America's Health Insurance Plans

Healthcare Management: An Introduction (AHM 250)

Providing a comprehensive overview, this course will get you up to speed on the basic concepts of healthcare management and its various types of organizational structures. You will learn about major operational areas of health insurance plans as well as legislative, regulatory, and ethical issues that affect the industry.

What You’ll Learn:

  • The evolution of healthcare delivery in the United States
  • Basic concepts of health plans
  • How to distinguish among HMOs, PPOs, POSs, and managed indemnity
  • The characteristics of health plans for specialty services
  • Different types of provider organizations
  • The essential functions and activities within the operations areas of health plans
  • Concepts of rating, underwriting, financing, and claims administration in health plan environments
  • Important legislative and regulatory issues affecting the health plan industry
  • Principal ethical issues confronting health plans 

Who Should take this Course:

  • Employees who work for health care providers or health insurance plans and want to acquire the educational background to pursue a management position in the industry
  • Case managers and medical directors who seek a broader administrative background
  • Educators at the college level who teach health care administration
  • Financial planners, and agents and brokers who specialize in life and health insurance
  • Medical management staff working in hospitals, health systems, HMOs, health insurance plans, and PPOs
  • Consumers and others in related fields who seek expertise in this area

Enrollment
$195 AHIP Members; $255 Non-members



To enroll in a course, or purchase a text book, please log in, and browse our online catalog. If you are a new user, please register for an account to get started.

Earn a Designation
This course is good towards earning the following Academy for Healthcare Management designations:

The Academy for Healthcare Management
This course is brought to you by the Academy for Healthcare Management (AHM). Sponsored by America’s Health Insurance Plans and the Blue Cross Blue Shield Association, AHM relies on both associations’ decades of experience providing continuing education for health insurance plan professionals. AHM serves more than 1,300 health insurance plans caring for and providing coverage to more than 200 million people.


Governance and Regulation (AHM 510)

This course describes the formation, types, and structure of healthcare management organizations. Along with the role of healthcare management in government-sponsored programs, you’ll learn the overall purpose and direction of healthcare management, the impact of fraud and abuse, and the role of public policy.

What You’ll Learn:

  • Major factors shaping the environment of the health plan industry
  • How health plans use reorganization and reengineering to improve performance
  • Key legal issues in health plans
  • Federal and state regulatory requirements that affect health plans
  • The role of the federal government as a purchaser of healthcare benefits
  • How fraud and abuse affect the cost and quality of healthcare
  • How health plans use organizational control systems to build internal structures that meet external demands for accountability
  • Methods that health plans and interest groups use to influence healthcare public policy development

Who Should take this Course:

  • Employees who work for health care providers or health insurance plans and want to acquire the educational background to pursue a management position in the industry
  • Case managers and medical directors who seek a broader administrative background
  • Educators at the college level who teach health care administration
  • Financial planners, and agents and brokers who specialize in life and health insurance
  • Medical management staff working in hospitals, health systems, HMOs, health insurance plans, and PPOs
  • Consumers and others in related fields who seek expertise in this area

Enrollment
$195 AHIP Members; $255 Non-members



To enroll in a course, or purchase a text book, please log in, and browse our online catalog. If you are a new user, please register for an account to get started.

Earn a Designation
This course is good towards earning the following Academy for Healthcare Management designation:

The Academy for Healthcare Management
This course is brought to you by the Academy for Healthcare Management (AHM). Sponsored by America’s Health Insurance Plans and the Blue Cross Blue Shield Association, AHM relies on both associations’ decades of experience providing continuing education for health insurance plan professionals. AHM serves more than 1,300 health insurance plans caring for and providing coverage to more than 200 million people.


Health Plan Finance and Risk Management (AHM 520)

Get a comprehensive look at health insurance plan finance. You’ll learn about financial management techniques, funding, risk management, provider reimbursement, plan risk, pricing, underwriting, and rating methods.

What You’ll Learn:

  • Key accounting principles associated with a health plan's financial information.
  • Types of risks health plans face and approaches they use to manage them.
  • Differences between fully funded and self-funded health plans.
  • Major risks and cost factors associated with the delivery and financing of health-care services under Medicare and Medicaid contracts.
  • Key factors and methods associated with underwriting and rating healthcare benefits.
  • Factors health plans consider when developing and pricing healthcare products.
  • How to analyze and interpret results of a health plan's financial statements through the use of financial ratios.
  • How to use financial information to develop a health plan's strategic plan and manage the health plan's cash and capital effectively.

Who Should take this Course:

  • Employees who work for health care providers or health insurance plans and want to acquire the educational background to pursue a management position in the industry
  • Case managers and medical directors who seek a broader administrative background
  • Educators at the college level who teach health care administration
  • Financial planners, and agents and brokers who specialize in life and health insurance
  • Medical management staff working in hospitals, health systems, HMOs, health insurance plans, and PPOs
  • Consumers and others in related fields who seek expertise in this area

Enrollment
$195 AHIP Members; $255 Non-members



To enroll in a course, or purchase a text book, please log in, and browse our online catalog. If you are a new user, please register for an account to get started.

Earn a Designation
This course is good towards earning the following Academy for Healthcare Management designation:

The Academy for Healthcare Management
This course is brought to you by the Academy for Healthcare Management (AHM). Sponsored by America’s Health Insurance Plans and the Blue Cross Blue Shield Association, AHM relies on both associations’ decades of experience providing continuing education for health insurance plan professionals. AHM serves more than 1,300 health insurance plans caring for and providing coverage to more than 200 million people.


Network Management (AHM 530)

Learn about the network management function in health insurance plans as this course provides you with insight into both network development strategies (risk management, recruiting, selection and contracting) and network maintenance strategies (managing provider performance and feedback). You’ll also learn about considerations for different types of networks.

What You’ll Learn:

  • The scope and organization of the network management function in health plans
  • Network strategies for access, quality, and cost-effectiveness
  • The process for network provider selection
  • Essential elements of a contractual relationship between health plans and providers
  • The primary responsibilities and obligations of health plans and providers under a provider contract
  • How health plans select, contract with, and compensate specialists and healthcare facilities
  • Special requirements that affect network management for Medicare, Medicaid, and workers' compensation networks
  • How health plans ensure their provider networks remain adequate to meet member needs

Who Should take this Course:

  • Employees who work for health care providers or health insurance plans and want to acquire the educational background to pursue a management position in the industry
  • Case managers and medical directors who seek a broader administrative background
  • Educators at the college level who teach health care administration
  • Financial planners, and agents and brokers who specialize in life and health insurance
  • Medical management staff working in hospitals, health systems, HMOs, health insurance plans, and PPOs
  • Consumers and others in related fields who seek expertise in this area

Enrollment
$195 AHIP Members; $255 Non-members



To enroll in a course, or purchase a text book, please log in, and browse our online catalog. If you are a new user, please register for an account to get started.

Earn a Designation
This course is good towards earning the following Academy for Healthcare Management designation:

The Academy for Healthcare Management
This course is brought to you by the Academy for Healthcare Management (AHM). Sponsored by America’s Health Insurance Plans and the Blue Cross Blue Shield Association, AHM relies on both associations’ decades of experience providing continuing education for health insurance plan professionals. AHM serves more than 1,300 health insurance plans caring for and providing coverage to more than 200 million people.


Medical Management (AHM 540)

Explore medical policy and technology evaluation, appropriateness of care issues, authorization systems, and clinical practice guidelines. With this course, you’ll discover focused strategies for utilization management, including clinical paths and disease management. Quality management (QM) methods and strategies are also described. You’ll also learn about accreditation, quality improvement studies, benchmarking, performance measurement, and legal aspects of QM are addressed, as well as QM strategies for different clinical settings.

What You’ll Learn:

  • The role of medical management in a health plan
  • How and why a delegation is used in medical management
  • How health plans develop and implement medical policy
  • The importance of preventive care and self-care programs
  • Strategies for managing complex individual cases
  • Disease management—its purpose, processes, and programs
  • How medical management is used in different types of care
  • Quality management methods—measurement and improvement
  • How medical management applies to government-sponsored programs

Who Should take this Course:

  • Employees who work for health care providers or health insurance plans and want to acquire the educational background to pursue a management position in the industry
  • Case managers and medical directors who seek a broader administrative background
  • Educators at the college level who teach health care administration
  • Financial planners, and agents and brokers who specialize in life and health insurance
  • Medical management staff working in hospitals, health systems, HMOs, health insurance plans, and PPOs
  • Consumers and others in related fields who seek expertise in this area

Enrollment
$195 AHIP Members; $255 Non-members



To enroll in a course, or purchase a text book, please log in, and browse our online catalog. If you are a new user, please register for an account to get started.

Earn a Designation
This course is good towards earning the following Academy for Healthcare Management designation:

The Academy for Healthcare Management
This course is brought to you by the Academy for Healthcare Management (AHM). Sponsored by America’s Health Insurance Plans and the Blue Cross Blue Shield Association, AHM relies on both associations’ decades of experience providing continuing education for health insurance plan professionals. AHM serves more than 1,300 health insurance plans caring for and providing coverage to more than 200 million people.