Impact Lives

PBHL 6302 Organizational Resource Management


Discover how the business of health care helps make health care work.

Format: Online
Duration: 8 weeks

Today many insurance programs are under a "Managed Care Umbrella," meaning that freedom of movement inside the health care system is more controlled. MPH 6080 The Business of Health Care explores current topics in the business of delivering health services in the U.S. including insurance, privacy of information, accountable care organizations and financing structures.

This course deals with the intricacies of health care. You'll learn about the many health care categories, coverages, reimbursement methods and costs. You'll look at the infrastructure of health care organizations and analyze the effects of state and federal regulations.

You'll participate in weekly discussions on timely issues like health care privacy. These discussions allow you to interact with fellow classmates and give you valuable insights into the business of health care.

What You'll Learn in MPH 6080

This course provides an overview about health care in the United States. It covers government programs, government grants, insurance companies, the managed care environment and HIPAA.

You'll gain an in-depth understanding of how health care works in the U.S. through a greater understanding of physician and hospital structures, reimbursement models, insurance operations and managed care. In addition, you'll learn how HIPAA can lower administrative costs, particularly those associated with paper transactions and electronic technology.

Finally, you'll explore the newer dimensions of health care: The Affordable Care Act of 2010, ICD-10 diagnosis coding, Quality initiatives in health care and "meaningful use," health insurance exchanges (HIEs) and Health information exchanges and accountable care organizations (ACOs).

Course Topics

Throughout this course, weekly topics may include but are not limited to:

  • The Origins of Managed Care Organizations (MCOs)
  • The Managed Care Umbrella
  • The Payer World
  • The Provider World
  • Risk and Reimbursement: Payment Methodologies for Hospitals and Physicians
  • New Initiatives in Health Care
  • Grant Funding
  • Privacy in Health Care: HIPAA and the Importance of Confidentiality

Course Learning Outcomes

Upon completion of MPH 6080 The Business of Health Care, you will be able to:

  • Explain the origins of managed care.
  • Examine the current payer systems: managed care, fee-for-service insurance, Medicare and Medicaid.
  • Compare and contrast the differing infrastructures within these business organizations.
  • Apply your understanding of provider networks and utilization management when negotiating a managed care contract.
  • Compute provider reimbursements using one or more reimbursement methodologies across various provider types.
  • Contrast and compare different contracting and risk arrangements.
  • Differentiate across the new dimensions in health care:  Accountable Care Organizations, Health Insurance Exchanges and Health Information Exchanges.
  • Forecast transformations in the health care industry by utilizing quality initiatives, meaningful use and electronic health records.
  • Analyze the significance of privacy and HIPAA through a variety of health care settings.
  • Analyze the objectives of the administrative simplification provisions.

Request More Information

To learn more about the online Master of Public Health curriculum from Benedictine University, including The Business of Health Care, call (866) 295-3104 to speak with a program manager or request more information.