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OVERVIEW OF SYSTEMS-BASED PRACTICE

This class will give some terms commonly used in systems-based practice. A “Framework for Analysis” approach is used in this course as a method to help analyze the evolving healthcare delivery system by using different perspectives.

The “Framework for Analysis” approach consists of different perspectives to assist physicians and other providers with an awareness of and responsiveness to the larger context and system of healthcare. The “Framework for Analysis” consists of the following perspectives:

  1. Consumers (actual or potential recipients of healthcare);
  2. Patients;
  3. Providers (the term “providers” is an all inclusive term for providers of medical care including physicians, hospitals and others);
  4. Payors for example, governmental programs such as Medicare and Medicaid; Employer Groups; and individuals purchasing health care benefits;
  5. Health Plans such as Health Maintenance Organizations (HMOs)/ Preferred Provider Organizations (PPOs), Managed Care Organizations (MCOs), Insurers; and
  6. Laws and Public Policies encompassing all of the above listed perspectives.

Systems care practice is dynamic. New laws on a local, state and federal level are continually in the making. The systems-based practice is changing with various mergers, acquisitions, and new types of health care companies. This course gives physicians and other healthcare providers a framework for analyzing how systems-based practice affects providers.

Framework for Analysis:

  • Consumers;
  • Patients;
  • Providers;
  • Health Plans such as HMO/PPO/MCOs/Insurers;
  • Payors such as companies purchasing health care benefits on behalf of their employees, governmental sponsored programs such as Medicare and Medicaid; and
  • Laws and Public Policies encompassing any and all of the above perspectives.