Harvard School of Public Health HPM 206 Economic Analysis

Fall 2016 Monday, Wednesday, Friday 1:30-3:00

Snyder Auditorium (G-1)

Instructor David Hemenway Professor of Health Policy Health Policy and Management Email: hemenway@hsph.harvard.edu Kresge 309 Office: (617) 432-4493 Fax: (617) 432-3699 Teaching Assistants Ben Biglow beb601@mail.harvard.edu Alex Chan alc619@mail.harvard.edu Simiao Chen sic104@mail.harvard.edu

Nicole Perales nip877@mail.harvard.edu Texts and Reading Materials: Books may be purchased at the Harvard Coop in Cambridge. The reading packet is available for purchase at the Curriculum Development Office, Kresge first floor. Course Objectives At the completion of the course, you should be able to:

a) articulate the key assumptions of the economic model b) explain the applications and limitations of the economic approach c) analyze and evaluate health policies using economic theory

Outcome Measure There are 3 in-class examinations on the material covered up to that point, both from lecture and readings. Grading Criteria Grades are based 25% each on the first two exams, and 50% on the last or final exam. You must hand in a very short (less than 200 words) paper describing two policies--one traditional economic and one behavioral economic--to ameliorate any public health problem of your choice. Course Evaluations

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Completion of the evaluation is a requirement. Your grade will not be available until you submit the evaluation. Please complete the evaluation. Thank you kindly. HPM 206-F ECONOMIC ANALYSIS Fall 2016 David Hemenway Required Textbooks: Hemenway, D., Prices and Choices (P&C), 3rd ed. Lanham, MD: University Press of

America (1993). Acquire one or the other Baumol, W.J., Blinder, A.S., Microeconomics: Principles and Policy, 13th ed. New

York, NY: Harcourt College Publishing (2016), or Frank, R.H., Microeconomics and Behavior, 9th ed. New York, NY: McGraw-Hill,

(2014). (older editions are fine) Recommended: Study Guide to accompany Baumol & Blinder, or to accompany Frank Sessions 1 and 2 8/29,31 Introduction Topics: Basic Assumptions of Economics Production Possibility Curve Opportunity Costs Law of Diminishing Returns Required Reading: Radford, R.A., “The Economic Organization of a P.O.W. Camp,” Economica, v12,

(November 1945), pp. 189-201. http://links.jstor.org.ezp1.harvard.edu/sici?sici=0013-0427%28194511%292%3A12%3A48%3C189%3ATEOOAP%3E2.0.CO%3B2-D

Hemenway, D., “The Bible,” “Basic Assumptions” and “Aphorism,” P&C, pp. 1-11 and

Chapter 26. Baumol & Blinder, Chapter 3. Handouts: Problem Sets 1, 1A, 2, 2A

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HPM 206-F 2016 Sessions 3-5 9/2,7,9 Supply and Demand Topics: Experiment Elasticity Applications Required Reading: Baumol & Blinder, Chapters 4, 6 Hemenway, D., “Crime,” P&C, Chapter 12. Handouts: Problem Sets 3, 4, 5 and 5A Session 6 9/12 Demand Side: Consumer Behavior Topics: Marginal Utility Consumers’ Surplus Required Reading: Baumol & Blinder, Chapter 5.

Hemenway, D., “Temptation” and “Fashion”, P&C, Chapters 2 and 4. Handout: Problem Set 6.

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HPM 206-F 2016 Sessions 7 and 8 9/14,19 Indifference Curve Analysis Topics: Revealed Preference Income and Substitution Effects Required Reading: Baumol & Blinder, Appendix to Chapter 5. Frank, R.H., Microeconomics and Behavior, Chapters 3 and 4. Hemenway, D., “Food Supplements,” P&C, Chapter 20. Handouts: Problem Sets 7 and 8 Session 9 9/21 Supply Side: Short-Run Costs Topics: Cost Concepts Graphical Representation of Profit Maximization Marginal Cost as the Supply Curve Required Reading: Baumol & Blinder, Chapters 7, 8 and 10 (pp. 195-203). Handouts: “Economic Cost:” Problem Sets 9 and 10 Profit-Maximization Problem

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HPM 206-F 2016 Session 10 9/23 Normative Implications Topics: Implications of the Model Introduction to Externalities Required Reading: Baumol & Blinder, Chapter 10 (pp. 203-212). “Notes on Competitive Supply” Course Packet Handouts: Easy Review Questions Sample Hour Exam Session 11 9/28 Exam Session 12 9/30 Imperfect Competition: Monopoly Topics: Allocative Inefficiency Natural Monopoly Required Reading: Baumol & Blinder, Chapter 11 (pp. 213-222). Hemenway, D., “The Ice Trust,” P&C, Chapter 19. Handouts: Problem Set 11 Monopoly and the Perfect Competitor

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HPM 206-F 2016 Sessions 13 and 14 10/5, 7 Price Discrimination Topics: Prevalence Effects Haggling Two-Part Tariff Required Reading: Baumol & Blinder, Chapter 11 (pp. 222-227). Hemenway, D., “Haggling” and “Cover Charge”, P&C, Chapters 7 and 8. Handouts: Problem Sets 12, 13 and 14 Sessions 15 and 16 10/12,14 Oligopoly Theory Topics: Game Theory Prisoner’s Dilemma Required Reading: Baumol & Blinder, Chapter 12 (pp. 234-239; 243-247). Hemenway, D., “Appendix on Payoff Matrices,” P&C, pp. 263-268. Recommended Reading: Schelling, T.C., The Strategy of Conflict. New York, NY: Oxford University Press,

(1963), Chapters 3 and 5, pp. 53-80, 119-150. Handouts: Questionnaire Game Theory Problem

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HPM 206-F 2016 Sessions 17 and 19 10/17, 21 Insurance Topics: Risk and Utility Moral Hazard Adverse Selection Propitious Selection Required Reading: Frank, R.H., Microeconomics and Behavior, Chapter 6 . Hemenway, “Insurance,” “Nervous Nellies,” and “Health Care,” P&C, Chapters 11, 22

and 25. Newhouse, J., Free for All? Lessons for the Rand Health Insurance Experiment.

Cambridge, MA: Harvard University Press, (1993), pp. 8-11, 41, 338-341. Course Packet Clyde, A.T., Hemenway, D., and Nagurney, J.T., “Seat Belt Use, Insurance Status and

Hospital Bad Debt,” Journal of Trauma, (1996), v14, pp. 100-104. Course Packet Hemenway, D. “Why Require Health Insurance?” Course Packet Handouts: Problem Sets 18 and 19 Session 18 10/19 U.S. Health Care Policy Guest Lecture: Professor Ben Sommers

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HPM 206-F 2016 Sessions 20 and 21 10/24, 26 Factor Markets Topics: Demand and Supply Side Monopoly Elements (Unions and Monopsony) Investment Decisions (Present Value) Required Reading: Baumol & Blinder, Chapters 18-20 Hemenway, D., “Tipping”, P&C, Chapter 9. Hammond, III, J.S., Introduction to Accumulated Value and Present Value. Boston, MA:

Harvard Business School, ICCH No. 9-173-003, Rev. 6/75. Course Packet Handouts: Problem Sets 15, 16 and 17 Sample Hour Exam Session 22 11/2 Exam

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HPM 206-F 2016 Session 23 11/7 Incentives (Traditional Economics) Topics: Financial Incentives; Risk Compensation Required Reading: Hemenway, D., “Risk Compensation,” P&C, Chapter 21. Hemenway, D., “Financial Incentives for Childhood Immunization,” Journal of Policy

Analysis and Management, v14, (Winter 1995), pp. 133-139. http://ezp1.harvard.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=9501280050&site=ehost-live&scope=site

Hemenway, D., et. al., “Physicians’ Responses to Financial Incentives”: New England

Journal of Medicine, v322, (April 1990) pp. 1059-1063. Course Packet Hemenway, D., “Authors and Authorship”, American Journal of Public Health, v88,

(1998), pp826-827. Course Packet Sandel MJ. What Money Can’t Buy: The Moral Limits of Markets. New York: Farrar,

Straus & Giroux, 2012. pp. 47-65. Course Packet Session 24 11/9 Pay for Performance Guest Lecturer: Professor Meredith Rosenthal

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HPM 206-F 2016 Session 25 11/14 Incentives (Behavioral Economics) Topics: Irrational Behavior Nudge: Libertarian Paternalism Required Reading: Kahneman, D., “A Psychological Perspective on Economics,” American Economic

Review, v93, (May 2003), pp. 162-168. http://ezp1.harvard.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=10015888&site=ehost-live&scope=site

Ariely, D. Predictably Irrational: The Hidden Forces that Shape Our Decisions. New

York, NY: HarperCollins Publishing, 2008, pp. 239-244. Thaler, R.H., Sunstein, C. R., “Libertarian Paternalism,” American Economic Review,

v93, (May 2003), pp. 175-179. http://ezp1.harvard.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=10015892&site=ehost-live&scope=site

Session 26 11/16 Information & Quality Topics: Product Quality Information Licenses Standards Measuring Quality Factors Affecting Quality Required Reading: Hemenway, D., “Product Quality Information,” Industrywide Voluntary Product

Standards. Cambridge, MA: Ballinger Publishing Co., (1975), Chapter 6. Course Packet Hemenway, D., “Voluntary Standards” “Quality Assessment” and “Determinants of

Quality” P&C, Chapters 14, 15, 16 .

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HPM 206-F 2016 Session 27 11/18 Regulation Topics: Social Regulation Inspection Enforcement Game Required Reading: Hemenway, D., and Solnick, S.J., “’You Better Shop Around’: The Market For Motor

Vehicle Inspection,” Law and Policy, v12 (Oct. 1990), pp. 317-329. Recommended Reading: Hemenway, D., Monitoring and Compliance: The Political Economy of Inspection.

Greenwich, CT: JAI Press, (1985), Chapter 3, pp. 45-91. Hemenway D., Book Review of David Kennedy “Don’t Shoot: One Man, A Street

Fellowship, and the End of Violence in Inner-City America” Injury Prevention 2012; 18:282.

Session 28 11/21 Economic Policy Approach Topic: Public Health and the Economic Approach Injury and Violence Prevention Required Reading: Hemenway D. “Public Policy” In: Li G, Baker S., eds. Injury Research: Theories,

Methods and Approaches. New York: Springer 2012. Course Packet Hemenway D. “Why Don’t We Spend Enough on Public Health?” New England Journal

of Medicine. 2010; 362:1657-58. http://www.nejm.org/doi/full/10.1056/NEJMp1001784.

Recommended Reading: Hemenway, D., While We Were Sleeping: Success Stories in Injury and Violence

Prevention. Berkeley, CA: U California Press, (2009), Chapters 1, 2, 8, 10.

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HPM 206-F 2016 Session 29 11/28 Normative Economics Topics: Pareto Criterion Kaldor-Hicks Criterion Optimal Location Theory of the Second Best Required Reading: Baumol & Blinder, Chapters 14, 15 and 17. Schelling, T., “Economic Reasoning and the Ethics of Policy”, Choice and Consequence.

Cambridge, MA: Harvard Press, (1984) Chapter 1. Course Packet. Hemenway, D., “Optimal Location,” P&C, Chapter 23. Hemenway, D., “The Second Best in Statistics,” Journal of Clinical Epidemiology, v44

(1991) pp. 957-959. http://ezp1.harvard.edu/login?url=http://dx.doi.org/10.1016/0895-4356(91)90060-

M?nosfx=y Handouts: Problem Set 20 Optimal Location of Doctors Session 30 11/30 Cost Benefit Analysis Topic: Value of a Life Required Reading: Folland, S., Goodman, A.C., Stano, M. “Cost-Benefit Analysis and Applications to

Health Care,” The Economics of Health and Health Care, 3rd ed., (2000) Chapter 4, pp. 74-95. Course Packet

Session 31 12/2 Health Care Policy Guest Lecture: Professor Kate Baicker

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HPM 206-F 2016 Sessions 32 and 33 12/5, 7 Externalities and Public Goods Topics: The Commons Pollution: Problems and Policy Public Goods Rent-Seeking Behavior Tipping Models Social Forces Required Reading: Baumol & Blinder, Chapter 16 (pp. 325-338). Hemenway, D., “Social Forces”, “Externalities” and “Is Monopoly Bad”, P&C, Chapters

5, 13 and 18. Schelling, T.C., “On the Ecology of Micromotives”, Public Interest, (Fall 1971), pp. 59-

98. Course Packet Olson, M., The Logic of Collective Action. Cambridge, MA: Harvard University Press,

(1965), pp. 1-3, 9-16, 132-141. Course Packet Frank, R.H., “Smart For One, Dumb for All”, in Luxury Fever, Princeton University

Press 2000, pp. 146-158. Course Packet Schelling, T.C., “Thermostats, Lemons and Other Families of Models.” In: Micromotives

and Macrobehavior, New York: W.W. Norton, 1978, Chapter 3, pp. 101-115. Course Packet Recommended Reading: Wheelan, C., “Government and the Economy” in Naked Economics New York: Norton 2002, Chapter 3. Handouts: Problem Sets 21 and 22

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HPM 206-F 2016 Session 34 12/9 Economic Approach and Critique Topics: Assumptions Revisited Positional Concerns Positive and Normative Economics Required Reading: Baumol & Blinder, Chapter 1 (pp. 4-7). Rhoads, S.E., The Economist’s View of the World, New York: Cambridge University

Press, (1985) pp. 158-163, 174-178 and 187-196. Course Packet. Solnick, S.J., Hemenway, D., “Is More Always Better? A Survey on Positional

Concerns,” Journal of Economic Behavior and Organization, v37, (1998), pp. 373-383.

http://ezp1.harvard.edu/login?url=http://dx.doi.org/10.1016/S0167-2681(98)00089-4?nosfx=y

Hemenway D. “What I Would Like Economic Majors to Know” Real-World Economics

Review, Issue #63, 2013. http://www.paecon.net/PAEReview/issue63/Hemenway63.pdf. Handout: Sample Final Exam Session 35 12/14 Final Exam

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HPM 206-F Calendar Summary 2016 August September

Date Session November Date Session

M 29 1 W 2 22 (Exam) W 31 2 F 4 No class F 2 3 M 7 23 M 5 Holiday W 9 24 (Rosenthal) W 7 4 F 11 Holiday F 9 5 M 14 25 M 12 6 W 16 26 W 14 7 F 18 27 F 16 No class M 21 28 M 19 8 W 23 No class W 21 9 F 25 Holiday F 23 10 M 28 29 M 26 Review W 30 30 W 28 Exam F 30 12

October Date Session December Date Session

M 3 No class F 2 31 (Baicker)

W 5 13 M 5 32 F 7 14 W 7 33 M 10 Holiday F 9 34 W 12 15 M 12 Review F 14 16 W 14 35 (Exam) M 17 17 F 16 No class W 19 18 (Sommers) M 19 Vacation F 21 19 M 24 20 W 26 21 F 28 No class M 31 Review

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Economics for Health Policy

HPM 209: Summer 2 Monday-Friday, 10:30-12:20

Instructor Information Meredith Rosenthal, Ph.D Anna Sinaiko, Ph.D. Professor of Health Economics and Policy Research Scientist Department of Health Policy and Management Dept of Health Policy and Management Email: mrosenth@hsph.harvard.edu Email: asinaiko@hsph.harvard.edu Phone: (617) 432-3418 Phone: (617) 432-6472 Office Hours: Friday from 1-2:30 Office Hours: Thursdays from 1-2:30 pm Office Address: Kresge 408 Office Address: Kresge 409 Overview Students will learn how to analyze current health policy issues through the application of basic economic principles. No previous economics training is required. The course will begin with an introduction to health economics and the U.S. health care “system” because we will be using examples drawn almost exclusively from the American context. The concepts we will be learning, however, are widely generalizable and students whose interests and experiences extend beyond the U.S. are welcomed. Among the topics we will discuss are health insurance coverage, benefit design, physician payment incentives, public reporting of quality information, and the pharmaceutical industry. This course will be discussion-oriented. It is imperative that students come prepared for class and be engaged in group learning. Diversity and inclusiveness are fundamental to public health education and practice. It is a requirement that you come to class with an open mind and respect for differences of all kinds. I share responsibility with you for creating a school climate that is hospitable to all perspectives and cultures; please come talk with me if you have any concerns or suggestions. Course Materials Readings from health policy and clinical journals and reports are required for most sessions. The majority of these readings is provided on the syllabus as hyperlinks to Countway electronic resources and may be read on-line or printed by you, at your discretion. A few readings will be distributed in class or posted on the course website. Paper copies of overheads and discussion questions will be distributed in class and posted on the course website (overheads will be posted after class; discussion questions will be posted in advance). Other materials such as assignments will also be made available on the course website For those who are interested, additional tutorials on different concepts in economics, including supply and demand can be watched through Kahn Academy: https://www.khanacademy.org/economics-finance-domain/microeconomics

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If you have never had economics before, we strongly recommend that you watch the Introduction to Economics, The Demand Curve, and the Supply Curve here before the first class: https://www.khanacademy.org/economics-finance-domain/microeconomics/supply-demand-equilibrium Course Objectives The main objective of the course is to demonstrate the usefulness of economics as a tool to examine health policy problems and develop solutions. By the end of the course, students will be able to:

1. Recognize economic issues as they arise in health policy dilemmas 2. Critique and form economic arguments for and against particular health policies 3. Understand key economic concepts including efficiency, asymmetric information,

agency, moral hazard, and adverse selection Outcome Measures Homework Daily homework consists of reading the assigned materials and being prepared to discuss them. On some days you will be asked to complete an additional small assignment before coming to class. Note: The links to required readings fro each class are provided below. Because many of them require an HUID and PIN for login, it is better to copy and paste the addresses into your web browser, rather than clicking the link on the syllabus. There will also be written policy analyses due on August 3rd and August 10th. For both assignments you will be asked to examine a health policy issue, identify and analyze the key economic issues and draw policy implications. No outside research will be needed to complete the assignment. Essays are restricted to 3 pages double-spaced, 12-point font, 1-inch margins. The object of the essay will be to test your skills at applying some of the economic ideas learned in the first week to new problems. Essays should be in paragraph form (no bullet points) and written clearly and concisely. We will also be using the discussion board feature of the course website. Once during the course each student must find an article about a health policy issue in the popular press, post the article, and start a discussion about the economic issues raised in the article. In addition, once during the course each student must weigh in on the discussion started by another student in the class by commenting on another student’s post. Examination

There will be an in-class exam on the last day of the course. The format of the exam will be a single essay. The exam will be closed book. Three questions will be distributed on the last Monday of the course and one of the three will be selected to be written in class without notes. Students may discuss issues in groups to prepare for the exam but written essays should reflect individual thinking.

Grading Criteria

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25%: For each policy analysis 10%: For discussion board 40%: Final exam Course Evaluations Completion of the evaluation is a requirement for every course at HSPH. Your grade will not be available until you submit the evaluation. In addition, registration for future terms will be blocked until you have completed evaluations for courses in prior terms. Class 1: An Introduction to the Course and to the U.S. Health Care System This session will introduce the content and purpose of the course and provide an orientation to the U.S. health care system, which will be the primary laboratory for our discussions. The session will conclude with identification of the key health policy problems that face the U.S. Medicare at a Glance. The Henry J. Kaiser Family Foundation, September, 2014. http://kff.org/medicare/fact-sheet/medicare-at-a-glance-fact-sheet/ Medicaid at a Glance. The Henry J. Kaiser Family Foundation, March, 2015 http://kff.org/health-reform/issue-brief/medicaid-moving-forward/ Blumenthal D. Employer-Sponsored Health Insurance in the United States – Origins and Implications. New England Journal of Medicine July 6, 2006; 355(1): 82-88. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJMhpr060703 Reinhardt U. Why does U.S. health care cost so much? New York Times, November 14, 2008. http://economix.blogs.nytimes.com/2008/11/14/why-does-us-health-care-cost-so-much-part-i/?scp=1&sq=why%20does%20U.S.%20health%20care%20cost%20so%20much?&st=cse Class 2: A whirlwind tour of economics (for health policy) Handout on basic economics of demand [Posted on course website] Handout on basic economics of supply [Posted on course website] Class 3: Private Insurance and Market Failure: Adverse Selection This session examines in greater detail a central economic problem of private insurance markets: adverse selection. We will discuss the experience of the Medicare program and the Federal Employees Health Benefits Program to explore how adverse selection arises, why it causes problems, and policy strategies to address it. Morgan RO, Virnig BA, DeVito CA, Persily NA. The Medicare-HMO Revolving Door – The Healthy Go In and the Sick Go Out. New England Journal of Medicine. July 17, 1997; 337(3):169-175. http://content.nejm.org.ezp-prod1.hul.harvard.edu/cgi/content/full/337/3/169

Foote SM and Jones SB. Consumer Choice Markets: Lessons from FEHBP Mental Health Coverage. Health Affairs, September/October 1999; 18(5): 125-130. http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/cgi/reprint/18/5/125

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For background: “A Note on Adverse Selection” [Available on course website] Additional Homework: Go to www.ehealthinsurance.com and simulate buying an individual insurance policy in anywhere in the country (you can try 02115, for example). What factors are associated with differences in prices? Did you notice that not everyone can buy a policy at this time of year? What is that about? Class 4: Risk Aversion and Moral Hazard The presence of insurance is one of the key distinguishing characteristics of the health care market. This session covers the economics of risk and insurance through a series of interactive exercises. Gladwell, M. The Moral-Hazard Myth. The New Yorker, August 29, 2005. http://www.newyorker.com/archive/2005/08/29/050829fa_fact?currentPage=all For background: “A note on risk aversion” [Available on course website] and “A note on moral hazard” [Available on course website] Class 5: How does insurance coverage affect health care access, cost, and health? In this session we will consider the impact of health insurance on health care and health. We will focus on evidence gleaned from a randomized study -- a recent Medicaid expansion by lottery in Oregon. “Expanding Health Insurance to Millions: Learnings from the Oregon Health Insurance Experiment.” Harvard Kennedy School Case #799. Case available on course website. RAND Research Highlight on the RAND HIE (free on-line publication) http://www.rand.org/pubs/research_briefs/RB9174.html Policy Analysis #1 will be handed out. Class 6: Nudging towards better health: the behavioral economics of health decision making Policy Analysis #1 is due at the beginning of class. Concepts such as moral hazard reflect an underlying model of rational, optimizing behavior. More nuanced economic theories of behavior take account of the limits of rational decision making, particularly where uncertainty is involved. So-called “behavioral economics” is increasingly being applied to health behavior and health care choices and these studies may have important policy implications. Homework: Prior to class, please view online the TED talk, “Saving for tomorrow, tomorrow” by Shlomo Benartzi, available at http://www.ted.com/talks/shlomo_benartzi_saving_more_tomorrow

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Volpp K.G., Asch D.A., Galvin R., Loewenstein G. Redesigning Employee Health Incentives — Lessons from Behavioral Economics. N Engl J Med 2011; 365:388-390, August 4, 2011 http://ezp-prod1.hul.harvard.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=63713416&site=ehost-live&scope=site Class 7: Expanding Coverage in the U.S.: Mandates, subsidies, and crowd-out (oh my!) In this session, we examine strategies for expanding health insurance coverage in the U.S. We will examine the economics of individual and employer mandates, subsidies and crowdout. We will discuss the Patient Protection and Affordable Care Act (also known as the ACA) and the economic reasons for why this legislation is structured the way it is. Please watch online: “The YouToons Get Ready for ObamaCare.” The Kaiser Family Foundation. http://kff.org/health-reform/video/youtoons-obamacare-video/ Glied S. Universal Coverage One Head at a Time — The Risks and Benefits of Individual Health Insurance Mandates. New England Journal of Medicine. April 10, 2008:1540, 1542. http://content.nejm.org.ezp-prod1.hul.harvard.edu/cgi/content/full/358/15/1540 Baicker, Katherine, and Amitabh Chandra. "The Veiled Economics of Employee Cost Sharing." JAMA internal medicine (2015). http://archinte.jamanetwork.com.ezp-prod1.hul.harvard.edu/article.aspx?articleID=2289129 Sanger-Katz, Margot. “What’s At Stake in Supreme Court’s Latest Health Care Case” The New York Times http://www.nytimes.com/2014/11/08/upshot/whats-at-stake-in-supreme-courts-latest-health-care-case.html?abt=0002&abg=0 Class 8: Quality Profiles and Reputation: Public Report Cards In this session, we explore the economic logic and experience with public reporting of performance data to improve quality (and/or reduce cost) and its potential unintended consequences. Werner RM et al. The Unintended Consequences of Publicly Reporting Quality Information. Journal of the American Medical Association; 3/9/2005, Vol. 293 Issue 10, p1239-1244. http://jama.ama-assn.org.ezp-prod1.hul.harvard.edu/cgi/content/full/293/10/1239 Judith H. Hibbard, Jean Stockard, and Martin Tusler. Hospital Performance Reports: Impact on Quality, Market Share, And Reputation. Health Affairs, July/August 2005; 24(4): 1150-1160. http://ezp1.harvard.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=17582449&site=ehost-live&scope=site Class 9: Price Transparency Policymakers and payers are increasingly interested in encouraging patients to “shop” based on price for their health care as a strategy to reduce health care spending, yet shopping for health care services is different than shopping for any other good. In this session we discuss price transparency in health care and the potential effects on both consumers and providers.

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Anna D. Sinaiko and Meredith B. Rosenthal. Increased Price Transparency in Health Care – Challenges and Potential Effects New England Journal of Medicine 2011 364: 891-894. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJMp1100041 Robinson, James C., and Timothy T. Brown. "Increases in consumer cost sharing redirect patient volumes and reduce hospital prices for orthopedic surgery." Health Affairs 32.8 (2013): 1392-1397. http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/content/32/8/1392.full Class 10: Agency and Physician Payment Policy Analysis #2 will be handed out. The principal-agent model is used by economists to describe the behavior of physicians. Principal-agent models address contracting problems in the presence of asymmetric information (here, the information problem is that insurers can’t observe patient need for services). The basic notion of this set up is that payers must take account of physician objectives and preferences and then align incentives with their own objectives. Readings Robinson JC. The Theory and Practice of Physician Payment Incentives. Milbank Quarterly; May2001, Vol. 79 Issue 2, p149, 29p. http://ezp-prod1.hul.harvard.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=4518586&site=ehost-live&scope=site Rosenthal MB, Fernandopulle R, Song HR, and Landon BE. Paying for Quality: Providers’ Incentives for Quality Improvement, Health Affairs, 2004 March-April; 23(2):127-41. http://ezp-prod1.hul.harvard.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=13679718&site=ehost-live&scope=site Class 11: The Alternative Quality Contract Policy Analysis #2 is due at the beginning of class. Guest Lecturer: Zirui Song, MD Ph.D., Resident, Massachusetts General Hospital Renewed interest in risk contracting became a dominant theme in U.S. health policy towards the end of the last decade. Much of the focus has been on Medicare demonstration programs and policy changes that launched the Accountable Care Organization movement. Leading commercial insurers have innovated their own versions of global payment and quality adjustment. In this class we will learn about the design and unfolding impact of one such contracting model: Blue Cross Blue Shield of Massachusetts “Alternative Quality Contract”. Song, Zirui, et al. "Changes in health care spending and quality 4 years into global payment." New England Journal of Medicine 371.18 (2014): 1704-1714.

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http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJMsa1404026#t=article Song, Zirui, et al. "Health care spending and quality in year 1 of the alternative quality contract." New England Journal of Medicine 365.10 (2011): 909-918. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/Nejmsa1101416#t=article Class 12: Tiered and limited networks Fully insured patients have no financial incentive to seek care with lower cost providers, yet prices can vary for the same service by more than twofold. In the past decade, insurers have designed tiered and limited networks that use cost sharing to steer patients to lower cost (in terms of total cost of care – both quantity and price) and higher quality providers. These benefit designs are controversial among physicians because of the often black-box nature of the tiering formula. In this class we review the economic theory and impact of tiered and limited networks and their role as a mechanism for increasing the value of patient care and spurring value-based competition. Sinaiko, A. D., & Rosenthal, M. B. "The impact of tiered physician networks on patient choices." Health services research 49.4 (2014): 1348-1363. http://onlinelibrary.wiley.com.ezp-prod1.hul.harvard.edu/enhanced/doi/10.1111/1475-6773.12165/ Sinaiko, A. D., & Rosenthal, M. B. (2010). Consumer experience with a tiered physician network: early evidence. The American journal of managed care,16(2), 123-130. http://www.ajmc.com/journals/issue/2010/2010-01-vol16-n02/ajmc_2010febsinaiko_123to130/ Class 13: Competition An important tenet of economics is that under certain circumstances market competition leads to efficient prices and quantities. Unfortunately, those conditions don’t hold in health care. In this session we first walk through a simple model to show how competition works in a “perfect” market and then discuss monopolistic competition as an alternative model for how health care providers compete. Finally we explore current policy issues related to competition and antitrust policy in light of market failures (the things that make competition fail to lead to efficient outcomes) in health care. Watch these before class: https://www.khanacademy.org/economics-finance-domain/microeconomics/perfect-competition-topic https://www.khanacademy.org/economics-finance-domain/microeconomics/perfect-competition-topic/monopolistic-competition-oligop/v/oligopolies-and-monopolisitc-competition Readings Dafny, Leemore. "Hospital Industry Consolidation—Still More to Come?." New England Journal of Medicine 370.3 (2014): 198-199. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJMp1313948

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Dafny, Leemore S., and Thomas H. Lee. "The Good Merger." New England Journal of Medicine 372.22 (2015): 2077-2079. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJMp1502338 Class 14: Prescription Drugs: Competition and Marketing This session reviews the important features of the pharmaceutical industry and related regulatory policy. The nature of competition and pricing will be discussed in the context of recent concerns about pricing and promotion, which are balanced against the benefits of innovation. Aitken, Murray, Ernst R. Berndt, and David M. Cutler. "Prescription drug spending trends in the United States: looking beyond the turning point." Health Affairs 28.1 (2009): w151-w160. http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/content/28/1/w151.full Kornfield, Rachel, et al. "Promotion of prescription drugs to consumers and providers, 2001–2010." PloS one 8.3 (2013): e55504. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0055504 Class 15: In-class exam

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United States Health Policy HPM 210, Fall 1, 2016

Mon. & Weds., 10:30-12:20pm Kresge 200

John E. McDonough, DrPH, MPA, Professor of the Practice of Public Health; Department of Health Policy and Management; jmcdonough@hsph.harvard.edu Office Phone: 617-432-2212 Office Hours: On request Office Address: 90 Smith Street, 2nd Floor Teaching Assistant: Lavinia Mitroi: lrm268@mail.harvard.edu Texts and Reading Materials

• McDonough, John. Inside National Health Reform. University of California Press & Milbank Fund. 2011. [On reserve at Countway Library]

• All other reading materials are available online through the course website.

Learning Objectives This course will provide you with a foundation to understand essential features of health policy in the United States. At the completion of this course, you will be able to:

1. Explain how the U.S. health care system is organized, financed, governed and negotiated; 2. Identify key system stakeholders and participants, public and private; 3. Describe the U.S. health care system's building blocks, including Medicare, Medicaid, private

health insurance, medical care delivery and quality, financing and payment, pharmaceutical policy, long-term services and supports, mental health, and public health;

4. Interpret current policy controversies relating to each key building block; 5. Describe the key purposes and components of the Affordable Care Act (ACA); 6. Identify challenges associated with reforming the U.S. health care system broadly, and specifically

relating to ACA implementation. 7. Prepare concise and professional health policy memos that evaluate pressing problems in U.S.

health policy. 8. Recall this class as one of your more exciting and vivid experiences at Harvard Chan!

Outcome Measures 1. Class Participation: 1. You should attend all classes; 2. Participate in the online discussion board, and

3. Contribute to class discussions. 4. You should review required teaching videos, readings and Powerpoint presentations (when included) before class. You are required to submit at least ONE comment or question related to these materials before 11:59pm the night before class on the Canvas discussion board. Guest lecturers will receive your responses the morning of the class to inform discussion. Some comments may receive responses from Prof. McDonough and/or TAs, and you are welcome to respond to fellow students’ comments as your own contribution.

2. Policy Memos – Formatting Instructions: One policy memo topic is assigned for each class. You will prepare three (3) policy memos in response to any three class topics of your own choosing. Memos should be no longer than two (2) pages using single-spaced, 12-point font, (double-spacing between paragraphs) and must be submitted via the Canvas course site. Deadlines are 48 hours after each class (12:30pm). Sample policy memos are posted on the course site. Please review the Policy Memo Grading Rubric on the website and reprinted at the end of this syllabus. TA assistance is available if needed. Key footnotes required – no more than five (5), and should be included on a third page. One

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policy memo will be due for sessions 1-5; one will be due for sessions 6-9; and one for sessions 10-13. You decide which policy memo assignment to tackle.

NOTE: Please treat the writing of policy memos as though intended for your real-life boss, a senior-level policy maker. Unedited, unproofed, sloppily written, and poorly constructed essays will be evaluated and graded as such without exception.

3. Final Exam: You may schedule your 48-hour take-home exam at any time during the last week of the term. The exam will consist of two essay questions designed to integrate topics covered in class and readings – and will be in the form of policy memos to senior-level policy makers similar to the class.

4. Note on the Readings: Readings are sorted into “Required” and “Recommended.” Please consider: a. If you plan to make a particular class topic the subject of a policy memo, then all readings

(required and recommended) are recommended for review as potential references for your policy memo. Other references you identify are also appropriate – though limit references to no more than 5 for each memo.

b. For other classes in which you will be not writing a memo, you should prioritize readings, and review them based on your sense of relevance and importance to you – just as any policy maker or staffer would do. Not all readings are created equal; prioritization is up to you.

Grading Criteria: Final grades will be determined as follows: (100 points max)

• Class Participation: 15 points max (attendance, writing questions/comments on discussion board and responding to other comments, questions/comments in classes)

• Policy Memos (3 memos total): 45 points max (15 points max for each memo) [See Grading Rubric at the end of this syllabus and on the website]

• Final Exam: 40 points max (20 points max for each question) Additional Information • Much of this class is “flipped” to maximize the value of our time together in class. As such, you should

view the foundational teaching videos at your own pace preceding each session (available on the Canvas site). Our class time will be spent engaging with the materials and with guest experts in interactive discussions, case studies and other exercises.

• The instructor must approve extensions on class assignments and late work. • Classes will include frequent references to current, ongoing and immediate U.S. health policy

controversies and issues. You should find at least one daily source of U.S. health policy news and information to keep you current with key health policy developments as they unfold over the duration of the course. Suggested sources include:

o Kaiser Family Foundation Daily Health Policy Briefing: http://www.kaiserhealthnews.org/daily-report.aspx

o Politico PULSE – daily email: http://www.politico.com/politicopulse/ o Fierce Healthcare – daily news digest: http://www.fiercehealthcare.com/newsletter-

subscription • Also check out the Incidental Economist at: http://theincidentaleconomist.com/

Course Evaluations: Completion of the course evaluation is required. Your final grade will not be available to you until evaluations are submitted. Also, registration for future terms will be blocked until evaluations have been completed for courses in prior terms.

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United States Health Policy: HPM 210, 2016 Fall 1 Class Schedule SESSION 1: Course Overview; Health Policy Process Overview; Policy Models; Case Study on Civil

Rights and the Creation of Medicare and Medicaid; and writing a good policy memo M: 8/29/2016 John McDonough, HSPH/HPM; Guest Lecturer, H-Chan Writing Coach Don Halstead SESSION 2: Introduction to the U.S. Health System, U.S. Health Policy and International

Comparisons; Medical Care and Social Services W: 8/31/2016 John McDonough, HSPH/HPM NO CLASS ON MONDAY, SEPTEMBER 5, LABOR DAY SESSION 3: U.S. Health Reform and the Affordable Care Act W: 9/7/2016 John McDonough, HSPH/HPM SESSION 4: Medicare 1 M: 9/12/2016 Guest Lecturer: Kate Baicker, HSPH/HPM SESSION 5: Health Care Quality and Delivery System Reform W: 9/14/2016 Guest Lecturer: Ashish Jha, HSPH/HPM SESSION 6: Medicare 2 M: 9/19/2016 Guest Lecturer: Arnie Epstein, HSPH/HPM SESSION 7: Private Health Insurance W: 9/21/2016 Guest Lecturer: Nancy Turnbull, HSPH/HPM SESSION 8: Medicaid M: 9/26/2016 Guest Lecturer: Ben Sommers, HSPH/HPM SESSION 9: A Conservative Perspective on the ACA W: 9/28/2016 Guest Lecturer: Stuart Butler, the Brookings Institution SESSION 10: Long-term Services & Support (LTSS) Policy M: 10/3/2016 Guest Lecturer: David Grabowski, HMS/HCP SESSION 11: Public Health and Prevention Policy W: 10/5/2016 Guest Lecturer: Howard Koh, HSPH/HPM NO CLASS ON MONDAY, OCTOBER 12, COLUMBUS DAY SESSION 12: Pharmaceutical Payment Policy W: 10/12/2016 Guest Lecturer, Elizabeth Seeley, HSPH/HPM SESSION 13: Mental Health Policy M: 10/17/2016 Guest Lecturer: Haiden Huskamp, HMS/HCP SESSION 14: Class Wrap-Up W: 10/19/2016 John McDonough HSPH/HPM

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Readings and Course Outline SESSION 1: Course Introduction; Introduction to Health Policy and Policymaking; Dynamics of Policy

Change; Writing a Good Policy Memo 8/29/2016 Dr. John McDonough, DrPH, HSPH-HPM; Guest – HChan Writing Coach Don Halstead Learning At the end of this class, you will be able to: Objectives: 1. Describe course structure, expectations and requirements. 2. Understand the key elements and forms of health care policy in the US. 3. Articulate key dynamics involved in changing public and public health policy 4. Understand how to write a well-done policy memo.

Class Discussion Topics: Review the Longest and Friedman readings. Consider the aspects/components of health policy making outlined by Longest. What do you see outlined by Longest that is reflected in the Friedman case? Consider the Friedman case in the context of Kingdon’s agenda setting model. Required Readings: • B. Longest. Chapter 1: “Health and Health Policy.” Health Policymaking in the United States, 6th

edition. Health Administration Press, 6th edition. Chicago, 2015. Pgs 1-33. [PDF on course website] • E. Friedman. “US Hospitals and the Civil rights Act of 1964.” H&HN Daily. June 3, 2014. Available

at: http://www.hhnmag.com/articles/4179-u-s-hospitals-and-the-civil-rights-act-of-1964 • John Kingdon. Agendas, Alternatives & Public Policies 2nd edition. New York. HarperCollins College

Publishers. 231-245. [PDF on course website] • How to Write an Effective Policy Memorandum.

Recommended Readings: If you would like to better understand the U.S. Health Public Policy Process: S. Burke. U.S. Congress and Health Policy. Kaiser Family Foundation. Washington DC. 2011. Available

at: http://kff.org/interactive/the-u-s-congress-and-health-policy-tutorial/ A. Weil. The Role of States in Health Policy. Kaiser Family Foundation, Washington DC. 2006. Available

at: http://kff.org/interactive/role-of-states-in-health-policy-tutorial/ G. Wasserman. The Basics of American Politics, 15th edition. Pearson. 2014.

Policy Memo: You are the health policy legislative aide (Health LA) for a sitting member of the U.S. House of Representatives (choose any current Member and identify and address your memo to that person). Your boss has asked you to write a brief (two-page) policy memo explaining section 1557 (Non-Discrimination) of Title I of the Affordable Care Act and what it means for hospitals. Your boss thought that the 1965 law that created Medicare had addressed discrimination in health care. Please enlighten your Boss. Due no later than August 31st at 12:30pm via Canvas. Please pay attention for the formatting instructions on page 1.

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SESSION 2: Introduction to the U.S Health Care System; Medical vs. Social-Service Spending. 8/31/2016 Dr. John McDonough, DrPH, HSPH-HPM Learning At the end of this class, you will be able to: Objectives: 1. Recognize key building blocks of the US health care system, including financial flows 2. Categorize U.S. health care system stakeholders as patients, providers, purchasers,

payers, and policy makers. 3. Compare the US to other OECD health systems on cost, quality, and access metrics. 4. Assess differences and relationships between medical and social services spending.

Class Discussion Topic. Review the Moses, Bradley and Frakt articles plus other optional readings. What overarching impressions and conclusions do you draw about the US health care system? Do you see any flaws in analysis or reasoning? What are the implications of your conclusions? Review Session Videos at https://canvas.harvard.edu/courses/5743/pages/videos-session-1 Required Reading: • H. Moses et al. “The Anatomy of Health Care in the United States.” JAMA 2013; 310(18): 1947-1964.

http://jama.jamanetwork.com.ezp-prod1.hul.harvard.edu/article.aspx?articleid=1769890 • E. Bradley et al. “Health and Social Services Expenditures: Associations with Health Outcomes.” BMJ

Quality and Safety. 2011;20:826-831. http://qualitysafety.bmj.com.ezp-prod1.hul.harvard.edu/content/20/10/826.full.pdf+html

• A. Frakt. “Middle Aged, white Americans’ death rate is up. Alcohol and drugs are to blame.” Incidental Economist. November 3, 2015. http://theincidentaleconomist.com/wordpress/middle-aged-white-americans-death-rate-is-up/

Recommended Reading: • Victor Fuchs, “Major Trends in the U.S. Health Economy since 1950,” New England Journal of

Medicine, 2012; 366:973-977 March 15, 2012. http://www.nejm.org/doi/full/10.1056/NEJMp1200478

S. Keehan et al. “National Health Expenditure Projections, 2015-25: Economy, Prices, and Aging Expected to Shape Spending and Enrollment.” Health Affairs 35, Nol 8 (2016): 1522-31. http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/content/35/8/1522.full

Karen Davis et al. Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally. June 2014. Commonwealth Fund, New York. http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/jun/1755_davis_mirror_mirror_2014.pdf

GF Anderson, UE Reinhardt, PS Hussey and V Petrosyan. “It’s the Prices Stupid: Why The United States Is So Different From Other Countries.” 10.1377/hlthaff.22.3.89 Health Affairs, May 2003 vol. 22 no. 3 89-105. http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/content/22/3/89.full.pdf+html

Policy Memo: You are the chief health policy advisor to a Member of the Committee on Ways & Means of the U.S. House of Representatives. At a recent Town Hall meeting, a constituent asked your boss whether he/she believes that the U.S. has the best health care system in the world. Write a memo providing suggested answers and your recommended choice. Choose an actual current US House Member from either party who is a current Ways and Means Committee Member and demonstrate some knowledge of that Member’s district and political orientation. Due no later than September 2nd at 12:30pm via Canvas. Please pay attention for the formatting instructions on page 1.

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SESSION 3: U.S Health Reform and the Affordable Care Act (ACA) 9/7/2016 Dr. John McDonough, DrPH, HSPH-HPM Learning At the end of this class, you will be able to: Objectives: 1. Compare the ACA with prior attempts to reform the US health care system.

2. Describe how and why US health reform happened in 2010. 3. Distinguish among the key purposes and intents of the ACA’s 10 titles. 4. Explain how the ACA’s financing – spending and revenues – works. 5. Describe major ACA implementation challenges since March 2010.

Class Discussion Topic: In class, we will explore the history and structure of the ACA. We will also explore the ACA’s financing through the lens of the Congressional Budget Office, and in particular, their June 2015 report on the projected economic impacts of repealing the ACA in 2015. The report is included as a required reading below – please review it. Review Session Videos at https://canvas.harvard.edu/courses/5743/pages/videos-session-2 Required Readings:

• J. McDonough. Inside National Health Reform. Chapters 1, 2, 3, 4. 2011. University of California Press. Available on reserve at Countway Library.

• B. Obama. “United States Health Care Reform: Progress to Date and Next Steps.” JAMA. 2016;316(5): 525-532. August 2 2016. http://jama.jamanetwork.com/article.aspx?articleid=2533698

• S. Butler. “The Future of the Affordable Care Act: Reassessment and Revision.” JAMA 2016;316(5):495-97. http://jama.jamanetwork.com/article.aspx?articleid=2533696

• Elisabeth Goodridge and Sarah Arnquist, “Interactive Timeline: A History of Overhauling Health Care,” The New York Times. http://www.nytimes.com/interactive/2009/07/19/us/politics/20090717_HEALTH_TIMELINE.html

• Congressional Budget Office. Budgetary and Economic Effects of Repealing the Affordable Care Act. June 2015. https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/50252-Effects_of_ACA_Repeal.pdf

Recommended Readings: • James A. Morone, “Presidents and Health Reform: From Franklin D. Roosevelt to Barack Obama,”

Health Affairs, 29, no.6 (2010):1096-1100. http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/content/29/6/1096.long

• John McDonough’s blog site: www.healthstew.com

Policy Memo: Your boss is a 2016 candidate for a seat in the U.S. Senate – pick a real general election candidate from either party running this year (make sure to identify the candidate). Your Boss wants a memo explaining two things: first, what is most important for him/her to say publicly about ObamaCare; and second, what is most important and essential to say about the process by which the ACA became law. As this Candidate’s likely policy director (if he or she wins), you have been directed to write this memo with a suggested response. Due no later than September 9th at 12:30pm via Canvas. Please pay attention for the formatting instructions on page 1.

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SESSION 4: Medicare 1 9/12/2016 Guest Lecturer: Dr. Katherine Baicker, PhD, HSPH-HPM Learning At the end of this class, you will be able to: Objectives: 1. Understand the history, function and importance of Medicare Parts A, B, C and D

2. Compare advantages and disadvantages of “Traditional Medicare” (Parts A & B) versus “New Medicare” (Parts C & D) from patient, provider and government perspectives. 3. Consider the Impact of the ACA on all of Medicare and especially Parts A & B 4. Contrast key Medicare reforms, Accountable Care Organizations vs. Bundled Payments

Review Session Videos at https://canvas.harvard.edu/courses/5743/pages/videos-session-3 Class Discussion Topic: Pre-ACA Medicare had two primary payment methods, fee-for-service in A & B, and capitation in C & D. Post-ACA introduced a 3rd form, the Accountable Care Organization (ACO) capitation method in A&B. Some now suggest that the narrower “Bundled Payment” approach will have the biggest impact. What is the future of Medicare payment? Will fee-for-service disappear? Review Session 4 Videos at https://canvas.harvard.edu/courses/1056/modules Required Readings:

• Kaiser Family Foundation. “An Overview of Medicare.” April 1 2016. http://kff.org/medicare/issue-brief/an-overview-of-medicare/

• McDonough, John. “Title III – Medical Care, Medicare, and the Cost Curve.” From: Inside National Health Reform, Chapter 7. Berkeley, University of California Press and the Milbank Fund. 2011.

• S. Baseman et al. “Payment and Delivery System Reform in Medicare.” Kaiser Family Foundation. May 2006. http://files.kff.org/attachment/Report-Payment-and-Delivery-System-Reform-in-Medicare-A-Primer

• B. James and G. Poulsen. “The Case for Capitation.” Harvard Business Review. July August 2016. https://hbr.org/2016/07/the-case-for-capitation

• M. Porter and R. Kaplan. “How to Pay for Health Care.” Harvard Business Review. July August 2016. https://hbr.org/2016/07/how-to-pay-for-health-care

• Medicare Payment Advisory Commission. Health Care Spending and the Medicare Program, June 2016. http://medpac.gov/documents/data-book/june-2016-data-book-health-care-spending-and-the-medicare-program.pdf?sfvrsn=0

Recommended Readings: • Kaiser Family Foundation. “Medicare Advantage Fact Sheet.” May 11, 2016. http://kff.org/medicare/fact-sheet/medicare-advantage/ • Kaiser Family Foundation. “Medicare Prescription Drug Benefit Fact Sheet.” September 2014. http://kff.org/medicare/fact-sheet/the-medicare-prescription-drug-benefit-fact-sheet/ • A. Jha. “Will Episode Payment Models Show How to Better Pay for Hospital Care?” The JAMA

Forum. August 4 2016. https://newsatjama.jama.com/2016/08/04/jama-forum-will-episode-payment-models-show-how-to-better-pay-for-hospital-care/

Policy Memo: You are a health policy staffer for any current member of the US Senate Finance Committee. Your Chief of Staff’s mother is just about to turn age 65 and needs to decide whether to enroll in Medicare Advantage (Part C) or in traditional Medicare (Parts A & B). Your Boss knows next-to-nothing about Medicare and wants your help. Write a two page memo explaining the essential

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differences between the two options and how your Boss should advise his/her mother. Due no later than September 14th at 12:30pm via Canvas. Please pay attention for the formatting instructions on page 1. SESSION 5: Reforming the Health Care Delivery System: Quality Improvement 9/14/2016 Guest: Dr. Ashish Jha, MD, MPH, HSPH-HPM Learning At the end of this class, you will be able to: Objectives 1. Compare and contrast quality and safety.

2. Contrast where the US stands relative to other countries regarding high quality care. 3. Describe how the ACA seeks to improve the quality of care. 4. Apply your understanding to examples of policy interventions such as readmissions.

Class Discussion: ACA policy for hospitals involves targeting various metrics including readmissions, hospital acquired conditions (HACs), patient experience, and mortality. Is this being done well or badly? If you change the approach to paying hospitals based on quality, what changes would you make, if any? Review Session 11 Videos at: • https://canvas.harvard.edu/courses/5743/pages/videos-session-11?module_item_id=67326 • https://canvas.harvard.edu/courses/5743/pages/videos-session-11-2?module_item_id=67333

Required Readings: • Zuckerman et al. “Readmission, Observation, and the Hospital Readmissions Reduction Program.”

NEJM 2016; 374:1543-51. April 21, 2016. www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJMsa1513024

• Figueroa et al. “Association between the Value-Based Purchasing pay for performance program and patient mortality in US hospitals: observational study. BMJ 2016; 353. May 9, 2016. . http://www.bmj.com/content/353/bmj.i2214

• Ashish Jha. “Readmissions, Observation, and Improving Hospital Care.” HSPH Blog Post. February 26 2016. https://blogs.sph.harvard.edu/ashish-jha/2016/02/26/readmissions-observation-and-improving-hospital-care/

• Barnet, Michael et al. “Patient Characteristics and Differences in Hospital Readmission Rates.” JAMA Internal Medicine. Doi:10.1001/jamainternmed.2015.4660 Online September 12 2015. http://archinte.jamanetwork.com.ezp-prod1.hul.harvard.edu/article.aspx?articleid=2434813

Optional Readings • Blumenthal D. “Quality of Health Care, Part 1: Quality of Care: What Is It?” NEJM 1996; 335(12):891-

894. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJM199609193351213 • McGlynn EA, et al. “The Quality of Health Care Delivered to Adults in the United States.” New Engl J

Med 2003; 348(26): 2635-2645. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJMsa022615

• IOM. Crossing the Quality Chasm. Executive Summary (pp. 1-22). http://www.nap.edu/openbook.php?record_id=10027&page=1

• Jha AK, Larizgoitia I, Audera-Lopez C, Prasopa-Plaizier N, Waters H, and Bates DW. “The global burden of unsafe medical care.” BMJ Quality and Safety. 2013;22:809-815 doi:10.1136/bmjqs-2012-001748. http://qualitysafety.bmj.com/content/22/10/809.full.pdf+html

Policy Memo: You are a health policy staffer for The Business Roundtable (TBR), an organization of large U.S. corporations who seek to influence public policy. They are concerned about productivity and other economic losses from the U.S. health care system’s failure to deliver safe, high quality care. The organization was asked by the U.S. House Committee on Commerce and Energy to discuss how to drive more improvement in health care value in the U.S. Write a memo for TBR President John Engler suggesting what TBR should say in testimony on how the ACA is or is not driving improvement and what

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changes might be most helpful. Due no later than September 16th at 12:30pm. Please pay attention to formatting instructions on page 1. SESSION 6: Medicare 2 9/19/2016 Guest Lecturer: Prof. Arnie Epstein, HSPH HPM Learning At the end of this class, you will be able to: Objectives 1. Understand the history and structure of physician payment in Medicare Part B

2. Explain major ACA reform strategies to transform Medicare from a fee-for-service to a value based payment model 3. Articulate the role and importance of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), especially its Merit-Based Incentive Payment System (MIPS) to replace the “Sustainable Growth Rate” (SGR) formula that operated between 1997-2015

Class Discussion Topic: In class, we will consider, with our Guest Lecturer, Dr. Arnold Epstein, the new federal MACRA law and its impact on changing the incentives and payment model in Medicare Part B. OPTIONAL video on Medicare Parts C&D with Prof. Joe Newhouse: https://canvas.harvard.edu/courses/5743/pages/videos-session-5?module_item_id=98597 Required Readings:

• Burwell, Sylvia. “Setting Value-Based Payment Goals – HHS Efforts to Improve U.S. Health Care.” New England Journal of Medicine. 2015; 372:897-899, March 5 2015. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJMp1500445

• J. Halamka. “A Deep Dive on the MACRA NPRM.” Life as a Healthcare CIO. May 5 2016. http://geekdoctor.blogspot.com/2016/05/a-deep-dive-on-macra-nprm.html

• S. Matousek. “What is MACRA and Why Do I Need to Know?” June 28 2016. Day Health Strategies. http://dayhealthstrategies.com/what-is-macra-and-why-do-i-need-to-know/ and “What Is MACRA Part 2” July 6 2016. http://dayhealthstrategies.com/what-is-macra-part-2-digging-into-the-quality-payment-programs/

• R. Mechanic. “When New Medicare Payment Systems Collide.” NEJM 2016;374:1706-09. May 5 2016. http://www.nejm.org/doi/full/10.1056/NEJMp1601464

Recommended Readings:

• Abrams, Melinda et al. The Affordable Care Act’s Payment and Delivery System Reforms: A Progress Report at Five Years. May 7 2015. Commonwealth Fund. http://www.commonwealthfund.org/publications/issue-briefs/2015/may/aca-payment-and-delivery-system-reforms-at-5-years

• Aaron, Henry. “Three Cheers for Logrolling – The Demise of the SGR.” New England Journal of Medicine. 2015; 372:1977-1979, May 21 2015. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJMp1504076

Policy Memo: Your boss is a US Senator running for re-election in the November 2016 federal elections. Many physicians keep complaining and asking for his/her opinion/position on the MACRA/MIPS law. Write a 2-page memo with suggested options and a recommendation. Due no later than September 21st, at 12:30pm via Canvas. Please pay attention for the formatting instructions on page 1.

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SESSION 7: Private Health Insurance 9/21/2016 Prof. Nancy Turnbull, HSPH/HPM Learning At the end of this class, you will be able to: Objectives: 1. Summarize the role and history of private health insurance in the US;

2. Identify populations covered by private insurance and self-insured employer plans. 3. Describe how insurers historically protected themselves from adverse selection. 4. Describe ACA’s changes to private health insurance, especially guaranteed issue and underwriting, exchanges /marketplaces, premium/cost sharing subsidies, and mandates. 5. Consider how ACA marketplaces/exchanges will develop over coming years.

Class Discussion: Prof. Nancy Turnbull, a member of the board of directors of the Massachusetts Health Connector, will lead an exploration of the ACA’s health exchanges/marketplaces. Prior to class, each table of students will have gone online and assessed the plan options available from one state health insurance marketplace: California, Connecticut, Florida, Kentucky, Massachusetts, Michigan, or New York Review Session Videos at https://canvas.harvard.edu/courses/5743/pages/videos-session-4?module_item_id=67238 Required Readings:

1. McDonough, John. “Title I – The Three Legged Stool.” From: Inside National Health Reform, Chapter 5. Berkeley, University of California Press and the Milbank Fund. 2011.

2. N. Uberoi et al. “Health Insurance Coverage and the Affordable Care Act, 2010–2016.” ASPE Issue Brief. US DHHS. March 3, 2016. http://garnerhealth.com/wp-content/uploads/2014/02/ACA2010-2016.pdf

3. Blumberg L. and Holahan, John. After King v. Burwell: Next Steps for the Affordable Care Act. Urban Institute. August 11, 2015. http://www.urban.org/research/publication/after-king-v-burwell-next-steps-affordable-care-act

Recommended Readings: • Deborah Stone, “The Struggle for the Soul of Health Insurance,” Journal of Health Politics,

Policy and Law, Summer 1993 18(2):287-317. https://policyparadox.files.wordpress.com/2014/11/journal-of-health-politics-policy-and-law-1993-stone-287-317.pdf

• David Blumenthal, “Employer-Sponsored Health Insurance in the United States—Origins and Implications,” The New England Journal of Medicine, July 6, 2006, 355:82-88. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJMhpr060703

• Aetna. Reform Explained: Health Insurance Exchanges/Marketplaces. http://www.aetna.com/health-reform-connection/reform-explained/exchanges.html

Policy Memo: You are the health policy analyst for the Insurance Committee in a STATE House of

Representatives (not US). You report to the Committee Chairman. Some committee members have become interested in Presidential Candidate Hillary Clinton’s proposal that states be encouraged to set up their own “public option” plans in state health insurance exchanges. Write a two-page memo explaining reasons for and against this proposal – and in the real context of that state. Make your own recommendation to the Chairman. Please pick and identify a real state and real Insurance Committee Chairperson. Due no

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later than September 23th at 12:30pm via Canvas. Please pay attention for the formatting instructions on page 1.

SESSION 8: Medicaid 9/26/2016 Guest Lecturer: Dr. Ben Sommers, HSPH HPM Learning At the end of this class, you will be able to: Objectives: 1. Identify key features of Medicaid, including its federal-state structure, eligible

populations and services (pre-post ACA), and financing 2. Compare Medicaid eligibility requirements with other insurance programs 3. Assess Title II, the Medicaid portion of the ACA on multiple impacts 4. Analyze key cost trends in Medicaid, the impact of the 2014 ACA expansion, and tradeoffs between state and federal spending for the program. 5. Evaluate current state options regarding Medicaid since the Supreme Court’s 2012 health care ruling, and assess political/economic arguments for and against expansion.

Class Discussion: The Arkansas Medicaid Expansion Model under the ACA – and its derivatives in Iowa, Michigan, Indiana and elsewhere – is it a step forward, backwards, or sideways? Arkansas was the first state to get federal approval to obtain ACA-Medicaid expansion funding, not by expanding Medicaid, but by making all new eligibles enroll in private coverage through the state’s insurance exchange. 1. Is this a good or bad idea? 2. Is this a big deal or not? 3. What are the long-range prospects for this state option? Review Session 6 Videos at https://canvas.harvard.edu/courses/5743/pages/videos-session-3-2 Required Readings:

• McDonough, John. “Title II – Medicaid, CHIP and the Governors.” From: Inside National Health Reform, Chapter 6. Berkeley, University of California Press and the Milbank Fund. 2011.

• B. Sommers et al. “Both the ‘Private Option’ and Traditional Medicaid Expansions Improved Access to Care for Low-Income Adults.” Health Affairs. January 2016, vol. 35, no 1, 96-105. http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/content/35/1/96.long

• Benjamin D. Sommers, M.D., Ph.D., Katherine Baicker, Ph.D., and Arnold M. Epstein, M.D. “Mortality and Access to Care among Adults after State Medicaid Expansions.” New England Journal of Medicine. July 25, 2012. (10.1056/NEJMsa1202099) http://www.nejm.org/doi/full/10.1056/NEJMsa1202099#t=article

Recommended Readings: • Alan Weil, “There’s Something About Medicaid,” Health Affairs, 22, no.1 (2003): 13-30.

http://content.healthaffairs.org/content/22/1/13.full.html • Benjamin D. Sommers, M.D., Ph.D., and Arnold M. Epstein, M.D “Why States Are So Miffed about

Medicaid — Economics, Politics, and the “Woodwork Effect” N Engl J Med 2011; 365:100-102 7/14/11. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJMp1104948

• Timothy Stoltzfus Jost, J.D., and Sara Rosenbaum, J.D. “The Supreme Court and the Future of Medicaid.” New England Journal of Medicine. July 25, 2012 (10.1056/NEJMp1208219). http://www.nejm.org/doi/full/10.1056/NEJMp1208219

Policy Memo: You are the senior health policy adviser to a governor (identify the Governor and which state s/he governs) whose state has NOT expanded Medicaid as permitted by the ACA’s Title II, and who is now re-examining that decision. Your boss has been asked to speak at an upcoming panel at the National Governors Conference to explain what’s going on. Write a memo explaining the Governor’s prior decision

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not to expand and recommend where the state should go post-November 8. Due no later than September 28th at 12:30pm. Pay attention to formatting instructions on page 1. SESSION 9: A Conservative’s Perspectives on the ACA 9/28/2016 Dr. Stuart Butler, PhD, The Brookings Institution Learning At the end of this class, you will be able to: Objectives: 1. Understand the evolution of conservative thinking on US health reform since 1990 2. Articulate the conservative critique of the ACA and the key objections to the law 3. Distinguish the future paths that conservative responses to the law may follow

Class Discussion: Dr. Stuart Butler, formerly of the Heritage Foundation and now at the Brookings Institute, long-time scholar on conservative approaches to US health reform, will participate in class to discuss conservatives and US health reform and the ACA. For info on Dr. Butler see: http://www.brookings.edu/~/media/experts/b/butlers/butlers_cv.pdf

Required Readings: • S. Butler. “The Future of the Affordable Care Act: Reassessment and Revision.” JAMA

2016;316(5):495-97. http://jama.jamanetwork.com/article.aspx?articleid=2533696 • Butler, Stuart. Using Tax Credits to Create an Affordable Health System.” July 20 1990. Heritage

Foundation, Washington DC. http://www.heritage.org/research/reports/1990/07/using-tax-credits-to-create-an-affordable-health-system

• Butler, Stuart. “Don’t Blame Heritage for ObamaCare Mandate.” 2/6/2012. USA Today. http://usatoday30.usatoday.com/news/opinion/forum/story/2012-02-03/health-individual-mandate-reform-heritage/52951140/1

• Butler, Stuart. “States Are the Key to Both Strengthening and Replacing the Affordable Care Act.” JAMA. 2015;313(2):123 http://jama.jamanetwork.com/article.aspx?articleid=2089341

Recommended Reading:

• J. Antos et al. “Improving Health and Health Care: An Agenda for Reform.” American Enterprise Institute. December 9 2015. https://www.aei.org/publication/improving-health-and-health-care/

• U.S. House Republican Conference. A Better Way: Health Care. http://abetterway.speaker.gov/?page=health-care

• D. Trump. “Healthcare Reform to Make America Great Again.” https://www.donaldjtrump.com/positions/healthcare-reform

Policy Memo: You are the health policy aide to a sitting Democratic Member of the U.S. House of Representatives (please identify) who wants to understand the long-term resistance of conservatives and Republicans to the Affordable Care Act/ObamaCare in preparation for a new President and Congress in 2017. Please prepare a 2-page memo explaining the resistance and considering options for a changed position beginning in 2017. Due no later than September 30th at 12:30pm. Please pay attention for the formatting instructions on page 1.

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SESSION 10: Long-term Services and Support (LTSS) Policy 10/3/2016 Guest: Dr. David Grabowski, PhD, HMS-HCP Learning At the end of this class, you will be able to: Objectives: 1. Describe the categories of services considered “long-term services and supports” (LTSS)

and identify where these services are delivered. 2. Compare and contrast the characteristics of long-term versus acute care. 3. Identify populations at greatest risk of needing LTSS. 4. Compare and contrast the LTSS financing system to the general health care system. 5. Explain why informal unpaid care and care paid through Medicaid are the two largest most common types of long-term care. 6. Compare the markets for long-term care insurance and for private health insurance. 7. Evaluate potential policy reform strategies, based on lessons learned from US policy failures as well as examples from other countries.

Class Discussion: What are the options for reform of long term services and support today? Review Session 10 Videos at https://canvas.harvard.edu/courses/5743/pages/videos-session-

10?module_item_id=67314 Required Readings: • Bernstein Nina. “Fighting to Honor a Father’s Last Wish: To Die at Home.” New York Times.

9/25/2014. http://www.nytimes.com/2014/09/26/nyregion/family-fights-health-care-system-for-simple-request-to-die-at-home.html

• H. Stephen Kaye, Charlene Harrington, and Mitchell P. LaPlante, “Long-Term Care: Who Gets It, Who Provides It, Who Pays, And How Much?” Health Affairs, 29, no. 1 (2010): 11-21. http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/content/29/1/11.long

• Grabowksi Powerpoint Deck, available on course website

Recommended Reading • Pamela Doty, Kevin J. Mahoney, and Mark Sciegaj, “New State Strategies to Meet Long-Term Care

Needs,” Health Affairs, 29, no. 1 (2010): 49-56. http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/content/29/1/49.long

• McDonough, John. “Title VIII – CLASS Act.” From: Inside National Health Reform, Chapter 12. Berkeley, University of California Press and the Milbank Fund. 2011. Pp. 238-249.

• Katherine Swartz. “Searching for a Balance of Responsibilities: OECD Countries' Changing Elderly Assistance Policies.” Annual Review of Public Health.Vol. 34: 397-412 (Volume publication date March 2013) http://www.annualreviews.org.ezp-prod1.hul.harvard.edu/doi/pdf/10.1146/annurev-publhealth-031912-114505

Policy Memo: You are the chief policy adviser to the new Health & Human Services Secretary in your state (identify the state). The Secretary has just been told that one of the biggest challenges s/he will face involves long-term care services and supports (LTSS). You have been directed to write a memo explaining why this is the case or not and how to respond. Due no later October 5th at 12:30pm. Please pay attention for the formatting instructions on page 1.

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SESSION 11: Public Health and Prevention 10/5/2016 Guest: Dr. Howard Koh; HSPH/HPM Learning At the end of this class, you will be able to: Objectives: 1. Explain the definition, core values, and essential services of public health.

2. Compare and contrast public health, population health, and clinical care. 3. Assess the impact of public health achievements in the US in the 20th century. 4. Identify leading causes of death and illness in the US and how they shift over time. 5. Define “social determinants of health” and distinguish between social and non-social determination of health and apply social determinates of health to racial and ethnic disparities/inequities in health and health care. 6. Identify the key organizations and their roles in public health in the U.S. 7. Identify key ACA provisions regarding public health and predict their impact.

Class Discussion: Considering the progress and setbacks in advancing public and population health in the 21st century Review Session Videos at https://canvas.harvard.edu/courses/5743/pages/videos-session-12 Required Readings: • US Department of Health & Human Services. Healthy

People.Gov http://www.healthypeople.gov/2020/default.aspx • National Center for Health Statistics. US Centers for Disease Control and Prevention. Healthy People

2020. http://www.cdc.gov/nchs/healthy_people/hp2020.htm • Howard Koh. “A 2020 Vision for Healthy People.” NEJM 2010; 362:1653-

56. http://www.nejm.org/doi/full/10.1056/NEJMp1001601 • Howard Koh et al. “Healthy People 2020: A Report Card on the Health of the Nation.” JAMA

Viewpoint. June 25, 2014. http://jama.jamanetwork.com/article.aspx?articleid=1876599 • McDonough, John. “Title IV – Money, Mammograms, and Menus.” Inside National Health Reform,

Chapter 8. Berkeley, University of California Press and the Milbank Fund. 2011.

Recommended Readings: • The National Prevention Strategy, 2011, National Prevention, Health Promotion and Public Health

Council, pages 14-51. http://www.surgeongeneral.gov/priorities/prevention/strategy/index.html • “A Healthier America 2013: Strategies To Move From Sick Care To Health Care In The Next Four

Years.” Trust for America’s Health, Section 1, http://healthyamericans.org/report/104/ • “Health Departments in a Brave New World”, Christopher Maylahn, MPH, David Fleming, MD, Guthrie

Birkhead, MD, MPH, Prev Chronic Dis. 2013;10, http://www.cdc.gov/pcd/issues/2013/13_0003.htm

Policy Memo: You are the newly appointed Commissioner of Public Health to your state’s newly elected Governor. In your final selection interview, the Governor-elect told you that s/he doesn’t understand what public health is, and would like you to write a 2-page memo on: what public health is, why s/he should care, and what are the opportunities in public health to advance his/her agenda. He has also heard about something called “health in all policies” and would like to understand that as well. Due no later than October 7th at 12:30pm. Please pay attention to formatting instructions on page 1.

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SESSION 12: Pharmaceutical Policy and Payment 10/12/2016 Guest Lecturer: Dr. Elizabeth Seeley, PhD, HSPH HPM Learning At the end of this class, you will be able to: Objectives 1. Understand the structure and nature of the U.S. pharmaceutical industry. 2. Recognize key public policy challenges relating to pharmaceuticals in the US. 3. Assess different ways that pharmaceutical payment policy is set in the United States. 4. Relate objectives 1,2,3 to the new situation of high cost specialty pharmaceutical

products now emerging in the US drug market. 5. Appreciate how other nations tackle the drug payment challenge differently. Class Discussion: Understand the challenges of setting pharmaceutical payment policy relating to high cost specialty drugs. Review Session 7 Videos

at https://courses.edx.org/courses/HarvardX/PH210x/1T2014/courseware/8663e2d83a5445e89c174be528a0cee1/9ed3a257bc7043c0b3ebec6eded79eff/ (from HarvardX)

Required Readings:

• Altman, Drew. “Why Higher Drug Costs are Consumers’ Biggest Worry” Wall Street Journal Washington Wire. September 8, 2015. http://blogs.wsj.com/washwire/2015/09/08/why-higher-drug-costs-are-consumers-biggest-cost-worry/

• S. Kirchhoff. “Specialty Drugs: Background and Policy Concerns.” Congressional Research Service. August 3 2015. https://www.fas.org/sgp/crs/misc/R44132.pdf

• Bruen B. and Young K. Kaiser Family Foundation Issue Brief. “What Drives Spending and Utilization on Medicaid Drug Benefits in States?” December 2014. http://files.kff.org/attachment/brief-what-drives-spending-and-utilization-on-medicaid-drug-benefits

• Garber, A. and McClellan M. (2007) “Satisfaction Guaranteed—‘Payment by Results’ for Biologic Agents” New England Journal of Medicine. 357:1575-1577. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/pdf/10.1056/NEJMp078204

• A. Kesselheim et al: “The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform.” JAMA. 2016;316(8):858-871. August 23-30 2016. http://jama.jamanetwork.com.ezp-prod1.hul.harvard.edu/issue.aspx?journalid=67&issueid=935665&direction=P

Policy Memo: You are the head of the Health Policy Office in your state’s Medicaid program. The agency is grappling with its options to deal with the emergence of very effective and very high cost specialty drug products such as Sovaldi. Identify your state. Write a memo that articulates the core of the problem and the options available to the Medicaid program. Due no later than October 14th at 12:30pm. Please pay attention for the formatting instructions on page 1.

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SESSION 13: Mental Health Policy 10/17/2016 Guest: Dr. Haiden Huskamp, HMS/HCP Learning At the end of this class, you will be able to: Objectives 1. Distinguish between mental health, mental illness, and behavioral health.

2. Articulate the prevalence of behavioral health disorders in the US. 3. Identify key landmarks in mental health policy in the US. 4. Compare the financing of general health to the behavioral health system. 5. Identify misconceptions contributing to mental illness stigma. 6. Identify how the Mental Health Parity and Addiction Equity Act and the ACA have improved behavioral health outcomes and fallen short of doing so.

Class Discussion: Dr. Haiden Huskamp will lead discussion to understand the impact, success, and

shortcomings of the Mental Health Parity and Addiction Equity Act and the ACA on behavioral health services in the US.

Review Session Videos at https://canvas.harvard.edu/courses/5743/pages/videos-session-8?module_item_id=67290

Required Reading:

• Richard G. Frank and Sherry A. Glied, Better but Not Well: Mental Health Policy in the United States since 1950, The Johns Hopkins University Press, 2006, Chapter 4 (pages 48-69) and Chapter 6 (pages 91-103). Chapters 4 and 6 available at:

o http://muse.jhu.edu.ezp-prod1.hul.harvard.edu/books/9780801889103/9780801889103-7.pdf

o http://muse.jhu.edu.ezp-prod1.hul.harvard.edu/books/9780801889103/9780801889103-9.pdf

• C. Barry et al. “The Early Impact of the ‘Alternative Quality Contract’ on Mental Health Service Use and Spending in Massachusetts.” Health Affairs. 2015 Dec; 34(12):2077-85 http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/content/34/12/2077

• H. Huskamp and J. Iglehart. “Mental Health and Substance-Use Reforms – Milestones Reached, Challenges Ahead.” NEJM. 2016; 375:688-95. August 18, 2016. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJMhpr1601861

• C. Barry et al. “Federal Parity in the Evolving Mental Health and Addiction Care Landscape. Health Affairs. 2016 June 1;35(6):1009-16. http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/content/35/6/1009

Recommended Reading: For those wanting more background on parity

• Howard H. Goldman, et al., “Behavioral Health Insurance Parity for Federal Employees,” New England Journal of Medicine 354(13):1378-1386, (2006). http://www.nejm.org/doi/pdf/10.1056/NEJMsa053737

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• Colleen L. Barry, Haiden A. Huskamp, and Howard H. Goldman, “A Political History of Federal Mental Health and Addiction Insurance Parity,” Milbank Quarterly 88(3):404-433, (2010). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950754/

Policy Memo: You are the health policy adviser to a Member of the U.S. House of Representatives. Your boss has been asked to testify before his/her state’s legislative committee on Health & Human Services about federal responses to the opioid addiction crisis. Write a memo explaining what has happened in federal policy to address the crisis, what Congress has done, and what still needs to be done to assist states. Due not later than October 19th at 12:30pm. Please pay attention for the formatting instructions on page 1.

SESSION 14: Class Discussion and Wrap-Up 10/19/2016 Prof. John McDonough HSPH/HPM Learning At the end of this class, you will be able to: Objectives 1. Consolidate key learnings from classes, videos, readings, discussion board etc.

2. Consider cases/policy issues in context of policy analysis models 3. Recognize lessons from policy memo writing practice 4. Articulate your framework for future health policy analysis work

Class Discussion: Opportunity to evaluate and revisit key messages and learnings from the previous 13

classes and exercises.

No readings.

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Policy Memo Grading Rubric: 15 Points Total Executive Summary and Conclusion 3 Includes one paragraph executive summary with brief overview of issues and recommendations and a conclusion summarizing main points. Problem Description 3 Problem is clearly identified, and includes research and facts to make the case; comprehensive and concise. Options and Recommendations 3 Describes two or three policy options with recommended policy. Research is cited for the option selected and follows from evidence and reason. Potential consequences are included. Audience 2 Written with a specific audience and reader’s needs in mind, and considering the policymaker’s interests and obligations. Organization, Style, Mechanics 3 Well organized with well-constructed paragraphs, transitions, and subheadings. Sentences are well written and with varied structure. No grammatical, spelling, or punctuation errors. Sources 1 Minimum of three high quality sources are included and correctly formatted. Category Comment Score Executive Summary/Conclusion (3)

Problem Description (3) Options/Recommendations (3)

Audience (2) Organization/Style/ Mechanics (3)

Sources (1) TOTAL

Version date: 03/14/16

Public Health Law HPM 213, Spring2 2016

Thursday, 5:30pm-8:20pm Room FXB-G13

Instructor Ameet Sarpatwari, J.D., Ph.D. Instructor in Medicine, Harvard Medical School Assistant Director, Program On Regulation, Therapeutics, And Law (PORTAL) Associate Epidemiologist, Brigham and Women’s Hospital asarpatwari@partners.org Office Hours: At One Brigham Circle offices, by appointment Teaching Assistant Dalia Deak Email: dalia.deak@mail.harvard.edu Office Hours: By appointment Texts and Reading Materials To minimize costs imposed on you, all readings are available electronically online through hyperlinks or on the course website. Course Objectives In this course, you will learn to:

Understand some of the major policy issues at the nexus of public health and the law

Explain the powers and roles of legislatures, courts, and administrative agencies in regulating matters of public health, and the strengths and weaknesses of each as a regulator

Describe the nature and sources of legal rights

Analyze conflicts between individual rights and the collective good in public health policy

Identify and critically analyze legal issues arising in public health policies

Read a judicial opinion and write a legal analysis

Speak “the language of the law” in conversations with policymakers, demonstrating an understanding of basic legal concepts and constitutional principles

Outcome Measures 1. Blog Posts: You will write two blog posts during the course. The blog posts should be

approximately 350 words and can be a response to the readings or on a topic raised by the readings. Posts will be due by by 11:59pm Tuesday each week.

2. Essay: You will answer an essay question designed to deepen your understanding of the case

law and give you practice applying what you have learned to new legal and policy scenarios. You must answer in no more than 3 double-spaced pages.

3. Exam: You will take a 2-hour in-class exam consisting of essay questions. You will be allowed

to consult your course readings and notes during the exam. Grading Criteria 1. Blog Posts: The blog posts will constitute 20% (i.e., 10% each) of the overall course grade.

2. Essay: The essay will constitute 25% of the overall course grade.

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3. Exam: The exam will constitute 55% of the overall course grade. 4. Class Participation: Class participation will be evaluated qualitatively and ratings will be used to

move up students whose written work scores are near a grade cutoff point on the final distribution, and who have excellent class participation. Class participation consists of three elements: attendance; preparation; and thoughtful, relevant contributions to class discussions.

Additional Information Attendance: Attendance at each class is expected. Absences should be excused beforehand. Class Structure: The first half of class will be largely lecture-based with some discussion and will be followed by a 10-15 minute break. The second half of class will be more interactive, often featuring a class exercise. Given our meeting time, I welcome you to bring your dinner to class. Lecture slides: The lecture slides will be available on the course website by noon on the day of the lecture. Supplementary materials and announcements will also be posted online from time to time. You will receive email notification of important materials (other than lecture slides) and announcements. You should check your email daily. Policy on academic integrity: Please make sure you understand the following rules regarding collaboration on assignments and academic integrity. If anything about these policies is unclear, it is your responsibility to ask the instructor for clarification.

Blog Posts and Essay: Your blog posts and essay must represent your own work. When you

derive facts or ideas from reading and research, you must indicate the sources. It is not necessary to make attributions to course lectures.

Final Exam: Final exams must be completed independently. During the exam, you may consult your notes and course readings. You should acknowledge cases and other readings by short name (e.g., “In Jacobson, the court held…”). It is not necessary to make attributions to course lectures.

Policy on extensions: HSPH students typically juggle a number of responsibilities. Although this can create challenges for timely completion of coursework, in fairness to all students, I am not able to grant extensions on the homework to accommodate competing demands (e.g., conferences, other coursework). However, emergencies do arise (e.g., family emergency, illness), and I can often offer flexibility in such cases. Let me know as soon as you become aware of such a situation. Policy on late work: Written work that is received late, when an extension was not granted in advance of the deadline, will ordinarily be assessed a penalty. For work received within 12 hours of the deadline, 10% will be deducted. For work received 12-24 hours late, 15% will be deducted. For work received 24-48 hours late, 20% will be deducted. A score of 0 will be entered for assignments still missing at that point. Exam accommodations: Please follow standard HSPH procedures for requesting accommodations relating to a disability. Requests to take the final exam at an alternative time for personal reasons will be considered, but granted only in exceptional circumstances. Please make such requests as early as possible. Videotaping: I have requested that HSPH A/V Services videotape the optional review session that will be held outside of regular class time. Regular class sessions will not be videotaped.

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Course Evaluations HSPH requires completion of a course evaluation for each course you take. Your grade will not be available until you submit the evaluation. In addition, registration for future terms will be blocked until you have completed evaluations for courses in prior terms. Class Schedule and Readings Required readings (generally about 75-90 pages per class) should be read in advance of class. CLASS 1 Thursday, March 24: Battling Bugs in the “Laboratories” of the States Legal Concepts: Police and emergency powers; substantive due process; incorporation Public Health Topics: Nature of public health law; mandatory vaccination; isolation; quarantine Readings: 1. Gostin, LO. Public health law: power, duty, restraint. Berkeley: University of California Press, 3rd Edition, 2016. [Note: read chapter 1] 2. Jacobson v. Massachusetts, 25 S. Ct. 58 (1905). 3. Barmore v. Robertson, 134 N.E. 815 (Ill. 1922).

4. Parmet WE, Goodman RA, Farber A. Individual rights versus the public’s health. N Engl J Med 2005;352(7):652-4.

5. Haffajee R, Parmet WE, Mello MM. What is a public health “emergency”? N Engl J Med 2014;371(11):986-8.

6. Burrough B. Trial by Ebola. Vanity Fair. February 2015. [Note: skim] 7. Mayhew v. Hickox, No. CV-2014-36 (D. Maine October. 31, 2014) (order pending hearing).

OPTIONAL SESSION: Tuesday, March 29, 12:30pm-1:20pm: Primer on American Government, the Judicial Process, and Legal Analysis Room K-G2 This session is aimed at students without legal training. However, I recommend that all students review the slides. Concepts: The structure of American government; how to read a judicial opinion and

brief a case; legal reasoning and how to write a strong legal analysis. CLASS 2 Thursday, March 31: Eat Your Broccoli! The Reach of Uncle Sam Legal Concepts: Preemption; rulemaking; commerce clause powers; tax and spend powers Public Health Topics: Generic drugs; Affordable Care Act Readings: 1. Kesselheim AS, Darrow JJ. Hatch-Waxman turns 30: Do we need a redesigned approach for the modern era? Yale J Health Policy Law Ethics 2015;15(2):293-347. [Note: read parts I and II]

2. Pliva v. Mensing, 131 S. Ct. 2567 (2011). [Note: read majority opinion] 3. Food and Drug Administration, Supplemental Applications Proposing

Labeling Changes for Approved Drugs and Biologics Products, 78 Fed. Reg. 67,985. [Note: read executive summary only] 4. National Federation of Independent Business v. Sebelius, 132 S. Ct. 2566 (2012). [Note: read majority opinion] 5. Blumenthal D, Abrams M, Nuzum R. The Affordable Care Act at 5 years. New Engl J Med 2015;372(25):2451-8.

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Note: The first half of this class will be led by Aaron Kesselheim, M.D., J.D., M.P.H.; Associate Professor of Medicine, Harvard Medical School; Director, Program On Regulation, Therapeutics, And Law (PORTAL) CLASS 3 Thursday, April 7: Hurting People Fairly Legal Concepts: Procedural due process; equal protection Public Health Topics: Mental health; opioids; coercive treatment Readings: 1. Jew Ho v. Williamson, 103 F. 10 (N.D. Cal. 1900). 2. Deinstitutionalization: a psychiatric “Titanic.” Frontline. May 10, 2005. 3. Addington v. Texas, 99 S. Ct. 1804 (1979). 4. Rogers v. Commissioner of Department of Mental Health, 390 Mass. 489 (1983). 5. Aviv R. Prescription for disaster. New Yorker. May 5, 2014. 6. An Act Relative to Substance Use Treatment, Education, and Prevention, H.R. 4209, 189th Gen. Ct. (Mass. 2015). CLASS 4 Essay Distributed Thursday, April 14: You Can’t Say That! Legal Concepts: Freedom of speech; commercial speech; professional speech Public Health Topics: Off-label drug marketing; direct-to-consumer advertising; physician speech Readings: 1. Sorrell v. IMS Health, 131 S. Ct. 2653 (2011). 2. United States v. Caronia, 703 F.3d 149 (2d Cir. 2012). 3. Avorn J, Sarpatwari A, Kesselheim AS. Forbidden and permitted statements-loosening the rules. New Engl J Med 2015;373(13):967-73.

4. Donohue JM, Cevasco M, Rosenthal MB. A decade of direct-to- consumer advertising of prescription drugs. New Engl J Med 2015;373(13):673-81.

5. Wollschlaeger v. Governor, 2015 WL 8639875 (11th Cir. 2015) [Note: read parts I and IV of majority opinion]

6. Volokh E. Can Florida restrict doctors’ speech to patients about guns? Washington Post. February 4, 2016.

CLASS 5 Essay Due Thursday, April 21: In God We Trust Legal Concepts: Fraud, freedom of religion; Religious Freedom Restoration Act Public Health Topics: Vaccination exemptions; contraception coverage Readings: 1. The Vaccine War. Frontline [Note: Watch until minute 11:06] 2. Wakefield, AJ et al. Ileal-lymphoid-nodular hyperplasia, non-specific

colitis, and pervasive developmental disorder in children. Lancet 2011;351(9103):637-41.

3. Deer B. How the case against the MMR vaccine was fixed. BMJ 2011;342:c5347. 4. Phillips v. City of New York, 27 F. Supp. 3d 310 (E.D.N.Y. 2014). 5. Mello MM, Studdert DM, Parmet WE. Shifting vaccination politics—the end of personal-belief exemptions in California. New Engl J Med 2015;373(9):785-7. 6. Burwell v. Hobby Lobby Stores, 134 S. Ct. 2751 (2014).

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7. Cohen IG, Lynch HF, Curfman GD. When religious freedom clashes with access to care. New Engl J Med 2014;371(7):596-9.

Note: The second half of this class will be led by Holly Fernandez Lynch, J.D., M.Bioethics, Executive Director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School.

CLASS 6 Thursday, April 28: Knock Knock. Who’s There? HIPAA? HIPAA Who? I Can’t Say. Legal Concepts: HIPAA, HITECH Act, Common Rule Public Health Topics: Health privacy, big data, secondary use of biospecimens Readings: 1. Committee on Health Research and the Privacy of Health Information, Institute of Medicine. Beyond the HIPAA Privacy Rule: Enhancing Privacy, Improving Health Through Research. (Sharyl J. Nass, Laura A. Levit & Lawrence O. Gostin eds., 2009). [Note: read pgs. 75-93, 21-22, 94-100]

2. Sarpatwari A, Kesselheim AS, Malin BA, Gagne JJ, Schneeweiss S. Ensuring patient privacy in data sharing for postapproval research. New Engl J Med 2014;371(17):1644-9. 3. Malin B, Loukides G, Benitez K, Clayton EW. Identifiability in biobanks: models, measures, and mitigation strategies. Hum Gen 2011;130(3):383-92. 4. Evans BJ. The ethics of postmarketing observational studies of drug safety under section 505(O)(3) of the Food, Drug, and Cosmetic Act. Am J Law Med 2012;38(4)577-606. 5. Kass NE, Faden RR, Goodman SN, Provonost P, Tunis S, Beachamp TL. The research-treatment distinction: a problematic approach for determining which activities should have ethical oversight. Hastings Cent Rep 2013;S4-14. 6. Largent EA, Miller FG, Joffe S. A prescription for ethical learning. Hastings Cent Rep 2013;S28-9.

CLASS 7 Thursday, May 5: Sue the B*stards! Legal Concepts: Tort law, the use of class-action tort litigation to achieve public health

goals; review of course themes; Public Health Topics: Cigarettes, mercury contamination/poisoning Readings: 1. Gifford DG. Suing the tobacco and lead pigment industries. Ann Arbor:

University of Michigan Press, 2010. [Note: read chapter 2] 2. Brandt AM. The cigarette century: the rise, fall, and deadly persistence of the product that defined America. Basic Books: New York, 2007.

[Note: read pgs 401-42]. 3. Rutkow L, Teret S. Role of state attorneys general in health policy. JAMA 304(12):1377-8. 4. Maine People’s Alliance v. Holtrachem Manufacturing, Order on Remediation Plan (D. Me. 2014). [See course site] 5. Maine People’s Alliance v. Holtrachem Manufacturing, Volume XI— Transcript of Proceedings (D. Me. 2014).[See course site]

Note: The second half of this class will be led by Aaron Colangelo, J.D., Co-Litigation Director, National Resources Defense Council (NRDC).

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CLASS 8 Thursday, May 12: Final Examination

Syllabus: HPM 219 Financial Transactions and Analysis Section 1: Monday and Wednesday, 8:30 am – 10:20 pm, Room FXB-G13

Section 2: Monday and Wednesday, 10:30 am – 12:20 pm, Room 502 Kresge

Instructor Information

Dee Dee Chen, SM, CFP®, FACHE Instructor Department of Health Policy and Management E-mail: dchen@hsph.harvard.edu Office hours: I would be most willing to meet with you by appointment. If you prefer, I check my e-mail regularly. Office address: Room 419 Kresge

Sam Levitt, SM, ScD, CFA Instructor Department of Health Policy and Management E-mail: levitt@hsph.harvard.edu Office hours: I am generally available for shorter conversations after class. In addtion, we can schedule time by appointment. In addition, please feel free to contact me by email, and I will do my best to respond within 48 hours. Office address: Room 420 Kresge

Teaching Assistants: Megan McMenamin Melanie Sottile Use HPMTAs@gmail.com to contact both TAs

Teaching assistants will conduct question/answer review sessions at times to be determined and will generally be available to answer questions.

Texts and Reading Materials

1. Essentials of Accounting, 11th ed., Leslie K. Breitner and Robert N. Anthony, Prentice Hall, 2010, ISBN: 978-013-274437-9.

[The 10th ed., ISBN: 978-0-13-607182-2 will also suffice]

This is a programmed text and you should complete Chapters 1 – 10 before the first class. There is a short quiz at the end of each chapter to test your understanding. We suggest you complete one chapter at a sitting. Do not do the mini-cases at the end of each chapter. It will probably take 20 hours to complete the workbook. Several students have told us they worked through this text 2-3 times before they understood everything.

2. Financial Management of Health Care Organizations, 4th ed., William N. Zelman, Michael J. McCue, Noah D. Glick, and Marci S. Thomas, Jossey-Bass, 2014, ISBN: 978-1-118-46656-8

This book covers the financial accounting, reporting and analysis topics that will be taught in this course. In addition, the book contains material that you will find helpful in your managerial accounting, finance, and reimbursement classes. The book does a very good job of explaining accounting principles used by not-for-profit hospitals and complements Essentials of Accounting (which covers mostly for-profit organization accounting). Students have given this book high praise and we strongly recommend it.

3. Case materials and readings. The locations of these vary, so read the syllabus. All of the materials are in electronic format either through a hyperlink in the syllabus or on the course web site.

4. Excel and Word tutorials. You will need to use Excel and Word to complete the assignments. A simple tutorial that will get you through the basics is available on line at http://www.baycongroup.com/ or do a search for Excel tutorials in YouTube, e.g., http://www.youtube.com/watch?v=8L1OVkw2ZQ8. You might want to do the first 4 of these 10 minute videos.

Course Objectives

This intensive course introduces concepts of financial accounting to the non-accountant user of financial information. Basic accounting transactions, financial report preparation, concepts of accrual vs. cash accounting, and not-for-profit health care accounting are presented in the first half of the course. The second half focuses on the analysis of health care organization financial reports for a variety of purposes.

The course has two primary objectives: (1) to give you a basic understanding of accounting concepts, vocabulary, and the accounting cycle, including the preparation of financial statements and (2) to enable you to analyze financial statements from a variety of perspectives. Accounting principles apply to both for-profit and not-for-profit organizations, but there are some peculiarities in not-for-profit accounting that will be discussed in this course. Because there are some unique aspects of the health care industry that affect financial statements, many of the cases will use health care examples.

Managers use financial statements for a variety of purposes, including measurement of financial performance, negotiations with creditors (banks and vendors), and discussions with regulators and managed care organizations. Knowing how financial statements are prepared helps you to interpret those financial statements. Several areas of financial accounting allow for managerial/organizational discretion. You should understand whether the principles used are conservative or aggressive. Many times the critical information is not disclosed and must be discovered through discussions with the preparer of the financial statements. Knowing the kinds of questions to ask is very important and this course will help you to ask the right questions.

In addition to managers, other users of financial statements include policy makers, investors, funders, unions, lenders, taxing authorities, and regulators. Different users may place different emphasis on certain aspects of the financial statements. We will explore some of these perspectives as we learn that financial information is not always precise.

After completing this course, you should be able to:

* Understand the fundamentals of accrual accounting, record basic financial transactions, and summarize transactions into financial statements

* Identify and read the four basic financial statements of both for-profit and not-for-profit health care organizations

* Analyze the financial statements of health care organizations using horizontal analysis, vertical analysis, and ratio analysis

* Calculate and interpret liquidity ratios, profitability ratios, turnover ratios, and capital structure ratios

* Understand how financial information can be used for decision making in health care organizations

* Understand how financial information can be used for policy making in health care

Schedule of classes and assignments

Listed below is the preparation required for each class. We expect you to complete the readings and prepare the cases before coming to class.

Sept 2 Introduction

1. Complete Essentials of Accounting, Chapters 1 – 10 and the post-tests at the end of each chapter. Do not do the mini-cases.

2. The following are brief and can be viewed when you have a few minutes: a. Cash and accrual accounting http://www.youtube.com/watch?v=aPwdgUDXkkE b. Bookkeeping 101 http://www.youtube.com/watch?v=fHS0xv0U_dA c. Transaction analysis and spreadsheets http://www.youtube.com/watch?v=jpgH5HyZY-A

Sept 7 Labor Day – No Class

Sept 9 Accounting equation and worksheet

1. Come prepared with questions based on Essentials.

2. Read Zelman Chapters 1, 2 (including Appendix A), and 3.

3. Read the Docs in a Box, Inc. case. Download the case from the course web site.

* Construct an Excel worksheet to record the transactions assuming the corporation is investor-owned

* Prepare an income statement for December. Disregard any income taxes that may be due.

* Prepare a balance sheet as of December 31

* If this corporation were a not-for-profit organization, what would the transaction worksheet, statement of operations, and balance sheet look like?

4. There will be a short quiz at the end of class with 10 multiple choice questions covering Essentials, Chapters 2 and 3 in Zelman, and the Docs in a Box, Inc. case.

Sept 14 Recording business transactions

1. Problems to do using a transaction worksheet and not T-accounts.

a. Zelman Chapter 2: #4, 5, 6, 7, 25

b. Zelman Chapter 3: #2, 3, 11 (ignore the hint in tx a), and 19 (tx e should read “hospital paid cash for previously incurred interest expense”).

Sept 16 Preparation of financial statements

1. Read the Mangpu Central Hospital (A) case .

* Prepare a pro forma income statement and balance sheet for the coming year. Your “plug figure” for the line of credit should be ¥26,986. Try to use the Excel transaction worksheet to organize the data.

* In no more than 300 words, what do these statements tell you about the financial management of MCH?

Sept 21 Cash flows

1. Read the Mangpu Central Hospital (B) case .

* Prepare the cash flow worksheet (Exhibit 4). What does it tell you about the operations of MCH?

* What causes MCH’s cash flow problems? What recommendations would you make to Dr. Zhigang to eliminate them?

2. Read O'Bryan, D., Berry, K.T., et al (2000). Using accounting equation analysis to teach the statement of cash flows in the first financial accounting course. Journal of Accounting Education 18: 2 147-155 .

3. Read Note on the Statement of Cash Flows .

4. Problems to do:

a. Zelman Chapter 2 #17

b. Zelman Chapter 3 #19 using the information previously assigned, prepare a statement of cash flows using the direct and indirect methods

5. Prepare a statement of cash flows for Mangpu Central Hospital using both the direct and indirect methods.

Sept 23 Accounting analysis

1. Read the Wm. Wrigley Jr. Company case (N9-190-033) .

2. Prepare Wrigley questions 1 and 2.

Sept 28 Ratio analysis

1. Read Zelman Chapter 4. Do not memorize the ratios, but do understand what they mean. The key points on p. 149-151 are very important.

2. Problems to do: Zelman Chapter 4: # 4, 5, 14, 20

3. Calculate as many of the Zelman ratios (p. 185-186) as you can for the Wm. Wrigley Jr. Company for the year ended 12/31/87 only. Since Zelman’s ratios are for not-for-profit organizations, you may have to adapt them to Wrigley (a for-profit organization). Be sure to read the footnotes on p. 186. Comment on the ratios as they compare to the hospital industry ratios shown on p. 185.

Sept 30 Reading a set of financial statements

1. Hand-in assignment #1 (Zelman, Chapter 3, problem #20, Glenwood Hospital.) is due at the beginning of class. Prepare in good format a transaction worksheet and four financial reports: balance sheet, income statement, statement of changes in net assets, and statement of cash flows. Please prepare the statement of cash flows using both the direct method and the indirect method. Be sure to submit your transaction worksheet. Points will be deducted if the assignment is not well-formatted.

2. Please hand in a hard copy of the assignment at the beginning of class and submit an electronic copy to the Canvas dropbox by the beginning of class.

3. Review Glenwood Hospital

4. Read the audited financial statements of Concord Hospital as of September 30, 2012 . Answer the questions relating to these financial statements .

Oct 5 Reading a set of financial statements

1. Complete discussion of Concord Hospital

Oct 7 Exam

Oct 12 Columbus Day – No Class

Oct 14 Reading financial statements

Read Cooley-Dickinson Hospital audited financial statements for the years ended September 30, 2011 and 2012, and complete the following assignment related to these financial statements.

Assignment

Calculate the financial ratios. (See "Ratios to Calculate.pdf." Compare them to the most relevant benchmark and explain why you chose that benchmark. (See "Benchmarks.pdf.") A consultant has hired you to come up with a recommendation on whether or not Cooley Dickinson is a financially sound hospital. What is your recommendation? A written memo is not required for this assignment, but we have included a brief paper on memo writing in preparation for your next turn-in assignment.

Documents

Cooley Dickinson Financial Statements.pdf Benchmarks.pdf Ratios to Calculate.pdf Read “Memo Writing”, The OWL at Purdue. https://owl.english.purdue.edu/owl/owlprint/590/

Oct 19 Reading financial statements

1. Complete the discussion of Cooley-Dickinson Hospital audited financial statements.

Oct 21 Reading financial statements

1. Read Zelman Chapter 13

2. Review Zelman Chapter 2, including the Appendix

3. Read Kane, N. M., “Hospital Profits: A Misleading Measure of Financial Health ”, Journal of American Health Policy, Vol. 1 (1), 1991.

4. Review Zelman Chapter 4

5. Gapenski, L. C., and G.H. Pink, Understanding Healthcare Financial Management, 6th ed., AUPHA, 2011, Chapter 13, “Financial Condition Analysis”, pp. 471-508 .

6. Read River Community Hospital (A) from Gapenski, LC and Pink, GH, Cases in Healthcare Finance, 5th ed., AUPHA, 2014. For class discussion answer all the questions enclosed here .

Ratios for Review Community Hospital (A) .xlsx

7. Hand-in assignment #2 (River Community Hospital (A)) is due at the beginning of class.

a. Assume you are the CEO at the hospital.

b. Write a 3-page memo to the Board of Directors which identifies financial and operating strengths and weaknesses and your recommendations to correct any weaknesses noted. (Please note the page limit is 3 pages in 12-point font, double spaced. Points will be deducted if the assignment is not well-formatted.)

c. The memo to the board based on this data should include: List 5 financial strengths of the hospital, list 5 financial weaknesses of the hospital, and based on the limited information given in the case, list your top 3 or 4 recommendations to the board.

8. Note: Please hand in a hard copy of the assignment at the beginning of class and also submit an electronic copy to the Canvas dropbox by the beginning of class.

Oct 26 Take Home Final Exam Due

Outcome Measures and Grading Criteria

We expect you to be an active classroom participant. This includes coming to all classes prepared to offer your ideas, questions, and analyses both voluntarily and when called on.

We encourage you to form study groups. You are free to discuss homework assignments with your study group, but all written work handed in must be your own. In-class exams will not be team efforts.

We will grade hand-in case assignments as satisfactory (A), marginal (B), or not satisfactory (C) and will comment on areas of your work that seem to need more attention. Satisfactory completion and on time submission of assignments is required. If you receive a “not satisfactory” on an assignment, we will probably ask you to re-do the assignment.

September 9: There will be a short quiz covering all of Essentials, Chapters 2 and 3 in Zelman, and the Docs in a Box, Inc. case.

September 30: Hand-in assignment #1 (Glenwood Hospital) is due at the beginning of class. Prepare in good format a transaction worksheet and three financial reports: balance sheet, income statement, and statement of cash flows. Please prepare the statement of cash flows using both the direct method and the indirect method. Be sure to submit your transaction worksheet. Points will be deducted if the assignment is not well-formatted.

Note: Please hand in a hard copy of the assignment at the beginning of class and also submit an electronic copy to the Canvas dropbox by the beginning of class.

October 7: The first exam will include short-answer questions and some analysis based on material covered in the preceding classes.

October 21: Hand-in assignment #2 (River Community Hospital (A)) is due at the beginning of class. Assume you are the CEO at the hospital. Write a 3-page memo to the Board of Directors which identifies financial and operating strengths and weaknesses and your recommendations to correct any weaknesses noted. See more details above. (Please note the page limit is 3 pages for the memo in 12-point font, double spaced. Points will be deducted if the assignment is not well-formatted.)

Please hand in a hard copy of the assignment at the beginning of class and also submit an electronic copy to the Canvas dropbox by the beginning of class.

October 26: The second exam will be cumulative, but will focus on the second half of the course.

Your course grade will be determined as follows:

In-class participation: 20%

Quiz – September 9: 5%

Glenwood Hospital - September 30: 15%

First exam – October 7: 20%

River Community Hospital (A) case – October 21: 20%

Second exam - October 23: 20%

Academic Integrity Statement

All students enrolled in classes at HSPH are expected to maintain integrity in all academic pursuits. These include the writing of papers, examinations, assignments, records and other details relative to the assessment of student performance. Any dishonesty with regard to these matters is subject to censure or penalty in proportion to the seriousness of the action.

Dishonesty would include things such as copying answers of another person or persons during an examination; secreting of unauthorized materials to assist in an examination; plagiarism, taking as one's own the statements of another without giving due credit to the author, even though such material may have been restated in one's own words; fraudulently obtaining test information; falsifying records, transcripts, recommendations or other documents indicative of student qualification.

In proportion to the seriousness of the action, censure and penalty may extend from a failing grade in the work in question to dismissal from the college. Ordinarily the responsibility for resolving the issues lies with the faculty member and student. For further details, please consult the Student Handbook.

Academic Accommodations

HSPH is committed to ensuring the full participation of all students in its programs. If you have a documented disability (or think you may have a disability of any nature) and, as a result, need reasonable academic accommodation to participate in class, take tests or benefit from HSPH services, then you should schedule a meeting as soon as possible with the Director of Student Services. This will be a confidential discussion of your needs and appropriate plans and should be done at the earliest possible time in the semester to maximize your academic success at HSPH. Please note that academic accommodation cannot be provided until appropriate documentation is completed. Academic accommodations are not retroactive.

Course Evaluations

Course evaluations are important. We read and take seriously all constructive comments. In addition, completion of the course evaluation is a requirement of the School. Your grade will not be available to you until you submit the evaluation. In addition, registration for future terms will be blocked until you have completed evaluations for courses in prior terms.

Financial Management and Control HPM 220

2015 Syllabus Faculty: Rick Siegrist, email rsiegris@hsph.harvard.edu, phone: 508-395-1884 Ruth Flint, email rkf854@mail.harvard.edu, phone: 857-389-1006 (teaching assistant) Objectives and Approach: The Financial Management and Control course is designed to expose you to cost accounting and management control concepts and uses. Approximately half of the sessions are devoted to the development of a basic knowledge of cost accounting. The remaining sessions focus on management control structure and process and build upon the cost accounting knowledge base. The course places particular emphasis on the practical application of cost accounting and management control concepts in health care and private industry settings and on the information systems aspects of management control. By the end of the course, you should be able to analyze the management control structure and process of your or any other organization and suggest modifications where appropriate. Changes in reimbursement, pay for performance, and an increased emphasis on cost containment and quality measurement have significantly enhanced the importance of management control in hospitals and other health care organizations. Because health care institutions have lagged far behind industry in understanding their costs and in applying management control principles, there is a pressing need for people who are familiar with those concepts both in managerial and policy settings. A goal of this course is to provide that basic familiarity. Class Preparation and Participation: I expect you to make an effort to prepare every case. This preparation is particularly important since the cases build upon one another and techniques introduced in one case are frequently applied in future cases. I suggest between two and three hours of preparation for each class and encourage case discussion in small study groups where feasible. The assigned readings are not simply background readings. They introduce key cost accounting and management control concepts that are essential to properly analyze the cases. Since the course will be primarily case oriented, class participation is very important. I value the quality of classroom participation over quantity.

Grading: I will determine your grade for the course as follows: Mid Term Paper due on November 23, 2015 40% Final Exam on December 16, 2015 40% Class preparation and participation 20% ____ Total 100% A three-page mid term paper will be due on November 23, 2015. I will distribute the case and related questions for the paper at the end of class on November 18, 2015. The final exam will be during normal class time on December 16, 2015 and will be an open book exam. It will address material primarily from the second part of the course. I will distribute the case for the exam on December 9, 2015. The questions for the exam will be handed out at the start of the exam period. Office Hours: My office hours will be by appointment, either in person or via the phone. My telephone number is 508-395-1884, and I can be reached at rsiegris@hsph.harvard.edu or at ricksiegrist@gmail.com. My office is Kresge 338.

Course Session Details: Session 1 10/26/15, 10:30 -12:20 Introduction/Lenny’s Lemonade Case: None Reading: Young DW. 2012. Chapter 1, “The Management Control Function,” Management

Control in Nonprofit Organizations. The Crimson Press 9th edition. 2-19. Siegrist RB. 2013. “Cost Accounting.” Assignment: None Session 2 10/28/15, 10:30-12:20 Full Cost Accounting Case: Young DW. 2012. “Harbor City Community Center.” Crimson Press. Reading: Young. Chapter 3, "Full-Cost Accounting." 58-72. Assignment: Answer the questions at the end of the case. Session 3 11/2/15, 10:30-12:20 Differential Cost Accounting Case: Young DW. 2009. “Carlsbad Home Care.” Crimson Press. Reading: Young. Chapter 4, "Differential-Cost Accounting." 79-98. Assignment: 1. Identify CHC’s fixed and variable costs. 2. What is the breakeven point? 3. What assumptions did you make in answering Questions 1 and 2? 4. What options does Ms. Tucker have if she does not wish to incur a deficit? Session 4 11/4/15, 10:30-12:20 Differential Cost Accounting Case: Young DW. 2012. “Lakeside Hospital” Crimson Press. Readings: Anthony RN and Welsch GA. 1977. "Alternative Choice

Decisions." Fundamentals of Management Accounting. Homewood, IL: Richard D. Irwin. 246-262.

Assignment: Answer the questions at the end of the case. Session 5 11/9/15, 10:30-12:20 Differential Cost Accounting Case: Siegrist RB. 2011. “Hospital in Transition.” Reading: Siegrist RB. 2009. "Financial and Operational Analysis of Non-Operating Room

Anesthesia: the Wrong Way versus the Right Way." Anesthesiology Clin 27 (2009) 17-23.

Assignment: 1. As John Leader, which of the recommendations for savings proposed by your senior management would you approve? Why? Would you suggest any alterations to the proposals?

2. How would you go about implementing those recommendations? 3. What additional information would you like to have? Session 6 11/16/15, 10:30-10:20 Differential Cost Accounting Case: Solomons D. “Liquid Chemical Company.” HBS # 9-112-028. Updated by

Richard Siegrist, 2011. Reading: Young. Chapter 7, "Programming." 147-161.

Gregory, MR. “Make or Buy? Using Cost Analysis to Decide Whether to Outsource Public Services.” Government Finance Review, Vol. 20, No. 4, August 2004.

Assignment: 1. Identify the four alternatives implicit in the case. 2. Using cash flow as the criterion, which alternative is the most attractive? 3. Using net present value (at 10%) as the criterion, which alternative is the most attractive? 4. What additional information, if any, do you think is necessary in order to make a sound decision? Session 7 11/18/15, 10:30-12:20 Management Control Structure Case: Anthony RN, Welsch GA. 1977. “Jessup Motors (A)(B)(C).” Fundamentals of

Management Accounting. Second Edition. 435-439. Updated by Richard Siegrist, 2008.

Reading: Young. Chapter 6, "The Management Control Environment." 122-142. Siegrist RB. 2013. “Management Control.” Assignment: Prepare the questions in each case. Complete the questions to (A) before moving

to (B). Session 8 11/23/15 (no class – paper due) Mid Term Paper Case: To be distributed Reading: None Assignment: A paper on the case distributed on November 18th will be due on, Monday

November 23rd by 5:00 p.m. Please put it in my box on the 3rd floor of Kresge. This paper should be a maximum of three double-spaced pages, plus exhibits. The paper should address the set of questions distributed with the case.

Session 9 11/30/15, 10:30-12:20 Management Control Structure Case: Jost MG, Young DW. 2012. “Boston University Medical Center Hospital.”

Crimson Press. Reading: Young. Chapter 5, "Pricing Decisions." 103-113.

Assignment: Answer the questions at the end of the case. Session 10 12/2/15, 10:30-12:20 Variance Analysis Case: Anthony RN and Young DW. 1988. "Mountainview PSRO.” Management

Control in Nonprofit Organizations. 4th Edition. 692-696. Figures revised by Richard Siegrist, 2011.

Reading: Young. Chapter 11, “Reporting on Performance: Technical Aspects.” 245-259. Assignment: 1. What are the specific reasons for the $9,000 negative variance shown in Exhibit 1? 2. How much of the total variance resulted from the changes in numbers of studies or reviews? 3. What does the information tell you about Ms. Nugent's management decisions during the first six months of the year? 4. What should Ms. Nugent do? Session 11 12/7/15, 10:30-10:20 Variance Analysis Case: Herzlinger RE. 1977. “Nasus Clinic.” HBS # 9-178-021. Revised 1991. Figures

revised by Richard Siegrist, 2015. Reading: Re-read Young. Chapter 11, “Reporting on Performance: Technical Aspects.”

245-259. Chapter 12, “Reporting on Performance: The Management Control Reports.” 272-291.

Assignment: 1. What are the standard and actual profits for Nasus Clinic by type of visit? 2. Why did the deviations from expected profits occur? Analyze in terms of volume, efficiency and price variances. 3. What should Nasus Clinic do? Session 12 12/9/15, 10:30-12:20 Budgeting Case: Young DW. 2012. “North Lake Medical Center.” Crimson Press. Reading: Young. Chapter 8, "The Operating Budget." 172-193. Assignment: Answer the questions at the end of the case. Session 13 12/14/15, 10:30-12:20 Management Control Structure/Process Case: Madden SL. 2014. “Mt. Scopus – Hadassah Medical Center” Reading: Young. Chapter 14, "Management Control Systems in Context." 304-312. Assignment: Answer the questions at the end of the case.

Session 14 12/16/15, 10:30-12:20 Final Exam Case: To be distributed Reading: None Assignment: The final exam will be during normal class time and will be an open book exam.

It will address material primarily from the second part of the course. The case for the exam will be distributed on December 9th. The questions for the exam will be handed out at the start of the exam period.

Financial Management and Control HPM 220

2016 Syllabus Faculty: Rick Siegrist, email rsiegris@hsph.harvard.edu, phone: 508-395-1884 Tiffany Lin, email tiffany.lin@mail.harvard.edu, phone: 949-748-9870 (teaching assistant) Ruth Flint, email rkf854@mail.harvard.edu, phone: 857-389-1006 (teaching assistant) Objectives and Approach: The Financial Management and Control course is designed to expose you to cost accounting and management control concepts and uses. Approximately half of the sessions are devoted to the development of a basic knowledge of cost accounting. The remaining sessions focus on management control structure and process and build upon the cost accounting knowledge base. The course places particular emphasis on the practical application of cost accounting and management control concepts in health care and private industry settings and on the information systems aspects of management control. By the end of the course, you should be able to analyze the management control structure and process of your or any other organization and suggest modifications where appropriate. Changes in reimbursement, pay for performance, and an increased emphasis on cost containment and quality measurement have significantly enhanced the importance of management control in hospitals and other health care organizations. Because health care institutions in the United States and internationally have lagged far behind industry in understanding their costs and in applying management control principles, there is a pressing need for people who are familiar with those concepts both in managerial and policy settings. A goal of this course is to provide that basic familiarity. Class Preparation and Participation: I expect you to make an effort to prepare every case. This preparation is particularly important since the cases build upon one another and techniques introduced in one case are frequently applied in future cases. I suggest between two and three hours of preparation for each class and encourage case discussion in small study groups where feasible. The assigned readings are not simply background readings. They introduce key cost accounting and management control concepts that are essential to properly analyze the cases. Since the course will be primarily case oriented, class participation is very important. I value the quality of classroom participation over quantity.

Grading: I will determine your grade for the course as follows: Mid Term Paper due on February 16, 2016 40% Final Exam on March 10, 2016 40% Class preparation and participation 20% ____ Total 100% A three-page mid term paper will be due on February 16, 2016. I will distribute the case and related questions for the paper at the end of class on February 9, 2016. The final exam will be during normal class time on March 10, 2016 and will be an open book exam. It will address material primarily from the second part of the course. I will distribute the case for the exam on March 3, 2016. The questions for the exam will be handed out at the start of the exam period. Office Hours: My office hours will be by appointment, either in person or via the phone. My telephone number is 508-395-1884, and I can be reached at rsiegris@hsph.harvard.edu or at ricksiegrist@gmail.com. My office is Kresge 338.

Course Session Details: Session 1 1/26/16, 8:30 -10:20 Introduction/Lenny’s Lemonade Case: None Reading: Young DW. 2012. Chapter 1, “The Management Control Function,” Management

Control in Nonprofit Organizations. The Crimson Press 9th edition. 2-19. Siegrist RB. 2013. “Cost Accounting.” (available on course iSite) Assignment: None Session 2 1/28/16, 8:30-10:20 Full Cost Accounting Case: Young DW. 2012. “Harbor City Community Center.” Crimson Press. Reading: Young. Chapter 3, "Full-Cost Accounting." 58-72. Assignment: Answer the questions at the end of the case. Session 3 2/2/16, 8:30-10:20 Differential Cost Accounting Case: Young DW. 2009. “Carlsbad Home Care.” Crimson Press. Reading: Young. Chapter 4, "Differential-Cost Accounting." 79-98. Assignment: 1. Identify CHC’s fixed and variable costs. 2. What is the breakeven point? 3. What assumptions did you make in answering Questions 1 and 2? 4. What options does Ms. Tucker have if she does not wish to incur a deficit? Session 4 2/4/16, 8:30-10:20 Differential Cost Accounting Case: Siegrist RB. 2014. “Eastern Cape Clinic (A).” Reading: None Assignment: 1. What portion of our costs are direct vs. indirect? Variable vs. fixed? Labor vs. non-labor? 2. What is the contribution margin statement for the Clinic overall? 3. Which type of visit is the most profitable? The least profitable? 4. Do all the visit types have positive variable contribution margins? Positive

direct contribution margins? Positive net margins? 5. How big a financial problem is she currently facing? Session 5 2/9/16, 8:30-10:20 Differential Cost Accounting Case: Siegrist RB. 2011. “Hospital in Transition.” Reading: Siegrist RB. 2009. "Financial and Operational Analysis of Non-Operating Room

Anesthesia: the Wrong Way versus the Right Way." Anesthesiology Clin 27

(2009) 17-23. (available on course iSite) Assignment: 1. As John Leader, which of the recommendations for savings proposed by

your senior management would you approve? Why? Would you suggest any alterations to the proposals?

2. How would you go about implementing those recommendations? 3. What additional information would you like to have? Session 6 2/11/16, 8:30-10:20 Differential Cost Accounting Case: Solomons D. “Liquid Chemical Company.” HBS # 9-112-028. Updated by

Richard Siegrist, 2011. Reading: Young. Chapter 7, "Programming." 147-161.

Gregory, MR. “Make or Buy? Using Cost Analysis to Decide Whether to Outsource Public Services.” Government Finance Review, Vol. 20, No. 4, August 2004. (available on course iSite or from ProQuest)

Assignment: 1. Identify the four alternatives implicit in the case. 2. Using cash flow as the criterion, which alternative is the most attractive? 3. Using net present value (at 10%) as the criterion, which alternative is the most attractive? 4. What additional information, if any, do you think is necessary in order to make a sound decision? Session 7 2/16/16 (no class – paper due) Mid Term Paper Case: To be distributed Reading: None Assignment: A paper on the case distributed on February 9 will be due on Tuesday, February

16 by 5:00 p.m. Please put it in my box on the 3rd floor of Kresge. This paper should be a maximum of three double-spaced pages, plus exhibits. The paper should address the set of questions distributed with the case.

Session 8 2/18/16, 8:30-10:20 Management Control Structure Case: Anthony RN, Welsch GA. 1977. “Jessup Motors (A)(B)(C).” Fundamentals of

Management Accounting. Second Edition. 435-439. Updated by Richard Siegrist, 2008.

Reading: Young. Chapter 6, "The Management Control Environment." 122-142. Siegrist RB. 2013. “Management Control.” (available on course iSite) Assignment: Prepare the questions in each case. Complete the questions to (A) before moving

to (B).

Session 9 2/23/16, 8:30-10:20 Management Control Structure Case: Jost MG, Young DW. 2012. “Boston University Medical Center Hospital.”

Crimson Press. Reading: Young. Chapter 5, "Pricing Decisions." 103-113. Assignment: Answer the questions at the end of the case. Session 10 2/25/16, 8:30-10:20 Variance Analysis Case: Anthony RN and Young DW. 1988. "Mountainview PSRO.” Management

Control in Nonprofit Organizations. 4th Edition. 692-696. Figures revised by Richard Siegrist, 2011.

Reading: Young. Chapter 11, “Reporting on Performance: Technical Aspects.” 245-259. Assignment: 1. What are the specific reasons for the $9,000 negative variance shown in Exhibit 1? 2. How much of the total variance resulted from the changes in numbers of studies or reviews? 3. What does the information tell you about Ms. Nugent's management decisions during the first six months of the year? 4. What should Ms. Nugent do? Session 11 3/1/16, 8:30-10:20 Variance Analysis Case: Herzlinger RE. 1977. “Nasus Clinic.” HBS # 9-178-021. Revised 1991. Figures

revised by Richard Siegrist, 2015. Reading: Re-read Young. Chapter 11, “Reporting on Performance: Technical Aspects.”

245-259. Chapter 12, “Reporting on Performance: The Management Control Reports.” 272-291.

Assignment: 1. What are the standard and actual profits for Nasus Clinic by type of visit? 2. Why did the deviations from expected profits occur? Analyze in terms of volume, efficiency and price variances. 3. What should Nasus Clinic do? Session 12 3/3/16, 8:30-10:20 Budgeting Case: Young DW. 2012. “North Lake Medical Center.” Crimson Press. Reading: Young. Chapter 8, "The Operating Budget." 172-193. Assignment: Answer the questions at the end of the case. Session 13 3/8/16, 8:30-10:20 Management Control Structure/Process

Case: Madden SL. 2014. “Mt. Scopus – Hadassah Medical Center” Reading: Young. Chapter 14, "Management Control Systems in Context." 304-312. Assignment: Answer the questions at the end of the case. Session 14 3/10/16, 8:30-10:20 Final Exam Case: To be distributed Reading: None Assignment: The final exam will be during normal class time and will be an open book exam.

It will address material primarily from the second part of the course. The case for the exam will be distributed on March 3, 2016. The questions for the exam will be handed out at the start of the exam period.

Harvard School of Public Health Public Speaking for Managers HPM 223

Fall 2 - 2015 Classes are held on Tuesday from 3:30PM to 5:20PM, October 27 - December 15, 2015

Instructor: Jack E Rossin Phone: 617-413-6106 between 9:00 AM and 5:00 PM Email: jack@jackerossin.com, www.jackerossin.com Office Hours: By appointment Course Description Public Speaking for Managers presents an opportunity for students to develop the presentation skills necessary for professional success. Emphasis is placed on the skills most critical to managers and their responsibilities as communicators. Course Objectives By the end of this course students will:

1. Deliver presentations confidently. 2. Apply the tools and techniques for designing powerful presentations 3. Deliver a variety of presentations applying #2 above. 4. Create PowerPoint presentations following the rules of "Dos and Don'ts"

Teaching/Learning Strategies This course requires that students actively participate in class and prepare for class presentations. We will focus on basic techniques of presentations, the tools available to speakers and special speaking presentations. The general format for each class will include:

1. A brief lecture by the instructor regarding a specific presentation tool or technique 2. Impromptu (1-2 minute) presentations by students 3. Prepared (5-7 minute) presentations by students 4. Presentation evaluations by peers and instructor

Evaluation There are a number of requirements for students to receive a passing grade. These are: -Students must attend 80% of the scheduled classes -Students must prepare and deliver a 4-5 minute "Ice Breaker" presentation -Students must prepare and deliver a 7 minute "Speaking with Conviction" presentation -Students must actively participate in the classroom activities, including offering feedback, and volunteering to speak on extemporaneous subjects, when they are offered. Recommended Textbooks No textbooks are required reading for this course, but here are four excellent books you should read if you want more insight in public speaking: -HBR Guide to Persuasive Presentations, Duarte, Nancy, Harvard Business Review Press, 2012, ISBN 978-1-4221-8710-4, Paperback

-Give Your Speech, Change the World, Nick Morgan, Harvard Business School Press, 2003, ISBN 1-59139-714-6, Paperback -The Exceptional Presenter, Timothy J. Koegel, Greenleaf Book Group Press, 2007, ISBN-13: 978-1-929774-44-9, Hardcover -Presentation S.O.S, Mark Wiskup, Warner Business Books 2005, ISBN 0-446-69554-8, Paperback -The Presentation Secrets of Steve Jobs: How To Be Insanely Great in Front of Any Audience, Carmine Gallo, McGraw Hill, 2010, ISBN 978-0071636087

Public Speaking for Managers Course Requirements Due Dates – HPM 223

Session 1 - October 27, 2015 - How to Appear Confident (even if you're not) Session 2 - November 3, 2015 - How to Build a Killer Opening Session 3 - November 10, 2015 - Speaking with Passion Creates Success Session 4 -November 17, 2015 - Storytelling is the Most Effective Way to Communicate Session 5 - November 24, 2015 - How to Rehearse Session 6 - December 1, 2015 - PowerPoint Do's and Don'ts (Mostly Don'ts) Session 7 - December 8, 2015 - Visualized language- Metaphors, analogies, the sky is the limit Session 8 - December 15, 2015 - How to Close a Presentation and Take Action

Public Speaking for Managers

Roles The following roles are designed to provide students with a number of opportunities to practice presentation skills. These opportunities, other than the two formal presentations requirements, will be limited to one to three minutes. This approach is based on the philosophy that individuals can best master the course objectives by having numerous, short duration speaking opportunities accompanied by feedback from peers and instructor. Speaker Public speaking can only be mastered by actually presenting under conditions of “protected practice.” The principle requirement of this course is that each student delivers two presentations of five and ten minutes. Instructions will be made available on the structure and focus of these presentations. Evaluator Each speaker will be assigned a student evaluator for his or her presentations. The evaluator will be provided specific instructions for describing observations that will be helpful to the speaker. The actual evaluation will be delivered from the lectern, thereby presenting an additional opportunity to apply public speaking skills. Topic Leader Each week a student volunteer will be assigned to prepare brief topics for the extemporaneous speaking portion of the class. This individual will prepare twelve topics his or her assigned class. The topics are frequently taken from current events or famous quotes. Speaking from the lectern, the topic leader will ask for volunteers to address each topic. The volunteer will also speak from the lectern for one to two minutes. Timer The volunteer timer will keep track of and note the time for each student’s presentation, evaluator’s comments and responses to table topics. When timing the formal presentations, the timer will hold up cards at the following intervals: two minutes, five minutes, eight minutes and ten minutes. When timing the table topics section of the class, the timer will hold up a card at one minute and two minutes.

Required Formal Presentations Ice Breaker (4 to 5 Minutes) This presentation is intended to introduce the speaker to his or her classmates. The Ice Breaker should be biographical in nature. Students often speak about family, professional goals and personal interests. It is often helpful to use anecdotes and/or photos to add energy and to help the student more easily remember key points. Speaking with Conviction (7 Minutes) The purpose of this speaking project is to advocate a point of view about something for which the student has great passion or strong feelings. The primary goal is to learn how to express feelings and enthusiasm to the audience. Concentrate on communicating the meaning your topic has to you. Convince the audience of your sincerity and they will be more likely to consider your point of view.

Harvard School of Public Health Public Speaking for Managers HPM 223

Spring 2 - 2016 Classes are held on Tuesday from 3:30PM to 5:20PM, March 22 - May 10

Instructor: Jack E Rossin Phone: 617-413-6106 between 9:00 AM and 5:00 PM Email: jack@jackerossin.com, www.jackerossin.com Office Hours: By appointment Course Description Public Speaking for Managers presents an opportunity for students to develop the presentation skills necessary for professional success. Emphasis is placed on the skills most critical to managers and their responsibilities as communicators. Course Objectives By the end of this course students will:

1. Deliver presentations confidently. 2. Apply the tools and techniques for designing powerful presentations 3. Deliver a variety of presentations applying #2 above. 4. Create PowerPoint presentations following the rules of "Dos and Don'ts"

Teaching/Learning Strategies This course requires that students actively participate in class and prepare for class presentations. We will focus on basic techniques of presentations, the tools available to speakers and special speaking presentations. The general format for each class will include:

1. A brief lecture by the instructor regarding a specific presentation tool or technique 2. Impromptu (1-2 minute) presentations by students 3. Prepared (4-6 minute) presentations by students 4. Presentation evaluations by peers and instructor

Evaluation There are a number of requirements for students to receive a passing grade. These are: -Students must attend 80% of the scheduled classes -Students must prepare and deliver a 4 minute "Ice Breaker" presentation -Students must prepare and deliver a 6 minute "Speaking with Conviction" presentation -Students must actively participate in the classroom activities, including offering feedback, and volunteering for storytelling and to speak on extemporaneous subjects, when they are offered. Recommended Textbooks

2

No textbooks are required reading for this course, but here are four excellent books you should read if you want more insight in public speaking: -HBR Guide to Persuasive Presentations, Duarte, Nancy, Harvard Business Review Press, 2012, ISBN 978-1-4221-8710-4, Paperback -Give Your Speech, Change the World, Nick Morgan, Harvard Business School Press, 2003, ISBN 1-59139-714-6, Paperback -The Exceptional Presenter, Timothy J. Koegel, Greenleaf Book Group Press, 2007, ISBN-13: 978-1-929774-44-9, Hardcover -Presentation S.O.S, Mark Wiskup, Warner Business Books 2005, ISBN 0-446-69554-8, Paperback -Long Story Short: The Only Storytelling Guide You'll Ever Need, Margot Leitman

3

Public Speaking for Managers

Course Requirements Due Dates – HPM 223 Session 1 - March 24, 2015 - How to Appear Confident (even if you're not) Session 2 - March 31, 2015 - How to Build a Killer Opening Session 3 - April 7, 2015 - Speaking with Passion Creates Success Session 4 -April 14, 2015 - Storytelling is the Most Effective Way to Communicate Session 5 - April 21, 2015 - How to Rehearse Session 6 - April 28, 2015 - PowerPoint Do's and Don'ts (Mostly Don'ts) Session 7 - May 5, 2015 - Visualized language- Metaphors, analogies, the sky is the limit Session 8 - May 12, 2015 - How to Close a Presentation and Get Action

4

Public Speaking for Managers

Roles

The following roles are designed to provide students with a number of opportunities to practice presentation skills. These opportunities, other than the two formal presentations requirements, will be limited to one to three minutes. This approach is based on the philosophy that individuals can best master the course objectives by having numerous, short duration speaking opportunities accompanied by feedback from peers and instructor. Speaker Public speaking can only be mastered by actually presenting under conditions of “protected practice.” The principle requirement of this course is that each student delivers two presentations of five and ten minutes. Instructions will be made available on the structure and focus of these presentations. Evaluator Each speaker will be assigned a student evaluator for his or her presentations. The evaluator will be provided specific instructions for describing observations that will be helpful to the speaker. The actual evaluation will be delivered from the lectern, thereby presenting an additional opportunity to apply public speaking skills. Topic Leader Each week a student volunteer will be assigned to prepare brief topics for the extemporaneous speaking portion of the class. This individual will prepare twelve topics his or her assigned class. The topics are frequently taken from current events or famous quotes. Speaking from the lectern, the topic leader will ask for volunteers to address each topic. The volunteer will also speak from the lectern for one to two minutes. Timer The volunteer timer will keep track of and note the time for each student’s presentation, evaluator’s comments and responses to table topics. When timing the formal presentations, the timer will hold up cards at the following intervals: two minutes, five minutes, eight minutes and ten minutes. When timing the table topics section of the class, the timer will hold up a card at one minute and two minutes.

5

Required Formal Presentations Ice Breaker (4 to 5 Minutes) This presentation is intended to introduce the speaker to his or her classmates. The Ice Breaker should be biographical in nature. Students often speak about family, professional goals and personal interests. It is often helpful to use anecdotes and/or photos to add energy and to help the student more easily remember key points. Speaking with Conviction (7 Minutes) The purpose of this speaking project is to advocate a point of view about something for which the student has great passion or strong feelings. The primary goal is to learn how to express feelings and enthusiasm to the audience. Concentrate on communicating the meaning your topic has to you. Convince the audience of your sincerity and they will be more likely to consider your point of view.

Consumers, Corporations

and Public Health

Spring 2016

Professor John A. Quelch

Assistant:

Elaine Shaffer

Bloomberg 368

Harvard Business School

617.495.1683

eshaffer@hbs.edu

With 18 percent of U.S. GDP now allocated to health care, it is essential for all businesspeople to have some familiarity with the health care system. This half-credit course examines how corporations aid and, in some cases, impede the solving of public health challenges. Targeting MPH and MBA students, the course aims to promote dialogue and understanding between public health and business professionals. Common ground can be found when we use a deep understanding of consumer behavior as the starting point for debate and collaboration.

The course is organized into seven modules:

Corporate Strategy and Public Health

Employee Safety, Wellness and Productivity

Prevention and Adherence

Consumer Access and Affordability

Consumer Analytics and Healthcare Strategies

Consumerism and Paternalism

Emerging Markets, Consumer Behavior and Public Health

All classes include recently-written case studies as the basis for learning. Most of the case studies are included in the book Consumers, Corporations and Public Health (Oxford University Press, 2016), assigned as the required text for the course. The book will be distributed to all students enrolled in the course at Week 3. Other case studies not in the book will be distributed separately. In preparation for

Weeks 1 and 2, hard copy case studies will be available to all students through HBS MBA Materials, lower level of Spangler Center.

Grades will be based 50 percent on class participation (attendance, punctuality, participation and performance). The remaining 50 percent of the grade will be a take-home exam. The exam will be available

for students to download on Friday, March 4 at 10:00 AM. The exam response (3,000 word maximum) should be uploaded in pdf format as an email to: eshaffer@hbs.edu by Monday, March 21.

Classes will be held Mondays/Tuesdays, 8:30 to 9:50 AM on the Harvard Business School campus in Hawes 201, January 25, 2016 through March 8, 2016. Class will be held on January 27 (not 26) and February 17 (not 15).

Session by Session Detail

Session #1: 8:30AM – 9:50 AM, Monday, January 25, 2016

Corporate Strategy and Public Health

Learning Objective: Demonstrate the importance of public health issues for for-profit corporations.

Case: Colgate-Palmolive Company: Marketing Anti-Cavity Toothpaste, HBS Case 515-050

Guest: Suzan Harrison, President-Oral Care, Colgate-Palmolive Company

Assignment Questions:

1. What is CP’s role in public health? 2. How important a breakthrough is CMCP+SAN?

3. What are CP’s options regarding the marketing of CMCP+SAN? 4. Evaluate the marketing mix proposed for the launch of CMCP+SAN in Brazil.

Session #2: 8:30AM – 9:50 AM, Wednesday, January 27, 2016

Corporate Strategy and Public Health

Learning Objective: Show how a major pharmaceutical company incorporates public health considerations into its core values and strategy.

Case: Vision 2020: Takeda and the Vaccine Industry, HBS Case 514-084

Guest: Rajeev Venkayya, Takeda, President, Global Vaccine Business Unit

Assignment Questions:

1. What is the motivation for Vision 2020? 2. What are the differences between old Takeda and new Takeda? 3. Will Takeda achieve its goals in the vaccine business? 4. What role do/should pharmaceutical companies play in the public health arena?

Case: Pfizer and AstraZeneca: Marketing An Acquisition, HBS Case 515-007

Assignment Questions:

1. Is this merger in the public health interest? 2. Would British consumers and/or taxpayers win or lose?

Session #3: 8:30AM – 9:50 AM, Monday, February 1, 2016

Employee Safety, Wellness and Productivity

Learning Objective: Understand the responsibilities of private and public stakeholders in insuring worker safety.

Cases: Rana Plaza: Workplace Safety in Bangladesh (A), HBS Case 514-034 Rana Plaza: Workplace Safety in Bangladesh (B), HBS Case 514-035 Rana Plaza (C): Primark and Victim Compensation, HBS Case 516-014 Guests: George Weston, Chief Executive, Associated British Foods Mike Toffel, Professor, Harvard Business School

Assignment Questions:

1. Why did the tragedy occur and who was responsible? 2. What needs to be done? 3. Are there minimal standards for workplace safety that should be applied worldwide? If so, who

should implement and enforce them? 4. Assess Primark’s approach to victim compensation.

Session #4: 8:30AM – 9:50 AM, Tuesday, February 2, 2016

Employee Safety, Wellness and Productivity

Learning Objective: Discuss the value and productivity impact of corporate wellness programs.

Case: Johnson & Johnson: The Promotion of Wellness, HBS Case 514-112

Guests: Dr. Fik Isaac, Vice President, Global Health, Johnson & Johnson

Assignment Questions:

1. Why has J&J been working on employee wellness for thirty years? Assess the evolution and impact of the programs.

2. Do you believe that the wellness initiatives have delivered a positive ROI? Why or why not? Does it matter?

3. What should J&J and CEO Gorsky do next in the employee wellness arena?

Note: Mental Health and the American Workplace, HBS Case 514-111

Assignment Questions:

1. Why does mental health apparently receive less attention than physical health? 2. How should companies address mental health problems?

Session #5: 8:30AM – 9:50 AM, Monday, February 8, 2016

Prevention and Adherence

Learning Objective: Show how commercial marketing services firms can provide consumer insights that improve the impact of public health messages.

Case: Cancer Screening in Japan: Market Research and Segmentation, HBS Case 514-057

Guest: Jun Fukuyoshi, Co-Founder and CEO, CancerScan

Assignment Questions:

1. What is the mission of CancerScan? How well is CancerScan doing? 2. What are the obstacles to breast cancer screening in Japan? 3. What are CancerScan’s growth options? What are the pros and cons of each? 4. After breast cancer, what are other cancers that CancerScan should focus on?

Case: Dumb Ways To Die: Advertising Train Safety (A), HBS Case 514-079

Assignment Questions:

1. What is MT’s objective? How should it be measured? 2. What responsibilities does MT have for passenger safety? 3. How can an advertising agency help?

Session #6: 8:30AM – 9:50 AM, Tuesday, February 9, 2016

Prevention and Adherence

Learning Objective: Show the value of consumer insight and segmentation in promoting adherence to healthy behaviors.

Case: CVS Health: Promoting Drug Adherence, HBS Case 515-010

Guest: TBA, CVS Health

Assignment Questions:

1. What forms does non-adherence take? 2. Why is non-adherence a problem? 3. Will CVS be able to improve adherence? How? 4. Can all stakeholders benefit?

Note: Note On Mobile Health Care, HBS Case 514-122

Assignment Questions:

1. Evaluate the potential of mobile health. How can mobile health applications make a difference to health care costs and quality of life?

2. Develop a new mobile health application. Come to class prepared to present your idea and launch plan.

Session #7: 8:30AM – 9:50 AM, Tuesday, February 16, 2016

Consumer Access and Affordability

Learning Objective: Emphasize the importance of value added innovations that improve the access of poor people to public health solutions.

Case: The Slingshot: Improving Water Access, HBS Case 514-007

Assignment Questions:

1. Is Slingshot relevant to improving access to clean water? How? 2. What factors will determine Slingshot’s success? 3. Why partner with Coca-Cola? 4. How is the partnership between DEKA and Coca-Cola evolving?

Case: Vaxess Technologies, Inc., HBS Case 514-107

Guest: Michael Schrader, Co-founder, President and CEO, Vaxess Technologies

Assignment Questions:

1. Evaluate the potential of Vaxess technology to improve access to and affordability of vaccines? 2. What roll out strategy would you recommend? Which disease targets and which customer targets? 3. Should Vaxess operate as a for-profit or a not-for-profit organization, given its mission?

Session #8: 8:30AM – 9:50 AM, Wednesday, February 17, 2016

Consumer Access and Affordability

Learning Objective: Evaluate the benefits of health care insurance exchanges in improving consumer choice and coverage.

Case: AccessHealth CT: Marketing Affordable Healthcare, HBS Case 514-119

Guest: Andrea Ravitz, Director of Marketing, Access Health CT

Assignment Questions:

1. What are the objectives of the ACA? What is the role of AccessHealth CT? 2. Do you consider AccessHealth CT’s performance a success? If so, why? 3. What metrics should be used to assess the public health impact of AccessHealth CT? 4. What challenges and opportunities face AccessHealth CT in the coming year?

Session #9: 8:30AM – 9:50 AM, Monday, February 22, 2016

Consumer Analytics and Healthcare Strategies

Learning Objective: Discuss how a provider system’s investments in data analytics can improve its patient outcomes and financial performance.

Case: Carolinas Healthcare System: Consumer Analytics, HBS Case 515-111

Guests: Dr. Michael Dulin, Chief Clinical Officer, Carolinas Healthcare Carol Lovin, Executive Vice President, Carolinas Healthcare

Assignment Questions:

1. Why has CHS invested in DA? 2. How successful has DA been so far? Why? 3. What are Dulin’s most important challenges going forward? 4. Which organizations are best-placed to provide integrated data management for individual patients?

Session #10: 8:30AM – 9:50 AM, Tuesday, February 23, 2016

Consumer Analytics and Healthcare Strategies

Learning Objective: Discuss which corporations in the healthcare ecosystem consumers will trust to integrate patient data.

Case: Philips Healthcare: Marketing the HealthSuite Digital Platform, HBS Case 515-113

Guests: Jeroen Tas, CEO, Philips Healthcare Informatics, Solutions and Services John Hegge, Group Strategy Manager, Philips Electron

Assignment Questions:

1. Why has Philips launched HealthSuite? 2. Does Philips need partners to succeed? 3. Can Philips lead in integrating patient data from multiple sources? 4. Which other players might challenge for this role?

Session #11: 8:30AM – 9:50 AM, Monday, February 29, 2016

Consumerism and Paternalism

Learning Objective: Demonstrate the value of empowering and engaging consumers in addressing their health and wellness challenges.

Case: PatientsLikeMe: An Online Community of Patients, HBS Case 511-093

Assignment Questions:

1. Why do patients join PLM? Does the platform work for any disease? 2. What are the reactions of physicians to sites like PLM? Do you agree with them? 3. Should PLM launch the General Platform? If yes, can it be as successful in engaging patients as its

current platform? If no, how does PLM grow? 4. Should PLM expand its business model beyond providing marketing research to pharmaceutical

companies, to insurance companies and research institutions? Does it have the potential of becoming the “Bloomberg of medical data”?

Case: 23andMe: Genetic Testing for Consumers (A), HBS Case 514-086

Guest: Andy Page, President, 23andMe

Assignment Questions:

1. Is the sale of DNA tests to consumers in the public health interest? 2. Would you invest in 23andMe? Why or why not?

3. What should Wojcicki do in response to the FDA letter?

Session #12: 8:30AM – 9:50 AM, Tuesday, March 1, 2016

Consumerism and Paternalism

Learning Objective: Show why public policy makers must consider consumer behavior responses before launching two types of behavior nudging initiatives.

Case: Demarketing Soda in New York City, HBS Case 514-003

Assignment Questions:

1. How is the ban expected to impact soda consumption in NYC? 2. What costs would the ban impose on the city? 3. Will the ban harm small business? 4. What is the expected public health impact in NYC if the ban is successful? 5. What should Bloomberg do next?

Session #13: 8:30AM – 9:50 AM, Monday, March 7, 2016

Emerging Markets, Consumer Behavior and Public Health

Learning objective: Debate the value of a new product category for which the public health implications could be both positive and negative.

Case: E-Cigarettes: Marketing Versus Public Health, HBS Case 514-059

Guest: Craig Weiss, ex-CEO, NJOY

Assignment Questions:

1. Assess the benefits of e-cigarettes to consumers. How is the United States market segmented? 2. How should the tobacco companies respond to e-cigarettes? 3. Assess the public health benefits and risks of e-cigarettes. How should e-cigarettes be

regulated? Why?

Session #14: 8:30AM – 9:50 AM, Tuesday, March 8, 2016

Learning objective: Debate the public health vs. freedom of choice tradeoffs inherent in the emergence of a fledgling market for a product of questionable public health benefit.

Case: Marketing Marijuana in Colorado, HBS Case 515-009

Guest: Neil Mahapatra, CEO, Kingsley Capital Partners

Assignment Questions:

1. Is Colorado right to legalize recreational marijuana? 2. What are the economic benefits and costs to? 3. How can a private company profit from the opportunity? 4. How do you think the marijuana “industry” will evolve?