Draft1 updated 20Jan15 325pmBus Adm 757: Managed Care and Integrated Health Networks Spring Semester 2015Mondays 530-810 pm Lubar N130

Robert J. De Vita Adjunct Faculty/LecturerMember, Advisory Councils Lubar School of BusinessAndCollege of Health Sciences University of Wisconsin - Milwaukee414.841.1742devita@uwm.edu“He who fights the future has a dangerous enemy.” - Soren Kierkegaard

Office hours : By appointment immediately before Monday classes beginning @ 430 or other, mutually agreeable times.

Course description : “Examines concepts and management of capitated and vertically integrated health care organizations; utilization control, risk and quality assessment, benefit design, pricing, management of clinical professionals.”

Course objectives :Our foremost objective in this course will be to “act as if” class time is IRL ( In Real Life) as in a real health care organization. We will treat being in class and the work as if it was actually our real work. While the content will feature managed care and integrated health networks, it will also feature how to prepare yourselves as leaders for the next versions of both managed and integrated care.

Here’s one example: listen to this 20 minute interview of U.S. Navy Captain David Marquet by The Healthcare Executives Network “Captain Marquet retired from the Navy in 2009 and is now the author of Turn the Ship Around! A True Story of Turning Followers Into Leaders. Fortune magazine called the book the “best how-to manual anywhere for managers on delegating, training, and driving flawless execution.” Captain Marquet’s Intent-Based Leadership model is turning around all types of organizations—from big manufacturers to start-ups and sport teams to government.

He helps leaders build environments where people contribute and feel valued —where everyone is a leader.

Motley Fool called Captain Marquet’s book: “One of the 12 best business books of all time.”

In this interview Captain Marquet talks about his philosophies and how they relate to healthcare. “

Listen to the interview here. Content is very solid about fundamentals of leadership that, in my opinion from experience, can and must be applied to health care: [note the source of the link and see; I’m not the only health care leader who believes this]. http://healthcareexecutivesnetwork.org/2015/01/captain-david-marquet-interview/

We will simulate management team meetings, for example, with in-class breakout groups and your project teams will be like Real Life Workgroups. And there will be similarities between being inclass and in a real management meeting: usually highly engaged & energetic. Sometimes boring and annoying. Just like In Real Life.

Here’s a great reference on team performance IRL:http://mobile.nytimes.com/2015/01/04/business/corner-office-maynard-webb-yahoos-chairman-even-the-best-teams-can-be-better.html?_r=0

Exams & in class exercises are intended to train, condition & prepare you for the wide range of work situations you will experience; especially given the need to learn how to adapt & adjust so as to prevail against adversity & make the rapid changes needed given industry disruptions.

Simply put, you will :

1. Know/ learn content about integrated networks & managed care2. Apply your learning to a series of deliverables ( see grading)3. Engage & commit yourself to learning, both individually & as a class to learning together 4. Simplify the complexity * around you & synthesize it ----as all good health care leaders

must do 5. Learn the value of creating counter-narratives…explanations that run counter to popular

thinking….and the value of a life-long learning cohort…..your classmates as your trusted advisors overtime.

Oliver Wendell Holmes : *I would not give a fig for the simplicity this side of complexity, but I

would give my life for the simplicity on the other side of complexity.

The basis for this quote is that you have to "complexify before you simplify" because the

simplicity that comes before knowing all of the varying, complicating factors in a situation is

really worthless, inane and naive. But, often times, the true answer is also remarkably simple:

you only have to be on the far side of complexity in order to see it clearly. And another guiding

principle gleaned from Occam’s Razor:

http://math.ucr.edu/home/baez/physics/General/occam.html

The most useful statement of the principle is"when you have two competing theories that make exactly the same predictions, the simpler one is the better."

Course Requirements:It is understandable that a student might miss one or two classes due to such things as job requirements, personal or family illness, emergencies, etc. It is expected that students will do the following regardless of the reason for missing class:

Contact the instructor prior to the absence to discuss what will be missed and what needs to be done to make-up the absence. In the case of an emergency (for example, being in a medical emergency room) the student is expected to contact the instructor within 24 hours or have a family member or friend contact the instructor.

Turn in make-up work as stipulated by the instructor.

After two absences, the student must initiate a conversation with the instructor to determine what is required to complete the course successfully. Failure of the student to initiate this conversation will affect the final grade and may result in withdrawal from the course.

More than three absences will result in loss of all attendance/participation points for the term and may result in withdrawal from the course.

Late Arrival/Departure: Simply put, unless the instructor knows ahead, or there is an emergency; arriving late to class or departing early discouraged. It is discourteous and disruptive to your classmates and the instructor, and impairs your development of your future leadership skills.

Participation and engagement: At University of Wisconsin – Milwaukee graduate level classes are kept relatively small so students can actively participate in the interactive learning model that is central to our adult learning philosophy. Students are expected to participate and engage in a meaningful way that demonstrates their ability to think critically and apply concepts from course assignments. It is assumed that students will listen respectfully to the instructor and to class members. Students are expected to refrain from engaging in side conversations while the instructor or a classmate is talking. While there will undoubtedly be

disagreements about topics of discussion, it is expected that students use critical thinking in expressing opinions, as well as listen to others’ with respect and an eagerness to hear others’ viewpoints.

Classroom Behavior: Part of UWM’s mission is to provide an education that is respectful, safe, and caring for all individuals. It is expected that, as UWM community members, students contribute to this kind of learning environment. Students whose behavior is disruptive, or who behave disrespectfully toward other students or toward an instructor, may be instructed to leave class or be withdrawn from the course. Depending on the nature of the behavior, the student may be expelled from the University. According to the University of Wisconsin - Milwaukee Student Handbook (www.uwm.edu):

• Disruption of the educational process including behavior which inhibits or prevents faculty and staff from carrying out their institutional functions and/or other students from learning;

• Use of illegal drugs or alcohol, or under the influence of illegal drugs or alcohol, while on school property. Conduct contrary to responsible behavior may lead to refusal to issue a diploma or transcript or withdrawal from the institution.

Distractions in the Classroom: Cell phones, pagers, PDA’s, and all other electronic devices are to be silenced during class time. Text messaging will not be allowed during class. Children are not permitted in classes. Make arrangements for childcare as well as a “first responder” in the event of any emergencies regarding family members. If you would like to bring a guest to class, contact the instructor prior to class.

Grading :

30 % Cases : write ups & in-class discussion for 3 HBS cases 150 points [3 cases @ 50 pts]40% Exams : mid- term & final ( in-class) 200 points [2 exams @100 pts]30 % Team project : write up & in-class presentation 150 points [ 75 pts each part]100% Total 500 Total

Grade Percentage

A 92-100%

B 83-91

C 75-82

D 66-74

F Below 66

Final grades are submitted when all work is completed.

As in-class engagement is an essential “given” for a graduate-level seminar, it is a joint accountability for all of us. I will assess your in-class engagement using the following resources :

1. Exercises such as Improbable Pairing--- which is rapid responses to peer questions via 2-minute drills.

2. Student volunteering [or selected ]as the content expert to describe in a 5 minute standup the takeaways from each week’s readings.

3. Your guest lecturer interactions: questions, responses, overall engagement.

These 3 resources will influence my assessment about individual student in-class performance.

Readings: Text, Cases & Articles

Health Care USA – Sulz & Young (S&Y). 8th ed. Jones & BartlettISBN: 978-1-284-o2988-8Copyright 2014

Reinventing American Health Care - E. Emanuel MD [EE]Public Affairs Books GroupISBN : 978-1-61039-345-4Copyright 2014

*Note: At the risk of making an assumption that some students may see my selection of Dr. Emanuel’s work as a liberal bias, basically because his brother is Rahm Emanuel is Mayor of Chicago and was formerly a high-ranking member of the Obama Administration, please know it’s not.

I am an equal opportunity, non-partisan observer and listener. It’s just this: A. His work was just published and B. He’s a well known oncologist at a well-known academic medical center [U Penn], so he has some chops.

Here’s an alternative that was published after Dr. E’s, and was reviewed by the health care economists featured in the blog, The Incidental Economist. Phil Klein is a well-published columnist for the conservative Washington Examiner. I will reference some of his

comments if I can snag a copy. http://theincidentaleconomist.com/wordpress/philip-kleins-overcoming-obamacare/

Harvard cases : Your written case analyses should answer the case questions posted on d2L. Provide 3 to 5 double spaced pages on a Word document. Use your judgment and adjust length given the case length & complexity.

1.HBS Engaging Doctors in the Healthcare Revolution- Lee& CosgroveCase reprint http://hbr.org/search/R1406H . 9 pgsJune, 2014 https://cb.hbsp.harvard.edu/cbmp/content/R1406H-PDF-ENG

2. HBS Access Health CT: Marketing Affordable Care  - Quelch & NorrisCase  9-514-119          29pgs Aug.26, 2014https://cb.hbsp.harvard.edu/cbmp/content/514119-PDF-ENG

3. HBS Steward Health Care System- Higgins & Fisher note: for profit health care case 9-814-029 18 pgsJuly 15, 2014https://cb.hbsp.harvard.edu/cbmp/content/814029-PDF-ENG

I will upload 2 cases below to d2L

Cases for reading and discussion but not a case write up:

4.Personal experience case authored by Robert DeVita, 2012 & updated 2014 : Blue Cross v Marshfield Clinic, 1994-95 decided by 7th Circuit Court of Appeals, Chicago, IL. Chief Judge Richard Posner Presiding.

5.Commonwealth Fund case

Projects & presentations : as a team, you will :

1) Identify a problem facing integrated health care organizations,

specifically pertaining to managed health care 2) Create a fix to solve the problem 3) Describe / present your plan to execute the solution

Format & length of presentation : TBD

Articles- Because of rapid changes in the managed health care market, I will paste here and post relevant, recent articles weekly e.g. one timely and major event driving markets is that ACA Exchanges will maintain open enrollment until Feb.15. Another is the Supreme Court decision on subsidies expected in June.

You will need to check both D2L & this Syllabus daily. I am using a JIT [Just in Time] approach to your readings, which again, closely parallels Real Life because the half-life of business news and ideas is so brief. This brevity of exposure is because the market/audience for news and ideas overemphasizes the impact of trends and changes in the short-run, while under emphasizing them in the long-run. This is more a reflection of human behavior and today’s attention span and appetite amidst the incredible surge of social media than the newsworthiness of content.

Guest Lecturers: The list includes both those leaders Invited& those Confirmed. Busy schedules may require some to beg off & others to move around or be added. These schedule changes reflect the reality of business these days.

These leaders are real life subject matter experts whom I personally know, respect & have selected as our guests. They are community volunteers taking time away from family, work and R&R to be with us because they care deeply about educating future leaders.

One more clarifying point because it always comes up. To the question: Don’t the guests just mean less work for me as instructor? Not at all—I personally work with each guest, first contacting them and then meeting usually at least twice, and some three times. This began last summer and continued throughout my Fall and Winter planning—to assure they are prepared & comfortable.

Class Schedule :

Session 1- Jan.26, 2015

We will get to know one another, get acquainted with the course work & set a baseline.

Introductions & dialog re: everyone’s personal objectives for and/or reflections on this course.

Review course syllabus. Set the baseline via review & discussion from major healthcare

stakeholder perspectives. See readings Conduct an exercise : Ask the expert. For today, that will be me.

For the future, each of you will take a turn. Think about your team project idea & with whom you’d team up

1. Text(s): EE Ch.1, 3, 4.2.Readings:

TIE [The Incidental Economist] links to a terrific healthcare economics- specific website run by a couple of innovative, some might say “rogue” health care economists a la the Freakonomics guys* from several years ago. http://theincidentaleconomist.com/wordpress/critiquing-health-care-in-the-us/*note: Levitt and Dubner, 2005 ed.

How the Brits see the ACA doinghttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60003-4/fulltext

How popular media see the ACA: Steve Brill is famous for his 26 page Time magazine article in 2013 on the ‘charge master’….the longest Time article…..ever

How conservatives see the ACA: http://www.thefiscaltimes.com/2015/01/14/Top-Republican-Says-He-Has-Answer-Obamacare

How a famous Princeton health care economist sees Gruber and the ACA :http://healthaffairs.org/blog/2014/12/29/rethinking-the-gruber-controversy-americans-arent-stupid-but-theyre-often-ignorant-and-why/#more-43665http://www.npr.org/blogs/health/2015/01/05/375024427/americas-bitter-pill-makes-case-for-why-health-care-law-wont-work

How hospitals are faring under the ACAhttp://kaiserhealthnews.org/news/how-a-states-choice-on-medicaid-expansion-affects-hospitals/How business community views health care consolidationhttp://johntorinus.com/general-blog/business-and-education/wheres-transparency-uw-dollars-headed-state/

Session 2 – Feb. 2 What do the following questions mean :

1. What do these terms mean to you in the real life of a health care organization and its leadership: integrated health care, managed health care, accountable care?

2. What are, and how do, ACOs fit in to integrated care, managed care, population health & public health? Provide examples.

3. How do the first two points relate to your career choices and own your personal choices when seeking health care?

1. Text: ch.1,2 S&Y + read Index references to accountable care organizations in both S&Y & EE. 2. Readings: -BDV’s top 7 (see D2L Word doc) re ACOs

- CommonWealth Fund : http://www.commonwealthfund.org/~/media/files/publications/case-study/2014/oct/1771_klein_marshfield_clinic_aco_case_study.pdf

-The Dane Difference:

Read pgs. 1-7 of the 32 pages as these are the main takeaways. What famous health care maven appears on pg. 7’s list of names…… and why is he so famous? http://communityadvocates.net/userimages/The%20Dane%20Difference.pdf

-Oliver Wyman: a national health care consulting company (see D2L) PeaceHealth Board of DirectorsIndustry Outlook & Strategic ImplicationsNovember 21, 20143.Readings on the Budget Bill [aka “cromnibus”] impact on health insurance market :CRomnibus affects QHPs (& Coops)……BDV will note similarities to Gov. Walker’s WEDChttp://healthaffairs.org/blog/2014/12/12/implementing-health-reform-beneath-the-hood-of-the-cromnibus/

http://www.washingtonexaminer.com/cromnibus-and-corporate-welfare-insurer-bailout-and-ex-im-provisions-in-spending-bill/article/2557195?custom_click=rss

Session 3- Feb. 9

1. Text : ch.4,5,7 S&Y2. Readings: Copies CON text on pop health (2)

On disruptions coming in health care: http://www.geppettoavatars.com/http://www.commonwealthfund.org/publications/blog/2014/dec/value-based-payment-is-spreading

Guest: Sally Lundeen PhD, Dean, UWM College of Nursing, will explore many facets of managed care and integrated networks from the standpoint of:

-the emergence of nursing in new clinical roles- the focus on population health -the need for inter- professional teams and

-the role of disruption in forging the new health care e.g. integrated primary care [pre-medical home].

Session 4 – Feb. 16

1. Text : Ch. 6 S&Y2. Readings : TBD introduce VCRE. Stockdale's paradox & Tichy \ Marshall

case 1 due HBS Engaging Doctors in the Healthcare Revolution- Lee& Cosgrove Case reprint http://hbr.org/search/R1406H . 9 pgsJune, 2014 ttps://cb.hbsp.harvard.edu/cbmp/content/R1406H-PDF-ENG

The real “Unbroken” : Louie ZamperiniHardiness & Pain. Never give up. If you can take it you can make it. One Moment of Pain ......a lifetime of glory. https://m.youtube.com/watch?v=qNQHsONP4ishttps://m.youtube.com/watch?v=n5OPsjiLweohttps://m.youtube.com/watch?v=mlHusz_z1wE Al Michael's. Brokaw

Guest: confirmed Susan Marshall, CEO, Backbone Institute and Patricia J. Lenius, President, PJL & Associates

Health care is an industry in rapid transition given the resurgence of managed care & industry integration & consolidation. Hence, health care leaders need to pay attention to conditioning to maintain personal health, well- being & high performance while they role model the same within their organizations.

Session 5 - Feb. 23

Guest:confirmed Larenda Mielke, Assistant Dean for Executive Education& Career Services, UWM Lubar School of Business

“ Difficult to predict, but sure to change….. given the rapid integration and consolidation going on within health care. ” : These are the words I used to portray the future of health care at a Milwaukee Press Club

conference panel in December, 2013. Hence, this creates an essential challenge for health care leaders to develop their strategic thinking skills amidst complexity and chaos. You will learn that there are proven ways to do that.

1. Text :ch. 13 S&Y and ch.13 & CODA from EE ( Future of health care & Megatrends )2. Readings : TBD

Session 6 – Mar. 2

Negotiating the managed care contract between potentially adversarial parties ( the health insurance company & the health care service provider) is both an art & science. Our focus this week is on learning firsthand about ways to apply proven leadership practices to this endeavor.

Guest: Confirmed Alyce Katayama JD – Partner, Quarles & Brady law firm. Chair, Health Law Practice Group. Founding Board Member & Legal Advisor to Common Ground Healthcare Cooperative of Wisconsin.

1. Text : Ch. 8 S&Y Financing and trends 2. Readings:

http://www.forbes.com/sites/dandiamond/2015/01/11/60-minutes-just-called-obamacare-a-disaster-heres-what-they-didnt-tell-you/2/

Caution: Ed. Comments follow Steve Brill is a reporter/columnist/ author who until two years ago knew nothing abt health care economics except what he learned as a patient. Now---he's a pundit. An expert. Dan Diamond is a Forbes contributor and an editor at The Advisory Board, a national consulting company begun by very book smart Ivy Leaguers, whom, in my opinion, never ran anything in health care, or had to make a payroll. Sorry, my Ed. Comment turned into a Rant.

Trends in health care premium increases over time http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2015/jan/1798_schoen_state_trends_2003_2013.pdf?la=en

Session. 7- Mar 9 midterm Group work

Session 8- Mar 16 Spring break

Session 9- Mar 23

On building a provider-centric managed health care capability for ACOs, and on developing other vehicles and infrastructure for promoting the integration of care.

Guest : Jeff Zavada , CEO, FlagshipSails, Inc., Wi and former United Health Care executiveReadings: NB: this week OR next 1. Text : Ch. 6 S&Y and Ch.8 EE (Health care financing & Exchanges)2. BX case [not for written analysis]

Session 10- Mar 30

"Health care goes retail…..so moving fast to get there is usually better " Oliver Wyman consultant Nov. 21, 2014 Peace Healthcare board meeting

Case 2 dueHBS Access Health CT: Marketing Affordable Care - Quelch & NorrisCase 9-514-119 29pgs Aug.26, 2014https://cb.hbsp.harvard.edu/cbmp/content/514119-PDF-ENG

Confirmed. Guests : On the mission of a Health Insurance Cooperative ( a distinct difference) & the role/ function of public & private health

insurance exchanges : Cathy Mahaffey, CEO & Jim Wesp, Board Chair & small business owner.

1. Text : Ch. 6 S&Y and Ch.8 EE (Health care financing & Exchanges)2. Readings :TBD

Session 11- Apr. 6On the case for a revitalized public health sector in American health care

Guest: Magda Peck, DSc, Founding Dean, UWM Zilber School of Public Health

1.Text : Ch.11 S&Y Public Health & Public Policy &

2.Readings: http://www.academyhealth.org/files/publications/AHRIPHinACA2014.pdf

Next:

What the Supreme Court said the first time [see Ch. Xx EE]What the Supremes may say this June. Duke Policy Journalhttp://jhppl.dukejournals.org/content/early/2014/11/21/03616878-2867881.full.pdfNEJM https://pod51041.outlook.com/owa/service.svc/s/GetFileAttachment?id=AAMkADlkNDk1NGM2LWI5Y2UtNDZiMS05MmFlLTQ2MTI2ZDBiOTY1OABGAAAAAAB1XqognzGZQ6CZ9X5o9okQBwBbHWneGtGjQrIQasfGkD8KAAAAAAEMAABbHWneGtGjQrIQasfGkD8KAABzhFOTAAABEgAQAEmFC6qU0ztMhgOkfWQ8Iw8%3D&X-OWA-CANARY=QWd6OMaKqkiut2SlVGRnr3oOldyu-dEIyxBDEq9015NP8S9-Cv-j78VNT81OIo5DDFtngm_Du3A.

Gov. Walker in 2013 WSJ interview N.B. reported in Slatehttp://www.slate.com/articles/news_and_politics/politics/2015/01/scott_walker_s_unexpected_defense_of_obamacare_the_wisconsin_governor_may.html

Group work

Session 12- Apr 13

1. Text : TBD2. Readings: TBD

Case 3 due HBS Steward Health Care System- Higgins & Fisher note: for profit health care case 9-814-029 18 pgsJuly 15, 2014https://cb.hbsp.harvard.edu/cbmp/content/814029-PDF-ENG

Session 13- Apr 20

On the employer’s view of health care integration, consolidation and managed health.

Guest confirmed: John Torinus, Chairman, Serigraph, Inc. West Bend, Wi. Active with local startup community including serving as chair, BizStarts. Noted author and blogger on public policy and the business of health care:

1. Text : TBD2. Readings : www.johntorinus.com

Session 14 Apr 27

1. Text : 2. Readings : Case 4 on d2L

Personal experience case authored by Robert DeVita, 2012 & updated 2014 : Blue Cross v Marshfield Clinic, 1994-95 decided by 7th Circuit Court of Appeals, Chicago, IL. Chief Judge Richard Posner Presiding

Group work – final in class prep time for next week !

Session 15- May 4 project presentations

Guest judges Invited: Nick Desien, CEO, Ascension/Ministry Healthcare. Carrie Duda, Senior VP, Revenue Cycle, Aurora Healthcare. Tim Masek VP Finance/Andrew Hillig, VP Performance Improvement, Wheaton Franciscan Healthcare

1. Text : TBD2. Readings: TBD

Session 16- May 11 final exam inclass