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Managed Care for Commercial, Medicare and Medicaid Populations

In this course, you will study the factors that impact emerging managed care product lines and competing alternative delivery systems. You will examine managed care market penetration in various markets and the strategic responses of hospitals, healthcare providers, integrated delivery systems and others.

Coursework Highlights

Coursework is designed for engagement and collaboration. Here is an example of just some of the assignments and projects you will complete as part of HCMG 7380.

  • Write a research paper based on a chosen topic, including a summary presentation.
  • Create PowerPoint presentations on topics like special markets.

Course Topics

Throughout each week of the course, you will focus on a core topic or theme. Sample topics from HCMG 7380 are listed below and are subject to change based on the instructor.

  • Network Contracting and Provider Payment
  • Management of Utilization and Quality
  • Management of Utilization and Quality (Continued)
  • Sales, Finance and Administration
  • Special Markets
  • Laws and Regulations

Learning Outcomes

Upon completion of HCMG 7380 students will be able to:

  • Demonstrate an understanding of key concepts, components, determinants, and issues associated with health, the health care industry, and health services management in the US.
  • Demonstrate an understanding of the major components, characteristics, and general organizational processes of various types of managed care models occurring in the marketplace.
  • Demonstrate an understanding of the major administrative, organizational, and operational factors related to recruiting, credentialing, and compensating primary care physicians in open and closed panel managed care health plans.
  • Demonstrate an understanding of management issues and techniques involved in negotiating and contracting with consulting specialists, hospitals, and other institutions.
  • Demonstrate an understanding of the administrative characteristics and management issues involved in major contemporary approaches to controlling utilization of services in managed care organizations.
  • Demonstrate an understanding of the administrative characteristics, institutional processes and management issues associated with contemporary organizational approaches to assuring quality of care and assessing institutional, provider, and contract performance.
  • Demonstrate an understanding of the issues and factors involved in developing managed care contracts for Medicare and Medicaid.
  • Demonstrate an ability to critically analyze legal, financial, and operational problems commonly experienced in managed care organizational arrangements.
  • Demonstrate sufficient familiarity with current literature in the field so as to use it effectively in problem-oriented applications in managing contemporary health services delivery organizations.

Get Started

To learn more about this course, or other courses in the online MBA from Our Lady of the Lake University, call 855-275-1082 to speak with an admissions adviser or request more information.

The content presented on this page is representative information for example purposes and is subject to change as course and student needs change over time.

Programs that include this course