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Market Based Approaches to Finding Value In Healthcare
2 students
Market Based Approaches to Finding Value In Healthcare
Innovative Approaches to Keep Healthcare Affordable and Accessible for Patients
Created byKent McKinney, MPH
Last updated 2/2025
English
What you'll learn
- How to incorporate value-based design principles into insurance benefit designs while preserving healthcare access and affordability for patients
- Understand the financial language and key financial ratios used by health insurance plans and use these ratios in uniquely designed case studies
- Understand novel approaches to lowering overall health plan costs by integrating value-based principles
- Enhance learning through the use of interactive case studies
- We will run various simulations through the case studies which are designed to provide you direct experience managing P/L, MLRs and capital requirements
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Course content
6 sections • 6 lectures • 5h 13m total length
Requirements
- This course is designed to educate anyone who wants to learn more about value-based concepts and how they may be used to keep health insurance accessible and affordable for health plan members. Participants will benefit the most from course content if they currently maintain some understanding of health insurance marketplace issues including patient access and affordability, cost sharing, pharmacy and medical benefit management, etc.
Description
New health technologies that improve life and cure diseases are entering the marketplace at a rapid pace. While these new cures provide life-saving alternatives across different diseases and medical conditions, their costs place increased pressure on the health system. Through this course, participants will have the unique opportunity to operate and manage all aspects of a health insurance plan, including yet not limited to, managing plan finances and establishing benefit designs. Participants will gain an appreciation for the intricacies of how all operational aspects of plan management fit together and must be managed with precision for the health plan to remain viable. As with a real, operating health plan, the course will culminate with the production of a Certificate of Coverage suitable for issue to prospective health plan members.
Participants who successfully complete this course will be able to:
1. Utilize their analytical thinking skills through the analysis of various internal and external data sets in order to make strategic decisions pertaining to health plan management.
2. Produce significant health plan deliverables such as plan benefit designs and certificates of coverage.
3. Hone their financial management acuity though the management of key health plan financial functions such as medical loss ratios, capital adequacy requirements and general fund balances.
4. Develop member health policies at the population level by managing the population health status and chronic diseases of health plan members.
5. Strategically and successfully navigate the health plan through all aspects of healthcare reform.
6. Develop team leadership and influence skills with team members during the group project
Who this course is for:
- This course is designed for a wide audience, specifically those who want to learn more about the economic cost pressures health plans are currently experiencing and how value-based benefit design may present an opportunity to lower costs and improve patient outcomes. To this end, health policy professional, consultants, health insurance plans, pharmaceutical manufacturers, students and physicians represent just few specialties who may benefit.
- We also examine the evolution of managed care pharmacy and the key potential future role that pharmacists will play in keeping insurance acceccible and affordable.
- Health plan administrators designing pharmacy and medical benefits will understand the key role of harmonizing both products to produce better patient health outcomes and lower health plan costs.