Healthcare Ecosystems Course Map PDF

**D391 Healthcare Ecosystems Course Map** **Course Learning Objectives** **Identifies Elements of the Healthcare Ecosystems:** The learner examines how elements of the healthcare ecosystem relate to accessible, affordable, quality care for clients. **Identifies Insurance Regulations:** The learne...

**D391 Healthcare Ecosystems Course Map** **Course Learning Objectives** **Identifies Elements of the Healthcare Ecosystems:** The learner examines how elements of the healthcare ecosystem relate to accessible, affordable, quality care for clients. **Identifies Insurance Regulations:** The learner identifies insurance regulations and reimbursement procedures for affordable quality care. **Applies Processes for Delivery of Healthcare Services:** The learner applies processes for the delivery of efficient and quality healthcare services. **[Instructions: To support your success in this course please complete the following:]** ☐Complete Course Planning Tool ☐Click on Explore Cohort Offerings. Sign up for live or recorded cohort. ☐Checkout Course Announcements and Tips for important course information **Section 1** **Competency:** Examine Elements of the Healthcare Ecosystem **Essential Question:** - What is the healthcare ecosystem? - How do the elements of the healthcare ecosystem work together? - What roles do health and human services workers have within the U.S. healthcare ecosystem? Main Ideas ------------ -- **Questions** 1. What are the key components that comprise the complex healthcare ecosystem in the United States, as outlined by Wagner (2021), and how do these diverse stakeholders collaborate to deliver effective healthcare services across different stages of patient care? 2. Explain the various positions and responsibilities of healthcare workers. 3. Identify and describe the 5 P's of the U.S. Healthcare Ecosystem. 4. What is the purpose of the Healthcare Ecosystem? 5. How does the field of health and human services contribute to societal well-being through its diverse range of professions, from public health educators promoting preventative measures to social services administrators ensuring timely and effective support for individuals and communities? **Key Terms** 1. Healthcare Ecosystem 2. Healthcare System 3. Stakeholders **Notes for Lesson 2** **Essential Question:** - Where do patients find healthcare services to fit their needs? - Main Ideas ------------ -- **Questions** 1. What are the primary considerations consumers have regarding access to healthcare services, beyond just appointment availability, as outlined by physicians? How do factors like convenience of access sites and costs under high-deductible health plans influence their healthcare decisions? 2. Provide an overview of how Stanfield\'s Introduction to Health Professions categorizes healthcare systems, and explain how these systems aim to meet the diverse needs of patients? 3. How do the U.S. Department of Health and Human Services and its subagencies contribute to establishing safety guidelines that ensure quality patient care? 4. What insights does \"The United States Healthcare System: Overview, Driving Forces, and Outlook for the Future\" provide regarding the role of physicians within the healthcare system, and what are the educational requirements necessary to pursue a career as a physician in the United States? 5. How do government agencies, particularly the Department of Health and Human Services, uphold patients\' rights to receive comprehensive information about their healthcare, ensure economic responsibility from healthcare providers, and address patient grievances in cases of rights violations? **Notes for Lesson 3** **Essential Question:** - What roles do health providers play in the healthcare ecosystem? - Why are institutional providers necessary in the healthcare ecosystem? Main Ideas ------------ -- **Questions** 1. How do nonclinical healthcare positions, support both clinical staff and healthcare organizations, and what role do professionals like social workers play in bridging clinical and nonclinical aspects of patient care? 2. Identify and describe the Providers in the Healthcare Ecosystem. 3. Identify and describe the institutional providers in the Healthcare Ecosystem. 4. Explain the requirements for a nurse in terms of education and training. 5. Explain what institutional providers are. **Key terms** 1. Provider **Notes for Lesson 4** **Essential Question:** 1. How do healthcare producers impact the purposes of the healthcare ecosystem? 2. How do costs impact products and producers? Main Ideas ------------ -- **Questions** 1. What is the impact of technology on the U.S. Healthcare Ecosystem as described on Chapter 10? 2. Explain what medical suppliers are and the impact in the healthcare ecosystem. 3. Identify and describe the categories of health services. 4. What is the integrated healthcare model? 5. Which government agency plays a central role in regulating the complex components of the healthcare system in the United States, including providers, products, payers, and regulations, and what are the key functions of its eleven subsidiary agencies? **Key Terms** 1. Healthcare Producers 2. Product 3. Licensure **Notes for Lesson 5** **Essential Question:** 1. What are the payer options in the U.S. healthcare system? Main Ideas ------------ -- **Questions** 1. Explain the differences between payers, purchasers, and investors. 2. What is Employer-Provided Instruance? 3. Explain the difference between Medicare and Medicaid. 4. What are Self-Pay Programs? 5. Explain the differences between payers, purchases, and investors. **Key Terms** 1. Payers 2. Purchasers 3. Investors **Notes for Lesson 6** **Essential Question:** - What is the importance of regulators in the healthcare system? - What government agency establishes guidelines and policies that benefit patients, healthcare organizations, and the healthcare system? Main Ideas ------------ -- **Questions** 1. What is the U.S. Department of Health and Human Services and the subagencies that regulate and provide safety guidelines for patient care? 2. Identify and describe the difference between: HOMs, MCOs, HRRP and ACOs found in Chapter 2 (pages 12-16) in Lesson 6.1. 3. Explain the different Acts found in Chapter 13 (pp.434-438) in Lesson 6.2. **Key terms** 1. National Committee for Quality Assurance 2. Joint Commission on Accreditation of Healthcare Organizations 3. U.S. Department of Health and Human Services 4. Government Regulations **Section 2** Competency: **Identify Insurance Regulations** The learner identifies insurance regulations and reimbursement procedures for affordable quality care. **Notes for Lesson 1** **Essential Question:** - How do the fundamental principles of insurance payer models determine healthcare accessibility and affordability? - Does healthcare coverage protect a person from unexpected injury or illness? - Is value-based care a solution for payers\' challenges? Main Ideas ------------ -- **Questions** 1. After reviewing the models (Lesson 1.1), can you identify which is closest to your health insurance? Do you see the benefits of your policy? 2. What are the key differences between the Bismarck, Beveridge, national health insurance, and out-of-pocket healthcare funding models, and how does the United States\' hybrid approach incorporate elements from each of these models? 3. How did the evolution from the fee-for-service (FFS) model to health maintenance organizations (HMOs) and subsequently to value-based care (VBC) models impact healthcare delivery in the United States, particularly in terms of cost control, quality improvement, and accountability for providers? 4. Explain and describe the challenge of health plans (Lesson 1.2, Chapter 8, pages 253-257). 5. Identify and describe value-based care. **Key terms** 1. Health Insurance 2. Fee-For-Service 3. Health Maintenance Organizations 4. Insurance Risk 5. Insurance Expenses 6. Moral Hazards 7. Adverse Selection 8. Value-Based Care 9. Wellness and Prevention **Notes for Lesson 2** **Essential Question:** - Do current government regulations protect all Americans? - Main Ideas ------------ -- **Questions** 1. How do the False Claims Act and the Anti-Kickback Statute regulate and prevent fraudulent practices in the healthcare industry? 2. What are the potential consequences for physicians and healthcare providers who violate these laws, as described in Wagner (2021)? 3. How did the Patient Protection and Affordable Care Act (ACA) of 2010, expand healthcare coverage in the United States across government, employer, and individual plans? 4. What specific benefits and provisions did it introduce for Medicaid coverage and income-based credits? 5. How does the Health Insurance Portability and Accountability Act (HIPAA), enacted under the Clinton Administration in 1996, protect patient privacy and prevent discrimination based on pre-existing conditions during changes in employment or insurance coverage, as discussed in WHO (2020)? 6. Additionally, what role do antitrust laws play in ensuring insurance companies operate ethically and competitively to benefit consumers? **Key Terms** 1. Legislation 2. Affordable Care Act **Notes for Lesson 3** **Essential Question:** - What is the difference in coverage between Medicare Parts A, B, C, and D? - What is the federal government\'s role in regulations and reimbursements? Main Ideas ------------ -- **Questions** 1. Explain the history of Medicare. 2. What are the components of Medicare? 3. Identify and describe Medicare Regulations. 4. How do the Federal Trade Commission (FTC) and the Internal Revenue Service (IRS) each play distinct roles in regulating and supporting Medicare Advantage (MA) plans, as outlined by Cross & McWay (2020)? 5. Provide an overview of Tricare. **Key terms** 1. Medicare 2. Reimbursement 3. Food and Drug Administration 4. Federal Trade Commission **Notes for Lesson 4** **Essential Question:** - Who regulates Medicaid: state or federal agencies? - Main Ideas ------------ -- **Questions** 1. Provide an overview of State Insurance 2. Identify and describe the multiple options that Medicaid has under the Patient Protection and Affordable Care Act. 3. How do the Centers for Medicare and Medicaid Services (CMS) collaborate with state agencies to establish and enforce regulations that safeguard Medicaid recipients and ensure compliance with Medicaid Managed Care organizations (MCOs), as discussed by Wagner (2021)? 4. How do federal and state regulations collaborate to shape Medicaid eligibility, operations, and reimbursement policies across the United States, and what role does CMS play in overseeing and approving state Medicaid plans and MCO applications, as discussed by Cross & McWay? 5. Explain reimbursement procedures. **Key terms** 1. Medicaid 2. Children Health Insurance Program **Notes for Lesson 5** **Essential Question:** - Under the ACA, what changes were made to group insurance plans? Main Ideas ------------ -- **Questions** 1. How do employer-sponsored health insurance plans, including group insurance and individual policies, differ in terms of cost-sharing and eligibility for government subsidies under the ACA? 2. What are the main distinctions between health maintenance organizations (HMOs), preferred provider organizations (PPOs), exclusive provider organizations (EPOs), and point-of-service (POS) plans, particularly in terms of in-network versus out-of-network coverage and provider requirements, as explained in WHO (2021)? 3. Explain private insurance and the different types of coverage. 4. What is the differences between ERISA and HIPAA? 5. What are the effects of premiums, cost sharing, and out-of-pocket expenses (WHO, 2020)? **Key terms** 1. Group Health Insurance 2. Health Savings Account 3. Cost Sharing 4. Premiums **Notes for Lesson 6** **Essential Question:** - What are the similarities between managed care organizations and private insurance? - Who benefits from self-pay insurance? Main Ideas ------------ -- **Questions** 1. What are the benefits of ACA quality programs with HMOs? 2. What financial essentials should be considered for PPOs despite the fewer restrictions on seeing out-of-network providers? 3. Identify the pros and cons of concierge medicine. 4. Explain the Surprise Billing Act. 5. Explain the impact of the Affordable Care Act on healthcare. **Key terms** 1. Reimbursement 2. Self-Pay **Section 3** Competency: **Applies Processes for Quality Healthcare Services**\ The learner applies processes for the delivery of efficient and quality healthcare services. **Notes for Lesson 1** **Essential Question:** - What are some of the factors that affect healthcare efficiency and quality? Main Ideas ------------ -- **Questions** 1. Define and describe the PDSA in quality process. 2. Define and describe STEEEP in quality process. 3. How do healthcare workers positively impact clients? 4. What is quality of care? 5. Define and describe the six dimensions of Healthcare Quality. **Key terms** 1. Efficiency 2. Quality **Notes for Lesson 2** **Essential Question:** - How does the SHARE Approach to decision-making contribute to patient-centered care? Main Ideas ------------ -- **Questions** 1. Identify and describe each step in the SHARE approach. 2. What are three benefits of the SHARE approach? 3. Explain the difference between programmed and nonprogrammed decisions. 4. Identify and define the steps of rational decision making. Provide a scenario this form of decision making can be applied to. 5. Explain what decision making involves. **Key terms** 1. SHARE approach **Notes for Lesson 3** **Essential Question:** - How can the DECIDE model be applied to decision-making to improve client outcomes? Main Ideas ------------ -- **Questions** 1. Why is it importance to collaborate on health decisions? 2. Identify and define each step in the DECIDE model. 3. Apply the DECIDE model to a real-world decision. (ex. Purchasing a car). Define and explain each step in the process. **Key terms** 1. DECIDE Model **Notes for Lesson 4** **Essential Question:** - What is the purpose of the Quadruple Aim framework? Main Ideas ------------ -- **Questions** 1. How can healthcare teams improve client experiences using the Quadruple Aim framework? 2. Identify and describe three advantages of the Quadruple Aim framework. 3. Explain the relationship between Quadruple Aim and Value-Based Care. **Key Terms** 1. Quadruple Aim framework **Notes for Lesson 5** **Essential Question:** - What types of services do patients and clients need to improve outcomes? - What types of services do patients and clients need to improve outcomes? Main Ideas ------------ -- **Questions** 1. What are the type of services clients need? 2. Explain and provide two examples of programmatic Community Services. 3. How does medical transportation positively impact communities? 4. Identify and describe resources for decision-making. 5. Explain the significance of Health Information Exchange. **Key terms** 1. Programmatic Community Services 2. Electronic Medical Record 3. Health Information Exchange **Notes for Lesson 6** **Essential Question:** - How does telemedicine contribute to a more efficient and better quality of service? Main Ideas ------------ -- **Questions** 1. What is telemedicine? 2. How has the implementation impacted healthcare? 3. What are the benefits of telemedicine? 4. Describe the connection of telemedicine and decision-making. 5. Explain the reason for growth in medical technology related to consumer demand. **Key terms** 1. Telehealth 2. Telemedicine