The Structure & Functions of a Modern Health Plan

Catalog description

Health insurance companies serve as crucial intermediaries in the healthcare ecosystem, managing financial risk, facilitating care delivery, and coordinating services among various stakeholders. Their effectiveness in these roles fundamentally shapes healthcare access, quality, and affordability for millions of Americans. This course provides a comprehensive examination of health insurance operations through the lens of data and analytics. Students will explore how modern health plans leverage data across all aspects of their business - from clinical services and operations to provider partnerships and regulatory compliance. The course emphasizes the increasingly central role of data analytics, machine learning, and artificial intelligence in driving strategic decisions, improving operational efficiency, and enhancing member outcomes.