Faculty
Professors Paul B. Gardent, Michael Zubkoff
Objectives
Course Description
The course is intended to (1) illustrate the applicability of management concepts and techniques to the health care industry, (2) demonstrate how corporate leaders can exercise judgment and control over expenditures for health care benefits while protecting the health of the employees, and (3) enhance the ability of managers to serve as trustees and directors of health care organizations. Health care is a major area of interest for business leaders today and in the future. Health care represents the largest sector of the US economy with health care spending now at 16% of the gross domestic product and projected to be at 20% by 2015. Health care organizations, and corporations serving those organizations, are a major business sector offering significant career opportunities in management. Bio-Tech research and development is one of the most active areas of entrepreneurial and small business activity. Health care represents a major focus for investment banking and consulting. And health care benefits and financing is a major issue of concern for all US businesses and is now a major political issue.
The characteristics and components of the US health care system and their interactions and determinants will be analyzed. Particular emphasis will be on health system performance and value, and understanding the underlying issue of unwarranted variation in US health care services. The history of corporate and governmental intervention in health care will be reviewed. The importance of understanding the medical market dynamics and the options for data-driven strategies for market reform will be stressed. Case examples will highlight the use of new analytic techniques for understanding and managing medical markets. Outside speakers will bring a diversity of perspectives on the major issues facing health care today. A project will be an important part of the course.
Course Objectives:
Medical Care and the Corporation will introduce students to the structure, organization and financing of health care in relationship to business and the economy. Following this course students will understand;
• the structure, organization and financing of the health care industry including the unique aspects of this sector of the economy,
• the critical issues facing US health care including the challenges of costs, quality and access
• the underlying issues of unwarranted variation in health care services including effective care, preference sensitive care and supply sensitive care,
• the implications of health care trends and issues for corporations and the economy as they will affect business leaders and,
• the major US health care public policy issues currently being considered and the advantages and disadvantages of major approaches.
Requirements
Attendance
Attendance at each session should be considered mandatory. Please notify the instructors and the assistants before class, by any means available, if you are unable to attend a session due to illness, family emergency or a truly unavoidable conflict. If you must miss a class session for an interview, please notify an instructor by e-mail in advance of class..
Group Project
The Group Project is an opportunity for students to work on a real-life issue or problem related to health care. The projects represent the wide diversity of issues and topics within the health care sector, and are sponsored by a diverse group of organizations and businesses. The project is intended to allow you to apply management concepts and skills to a real-life health care business issue (or issues) which is considered important to your clients. Each project team will produce a written report for the client that will also be handed in as part of the course requirements. In addition, each team will give a project presentation on November 19.
Successful projects will demonstrate an ability to apply management concepts, health care knowledge and expertise to the problem or issue, demonstrate knowledge and understanding of a specific area or topic within health care, use an effective method and approach to address the issue and produce a professional an expert report which is worthwhile to the client.
A list of proposed projects will be reviewed at the first class. Detailed summaries of the projects will also be distributed and listed on Blackboard and Tuck Streams. Students will be asked to rank their top three projects to work on. Based on these rankings the instructors will develop project teams made up of two to four students. This course includes students from Tuck, DMS, and TDI. In forming the teams we will seek to have a good diversity of students from each group. Past students have indicated that a valuable part of the course was the opportunity to work and learn with students from these different graduate programs.
Project Timetable:
Thursday, September 17
In-class review of project assignment and overview of projects
Monday, September 21
Project ranking due to Katy Milligan no later than Noon
Tuesday, September 22
Project teams established
Wednesday, September 23
Coordinate plans for team meetings
Wednesday, September 30
Finalize project scope with client
Wednesday, October 14
One page progress report due to Merilee Perkins no later than Noon
Friday, November 13
Send Project Executive Summary and Final Project Presentation to Merilee Perkins via Email by Noon
Thursday, November 19
Class project presentations to guest faculty, clients and peers
Laptop Computers
Experience has taught us that use of laptops during class disengages users, and distracts other students and presenters. As a courtesy to all parties, we strongly request that no one use laptop computers during class. If you must use your computer during class to access the internet or your mail, please step out of the room.
Class Participation:
The course pack contains Schedule at a Glance, assigned readings and course materials. Classroom time will predominantly revolve around guest speaker presentations, associated readings and/or a group activity that will require prior attention to course materials. For the class to work well and for you to benefit maximally, preparation for each class meeting is critical. All students are expected to arrive at the class on time and prepared to participate.
The classroom is a forum for all students to test and challenge course materials, ideas and concepts. Class participation will be evaluated on the quality and intellectual integrity of student argument and discussion. As all students in this class have valuable contributions to make, every question and comment will be welcomed. . Following each class and prior to Friday at 5:00 pm, students are expected to submit “session take-aways”. These “take-aways” are your thoughts, observations or conclusions of the ideas and concepts presented in the session and session readings. The “take-aways” should include one to three observations and be no more than one page. The “take-aways” are not a description or summary of the session but your thoughtful observations and response to the session.
Materials
Cases and Readings
All cases and readings are required, and are on the attached class schedule and reading list. If the articles are available on the web for download web links are provided. If electronic copies are not available, hard copies are included in the course pack.
Additional readings, if assigned, will be posted on Tuck Streams and Blackboard at least one week prior to class. Notices of additional materials will be emailed to you. In an effort to reduce wasted resources and paper, please let Merilee Perkins know if you prefer to receive hard copies of the reading materials. Students are encouraged to find supplemental materials that speak to discussion topics for each class, based on their background and interest.
Course Textbooks:
Readings are an important part of the course. We use a combination of texts and articles. Frequently the guest speakers have asked that students read specific articles prior to their talk.
The course texts are:
Redefining HealthCare: Creating Value-Based Competition on Results, Michael Porter & Elizabeth Teisberg, Harvard Business School Press, 2006 (Porter/Teisberg)
Who Killed Health Care, Regina Herzlinger, McGraw-Hill, 2007 (Hertzlinger)
Understanding Health Policy: A Clinical Approach (fifth edition), Thomas S. Bodenheimer, Kevin Grumbach, McGraw-Hill, 2009 (Bodenheimber/Grumbach)
Honor Principle
Much of the success of this course is dependent upon good student interaction; therefore group work in preparing for cases and class discussions is encouraged. Students are expected to prepare and attend all class sessions unless prior arrangements are made. Projects may be completed individually or in groups. For group projects, each participant is expected to make a significant contribution to the project and all members of the group will receive an identical project grade, unless there are extraordinary circumstances. The take-home exam is to be completed individually, without consultation.
Office Hours
By appointment only.
Grading
Exam 33.3%
Project Paper and Presentation 33.3%
Class Participation, including session take-aways 33.3%
CREDIT FOR AUDITING
For Residents, Fellows and DMS I &II Students
• Active participation in six (6) of the nine (9) weekly sessions
• One-third of the readings (to be designated by professor)
• Full class participation, including session take aways
Exam
There will be a final take home exam with a time limit at the end of the course. The final exam is due to Merilee Perkins, via email no later than noon on November 23.
Schedule
Session 1:
Thursday 9/17
Project Reminder:
Project rankings due to Katy Milligan no later than noon Monday, 9/21
Text Book Readings
1. Porter-Teisberg, Introduction & Chapters 1 & 2
2. Hertzlinger, Introduction & Chapter 1
3. Bodenheimber/Grumbach, Introduction, Chapters 5 & 6
Selected Required Articles
4. High and Rising Health Care Costs Parts 1-4, T Bodenheimer, Annals of Internal Medicine,
Part 1: May 17, 2005, Vol. 142, No 10; p.847 - 854
Part 2: June 7, 2005 Vol. 142, No 11; p.932 - 937
Part 3: June 21, 2005, Vol. 142, No 12; p.996 - 1002
Part 4: July 5, Vol. 143, No, 1; p.26 – 31
5. Potential Health and Economic Consequences of Misplaced Priorities, SH Woolf, JAMA, 2007. 297(5): p. 523-526
6. The Cost Conundrum: What a Texas Town Can Teach us About Health Care, Gawande, A., The New Yorker, 2009 (June 1, 2009), p. 36
Hard copy not available. Please download from the web:
Session 2: Wednesday, 9/23
Project Reminder:
Project team meetings at end of class
Text Book Readings
1. Porter/Teisberg, Chapter 3
2. Hertzlinger, Chapters 2 – 4
3. Bodenheimber/Grumbach, Chapters 2, 4 & 9
Selected Required Articles
4. Employer-sponsored health Insurance in the United States – Origins & Implications, Blumenthal, D., NEJM, 2006. 355(1): p. 82-88
5. Employer-Sponsored Insurance - Riding the Health Care Tiger, D Blumenthal, NEJM, 2006. 355(2): p. 195-202
6. Universal Principles for Health Care Reform, D. Farrell, N. Henke, P. Mango, The McKinsey Quarterly, 2007, No 1
7. Three Imperatives for Improving US Health Care, P. Mango, V. Riefberg, The McKinsey Quarterly, December 2008
8. Why Understanding Medical Risk is Key to US Health Reform, O. Adigozel, T. Pellathy, S. Signhal
Session 3: Wednesday, 9/30
WORK TO DO PRIOR TO CLASS:
GO TO WWW.HOWSYOURHEALTH.ORG AND COMPLETE A SURVEY FOR 1) YOURSELF AND 2) A FAMILY MEMBER WHO IS OLDER AND SICKER. ALSO COMPLETE A PERSONAL HEALTH RECORD.
Project Reminder:
Finalize Project Scope with client
Text Book Readings
1. Porter/Teisberg, Chapter 4 & 7
2. Bodenheimer/Grumbach, Chapters 3 & 8
Selected Required Articles
3. Why Employers Need to Rethink How They Buy Health Care, Galvin RS, Delbanco S. Health Aff (Millwood) 2005;24: p.1549-1554
4. Wellness Programs and Lifestyle Discrimination – The Legal Limits, M Mello, M Rosenthal, New England Journal of Medicine, July 2008 359;2; p.192-198
5. Faith and Credit: Forgoing Insurance, Mr. Selby Bargains For His Health Care; Shopping Around, He Finds Discounts on Treatments, Pay Upfront, get 30% Off; A deal on Gallbladder Surgery, L Lagnado L. The Wall Street Journal, 2004. November 24: p. A.1
6. Health IT – More than EMR, Essay by Zastrow, R
7. How American Health Care Killed My Father, Goldhill, D, The Atlantic Online, September 2009
Hard copy not available. Please download from the web:
http://www.theatlantic.com/doc/200909/health-care
8. Engaging Quad/Graphics Employees in the Improvement of Their Health and Healthcare, Zastrow, R, Quadracci, Len, Journal of Ambulatory Care Management, July/September 2006, Pages 227 – 232
Optional: Articles On –Line
9. Extra Pounds Mean Insurance Fees for Alabama Workers, Phillip Rawls, Associated Press, Aug 21, 2008 –
http://news.yahoo.com/s/ap/20080822/ap_on_bi_ge/obesity_penalty
Session 4: Wednesday, 10/7
ASSIGNMENT PRIOR TO CLASS:
How Does Your Hometown and Hometown Hospital Stack Up?
Project Reminder:
One page Project Progress Report due to Merilee Perkins by noon 10/14
Text Book Readings
1. Herzlinger, Chapters 5 & 6
Selected Required Articles
2. The Dartmouth Atlas of Health Care 2008: Tracking the Care of Patients with Severe Chronic Illness. 2008: Hanover, NH. p. 1-20
3. Are Hospital Services Rationed in New Haven or Over-Utilized in Boston, J Wennberg, The Lancet, May 23, 1987; p.1185 - 1188
4. Avoiding the Unintended Consequences of Growth in Medical Care: How Might More Be Worse, E Fisher, HG Welch, JAMA, February 3, 1999; p.446 – 453
5. Learning to Deliver Better Health Care. Issues in Science and Technology, Fisher, E., 2008. XXIV(3): p. 58-62
Optional Articles On-Line
6. Geography and the Debate Over Medicare Reform, J Wennberg, E Fisher, J Skinner, Health Affairs Web Exclusive, February 13, 2002.
Hard copy not available. Please Download from the Web:
Session 5: Wednesday, 10/14
ASSIGNMENT PRIOR TO CLASS:
Complete web-based clinical decision aid and bring to class.
Text Book Readings
1. Porter/Teisberg, Chapter 6
Selected Required Articles
1. Give Patients the Tools to Make Good Decision, Managed Care March 2007; p. 41 - 47
2. Informed Patient Choice: Patient-Centered Valuing of Surgical Risks and Benefits, J Weinstein, K Clay, T Morgan, Health Affairs, Vol 26, No 3, May/June 2007; p.726 – 730
3. Toward the ‘Tipping Point’: Decision Aids and Informed Patient Choice, A O’Connor, J Wennberg, F Legare, H Llewllyn-Thomas, B Moulton, K Sepucha, A Sodano, J King, Health Affairs, Vol 26, No 3, May/June 2007; p.716 - 725
4. The Next Step in Guideline Development: Incorporating Patient Preferences, M Krahn, G Naglie, JAMA, July 23/30, 2008, Vol 300, No 4; p.436 – 438
5. Forester Report: Health Dialog: An Integrated Health Management Leader, B Holmes, W McEnroe
Hard copy not available, please download from the web: http://www.healthdialog.com/hd/Segments/HealthPlans/
6. Medical Guesswork: From Heart Surgery to Prostate Care, the Health Industry Knows Little About Which Common Treatments Really Work, Business Week, May 29, 2006
Hard copy not available, please download from web:
http://www.businessweek.com/magazine/content/06_22/b3986001.htm?chan=search
7. Policy Supported for Patienbt-Centered Care: The Need For Measurable Improvements in Decision Quality, K Sepucha, F Fowler Jr., G Mulley Jr, Health Affairs, Web Exclusive, Oct 7, 2004.
Hard copy not available, please download from the web:
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.var.54
8. Modifying Unwarranted Variations in Health Care: Shared Decision Making Using Patient Decision Aids, A O’Connor, H Llewllyn-Thomas, A Flood, Health Affairs, Web Exclusive, October 7, 2004.
Hard copy not available, please download from the web:
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.var.63
Wednesday, 10/10
No Class - Recruitment Week
Monday, 10/26
The Role of Venture Capital
Session 6: Wednesday, 10/28
Text Book Readings
1. Porter/Teisberg, Chapter 5
Selected Required Articles
2. The Quality of Health Care Delivered to Adults in the United States, EA McGlynn, SM Asch, J Adams et al. NEJM 2003; 348 (26):p.2635-2645
3. The Urgent Need to Improve Health Care Quality, M Chassin, RW Galvin and the National Roundtable on Health Care Quality, JAMA, 280(11): 1998; p.1000-1005
4. Median Household Income and Mortality Rate in Cystic Fibrosis, G O’Connor, H Quinton, T Kneeland, R Kahn, T Lever, J Maddock, P Robichaud, M Detzer, D. Swartz, Pediatrics, April 2003; Vol. 111, No. 4; p. e333 - e339
5. The Bell Curve: What happens when patients find out how good their doctors really are?, The New Yorkers, December 6, 2004
Hard copy not available. Please download from the web: http://www.newyorker.com/archive/2004/12/06/041206fa_fact
Monday, 11/2
1) Policy Issues Facing the Nation (Access, Quality, and Costs & Equity) and 2) Contemporary Issues in Biotechnology
Session 7: Wednesday, 11/4
Text Book Readings
1. Porter/Teisberg, Chapter 8
Selected Readings
2. PROLUGUE: Extending the Pay-for-Performance Agenda, Health Affairs, Vol 26, No 6, November/December 2007; p. 1563
3. Extending the P4P Agenda: Part 1: How Medicine Can Improve Patient Decision Making and Reduce Unnecessary Care, J.Wennberg, A O’Connor, ED Collins, J Weinstein, Health Affairs, Vol 26, No 6, November/December 2007; p. 1564 - 1574
4. Extending the P4P Agenda: How Medicine Can Reduce Waste and Improve The Care of the Chronically Ill, J Wennberg, E Fisher, J Skinner, K Bronner, Health Affairs, Vol 26, No 6, November/December 2007; p.1575 - 1585
5. Health Care Reform Requires Accountable Care Systems, S Shortell, L Casalin, JAMA Vol. 300 No. 1, July 2, 2008; p95 – 97
Optional Readings On-Line
6. Creating Accountable Care Organizations: The Extended Hospital Medical Staff, E Fisher, D Staiger, J Bynum, D Gottlieb, Health Affairs Web Exclusive, January/February 2007; 26(1)
Hard copy not available. Please download from the web:
7. Medical Staff Organizations: A Persistent Anomaly, K Smithson, S Baker, Health Affairs, Web Exclusive, December 5, 2006, Health Affairs, 26, no. 1 (2007); w76-w79
Hard copy not available. Please download from the web.
8. Taking Steps Toward Integration, By putting patients’ needs first, health care providers can take steps toward achieving a cohesive delivery system, D Cortese, R Smoldt, Health Affairs, Web Exclusive, December 5, 2006
Hard copy not available. Please download from the web.
Session 8: Wednesday, 11/11
Reminder
Send Project Executive Summary and Final Project Presentation to Merilee Perkins via Email by Noon Friday, November 13
Text Book Readings
1. Herzlinger, Review Chapter 1, Read Chapters 7, 8 & 9
2. Bodenheimber/Grumbach, Chapters 14, 15, 16
Selected Required Articles
3. Innovation in Health Care – Framework, Harvard Business School; R Hertzlinger, N9-306-042, July 21, 2006; p.1 - 55
Session 9: Wednesday, 11/18
Text Book Readings
1. Porter/Teisberg, Conclusion, Appendix A and Appendix B
2. Bodenheimber/Grumbach, Chapter 17
Selected Required Readings
1. Editorial; Health and Health Care for the 21st Century: For All the People, Koop, CE, American Journal of Public Health, Dec 2006; Vol 96, No. 12; p.2090 - 2092
Thursday, 11/19
Class project presentations to guest faculty, clients and peers.
