fee for Service (FFS) payment model. Some solutions, arguably the more sustainable solutions, are the combined strategies of new payment models, care management, insurance plan designs, consumer engagement tools, and technology.
Using that information we will explore various situations, showcasing coordinated care and payment strategies that can be implemented to improve patient health and the cost of delivery of healthcare services.
By the end of this course, the learner should be able to:
1. Identify the drivers and trends of healthcare spending from the perspective of various stakeholders, including medical providers, insurers, government and private purchasers and payments
2. Critically assess the impact of strategic and financial approaches that have been put in place by the ACA and the various modifications.
3. Evaluate how healthcare payment models currently work and the new direction that value-based payment is taking.
4.Identify how financial and non-financial metrics can be appropriately combined to improve a healthcare stakeholders’ value proposition.
Register for this course and see more details by visiting:
OpenCourser.com/course/s6bo97/future
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What's inside
Syllabus
Current Healthcare Spend and Trend
This week's focus will be on understanding the various stakeholders in healthcare. We will review the "math" surrounding healthcare costs and how it can fluctuate. Healthcare drivers will be reviewed to identify trends. As you move through the weekly material, I encourage you to think about the impact that the drivers have on the delivery of the healthcare services.
Read more
Syllabus
Current Healthcare Spend and Trend
This week's focus will be on understanding the various stakeholders in healthcare. We will review the "math" surrounding healthcare costs and how it can fluctuate. Healthcare drivers will be reviewed to identify trends. As you move through the weekly material, I encourage you to think about the impact that the drivers have on the delivery of the healthcare services.
Read more
I Thought we were done with this: Insurance Markets
This week we will describe the various elements which underline health insurance within the United States. For example, third party payment structures and risk pooling, to name a few. This week we will focus some time on the Affordable Care Act (ACA) which is a very complex piece of legislation. Special attention will be made on provisions of the ACA that impact insurance markets, financing, healthcare costs, and payment models.
Value-Based Payment Models
This week will continue to "follow the money". We will focus much of our attention on the shortcomings of a Fee-for-Service payment model. Our attention will shift to alternative payment models that have been implemented, allowing for certain comparisons to be made. Lastly, we will review some results that have been achieved because of the new payment models. This week I will leave you by asking, If we know that the Fee-for-Service payment model is dysfunctional, why is it continuously used?
Evolving Integrated Models: Putting It All Together
This week we shift our focus from reviewing current payment models and strategies to applying some of the models and concepts to "real-world" scenarios. We will use fictitious examples, as well as published articles to bring together all of the concepts. As with most things, there is not one single answer to solving the healthcare cost, quality, and value problems. I encourage you to think "outside of the box" and as always, "follow the money!"
Good to know
Good to know
Know what's good ,
what to watch for , and
possible dealbreakers
Provides an overview of healthcare spending, drivers, and trends for various stakeholders, including providers, insurers, and purchasers
Examines the Affordable Care Act (ACA) and its impact on insurance markets, healthcare costs, and payment models
Analyzes the shortcomings of Fee-for-Service payment models and introduces alternative value-based payment models
Presents real-world scenarios and case studies to illustrate the application of payment models and strategies
Taught by experienced healthcare professionals with extensive knowledge in the field
Offers a comprehensive understanding of payment strategies and models in healthcare
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Reviews summary
Well-received healthcare payment models
Learners say that this healthcare payment models course is well received and engaging. The instructor is highly praised for excellent explanations and animation, which learners describe as lucid and captivating. While some readings require subscriptions to access, many learners describe the readings and assignments as useful. Overall, learners say this course is highly informative and well structured.
Course is well-structured and organized.
"The models explained in this course were completely new to me, but Prof Vertes helped them come to life with her animated lectures and captivating real life examples."
"Prof Rina Vertes is an extremely structured orator who delivers complicated concepts as lucidly possible."
"Great course that teaches future health payment models into a a concise package."
Course provides useful information and insights.
"Highly recommended!"
"Good course. Give basic understanding of various payment model in a very clear and engaging manner "
"Good set of non-technical (but not simplistic) readings to support the lectures."
Instructor is passionate and engaging.
"Prof Rina Vertes is an extremely structured orator who delivers complicated concepts as lucidly possible."
"The energy the Professor brings into the course is amazing."
"Excellent instructor"
Some readings require paid subscriptions to access.
"Excellent instructorGave the course 5 stars, however one thing I would point out is that some articles are not available without paid subscriptions to the source newspapers."
Activities
Be better prepared
before
your course. Deepen your understanding
during
and
after
it. Supplement your coursework and achieve mastery of the topics covered
in Future Healthcare Payment Models with these
activities:
Review algebra and geometry
Show steps
Ensure that your math skills are still fresh and ready for this class by reviewing some of the basics from Algebra and Geometry
Browse courses on
Algebra
Show steps
Review core topics in healthcare
Show steps
Reviewing the fundamental principles of healthcare will help reinforce your understanding of the material covered in this course.
Browse courses on
Healthcare Systems
Show steps
-
Review lecture notes and textbooks from previous courses.
-
Complete practice problems and quizzes.
-
Attend a refresher workshop or seminar.
Read 'Essentials of Health Economics'
Show steps
This book provides a comprehensive overview of the key economic principles that drive healthcare decision-making. Reading it will enhance your understanding of the concepts discussed in this course.
Show steps
-
Read each chapter thoroughly, taking notes on key concepts.
-
Complete the end-of-chapter exercises and discussion questions.
-
Summarize each chapter in your own words.
Six other activities
Expand to see all activities and additional details
Show all nine activities
Analyze Healthcare Payment Models
Show steps
Discussing healthcare payment models with peers will help you develop a deeper understanding of their strengths and weaknesses.
Show steps
-
Form a study group with classmates.
-
Choose a specific healthcare payment model to analyze.
-
Research the model, including its structure, incentives, and outcomes.
-
Present your findings to the group and lead a discussion.
Compile a Resource List on Healthcare Cost and Quality
Show steps
Compiling a resource list will help you stay informed about the latest research and developments in healthcare cost and quality.
Show steps
-
Search for credible sources of information, such as academic journals, government reports, and industry publications.
-
Identify key articles and reports related to healthcare cost and quality.
-
Create an organized list of resources, including citation information and brief summaries.
-
Share your resource list with classmates and colleagues.
Volunteer at a local healthcare organization
Show steps
Volunteering will provide you with practical experience in healthcare and expose you to the challenges faced by patients and providers.
Show steps
-
Identify a local healthcare organization that you are interested in volunteering for.
-
Contact the organization and inquire about volunteer opportunities.
-
Commit to a regular volunteer schedule.
-
Perform assigned tasks and interact with patients and staff.
Mentor a Student Interested in Healthcare
Show steps
Mentoring a student can help you reinforce your understanding of healthcare principles while also supporting the next generation of healthcare professionals.
Show steps
-
Identify a student who is interested in pursuing a career in healthcare.
-
Share your knowledge and experience with the student.
-
Provide guidance and support as the student explores their career options.
-
Encourage the student to participate in extracurricular activities and networking events.
Design a New Healthcare Payment Model
Show steps
Creating a new healthcare payment model will challenge you to apply the principles learned in this course to a real-world problem.
Show steps
-
Identify a specific healthcare problem that you want to address.
-
Research existing healthcare payment models.
-
Design a new payment model that addresses the identified problem.
-
Write a paper describing your model, including its structure, incentives, and expected outcomes.
Enter a Healthcare Innovation Contest
Show steps
Participating in a healthcare innovation contest will push you to think creatively and develop innovative solutions to healthcare challenges.
Show steps
-
Research healthcare innovation contests and identify one that aligns with your interests.
-
Form a team and develop a project proposal.
-
Develop a prototype or business plan for your solution.
-
Submit your entry and present it to a panel of judges.
Review algebra and geometry
Show steps
Ensure that your math skills are still fresh and ready for this class by reviewing some of the basics from Algebra and Geometry
Browse courses on
Algebra
Show steps
Show steps
Show steps
Review core topics in healthcare
Show steps
Reviewing the fundamental principles of healthcare will help reinforce your understanding of the material covered in this course.
Browse courses on
Healthcare Systems
Show steps
Show steps
Show steps
- Review lecture notes and textbooks from previous courses.
- Complete practice problems and quizzes.
- Attend a refresher workshop or seminar.
Read 'Essentials of Health Economics'
Show steps
This book provides a comprehensive overview of the key economic principles that drive healthcare decision-making. Reading it will enhance your understanding of the concepts discussed in this course.
Show steps
Show steps
Show steps
- Read each chapter thoroughly, taking notes on key concepts.
- Complete the end-of-chapter exercises and discussion questions.
- Summarize each chapter in your own words.
Six other activities
Expand to see all activities and additional details
Show all nine activities
Analyze Healthcare Payment Models
Show steps
Discussing healthcare payment models with peers will help you develop a deeper understanding of their strengths and weaknesses.
Show steps
Show steps
Show steps
- Form a study group with classmates.
- Choose a specific healthcare payment model to analyze.
- Research the model, including its structure, incentives, and outcomes.
- Present your findings to the group and lead a discussion.
Compile a Resource List on Healthcare Cost and Quality
Show steps
Compiling a resource list will help you stay informed about the latest research and developments in healthcare cost and quality.
Show steps
Show steps
Show steps
- Search for credible sources of information, such as academic journals, government reports, and industry publications.
- Identify key articles and reports related to healthcare cost and quality.
- Create an organized list of resources, including citation information and brief summaries.
- Share your resource list with classmates and colleagues.
Volunteer at a local healthcare organization
Show steps
Volunteering will provide you with practical experience in healthcare and expose you to the challenges faced by patients and providers.
Show steps
Show steps
Show steps
- Identify a local healthcare organization that you are interested in volunteering for.
- Contact the organization and inquire about volunteer opportunities.
- Commit to a regular volunteer schedule.
- Perform assigned tasks and interact with patients and staff.
Mentor a Student Interested in Healthcare
Show steps
Mentoring a student can help you reinforce your understanding of healthcare principles while also supporting the next generation of healthcare professionals.
Show steps
Show steps
Show steps
- Identify a student who is interested in pursuing a career in healthcare.
- Share your knowledge and experience with the student.
- Provide guidance and support as the student explores their career options.
- Encourage the student to participate in extracurricular activities and networking events.
Design a New Healthcare Payment Model
Show steps
Creating a new healthcare payment model will challenge you to apply the principles learned in this course to a real-world problem.
Show steps
Show steps
Show steps
- Identify a specific healthcare problem that you want to address.
- Research existing healthcare payment models.
- Design a new payment model that addresses the identified problem.
- Write a paper describing your model, including its structure, incentives, and expected outcomes.
Enter a Healthcare Innovation Contest
Show steps
Participating in a healthcare innovation contest will push you to think creatively and develop innovative solutions to healthcare challenges.
Show steps
Show steps
Show steps
- Research healthcare innovation contests and identify one that aligns with your interests.
- Form a team and develop a project proposal.
- Develop a prototype or business plan for your solution.
- Submit your entry and present it to a panel of judges.
Career center
Learners who complete Future Healthcare Payment Models will develop knowledge and skills
that may be useful to these careers:
Healthcare Consultant
Healthcare Consultant
Healthcare Consultants provide guidance to healthcare organizations on how to improve their operations. They analyze data, identify inefficiencies, and develop and implement solutions to improve quality of care and reduce costs. This course provides a strong foundation in healthcare payment models, which are a key factor in determining the cost and quality of healthcare services. By understanding how payment models work, Healthcare Consultants can make informed recommendations to their clients on how to improve their financial performance and patient outcomes.
Healthcare Data Analyst
Healthcare Data Analyst
Healthcare Data Analysts collect, analyze, and interpret healthcare data to identify trends and patterns in healthcare costs, quality, and utilization. They use their findings to develop and implement strategies to improve the efficiency and effectiveness of healthcare delivery. This course provides a strong foundation in healthcare payment models, which are a key factor in determining the cost and quality of healthcare services. By understanding how payment models work, Healthcare Data Analysts can make informed decisions about how to collect, analyze, and interpret data to improve the healthcare system.
Public Health Analyst
Public Health Analyst
Public Health Analysts research and analyze public health data to identify trends and patterns in health outcomes. They use their findings to develop and implement programs to improve the health of populations. This course provides a strong foundation in healthcare payment models, which are a key factor in determining the cost and quality of healthcare services. By understanding how payment models work, Public Health Analysts can make informed decisions about how to design and implement programs that improve the health of populations.
Health Economist
Health Economist
Health Economists apply economic principles to the healthcare industry to analyze the cost, quality, and access to healthcare services. They use their findings to develop recommendations for policymakers on how to improve the healthcare system. This course provides a thorough understanding of healthcare payment models, which are a key component of healthcare economics. By understanding how payment models work, Health Economists can make informed recommendations on how to design policies that improve the healthcare system.
Healthcare Policy Analyst
Healthcare Policy Analyst
Healthcare Policy Analysts research and analyze healthcare policies to identify their impact on the cost, quality, and access to healthcare services. They use their findings to develop recommendations for policymakers on how to improve the healthcare system. This course provides a thorough understanding of healthcare payment models, which are a key component of healthcare policy. By understanding how payment models work, Healthcare Policy Analysts can make informed recommendations on how to design policies that improve the healthcare system.
Healthcare Finance Manager
Healthcare Finance Manager
Healthcare Finance Managers oversee the financial operations of healthcare organizations, including budgeting, forecasting, and financial reporting. They work with senior management to develop and implement financial strategies to improve the financial performance of their organizations. This course provides a strong foundation in healthcare payment models, which are a key factor in determining the cost and quality of healthcare services. By understanding how payment models work, Healthcare Finance Managers can make informed decisions about how to manage the financial resources of their organizations.
Healthcare Administrator
Healthcare Administrator
Healthcare Administrators plan, direct, and coordinate the delivery of healthcare services in a variety of settings, such as hospitals, clinics, and nursing homes. They are responsible for managing the financial and operational aspects of their organizations, including budgeting, staffing, and purchasing. This course provides a strong foundation in healthcare payment models, which are a key factor in determining the cost and quality of healthcare services. By understanding how payment models work, Healthcare Administrators can make informed decisions about how to allocate resources and improve the financial performance of their organizations.
Health Insurance Underwriter
Health Insurance Underwriter
Health Insurance Underwriters assess the risk of insuring individuals and groups for health insurance. They use their knowledge of healthcare costs, payment models, and insurance regulations to determine the appropriate premiums and coverage for each policy. This course provides a comprehensive overview of healthcare payment models, which are essential for Health Insurance Underwriters to understand in order to accurately assess risk and price insurance policies.
Healthcare Actuary
Healthcare Actuary
Healthcare Actuaries use mathematical and statistical techniques to assess the financial risks associated with health insurance plans. They use their findings to develop and price insurance policies, and to make recommendations on how to improve the financial performance of health insurance companies. This course provides a strong foundation in healthcare payment models, which are a key factor in determining the cost and quality of healthcare services. By understanding how payment models work, Healthcare Actuaries can make informed decisions about how to price insurance policies and improve the financial performance of health insurance companies.
Managed Care Analyst
Managed Care Analyst
Managed Care Analysts develop and implement strategies to improve the quality and cost-effectiveness of healthcare services. They work with healthcare providers, insurers, and employers to design and implement care management programs, negotiate contracts, and develop performance improvement initiatives. This course provides a strong foundation in healthcare payment models, which are a key factor in determining the cost and quality of healthcare services. By understanding how payment models work, Managed Care Analysts can make informed decisions about how to design and implement programs that improve the healthcare system.
Health Insurance Agent
Health Insurance Agent
Health Insurance Agents sell and service health insurance policies to individuals and groups. They work with clients to assess their needs and find the best coverage options. This course provides a strong foundation in healthcare payment models, which are a key factor in determining the cost and quality of healthcare services. By understanding how payment models work, Health Insurance Agents can make informed recommendations to their clients on how to find the best coverage options for their needs.
Healthcare Information Manager
Healthcare Information Manager
Healthcare Information Managers oversee the collection, storage, and use of healthcare data. They work with healthcare providers, insurers, and other stakeholders to develop and implement systems to improve the quality and efficiency of healthcare delivery. This course provides a strong foundation in healthcare payment models, which are a key factor in determining the cost and quality of healthcare services. By understanding how payment models work, Healthcare Information Managers can make informed decisions about how to collect, store, and use data to improve the healthcare system.
Health Policy Researcher
Health Policy Researcher
Health Policy Researchers study the impact of health policies on the cost, quality, and access to healthcare services. They use their findings to develop recommendations for policymakers on how to improve the healthcare system. This course provides a thorough understanding of healthcare payment models, which are a key component of healthcare policy. By understanding how payment models work, Health Policy Researchers can make informed recommendations on how to design policies that improve the healthcare system.
Healthcare Executive
Healthcare Executive
Healthcare Executives oversee the operations of healthcare organizations, including hospitals, clinics, and nursing homes. They are responsible for developing and implementing strategies to improve the financial performance and quality of care of their organizations. This course provides a strong foundation in healthcare payment models, which are a key factor in determining the cost and quality of healthcare services. By understanding how payment models work, Healthcare Executives can make informed decisions about how to manage their organizations to improve the healthcare system.
Healthcare Provider
Healthcare Provider
Healthcare Providers provide medical care to patients, including physicians, nurses, and pharmacists. They work with patients to diagnose and treat illnesses and injuries, and to promote health and wellness. This course provides a strong foundation in healthcare payment models, which are a key factor in determining the cost and quality of healthcare services. By understanding how payment models work, Healthcare Providers can make informed decisions about how to provide care to their patients in a cost-effective and efficient manner.
For more career information including salaries, visit:
OpenCourser.com/course/s6bo97/future
Reading list
We've selected ten books
that we think will supplement your
learning. Use these to
develop background knowledge, enrich your coursework, and gain a
deeper understanding of the topics covered in
Future Healthcare Payment Models.
Provides a comprehensive introduction to the field of healthcare economics and policy, covering topics such as healthcare financing, healthcare delivery, and healthcare regulation.
Applies disruptive innovation theory to the healthcare industry, providing insights into how to improve healthcare delivery and outcomes.
Provides a framework for understanding and addressing the challenges facing the healthcare system. It valuable resource for anyone who is interested in transforming healthcare delivery.
Provides a comprehensive overview of the Affordable Care Act (ACA) and its impact on the healthcare system. It valuable resource for anyone who wants to understand the ACA and its implications for healthcare delivery.
Covers the emerging field of precision medicine, which uses genetic information to tailor medical treatment to individual patients.
Save
Provides a vision of the future of healthcare. It valuable resource for anyone who wants to understand the technological and social forces that are shaping the future of healthcare.
Provides an overview of the economics of health and medical care, covering topics such as the demand for health care, the supply of health care, and the regulation of health care.
Provides a personal perspective on the future of medicine. It valuable resource for anyone who wants to understand the ways in which technology is changing the healthcare system.
Save
Provides a global perspective on the health gap. It valuable resource for anyone who wants to understand the social and economic factors that contribute to health inequalities.
Provides a comprehensive overview of the health and human rights in a changing world. It valuable resource for anyone who wants to understand the ethical and legal dimensions of healthcare.
For more information about how these books relate to this course, visit:
OpenCourser.com/course/s6bo97/future
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Level
Introductory
Via
Coursera
Institution
Northeastern University
Instructor
Rina Vertes
Language
English
Transcripts
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This course belongs to a
collection
called
Healthcare Trends for Business Professionals. It's comprised of four courses:
Good to know
Provides an overview of healthcare spending, drivers, and trends for various stakeholders, including providers, insurers, and purchasers
Examines the Affordable Care Act (ACA) and its impact on insurance markets, healthcare costs, and payment models
Analyzes the shortcomings of Fee-for-Service payment models and introduces alternative value-based payment models
Presents real-world scenarios and case studies to illustrate the application of payment models and strategies
Taught by experienced healthcare professionals with extensive knowledge in the field
Offers a comprehensive understanding of payment strategies and models in healthcare
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