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Overview

Healthcare Management: An Introduction, (AHM 250) has been written for participants in the Academy for Healthcare Managements self-study examinationbased program. The objective of this introductory course is to provide a survey of health insurance plans their fundamentals, philosophy, and terminology. The course describes the major types of health insurance plans and their products, and it provides an introduction to the major operational areas of health plans. The course concludes with an overview of the impact of legislation and regulation on health plan and a brief discussion of some of the ethical issues impacting the health plan industry. The study materials for AHM 250 include: Healthcare Management: An Introduction, Third Edition, which serves as the Course Manual for AHM 250 Printable Executive Summaries, lesson pre and post tests and the Glossary of Terms, found on the Lesson Introduction page of each lesson.

To aid your self-study of the lessons, this Course includes additional features such as: Learning objectives Figures that illustrate important concepts Insights that provide a real-world perspective on topics presented Glossary

Course Goals and Objectives


AHM 250 Healthcare Management: An Introduction, Third Edition, will help you meet your goals for completing and reinforcing your knowledge of the health insurance plan by: Exploring the evolution of healthcare delivery in the United States. Outlining the basic concepts of health insurance plans. Defining HMOs, PPOs, POS products, and managed indemnity. Examining health plans for specialty services. Identifying the components of integrated delivery systems. Exploring tools and strategies for medical management. Describing healthcare systems management and health plan operations. Examining rating, underwriting, financing, and claims administration in health insurance plan environments. Determining important legislative and regulatory issues in health plans. Exploring ethical issues in health plans.

Overview

CE for Nurses

Disclosure of Significant Relationships with Relevant Commercial Companies and Organizations


AHM 250 Healthcare Management: An Introduction, Third Edition The America's Health Insurance Plans (AHIP) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities disclose significant relationships with commercial companies whose products or services are discussed in educational activities. For sponsors, significant relationships include educational and research grants, institutional agreements for joint initiatives, or other relationships that benefit the institution. For writers, significant relationships include receiving from a commercial company research grants, consultancies, honoraria and travel, and other benefits, or having a self-managed equity interest in a company. Disclosure of a relationship is not intended to suggest or condone bias in the activity, but is stated to provide participants with information that might be of potential importance in their evaluation of the activity. A significant relationship exists with the following individual and/or organization(s): The Academy for Healthcare Management is a Limited Liability Company owned by America's Health Insurance Plans, and the Blue Cross and Blue Shield Association (BCBSA).

Overview

The Academy and Its Education Program


The Academy for Healthcare Management was established in 1997 to offer an industry-wide educational program recognizing the unique challenges, complexities, and opportunities associated with the health insurance plan industry. Formed by three leading healthcare associations, the Academy is committed to providing leading-edge education and professional credentials that recognize healthcare professionals who demonstrate educational excellence. The formation of the Academy represents a partnership among two organizations: the America's Health Insurance Plans and the Blue Cross and Blue Shield Association. These organizations collectively represent more than 1,000 health plans caring for more than 200 million people, and they offer decades of experience in providing continuing education opportunities for insurance and healthcare professionals.

Overview
The Academy and Its Education Program
The Academys Education Program
Course materials for the Academy for Healthcare Managements Education Program are written at the college level and are designed for self-study. The complete

program consists of two levels of study: an Introductory Level and an Advanced Level. Participants who satisfactorily complete each level will attain respected professional designations described in the following sections.

Overview

The Academy and Its Education Program


Introductory Level (Level 1)
Successful completion of the Introductory Level (Level 1) leads to the Professional, Academy for Healthcare Management (PAHM) designation. The Level 1 program is designed to benefit a broad audience at a variety of levels and consists of a single self-study course, Healthcare Management: An Introduction (AHM 250). There are no prerequisites for this course. The curriculum covers: Basic concepts of health insurance plans. Types of health plans and providers. Major operational areas of health plans. Legislative, regulatory, and ethical issues.

Overview

The Academy and Its Education Program


Advanced Level (Level 2)
The Fellow, Academy for Healthcare Management (FAHM) designation, will be earned upon successful completion of both the Introductory Level and the entire Advanced Level (Level 2) curriculum. The FAHM professional designation is the premier credential for anyone working in or with the health insurance plan industry. Participants in Level 2 will be required to display comprehensive knowledge of important functional areas of health plan management, including the following: Governance and Regulation Network Management Health Plan Finance Medical Management

There are no prerequisites or corequisites required for Level 2 courses, and lessons can be taken in any order. Information on Continuing Education credits for the Advanced Level courses may be found in the Academys website at http://www.academyforhealthcare.com/Content/NavigationMenu/Registration/CE_Cr edit/CE_Credit.htm.

Overview
The Academy and Its Education Program

What Can the Academy for Healthcare Managements Education Program Do for You?
The Academy for Healthcare Managements Education Program can provide you with knowledge and skills you need to succeed in the rapidly changing and evolving healthcare industry. The program is designed to benefit a broad audience at a variety of levelsfrom administrative to executive stafffrom a variety of different organizations including health plan organizations, indemnity insurers, provider networks, government agencies, employers, vendors, etc. By participating in the Academys program, you will learn about the unique complexities associated with health plans, and you will stay abreast of the latest trends, developments, and practices. A unique feature of the Academys program is its focus on cutting-edge business issues. By enrolling in Healthcare Management: An Introduction, you will be participating in a new and exciting course. Your participation will signify your commitment to professionalism. Completing the Academys programwhether at the Introductory or the Advanced Levelwill give you a sense of personal accomplishment and the respect of colleagues in your organization and throughout the industry. Not only will you add a new dimension to your career experience, you will also distinguish yourself as a person who is knowledgeable about the environment, products, operations, and issues of the health insurance plan industry.

Overview
The Academy and Its Education Program
Academy for Healthcare Management Headquarters:
Academy for Healthcare Management 601 Pennsylvania Ave., NW South Building, Suite 500 Washington, DC 20004 (202) 955-4386

Sponsoring Associations:
America's Health Insurance Plans

Contact: Charles W. Stellar (202) 778-3201


Blue Cross and Blue Shield Association

Contact: Kathy Wall (312) 297-5969

Overview

Acknowledgements
The development of study and examination materials for a course that covers the broad range of topics covered by this course requires a true team effort. The wide range of topics, as well as the frequent changes in laws and health plan practices, necessitate the contributions of many individuals in order to ensure that the material presents a balanced, accurate portrayal of the health insurance plan industry. The Academy would like to thank the many people who contributed their time, energy,

and considerable talents toward the development of this course and its study materials.

Overview
Acknowledgements
Curriculum Committee
Special thanks go to the members of the Academys Curriculum Committee. Each of the Academys three sponsoring organizations chose leading experts from member organizations to help guide the direction and development of the curriculum for all the Academys courses. These industry leaders have demonstrated remarkable vision and insight in shaping the curriculum for the health insurance plan leaders of tomorrow. The individuals on the Curriculum Committee served as text reviewers for the first edition of this Course Manual. The following members of this committee also participated as reviewers for subsequent editions of this course manual: Steven L. Coulter, M.D., Patricia A. Armocida, R.N., Don W. Bradley, M.D., Annette C. DuclosWatson, R.N., M.B.A., CCM, Sam Havens, J.D., CLU, Suzanne Scroggins, R.N., Cheryl C. Stacey, R.N., CMCE, and Bonnie Suminski, R.N., M.B.A., CPHQ, HIA, MHP, PAHM. Click here for a list of Curriculum Committee members.

Academic Advisor
We are greatly indebted to Peter R. Kongstvedt, M.D., FACP, Partner, Accenture Health & Life Sciences Peter R. Kongstvedt, M.D., FACP, Partner, Ernst & Young, for serving as academic advisor to the Academy. We have benefited from his wisdom and guidance.

Overview
Acknowledgements
Reviewers and Technical Advisors from the Academys Sponsoring Associations
Numerous staff members from the Academys sponsoring associations America's Health Insurance Plans (AHIP), and Blue Cross and Blue Shield Association (BCBSA), have worked diligently under very tight deadlines to provide extremely helpful comments, technical assistance, and review. These staff members are listed here.

Academy for Healthcare Management Board of Directors


Finally on behalf of the Academy and project staff, we wish to recognize the executives who serve on the Academys Board of Directors. Without their vision, wisdom, and support, this course and the Academys program would not be possible.