Topics:

• Fundamentals of the U.S. health care system
• The roles and relationships among the parties: providers, purchasers, insurers, consumers, legislators and regulators
• Health care insurance structures and products
• National spending and health status
• Managed care structures, functions and operations
• The evolution of managed care as an alternative system and a response to marketplace forces
• Typology of managed care organizations and insurance products
• Functions and infrastructure of health plans
• Health plans' relationships and financial arrangements with delivery systems and physicians
• Trends in managed care

Content and topic goals:The more complex our nation's health care delivery system and financing mechanisms become, the more important it is for health care professionals to understand the system in which they practice. Understanding the larger forces that influence their decisions and actions - forces like capitation and performance measurement - helps clinicians practice more effectively and gives them the means to help create change. Health care professionals also should be aware of the trends in spending and insurance that drive politics and policy. This part of the curriculum is designed to teach both how the system impacts practitioners, and how practitioners can impact the system. More specifically, virtually every health care practice in America is affected by managed care. This topic area considers the organizations and structures that have defined managed care for consumers, purchasers and providers. It goes on to trace the continuing evolution of managed care from institutions separate from the delivery system to a set of functions and a style of practice increasingly adopted by providers and their organizations. This knowledge will help clinicians interact more effectively with health plans and achieve the care management goals of their own groups and systems.