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Component 1:Introduction to

Health Care and Public Health

in the U.S.Component Guide

Health IT Workforce CurriculumVersion 4.0/Spring 2016

This material (Comp 1) was developed by Oregon Health & Science University, funded by the

Department of Health and Human Services, Office of the National Coordinator for Health Information

Technology under Award Number 1U24OC000015. This material was updated in 2016 by Oregon Health

and Science University under Award Number 90WT0001.

This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0

International License. To view a copy of this license, visit

http://creativecommons.org/licenses/by-nc-sa/4.0/

http://creativecommons.org/licenses/by-nc-sa/4.0/

Component Number: 1

Component Title:Introduction to Health Care and Public Health in the U.S.

Component Description:This component is a survey of how health care and public health are organized and services delivered in the U.S. It covers public policy, relevant organizations and their interrelationships, professional roles, legal and regulatory issues, and payment systems. It also addresses health reform initiatives in the U.S.

Component Objectives:At the completion of this component, the student will be able to:

1. Define key terms in health care and public health.2. Describe components of health care delivery and health care systems.3. Discuss examples of improvements in public health.4. Define core values and paradigm shifts in U.S. health care.5. Describe the technology used in the delivery and administration of health care.6. Describe the organization of healthcare at the federal, state, and local levels.7. Describe the organization of the VA system and Military Health System.8. Describe the structure and function of hospital clinical and administrative units.9. Describe different types of long-term care facilities, with an emphasis on their

function.10.Describe the organization of clinical health care delivery in the outpatient setting and

the organization of outpatient health care.11.Describe the organization of ancillary health care delivery in the outpatient setting.12.Compare the role of different health care providers, with an emphasis on the delivery

of care in an interdisciplinary setting.13.Describe the history and role of the health insurance industry in financing health care

in the United States, and the federal laws that have influenced the development of the industry.

14.Explain the importance of the health care industry in the U.S. economy and the role of financial management in health care.

15.Describe models of health care financing in the U.S. and in selected other countries.16.Explain the differences among various types of private health insurance and

describe the organization and structure of network-based managed care health insurance programs.

17. Describe the various roles played by government as policy maker, payor, provider, and regulator of health care.

18.Describe the organization and function of Medicare and Medicaid.

Health IT Workforce Curriculum Introduction to Health Care and Public Health in the U.S. 2Version 4.0

19.Describe the revenue cycle and the billing process undertaken by different health care enterprises.

20.Explain the billing and coding processes, and standard code sets used in the claims process.

21. Identify different fee-for-service and episode-of-care reimbursement methodologies used by insurers and health care organizations in the claims process.

22.Review factors responsible for escalating health care expenditures in the U.S.23.Discuss methods of controlling rising medical costs.24.Describe the role of accreditation, regulatory bodies, and professional associations

in health care in the U.S.25.Describe the basic concepts of law in the U.S.: the legal system, sources of law,

classification of laws, the court system, and the trial process.26.Describe legal aspects of medicine involving the Affordable Care Act, professional

standards in health care, medical malpractice, tort reform, and Medicare and Medicaid fraud and abuse.

27.Describe key components of the Health Insurance Portability and Accountability Act (HIPAA) and efforts to promote patient safety in the U.S.

28.Discuss the need for quality clinical documentation for the use of the health record as a legal document, communication tool, and a key to prove compliance for health care organizations.

29.Discuss the main similarities and differences between public and private health.30.Describe the historic timeline and achievements of public health in the U.S.31.Define and discuss key terminology of public health.32. Illustrate the general organization of public health agencies and public health data

flow.33.Evaluate and explain the effect and value of public health.34.Give examples of and explain the general program categories of public health,

including communicable disease, chronic disease, terrorism response, and environmental public health.

35.Discuss the activities and achievements of public health in the realm of communicable disease.

36.Compare and contrast the different types of terrorism and the different public health responses.

37.Describe chronic disease activities and achievements of public health, and the work of public health in the realm of environmental health hazards.

38.Describe the application of evidence-based medicine and clinical practice guidelines39.Discuss quality indicators in medicine.40.Describe the patient-centered medical home and other models of care coordination.41.Define meaningful use (MU) of health information technology in the context of the

Health Information Technology for Economic and Clinical Health (HITECH) act.42.Describe the major goals of meaningful use.


43.Discuss the criteria for Stages 1-3 of meaningful use for eligible professionals, eligible hospitals, and critical access hospitals.

44.Describe the standards specified for MU.45.Discuss the likely evolution of the MU program

Component FilesEach unit within the component includes the following files:

Lectures (voiceover PowerPoint in .mp4 format); PowerPoint slides (Microsoft PowerPoint format), lecture transcripts (Microsoft Word format); and audio files (.mp3 format) for each lecture.

Application activities (discussion questions, assignments, or projects) with answer keys.

Self-assessment questions with answer keys based on identified learning objectives.

Some units may also include additional materials as noted in this document.


Component Units with Objectives and Topics

Unit 1: Introduction and History of Modern Health Care in the U.S.

Description:

This introductory unit covers definitions of terms used in the component, with an emphasis on paradigm shifts in health care, including the transition from physician-centric to patient-centric care, the transition from individual care to interdisciplinary team-based care, and the central role of technology in health care delivery. This unit also emphasizes the core values in U.S. health care.

Objectives:

1. Define key terms in health care and public health.2. Describe components of health care delivery and health care systems.3. Discuss examples of improvements in public health.4. Define core values and paradigm shifts in U.S. health care.5. Describe the technology used in the delivery and administration of health care.

Lectures:

a. Components of Health Care Delivery and Finance (25:54)

b. How Public Health has Improved Health Care (11:35)

c. Core Values and Paradigm Shifts in U.S. Health Care (11:19)

d. Technological Advances in the Administration of Health Care (14:42)

Suggested Readings

Trivedi, A (2016). Overview of Health Care Financing. Merck Manual, Professional Edition. R. Porter. Kenilworth, NJ, Merck Sharp & Dohme Corp.

http://www.merckmanuals.com/professional/special-subjects/financial-issues-in-health-care/overview-of-health-care-financing

Unit 2: Delivering Health Care, Part 1

Description:

This unit depicts the medical model of health care in the U.S., with an overview of the organization of health care and the physical structure of health care delivery in outpatient, inpatient, and long-term care settings, including an overview of the organization of the Veterans Affairs (VA) system. This unit is intended primarily for the student who does not have a background in health care, though the topics of this unit are described at a relatively advanced level.




Objectives:

1. Describe the organization of healthcare at the federal, state, and local levels.2. Describe the organization of the VA system and Military Health System.3. Describe the structure and function of hospital clinical and administrative units.4. Describe different types of long-term care facilities, with an emphasis on their

function.

Lectures:

a. Organization of Health Care and the Federal, State, and Local Levels (20:25)

b. The Organization of the VA and Military Health Systems (17:46)

c. Structure and Function of Health Care Facilities and Hospital Units (20:30)

d. Long-term Care Facilities (20:27)

Suggested Readings

O'Leary, Margaret R., and Joint Commission on Accreditation of Healthcare Organizations. Lexikon: Dictionary of Health Care Terms, Organizations, and Acronyms for the Era of Reform. Oakbrook Terrace, Ill.: Joint Commission on Accreditation of Healthcare Organizations, 1994. Print.

Siegler, Eugenia L., Mirafzali, Saeid, and Foust, Janice B. An Introduction to Hospitals and Inpatient Care. New York: Springer Pub., 2003. Print.

Unit 3: Delivering Health Care, Part 2

Description:

This unit depicts the medical model of health care in the U.S., with an overview of the organization of health care and the physical structure of health care delivery in the outpatient setting, including an overview of the people involved in the delivery of health care, their education and licensing. This unit is intended primarily for the student who does not have a background in health care, though the topics of this unit are described at a relatively advanced level.

Objectives:

1. Describe the organization of clinical health care delivery in the outpatient setting and the organization of outpatient health care.

2. Describe the organization of ancillary health care delivery in the outpatient setting.3. Compare the role of different health care providers, with an emphasis on the delivery

of care in an interdisciplinary setting.

Lectures:

a. Outpatient Facilities and Primary Care (11:07)Health IT Workforce Curriculum Introduction to Health Care and Public Health in the U.S. 6Version 4.0

b. Outpatient Primary and Secondary Care (10:34)

c. Retail Clinics, Urgent Care Centers, and Emergency Departments as Venues for Health Care (09:24)

d. Laboratory, Pathology, Radiology, and Ancillary Services (11:45)

e. Roles of Different Health Care Providers (09:25)

Suggested Readings

Stanfield, Peggy., Cross, Nanna, and Hui, Y. H. Introduction to the Health Professions. 6th ed. Burlington, MA: Jones & Bartlett Learning, 2012. Print.

Malone, Michael L., Capezuti, Elizabeth, and Palmer, Robert M. Acute Care for Elders A Model for Interdisciplinary Care. New York: Springer, 2014. Print. Aging Medicine.

Unit 4: Financing Health Care, Part 1

Description:

This unit provides an overview of the role of health care in the economy and a description of various models of health care financing. The unit provides a history of the current U.S. system and laws that have influenced its development. It also includes discussion of health care financing at the government, health care organization, and consumer levels.

Objectives:

1. Describe the history and role of the health insurance industry in financing health care in the United States, and the federal laws that have influenced the development of the industry.

2. Explain the importance of the health care industry in the U.S. economy and the role of financial management in health care.

3. Describe models of health care financing in the U.S. and in selected other countries.4. Explain the differences among various types of private health insurance and

describe the organization and structure of network-based managed care health insurance programs.

5. Describe the various roles played by government as policy maker, payor, provider, and regulator of health care.

Describe the organization and function of Medicare and Medicaid.

Lectures:

a. The history of the health insurance industry in the U.S. (20:54)

b. The role of health care in the U.S. economy (11:24)

c. Types of Health Care Systems (19:49)


d. Payors in the U.S. Health Care System (26:03)

e. The Government as an Insurance Payor (17:38)

Suggested Readings



Unit 5: Financing Health Care. Part 2

Description:

This unit continues the discussion of health care financing at the governmental, organizational, and consumer levels. The unit describes the revenue cycle for health care organizations, identifies the different reimbursement methodologies, and standards developed for the billing (reimbursement) process. Finally, this unit reviews some of the factors responsible for the escalating health care expenditures in the U.S. and discusses some methods for controlling rising medical costs.

Objectives:

1. Describe the revenue cycle and the billing process undertaken by different health care enterprises.

2. Explain the billing and coding processes, and standard code sets used in the claims process.

3. Identify different fee-for-service and episode-of-care reimbursement methodologies used by insurers and health care organizations in the claims process.

4. Review factors responsible for escalating health care expenditures in the U.S.5. Discuss methods of controlling rising medical costs.

Lectures:

a. The Revenue Cycle of Various Health Care Enterprises (16:58)

b. The Billing Process of Various Health Care Enterprises (14:35)

c. Factors Contributing to Increasing U.S. Health Care Costs (16:37)

d. Methods of Controlling Rising Medical Costs (24:52)

Suggested Readings






Unit 6: Regulating Health Care

Description:

This unit provides an overview of the regulation of health care, including regulatory and professional organizations, the regulation of safety in medicine, and key legal aspects of medicine. This unit also covers compliance issues including privacy violations, reimbursement, and fraud and abuse.

Objectives:

1. Describe the role of accreditation, regulatory bodies, and professional associations in health care in the U.S.

2. Describe the basic concepts of law in the U.S.: the legal system, sources of law, classification of laws, the court system, and the trial process.

3. Describe legal aspects of medicine involving the Affordable Care Act, professional standards in health care, medical malpractice, tort reform, and Medicare and Medicaid fraud and abuse.

4. Describe key components of the Health Insurance Portability and Accountability Act (HIPAA) and efforts to promote patient safety in the U.S.

5. Discuss the need for quality clinical documentation for the use of the health record as a legal document, communication tool, and a key to prove compliance for health care organizations.

Lectures:

a. Nonprofit Accrediting Orgs, Regulatory Bodies, and Professional Associations in U.S. Health Care (20:12)

b. Branches of Government and the Configuration of the U.S. Judicial System (17:47)

c. Legal Aspects of Medicine (17:01)

d. Health Insurance Portability and Accountability Act (19:06)

e. The Role of Medical Records in U.S. Health Care (14:55)

Suggested Readings

Walshe, Kieran. Regulating Healthcare: A Prescription for Improvement? Maidenhead: McGraw-Hill Education, 2003. Print.

McLean, S. A. M., and Mason, J. K. Legal and Ethical Aspects of Healthcare. Cambridge: Cambridge UP, 2003. Print.

Unit 7: Public Health, Part 1Health IT Workforce Curriculum Introduction to Health Care and Public Health in the U.S. 9Version 4.0



Description:

This unit provides a discussion of public health origins and history, the differentiation from private health, and the significant value provided by public health. It also reviews important terminology and includes an examination of the general organization of public health agencies and the flow of data within public health.

Objectives:

1. Discuss the main similarities and differences between public and private health.2. Describe the historic timeline and achievements of public health in the U.S.3. Define and discuss key terminology of public health.4. Illustrate the general organization of public health agencies and public health data

flow.5. Evaluate and explain the effect and value of public health.

Lectures:a. History of Public Health in the U.S. (11:20)

b. Public Health Terminology, Organization, Funding, and Roles (08:01)

c. The Effect and Value of Public Health (7:23)

Suggested Readings

Magnuson, J.A., and Fu, Paul C. Public Health Informatics and Information Systems. 2nd ed. London: Springer, 2014. Print. Health Informatics.

Sharma, Manoj., Branscum, Paul W, and Atri, Ashutosh. Introduction to Community and Public Health. Hoboken: Wiley, 2014. Print.

Unit 8: Public Health, Part 2

Description:

This unit provides an overview of public health topics, including: important communicable diseases and public health responses; terrorism, including biological, agricultural, and chemical surveillance; and chronic diseases and environmental health.

Objectives:

1. Give examples of and explain the general program categories of public health, including communicable disease, chronic disease, terrorism response, and environmental public health.

2. Discuss the activities and achievements of public health in the realm of communicable disease.

3. Compare and contrast the different types of terrorism and the different public health responses.


4. Describe chronic disease activities and achievements of public health, and the work of public health in the realm of environmental health hazards.

Lectures:

a. Public Health and Communicable Disease (09:46)

b. Bioterrorism, Agricultural Terrorism, Chemical Terrorism, Nuclear Terrorism (09:01)

c. Public Health and Chronic Disease (07:24)

Suggested Readings

Hawker, Jeremy., and Wiley InterScience. Communicable Disease Control Handbook. 2nd ed. Malden, Mass.; Oxford: Blackwell Pub., 2005. Print.

Unit 9: Evolution of and Trends in Health Care in the U.S.

Description:

This unit provides an overview of health care trends including evidence-based medicine, quality and practice-care recommendations, comparative effectiveness research, and an overview of health care reform initiatives in the U.S., including the Affordable Care Act (ACA).

Objectives:

1. Describe the application of evidence-based medicine and clinical practice guidelines2. Discuss quality indicators in medicine.3. Describe the patient-centered medical home and other models of care coordination.

Lectures:

a. Evidence-Based Medicine (11:46)

b. Clinical Practice Guidelines (05:23)

c. Quality Indicators and Comparative Effectiveness Research (08:05)

d. Patient-Centered Medical Home and Other Models of Care Coordination (11:07)

Unit 10: Meaningful Use

Description:

This unit describes the meaningful use program of the Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery and Reinvestment Act (ARRA). It discusses eligibility for meaningful use incentive payments and the criteria for achieving those payments. It also describes the clinical quality measures and standards that are required for the program.


Objectives:

1. Define meaningful use (MU) of health information technology in the context of the Health Information Technology for Economic and Clinical Health (HITECH) act.

2. Describe the major goals of meaningful use.3. Discuss the criteria for Stages 1-3 of meaningful use for eligible professionals,

eligible hospitals, and critical access hospitals.4. Describe the standards specified for MU.5. Discuss the likely evolution of the MU program.

Lectures:

a. What is Meaningful Use? (15:15)

b. Meaningful Use Operationalized (13:38)

c. Standards of Meaningful Use and the Future of Meaningful Use (11:54)


Component AuthorsComponent Originally Developed and Updated by:

Assigned Institution:Oregon Health & Science University (OHSU)

Team Lead:William Hersh, MD, OHSU

Primary Contributing Authors:William Hersh, MD, OHSU

Karen Eden, PhD, OHSU

Lecture Narration:Voiceover Talent

Kim Handysides

Digital One, Portland, OR, http://digone.com/

Team Members:

Karen B. Eden, PhD, Professor, Department of Medical Informatics and Clinical Epidemiology, OHSU

Kate Fultz Hollis, MS, MBI, OHSU

William Hersh, MD, Principal Investigator, Department Chair, Medical Informatics & Clinical Epidemiology, OHSU

Krystal A. Klein, PhD, MBI, OHSU

Kerri F. Nussbaum, MS, Project Manager/Instructional Design/Development, OHSU

Dana Womack, MS, RN, OHSU


http://digone.com/

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