CE Credits: Valid for 1.0 PDCs for the SHRM-CPSM or SHRM-SCPSMKnowledge Benefits is an approved SHRM recertification provider. Learn More
Release Date: April 12, 2017
Expires: April 11, 2019

Health Plans


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“This would be a great world to dance in if we didn’t have to pay the fiddler.”
Will Rogers


What is this course about?

The health­care mar­ket, like all mar­kets, com­pris­es dif­fer­ent play­ers that can be cat­e­go­rized as buy­ers and sell­ers. This sec­ond of four cours­es in the series, “Under­stand­ing the US Health­care Mar­ket,” focus­es on health plans (aka insur­ers) as a major com­mer­cial sell­er by describ­ing their roles, exam­in­ing their busi­ness strate­gies, and quan­ti­fy­ing their finan­cial expe­ri­ence.

How ser­vices are bought and sold deter­mines the rela­tion­ship between qual­i­ty and price. This is true of all mar­kets, although the health­care mar­ket can be par­tic­u­lar­ly com­plex because of the many play­ers with often mis­aligned incen­tives. Some­times these play­ers work togeth­er in a sin­gle struc­ture and oth­er times each play­er works rel­a­tive­ly inde­pen­dent­ly. In either case, pur­chasers and con­sumers do not always see how these play­ers relate in the over­all mar­ket­place nor is it easy to deter­mine either price or qual­i­ty.

Health plans typ­i­cal­ly func­tion as inter­me­di­aries between health­care pur­chasers (e.g. employ­ers) and healthcare’s major providers – hos­pi­tals and physi­cians. This course exam­ines key health plan pur­chas­ing, financ­ing, ben­e­fits and con­tract­ing trends. The oth­er cours­es in the series exam­ine finan­cial trends and behav­iors of healthcare’s major play­ers:

  • Employ­ers and oth­er Pur­chasers
  • Hos­pi­tals and Physi­cians
  • Drug Com­pa­nies and Phar­ma­cy Ben­e­fits Mangers

Who is it for?
Ben­e­fits admin­is­tra­tors on the front lines of employ­er spon­sored health insur­ance
HR pro­fes­sion­als inter­est­ed in improv­ing ben­e­fit pur­chas­ing
Pur­chas­ing man­agers inter­est­ed in improv­ing ben­e­fit pur­chas­ing
Chief Human Resources Offi­cers respon­si­ble for pur­chas­ing health­care ben­e­fits
Chief Finan­cial Offi­cers respon­si­ble for man­ag­ing the bot­tom line
Chief Exec­u­tive Offi­cers con­cerned about health­care costs erod­ing the bot­tom line

What will I learn to do?

  1. Define and delin­eate the roles of healthcare’s health plans/insurers.
  2. Exam­ine mar­ket and finan­cial trends in the health insur­ance indus­try.
  3. Define and iden­ti­fy trends in var­i­ous pay­ment mod­els.
  4. Describe how health plans mea­sure qual­i­ty.


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