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Reference: https://www.ahip.org/courses/healthcare-management-an-introduction-ahm250
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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Provider Network Management | 15% | - Network design and contracting - Provider compensation models - Quality and performance measurement |
| Topic 2: Health Plan Organizations and Models | 20% | - HMO, PPO, POS, and managed indemnity plans - Consumer-directed plans: HSAs, HRAs, FSAs - Structure and types of health insurance providers |
| Topic 3: Government Healthcare Programs | 15% | - Affordable Care Act and regulatory impact - Medicaid and CHIP programs - Medicare program structure and coverage |
| Topic 4: Health Plan Operations | 20% | - Underwriting and rating principles - Information technology and health plan systems - Claims administration and processing |
| Topic 5: Regulatory Compliance and Ethics | 15% | - Federal and state regulations - Legislative updates including 21st Century Cures Act - Ethical standards and industry conduct |
| Topic 6: Evolution of US Healthcare Delivery and Financing | 15% | - Historical development of health insurance - From prepaid plans to accountable care organizations (ACOs) |
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