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Reference: https://www.ahip.org/courses/healthcare-management-an-introduction-ahm250
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| Section | Weight | Objectives |
|---|---|---|
| Provider Network Management | 15% | - Quality and performance measurement - Network design and contracting - Provider compensation models |
| Health Plan Organizations and Models | 20% | - Structure and types of health insurance providers - HMO, PPO, POS, and managed indemnity plans - Consumer-directed plans: HSAs, HRAs, FSAs |
| Evolution of US Healthcare Delivery and Financing | 15% | - From prepaid plans to accountable care organizations (ACOs) - Historical development of health insurance |
| Regulatory Compliance and Ethics | 15% | - Federal and state regulations - Ethical standards and industry conduct - Legislative updates including 21st Century Cures Act |
| Health Plan Operations | 20% | - Claims administration and processing - Information technology and health plan systems - Underwriting and rating principles |
| Government Healthcare Programs | 15% | - Affordable Care Act and regulatory impact - Medicaid and CHIP programs - Medicare program structure and coverage |
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Health Plan Finance and Risk Management
Network Management
Governance and Regulation
Medical Management
Healthcare Management: An Introduction
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