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There are 7 modules in this course
Solving the problems and challenges within the U.S. healthcare system requires a deep understanding of how the system works. Successful solutions and strategies must take into account the realities of the current system.
This course explores the fundamentals of the U.S. healthcare system. It will introduce the principal institutions and participants in healthcare systems, explain what they do, and discuss the interactions between them. The course will cover physician practices, hospitals, pharmaceuticals, and insurance and financing arrangements.
We will also discuss the challenges of healthcare cost management, quality of care, and access to care. While the course focuses on the U.S. healthcare system, we will also refer to healthcare systems in other developed countries.
In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Visit the FAQs below for important information regarding 1) Date of the original release and expiration date; 2) Accreditation and Credit Designation statements; 3) Disclosure of financial relationships for every person in control of activity content.
What's included
12 videos2 readings4 assignments
Show info about module content
12 videos•Total 55 minutes
Introduction•2 minutes
A Simple Interaction Between Providers and Patients•3 minutes
The Problem of Risk•5 minutes
Solving the Problem of Risk: Risk Pooling•6 minutes
Insurance and Intermediaries for Risk Pooling•7 minutes
Beyond Patients, Providers, and Intermediaries: Other Players in the Health Care System•3 minutes
Overview of the Types and Roles of Intermediaries•3 minutes
Overview of the Types and Roles of Providers•7 minutes
Providers and Levels of Care•5 minutes
The Challenge of Rising Health Care Costs•6 minutes
The Challenges of Quality and Access•4 minutes
Lessons for AI and Data•4 minutes
2 readings•Total 5 minutes
Video Image Credit•0 minutes
Study Guide Module 1•5 minutes
4 assignments•Total 60 minutes
Reflection Exercise•10 minutes
Reflection Exercise•10 minutes
Reflection Execise•10 minutes
Knowledge Check•30 minutes
Physicians, Physician Practices, and Physician Payment
Module 2•2 hours to complete
Module details
What's included
12 videos1 reading3 assignments
Show info about module content
12 videos•Total 48 minutes
Characteristics of Physician Practices•5 minutes
Physicians, Intermediaries, and Networks•8 minutes
Fee for Service Payment•5 minutes
Procedure Codes and Diagnosis Codes•4 minutes
The Medicare Fee Schedule•4 minutes
Capitation Payment Systems: Overview and Structure•4 minutes
Capitation Payment Systems: Scope of Capitation•3 minutes
Episode-Based Payment Systems and Salary Systems•4 minutes
Risk Shifting in Physician Payment and Multi-Layered Physician Payment Arrangements•5 minutes
Incentives Created by Physician Payments•4 minutes
Lessons for AI and Data•3 minutes
Wrap Up•1 minute
1 reading•Total 5 minutes
Study Guide Module 2•5 minutes
3 assignments•Total 50 minutes
Reflection Exercise•10 minutes
Reflection Exercise•10 minutes
Knowledge Check•30 minutes
Hospitals, Other Provider Organizations, and Related Payment Systems
Module 3•2 hours to complete
Module details
What's included
13 videos2 readings4 assignments
Show info about module content
13 videos•Total 53 minutes
Basic Operations and Characteristics of Hospitals•4 minutes
How Hospitals Relate to Physicians and Intermediaries•3 minutes
Hospital Payment Methods: Charge Masters/FFS and Per Diem•4 minutes
Hospital Payment Methods: DRGs•6 minutes
Hospital Payment Methods: Global Budgets•3 minutes
Hospital Payment Topics: Payments for Inpatient vs Outpatient Services, Hospital vs Physician Payments; Charges and Payments•5 minutes
Risk and Incentives in Hospital Payment•5 minutes
Independent Facilities - Structure and Payment•3 minutes
Health Care Systems and Larger Provider Organizations•7 minutes
Pay for Performance•4 minutes
EMRs, EHRs, and PHRs•4 minutes
Providers, Provider Incentives, Data, and Tools•4 minutes
Wrap Up•1 minute
2 readings•Total 5 minutes
Video Image Credit•0 minutes
Study Guide Module 3•5 minutes
4 assignments•Total 60 minutes
Reflection Exercise•10 minutes
Reflection Exercise•10 minutes
Reflection Exercise•10 minutes
Knowledge Check•30 minutes
Intermediaries, Health Insurance Plans, and Health Care Financing
Module 4•2 hours to complete
Module details
What's included
15 videos1 reading3 assignments
Show info about module content
15 videos•Total 57 minutes
Intermediaries and their Goals•4 minutes
Intermediaries and the Broad Challenges Facing Health Care Systems•3 minutes
Networks and Selective Contracting•5 minutes
Provider Payment Methods and Levels•3 minutes
Patient Cost Sharing•6 minutes
Utilization Review, Gatekeepes, and Other Methods of Directly Influencing Care•4 minutes
Coverage Decisions•2 minutes
Combinations and Tradeoffs•3 minutes
Three Stereotypical Plan Designs: "Traditional," HMO, and PPO•6 minutes
Some More Recent Trends in Plan Design•2 minutes
Public and Private Plans (and Employer-Provided Private Insurance in the U.S.)•6 minutes
The U.S. Medicare Program•6 minutes
The U.S. Medicaid Program•3 minutes
Intermediaries: Lessons for Innovators•2 minutes
Wrap Up•1 minute
1 reading•Total 5 minutes
Study Guide Module 4•5 minutes
3 assignments•Total 50 minutes
Reflection Exericse•10 minutes
Reflection Exercise•10 minutes
Knowledge Check•30 minutes
Health Care Products and Prescription Drugs, and Quality Measurement and Improvement
Module 5•2 hours to complete
Module details
What's included
13 videos2 readings3 assignments
Show info about module content
13 videos•Total 48 minutes
Health care products, approvals, and prescription drugs•4 minutes
Prescription Drug Approval Processes•4 minutes
Patents, Branded Drugs, and Generic Drugs•3 minutes
Patients, Insurance, Formularies, and Prescription Drugs•5 minutes
Intermediaries, Pharmacy Benefit Managers, Drug Prices, and Rebates•6 minutes
Products and Prescription Drugs Wrap Up - Data and Opportunities for Innovation•1 minute
Quality of Care Overview and Key Organizing Concepts•5 minutes
Overview, and Structural Quality Measures•4 minutes
Process Quality Measures•4 minutes
Outcome Quality Measures and Satisfaction Measures•4 minutes
Overview of Some Approaches to Improving Quality•4 minutes
Innovation and Data in Quality Improvement•1 minute
Wrap Up•1 minute
2 readings•Total 5 minutes
Video Image Credit•0 minutes
Study Guide Module 5•5 minutes
3 assignments•Total 50 minutes
Reflection Exercise•10 minutes
Reflection Exercise•10 minutes
Knowledge Check•30 minutes
Ethics
Module 6•1 hour to complete
Module details
Ethics in Healthcare System
What's included
4 videos2 readings2 assignments
Show info about module content
4 videos•Total 21 minutes
Overview of AI applications in delivery of health care services and ethical issues•5 minutes
Ethical frameworks for health care and for AI•5 minutes
AI and incentives in health care delivery and payment structures•6 minutes
More examples of AI and incentives in health care delivery and payment structures•6 minutes
2 readings•Total 20 minutes
Exercise Reading•15 minutes
Study Guide Module 6•5 minutes
2 assignments•Total 45 minutes
Reflection Exercise•30 minutes
Reflection Exercise•15 minutes
Course Wrap Up
Module 7•1 hour to complete
Module details
Course Summary and Final Assessment
What's included
1 video3 readings1 assignment
Show info about module content
1 video•Total 1 minute
Course Summary•1 minute
3 readings•Total 15 minutes
Final Assessment Note•5 minutes
Claim CME Credit•0 minutes
Full Study Guide•10 minutes
1 assignment•Total 60 minutes
Final Assessment•60 minutes
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The Leland Stanford Junior University, commonly referred to as Stanford University or Stanford, is an American private research university located in Stanford, California on an 8,180-acre (3,310 ha) campus near Palo Alto, California, United States.
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Learner reviews
4.7
1,504 reviews
5 stars
80.98%
4 stars
15.35%
3 stars
2.19%
2 stars
0.46%
1 star
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A
AD
5·
Reviewed on Jan 31, 2021
For a Canadian healthcare worker who is not familiar with US healthcare or terminology this course was very beneficial. Course layout was organized. Highly recommended.
K
KG
5·
Reviewed on Mar 27, 2023
Easy to understand overview of the key players and themes in the healthcare system. Useful for an individual considering pursuing studies and a career in the healthcare field.
K
KM
5·
Reviewed on Jan 28, 2025
Great course! The content was clear, well-structured, and easy to follow. The flexibility made learning convenient, and I gained valuable knowledge. Highly recommend!
Is this activity accredited for Continuing Medical Education (CME)?
Dates and Duration
Original Release Date: 08/10/2023
Expiration Date: 08/10/2026
Estimated Time to Complete: 12 hours
CME Credits Offered: 12.00
Accreditation
The Stanford University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Stanford University School of Medicine designates this enduring material for a maximum of 12.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Disclosures
The Stanford University School of Medicine adheres to ACCME Criteria, Standards and Policies regarding industry support of continuing medical education. There are no relevant financial relationships with ACCME-defined commercial interests for anyone who was in control of the content of this activity.
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To access the course materials, assignments and to earn a Certificate, you will need to purchase the Certificate experience when you enroll in a course. You can try a Free Trial instead, or apply for Financial Aid. The course may offer 'Full Course, No Certificate' instead. This option lets you see all course materials, submit required assessments, and get a final grade. This also means that you will not be able to purchase a Certificate experience.
What will I get if I subscribe to this Specialization?
When you enroll in the course, you get access to all of the courses in the Specialization, and you earn a certificate when you complete the work. Your electronic Certificate will be added to your Accomplishments page - from there, you can print your Certificate or add it to your LinkedIn profile.
Is financial aid available?
Yes. In select learning programs, you can apply for financial aid or a scholarship if you can’t afford the enrollment fee. If fin aid or scholarship is available for your learning program selection, you’ll find a link to apply on the description page.