The program consists of 4 quarters of instruction, and students must complete 24 core units and 12 elective units.
(24 units total)
Daniel Dohan, Ph.D.
Jaime King, J.D., Ph.D.
The Health Policy and Law (HPL) Seminar is broken down into four quarters: Foundations, Capstone Proposal, Capstone Execution and Capstone Writeup.
During Foundations, you’ll get an introduction to the degree’s interdisciplinary philosophy, approach and goals. You’ll review central concepts in the HPL program, be introduced to a cohort-building experience, and learn about the framework for your capstone project.
The first two weeks of the course focus on fundamental concepts in health policy and health services research. Next, you’ll learn how to conduct legal research in order to find and identify key legal documents, bills and articles. You’ll then explore the challenge of translating evidence into policy and practice.
Use this foundation to begin identifying potential capstone ideas and projects, refine your ideas into a concrete project, and then execute the project with ongoing feedback from mentors and peers in the remaining quarters.
The following three quarters are devoted to developing and executing your Capstone Project. Read more about the sequence.
Dorie Apollonio, MPP, Ph.D.
Gain the skills needed to effectively advocate for change in direct patient care, within health care organizations and in the wider political infrastructure. Policy changes can dramatically shift health care and public health outcomes: Examples include the passage of the Affordable Care Act, tobacco control, motor vehicle safety, occupational safety, lead-poisoning prevention, funding for prevention and control of infectious diseases, and preparedness and response for epidemics and terrorism. These changes and others decreased the age-adjusted death rate in the U.S. from 881.9 per 100,000 in 1999 to 741.0 per 100,000 in 2009, a record low.
- Demonstrate an understanding of the key elements of the U.S. policy-making processes, explaining the role of formal and informal institutional arrangements
- Explain the major steps in the policy analysis and development process, including how and when policy issues become important, and how policy initiatives are developed, analyzed, presented, implemented, evaluated and terminated
- Interpret sources of evidence and information about public health challenges and possible solutions
- Apply an understanding of social diversity to the creation, implementation and outcomes of health policy changes
- Outline the processes involved in a major change in health policy
- Predict the likelihood of a specific health policy change being enacted and justify the assessment
- Compose a report on a major health policy challenge in the United States, including a statement of the problem, identification of possible solutions and assessment of the likelihood that they will be implemented
How to Evaluate Policy-Relevant Research
Daniel Dohan, Ph.D.
Chris Koenig, Ph.D.
Gain the competencies to understand what constitutes a well-circumscribed HPL question or problem and to distinguish strong from weak evidence about that question or problem. You’ll be prepared to examine policy and law questions and problems with a critical eye and with an understanding of what constitutes valid and defensible data and insights. By appreciating the different ways that scholars and practitioners grapple with a variety of evidence and data, you’ll be able to recognize when different types of data evaluation are occurring and what can be done to reconcile diverse perspectives on what “counts” as useful information.
You’ll also examine specific strategies to assess and evaluate the quality of data/information provided—be it numeric (quantitative) or narrative (qualitative) or the combination of the two.
- Recognize distinct approaches to assessing the value of evidence in health policy and law scholarship and practice
- Describe characteristics of evidence that distinguish high-quality from low-quality evidence across study types and designs
- Assess the quality of numeric evidence through inquiry related to research design, study execution, data analysis and reporting of results
- Assess the quality of narrative evidence through inquiry in purposeful design, participatory research, analytical processes and rich presentation
- Appraise the overall utility of an information source based on the reliability and validity of its evidence
- Identify evidence needed to provide a reasonable basis for formulating an evidence-based conclusion about a particular health policy and law question or problem
- Formulate plans to locate evidence that would provide a complete base to address a health policy and law question or problem
Organization and Finance
Janet Coffman, M.A., MPP, Ph.D.
To improve the U.S. health care system, you must have an understanding of the major components of the system and how they have evolved over time. In this course, you’ll receive an overview of U.S.–based health care organization and finance that serves as a foundation for courses you’ll take later in the program. The course begins with an overview of important milestones in U.S. health care from the 19th century to the present. You then discuss the major components of the health care system—providers, payors and purchasers—and innovations to increase health care value (i.e., the amount of health obtained per dollar spent) through integration and other strategies, as well as efforts to measure the quality of care that consumers receive.
- Describe major changes in the financing and organization of health care in the United States from 1900 to present
- Identify the major types of organizations that make up the U.S. health care system
- Describe how health care is financed in the U.S.
- Examine major innovations in health care organization and finance
- Learn about efforts to improve health care value and their impact
- Identify major barriers and facilitators to changing health care delivery
Joanne Spetz, Ph.D.
Reena Duseja, M.D., M.S.
The health care system constitutes nearly $2 trillion of spending in the United States and several trillion dollars more throughout the world. Rapid growth in spending on health services has raised alarm in some countries, including the United States. Focus on economic principles and how they shape people’s and organizations’ interactions with health care. You will understand the underlying drivers of health care purchasing and spending, and lay the foundation for analyzing proposed health policies.
- Apply the concept of a production function for health
- Explain how risk aversion leads to the incentive to purchase insurance, in health care and in other areas such as auto insurance
- Debate the extent to which moral hazard exists and is a problem in health care
- Describe key research findings around the effects of copayments and coinsurance on health care demand and health outcomes
- Discuss production characteristics, including marginal and average productivity and the elasticity of substitution among inputs
- Derive short-run and long-run costs of production
- Explain concept of induced demand and how it applies to health care services
- Discuss seller concentration, buyer concentration, barriers to entry and product differentiation in the pharmaceutical industry
- Define the economic theory of monopoly, the price effect of monopoly and the welfare loss from it
- Debate whether mergers in health care are beneficial or detrimental from an economic perspective
- Determine what cost containment strategies are most likely to be effective in the U.S. health system
- Identify non-health-system factors that influence health outcomes and how health care financing dis-incentivizes their use
U.S. Health Care System and the Law, Part 1
R. Greggory Cochran, M.D., J.D.
This introductory course provides you with an overview of the American health care system’s structure. You examine the statutes, regulations, court decisions and other authority that constitute the legal framework with which health care providers, health insurers and others must comply. You then explore principles of insurance—both public and private—and take an historical look at U.S. health care reform attempts leading up to the passage of the Affordable Care Act. Thereafter, you cover how the government regulates employee health benefit plans, the legal issues unique to health care business transactions and health care antitrust.
- Explain the fundamental policy objectives that drive the formation and enforcement of the U.S. health care laws and identify generally whether a statute or regulation responds (or fails to respond) to a policy concern
- Distinguish which types of health care laws fall under the purview of the federal government and which fall under the purview of the states
- Explain the general principles of public and private health care insurance
- Explain the difference between indemnity insurance and managed care plans and describe the legal issues unique to each
- Identify whether an employee’s lawsuit to recover benefits under his or her employer-provided benefit plan will be decided under ERISA or under state laws
- Explain how health care business transactions differ from those in other industries and why
- Identify potential antitrust issues and explain the general requirements for a health care transaction or arrangement to pass muster under antitrust rules
Sneak Peak Into the Course Content
U.S. Health Care System and the Law, Part 2
R. Greggory Cochran, M.D., J.D.
In this second-half of the course, you delve more deeply into the two big federal payor programs: Medicare and Medicaid. After studying the eligibility requirements for beneficiaries to obtain services, and how providers qualify and enroll in the programs, you will look at what the programs cover, how they determine reimbursement, and the types of managed care and other plans Medicare and Medicaid have developed to provide benefits more efficiently.
You then turn to the laws that address the prevention and punishment of fraud and abuse against Medicare and Medicaid, primarily the federal Anti-Kickback Statute and the Stark Law. You then shift gears toward a look at how the state and federal governments, and private accreditation bodies oversee and regulate hospitals and other institutional health care facilities, followed by a look at government oversight of physicians and other individual health care professionals. You round out the course by comparing the American system to those of other countries and looking at the ethical and policy issues that arise when trying to figure out how to allocate our health care resources.
- Explain the basic principles of Medicare and Medicaid, including how they are funded and administered, as well as the legal, economic and political factors that influence them
- Define relevant statutory, regulatory and case law authority and policy pertinent to health care fraud and abuse law
- Describe the difference between health care facility licensing, Medicare certification and accreditation, and explain the sources for the laws pertaining to each
- Explain the basic principles of individual health care professional licensing
- Summarize where the U.S. fits in terms of health care spending, quality and access as compared to other nations with similar and different types of health care systems
- Develop a general appreciation of the ethical and fairness considerations in allocating scarce health care resources
Health Policy Track Electives
(select 12 units)
Cost Analysis and Value-Based Care
James G. Kahn, Ph.D.
Joanne Spetz, Ph.D.
Examine economic aspects of health care, including costs and the internal financing of health care organizations, as well as the role of health care on the broader U.S. economy. Topics include comparing costs and benefits of health care, assessing the financial health of organizations, value-based payment approaches in health care, behavioral economics, economic and health inequality, health insurance effects on employment and how health spending affects U.S. business competitiveness.
- Portray the resources and associated costs of a health intervention
- Explain basic accounting concepts in health organization management and policy decision-making, and use these concepts to assess organizations
- Build a budget, and analyze variance from the budget
- Describe the differences between not-for-profit and for-profit health care organizations
- Describe the fundamental structure of cost-effectiveness, cost-benefit and return-on-investment analyses
- Define the concept of value-based pricing for pharmaceuticals
- Describe behavioral economics, including the role of heuristics and framing, and how it can be applied in health
- Assess the potential benefits of payment innovations in U.S. health care insurance
- Describe the nature and extent of unneeded care due to over-diagnosis
- Characterize the association of economic status and health, and evidence for the effects of interventions to reduce economic and health inequality
- Describe and measure the effect of health care and poor health on economy-wide costs
Maria Raven, M.D., M.P.H., MSc
Chris J. Koenig, Ph.D.
Learn to think critically about various types of programs, including health care interventions, workplace projects and social programs, and how to evaluate them. Consider how to evaluate the impact of initiatives that might not be considered traditional research “programs” but can still be evaluated using ideas in the course, such as mobile apps, training programs or electronic health record transformations. You will learn to identify which questions a particular program evaluation should answer and what data (and funding) might be needed to carry out an evaluation. In addition, learn to think ahead to the results your evaluation might provide and the implications of these outcomes.
- Critically examine examples of existing program evaluations and identify the essential aspects: evaluation design, primary outcomes, stakeholder involvement and policy implications
- Describe program evaluation models that can aid in evaluation design such as logic models and conceptual models, and how these models can inform an evaluation
- Explain how to conduct a basic needs assessment that can inform both program implementation and evaluation
- Discuss how programs and their evaluations are funded and sustained (or not)
- Identify a program to evaluate and carry out a step-by-step evaluation that includes determination of the most rigorous and most feasible study design, identification of questions the evaluation should address, identification of key stakeholders to involve, the outcomes you will measure and anticipated policy implications
Organization and System Change
Laura Schmidt, M.P.H., MSW, Ph.D.
Kim Hanh Nguyen, Sc.D.
Survey a range of translational tools at the health care system level that you can use to promote the adoption of evidence-based medicine by providers and delivery systems. Learn strategies for change in the broader context of sociological theories of organizational behavior and policy implementation. Focus your learning on translational tools that can be used by stakeholders outside of health care organizations—including purchasers, payors and government regulators—to promote the adoption of clinical innovations within organizations. Such tools can include contract-based payment incentives, performance monitoring, education and technical-assistance programs, changes in existing government licensing laws and quasi-government regulations used by credentialing agencies.
- Understand what’s unique about the health care industry and how this contributes to implementation challenges
- Analyze the parts of health care organizations and how they come together to produce leverage points for change
- Map barriers and facilitators of the successful implementation of health care policies within organizations
- Understand how strategic managers adapt health care organizations to meet the demands of their organizational environments
- Analyze the potential for implementation gaps and failures, and how to rig systems for implementation success
- Develop systems change strategies
- Promote collaborative systems change through “bottom-up” strategies
Advanced Policy Analysis
Brooke Hollister, Ph.D.
Andrew Bindman, M.D.
Focusing on your individual research or policy focus, learn an applied approach to building policy campaigns and engaging in policy efforts. Learn how to translate your research or your expertise into policy change. At the end of the course, you will have developed a policy campaign that includes:
- A political system map
- A stakeholder map
- A letter proposing collaboration with a community partner
- A community organizing and grassroots advocacy activity
- A media and communications strategy
- A policy brief to disseminate to policy makers or other stakeholders
- A logic model to help guide implementation and evaluation of your policy campaign
- A strategy to sustain your participation in the policy campaign
- Determine what makes a policy “ripe” for influence
- Identify policy targets at the local, state, national and international level
- Locate, interpret and influence existing legislative and administrative policy
- Map stakeholders around a policy issue and identify strategies to engage supporters or diffuse opponents
- Build strategic relationships with stakeholders engaged in a policy issue
- Design community-based participatory research or recognize how research is used in the policy process
- Develop strategies for disseminating research through the media to influence the policy process
- Organize effective communication strategies with policymakers to influence decision making
- Design a logic model to guide implementation and evaluation of a policy campaign
- Assess your capacity to sustain your participation in the policy campaign.
Health Law Track Electives
(select 12 units)
Health Care Reform: Legal Aspects
R. Greggory Cochran, M.D., J.D.
After many years of effort and failed attempts, the March 2010 passage of the Patient Protection and Affordable Care Act (ACA) started a fundamental transformation of the U.S. health care system, providing health care policymakers, payors, providers and even entrepreneurs with opportunities to redesign health care to promote quality, outcomes and affordability. In this course, you focus on the legal aspects of the ACA, as well the legislative attempts at reform, historic and future, and interpretations of the reform laws by courts and government agencies. While focusing predominantly on the laws themselves, you’ll also explore the policies that provide their framework.
- Summarize the need/context for reform of the American health care system
- Convey the legislative policy principles that frame the laws studied during the course
- Describe the key elements of the Affordable Care Act (programs, initiatives and changes), how they work, and how they were intended to improve the system, including: the individual mandate, federal program expansion, health insurance exchanges, premium and cost-sharing subsidies to individuals; employer requirements and subsidies; prevention/wellness efforts; tax-related implications; and long-term care coverage expansion
- Describe differing roles of state and federal government in regulating and implementing the ACA
- Describe the ACA’s impact to date on the U.S. health care system from the viewpoint of providers, payors, patients and employers
- Discuss progress in implementation and the current roadblocks the Act is facing, including possible repeal and replacement under the Trump administration
R. Greggory Cochran, M.D., J.D.
This course builds upon the foundational learning that you acquired in the U.S. Health Care System and the Law course. You delve into some of the primary areas in which distinct categories of health law have developed as to the relationship between patients and providers, including individual and institutional professional tort liability (primarily through medical malpractice); informed consent law in both the treatment and research settings; confidentiality, privacy and access to patient health information; abortion and birth control; and end-of-life issues.
- Explain the fundamentals of professional liability law, as well as the relationships between the various players in the health care system
- Defend arguments on both sides of the debate regarding tort reform
- Analyze and apply health care, statutes, regulation and case law to a fact pattern and to differentiate between the applicability of statutes, regulations and case law to a given fact pattern
- Explain the constitutional issues that impact birth control and abortion
- Explain core ethical issues in health care, including those pertaining to consent, withholding treatment and medically assisted death and dying
Advanced Legal Research
Hilary Hardcastle, J.D., MLIS
Gain an introduction to advanced legal research methodologies and strategies. During this 10-week course, you trace the steps involved in performing legal research. This includes developing a research strategy; gaining background using secondary sources; locating the controlling statutes, regulations and case law; updating those authorities; knowing when to stop researching; and keeping current.
- Develop and implement strategies for researching legal issues
- Identify the major primary and secondary authorities online and in print
- Evaluate and effectively use subscription online databases, including Lexis and Westlaw.
- Evaluate and effectively use reliable, free online alternatives to fee-based legal research databases
Institutional Regulation and Compliance
R. Greggory Cochran, M.D., J.D.
Hone your knowledge of the laws applicable to health care institutions, predominantly those of the provider side, including hospitals and health systems, nursing homes, clinics, surgery centers and the like. On the payor side, you also look at the laws of managed care organizations. Examine the many and varied ways in which the government and other entities oversee and regulate these institutions, all of which are beholden to a vast network of federal, state and local laws and regulations, and many of which are also subject to accreditation body oversight.
Some of the more specific areas of law examined include those related to health information privacy and security; the field of medical staff law, which pertains to the relationship between the institution and the physicians who provide services at the facilities; the laws governing an institution’s employment of its administrative and professional staff; liability of managed care organizations for harm related to coverage decisions they make; and more on Medicare and Medicaid liability related to improper billing and EMTALA violations.
- Differentiate between a few of the most common types of health care facilities with respect to their services and their compliance foci
- Distinguish the concepts of facility licensure; Medicare certification and accreditation; and identify the federal, state and/or private agencies that have primary enforcement responsibilities for facility licensure, certification and accreditation
- Describe the relationship between a hospital or health system and its staff of physicians and explain the peer-review process
- Summarize how federal and state laws protect the privacy and security of patient health information, and generally describe the principal aspects of HIPAA
- Explain how patients can use professional liability laws to sue health care institutions for damages related to care provided and managed care organizations for damages related to coverage decisions
- Identify common employment law issues within health care institutions that may need further legal analysis and counsel, particularly those that are unique to the health care industry
- Explain the types of billing and operational issues overseen by CMS under Medicare and Medicaid rules