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ACADEMY FOR HEALTHCARE MANAGEMENT

Organization Directory Page

• Organization description

• Source of official student records

• Titles of all evaluated learning experiences

• Descriptions and credit recommendations

The Academy for Healthcare Management (AHM) was established in 1997 to offer an industry‑wide educational program focusing on the unique complexities associated with healthcare management. As owner's of AHM, America's Health Insurance Plans and the Blue Cross and Blue Shield Association collectively, represent more than 1,100 health plans caring for more than 200 million people, as well as decades of experience in providing continuing education opportunities for insurance and healthcare professionals.

AHM offers a comprehensive leading‑edge curriculum in the evolving field of healthcare management, recognizing professionals through the award of designations and course completion. Healthcare professionals demonstrate mastery of operational and management concepts in healthcare management striving to improve healthcare quality through learning at every level. The complete education program consists of two levels: Introductory, which leads to the PAHM, or the Professional, Academy for Healthcare Management, and Advanced , which leads to the FAHM, or the Fellow,
Academy for Healthcare Management.

Source of official student records:  Academy for Healthcare Management, 601 Pennsylvania Ave NW, South Building, Suite 500, Washington, D.C. 20004.

Titles of all evaluated learning experiences

Health Plan Finance and Risk Management (AHM 520)
Managed Care Organizations: Governance and Regulation (AHM 510)
Managed Healthcare: An Introduction (AHM 250)
Medical Management in Managed Care Organizations (AHM 540)
Network Management in Managed Care Organizations (AHM 530)

Descriptions and credit recommendations

Health Plan Finance and Risk Management (AHM 520)
Location: Independent study and proficiency examination program administered from the central offices of the Academy for Healthcare Management.
Length: Independent study.
Dates: November 1999 - December 2006.
Objectives: Describe the types of risks that health plans face, and the approaches, including provider reimbursement methods and stop loss insurance, that health plans use to manage these risks; describe the key underwriting factors and rating methods associated with underwriting and rating large groups, small groups, and individuals for healthcare benefits; distinguish between fully funded and self funded health plans and describe the primary characteristics of alternative funding methods; identify the factors that health plans consider when developing and pricing healthcare products to ensure that these products are both profitable and competitive in the healthcare marketplace; explain how a health plan’s managers use financial information to develop a strategic plan, to monitor progress toward achieving strategic and operational goals, to budget effectively, and to manage cash and capital effectively.
Instruction: Health plan financial information; risk management in health plans; provider reimbursement arrangements; capitation and plan risk; fully funded and self-funded health plans; financial aspects of Medicare and Medicaid for health plans; rating and underwriting; small group and individual underwriting; pricing and rating; accounting and financial reporting; the strategic planning process in health plans; financial statement analysis in MCOs; management control; cash management and capital budgeting.
Credit recommendation: In the upper division baccalaureate degree category, 3 semester hours in Health Administration (12/99) (1/05 revalidation).

Managed Care Organizations: Governance and Regulation (AHM 510)
Location: Independent study and proficiency examination program administered from the central offices of the Academy for Healthcare Management.
Length: Independent study.
Dates: December 1998 - December 2006.
Objectives: Describe the major features of for-profit, not-for-profit, and mutual companies; discuss how health plans use reengineering, mergers, acquisitions, and healthcare integration to meet strategic goals; identify environmental forces affecting health plans; describe key state regulations that apply to various types of federal laws that affect health plans; describe the primary features of government programs such as TRICARE, FEHBP, workers’ compensation, Medicaid, and Medicare; describe laws that regulate healthcare fraud and abuse; explain the roles and responsibilities of the board of directors and senior management in an health plan; describe the strategic planning process and identify key strategic issues for health plans; describe an effective health plan compliance plan; identify the legal issues that may arise for health plans during the course of conducting business; describe how health plans influence public policy; explain how marketplace reform and regulatory reform bring about change in the managed care industry.
Instruction: Environmental forces; legal organization of health plans; formation and structure of health plans; state regulation of health plans; federal regulation of health plans; federal government as purchaser; fraud and abuse; components of governance in health plans; strategic issues in health plans; accountability and leadership; key legal issues in managed care; public policy; emerging trends in managed care.
Credit recommendation: In the upper division baccalaureate degree category, 3 semester hours in Health Administration, Insurance, or as an elective in Human Resource Management (12/99) (1/05 revalidation).

Managed Healthcare: An Introduction (AHM 250)
Location: Independent study and proficiency examination program administered from the central offices of the Academy for Healthcare Management.
Length: Independent study.
Dates: December 1997 - December 2006.
Objectives: Describe the evolution of healthcare delivery and financing in the United States; define basic concepts of managed healthcare; describe HMOs, PPOs, POS options and managed indemnity products; describe provider organizations; describe medical management; explain healthcare operations and health systems management; identify and describe legislative, regulatory and ethical issues in   managed healthcare.
Instruction: Evolution of healthcare delivery in the United States; basic concepts of managed healthcare; health maintenance organizations, preferred provider organizations, point of service options, and managed indemnity; managed healthcare for specialty services; provider organizations; medical management; managed healthcare operations; health systems management; legislative and regulatory issues in managed healthcare; ethical issues in managed healthcare.
Credit recommendation: In the upper division baccalaureate degree category, 3 semester hours in Health Administration, Insurance, or as an elective in Human Resource Management (12/97) (6/02 revalidation).

Medical Management in Managed Care Organizations (AHM 540)
Location: Independent study and proficiency examination program administered from the central offices of the Academy for Healthcare Management.
Length: Independent study.
Dates: November 2000 - December 2006.
Objectives: Describe the scope of medical management, the legislative and regulatory issues that affect medical management, and the impact of consumer, purchaser, and provider expectations; explain how MCOs perform technology assessment, develop medical policy, and establish clinical practice guidelines; describe the role of quality management, including accreditation, quality assessment, quality improvement, benchmarking, and the impact of laws and regulations; discuss the roles of and processes for utilization review and case management; explain the roles of preventive care, self-care, decision support, and disease management in an MCO’s health management strategies; discuss medical management strategies and considerations for different levels of care (i.e., acute and post-acute); describe the medical management issues that affect the delivery of pharmacy services and specialty services such as behavioral healthcare, dental care, vision care, and complementary and alternative medicine; describe medical management activities for government-sponsored healthcare programs, such as Medicare, Medicaid, workers’ compensation, TRICARE, and FEHBP.
Instruction: The role of medical management in an MCO; environmental influences on medical management; clinical practice management; quality management, assessment, and improvement; preventive care, self-care, and decision support programs; utilization review; case management; disease management; medical management considerations for acute care and post-acute care; pharmacy and specialty services; medical management for government-sponsored programs.
Credit recommendation: In the upper division baccalaureate degree category, 3 semester hours in Health Administration (1/01).

Network Management in Managed Care Organizations (AHM 530)
Location: Independent study and proficiency examination program administered from the central offices of LOMA on behalf of the Academy for Healthcare Management.
Length: Independent study.
Dates: April 1999 - December 2006.
Objectives: Describe how health plans manage provider panels; explain how health plans analyze healthcare markets to determine goals for network development; describe network strategies, such as network-within-a-network, tiered networks, and leased networks; identify factors that health plans consider in identifying potential network providers; explain the data collection and verification processes used in credentialing; identify the essential elements of a provider contract; describe the negotiating process for provider contracting; describe how health plans adjust their processes for different types of providers and services; describe the development and management of provider networks that serve Medicare, Medicaid, and workers’ compensation populations; describe situations that indicate a need to review network adequacy; identify ways that health plans provide service and support to network providers; explain how health plans measure the performance of network providers.
Instruction: Development and management of health plan provider networks; impact of environmental factors on network management; selecting, negotiating, and contracting with providers; managing network access and availability; managing provider performance, including provider profiling and provider incentives.
Credit recommendation: In the upper division baccalaureate degree category, 3 semester hours in Health Administration, Insurance, or an elective in Human Resource Management (12/99) (1/05 revalidation).


Updated 8/9/07

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