Shanholtzer 2026 Release, Instructors’ Manual
Chapter 1
Complete Solutions Manual for Health Information Management and Technology, 2026 Release
by M. Beth Shanholtzer & Gary W. Ozanich
ISBN: 9781264525744
CHAPTER 1
Healthcare in the United States
LESSON PLANS
Class Preparation: Teaching Focus and Resources
Chapter 1 describes the history of healthcare, outlines new governmental laws and regulations, and
summarizes the roles of the key stakeholders in shaping healthcare transformation. Empowering the
patient with health information is also explained.
Learning Outcomes
1.1 Describe the history of healthcare and the evolving role of patients, providers, insurers, and
regulators in the delivery of healthcare in the United States.
1.2 Outline how new laws and regulations have reshaped healthcare in the United States.
1.3 Summarize the roles of key stakeholders in shaping healthcare transformation in the United States.
1.4 Explain how health information is being used to empower patients.
Class Presentation (also see the teaching notes at the bottom of each slide in “Teaching Mode”)
L.O. 1.1 Describe the history of healthcare and the evolving role of patients, providers, insurers, and
regulators in the delivery of healthcare in the United States.
Slide 1-7 • Timeline and history of the evolution of healthcare.
• Have students define the “stakeholders” in healthcare; how their roles have
changed because of the changes in healthcare?
Slides 1-8 • External forces shaping the history of healthcare (Social Security Act, Medicare,
and 1-9 Medicaid (now Medical Assistance), Hill Burton Act, Medical Practice Act
(licensure), voluntary accrediting agencies such as The Joint Commission or the
Healthcare Facilities Accreditation Program (voluntary) and license to practice
medicine (healthcare providers), and license to operate any type of medical
facilities in the state in which the practice or facility is located.
• The Social Security Act of 1935 and how it changed the practice of medicine and
acute medical care facilities.
L.O. 1.2 Outline how new laws and regulations are reshaping healthcare in the United States.
Slide 1-10 • More recent government healthcare initiatives—how the Affordable Care Act,
HITECH, American Recovery and Reinvestment Act, etc., have changed healthcare
(explain or have the students explain (assuming they’ve read the chapter).
IM 1-1
©
, Shanholtzer 2026 Release, Instructors’ Manual
Chapter 1
Slide 1-11 • Medicare EHR Incentive Program vs. Medicaid Incentive Program—what are the
differences?
Slide 1-12 • The first stage of the original Meaningful Use program began in 2011, followed by
Stage 2 beginning in 2014, and required the meaningful use of electronic data to
advance clinical procedures, and finally Stage 3 focused on improved patient
outcomes; it began in 2016 and ended in 2018. Once the initial stages of MU
ended incentive money for the adoption of an electronic health record was no
longer provided for practices or other facilities that had not adopted the use of an
EMR/EHR.
L.O. 1.3 Summarize the roles of key stakeholders in shaping healthcare transformation in the United
States.
Slide 1-13 Ask students to define “stakeholder” and give examples in healthcare. Discuss how
their roles changed because of the transformation of healthcare discussed in this
chapter.
Healthcare in Transition
• Explain the definition of continuum of care, the role of the Department of
Human Services.
• Have students discuss the benefit(s) or disadvantage(s) to providers as well as
healthcare facilities of using an electronic record.
• What are the benefits (and disadvantages) to providers and healthcare facilities
using an electronic record.
• Have students complete the Thinking it Through questions individually or as a
group, and use for class discussion.
Slide 1-14 • Recap the transition talked about thus far in the text.
• Students have likely not had a reimbursement methods class; describe the basics
of the fee-for-service payment models; explain ICD-10-CM coding and what it has
to do with reimbursement.
• Compare and contrast the different Fee-for-service reimbursement models listed
on the screen.
Slide 1-15 The modified payment reimbursement models –pay for-performance and the
Medicare value-based payment modifier (students will most likely be taking a
Reimbursement Methods course either at the same time as this course or in a future
semester), thus a basic overview or definitions of the above should be discussed.
Modified reimbursement methods/processes use the traditional model of being
charged for each service provided, in some cases, equipment (canes, walkers); these
methods are focused on preventive care and management of disease, for example,
diabetes or chronic obstructive lung disease.
With this model, not all diagnoses are covered, and providers are reimbursed based
on a modified system that is impacted by quality outcomes (the patient improved,
recovered, was helped by the treatment, etc.).
IM 1-2
©
, Shanholtzer 2026 Release, Instructors’ Manual
Chapter 1
The quality measures are difficult to measure and report, not all diseases are covered,
and the provider may be penalized (lose money) for patient nonadherence to their
treatment plan.
Slide 1-16 • Fee-for-value reimbursement model
• Payment process.
• Description of this reimbursement model.
• Changes in patient care (preventive care, health outcomes, proactive
rather than reactive care).
• Issues with this payment model.
L.O. 1.4 Explain how health information is being used to empower patients.
Slide 1-17 • Health information empowering the patient by encouraging patients regarding
preventive measures in the form of following a healthy diet, exercise, and a team
approach to medicine/treatment. In this method, the patient’s care provider, the
patient and/or family members or caregiver use the patient portal and/or
personal health record (PHR), etc., to improve or maintain the patients' health
status.
• Patient Centered Medical Home (PCMH) model is a team approach to healthcare,
especially for patients with chronic conditions; involves family members and
outside caregivers, using the patient portal and/or EMR/EHR; and the patient
taking an active role in their healthcare (if able).
• Maintain and use of Personal Health Records (PHR).
Slide 1-18 • Focal areas of healthcare in the US-healthcare vs. medical care, i.e., coordination
of care and a team approach vs. managing illnesses/diseases vs. treating
diseases/conditions after the patient has become ill.
• The use of mHealth (mobile health using mobile phones, mobile devices and
other wireless devices) in diagnosing and treating patients
For instance, improved continuity of care, focus on wellness vs. disease, use the
electronic health record and/or personal health record for immediate access to
the patient’s past medical history, current medications, etc.
Have students answer the Thinking it Through questions on their own or in small
groups.
Summary Slide
Slide 1-19 • Synopsis of the chapter.
Teaching Tips
IM 1-3
©
, Shanholtzer 2026 Release, Instructors’ Manual
Chapter 1
•Ensure students understand the key terms—suggest flash cards, Jeopardy game, etc.
•Have students articulate why oversight and regulation of the U.S. Healthcare system has
increased throughout the 21st century.
• Have students research the origins of Medicare and Medicaid (now known as Medical
Assistance).
• Discuss the differences between the Medicare and Medicaid EHR Incentive Programs.
• Visit the CMS website (www.CMS.gov) and list requirements and examples of each original
Meaningful Use stage and its progression to Promoting Interoperability.
• Have students select one type of physician specialist and research the requirements beyond that
needed to become a medical doctor.
• Discuss the necessity for greater specificity in reporting healthcare data.
• Compare and contrast the fee-for-service, modified payments, and fee-for-value reimbursement
models.
• Have students create their own personal health records using one of the many free software
applications found on the internet.
• Research one specific mHealth device and discuss the features and benefits of the product.
• Complete the Thinking it Through exercises as the text is covered.
• Assign chapter review questions to be completed as a homework assignment or during class
time.
• Chapter test questions are available in Connect.
ANSWER KEYS
Thinking it Through ANSWER KEY
LO 1.1:
1. Question: Why was it necessary to increase the oversight of healthcare providers and facilities
that billed Medicare, Medical Assistance/Medicaid, and private insurance services for services
rendered to patients?
Answer: As the cost of providing health and medical care increased due to new advances in
medicine, expensive technology, salaries, etc., Medicare, Medical Assistance/Medicaid, and
other third-party insurers could no longer pay the amount billed without ensuring that the care
was medically necessary and reasonable for the patient’s current diagnosis, underlying
conditions, etc. Fraud and abuse have also increased. Thus, the increase in federal, state, and
third-party payer regulation and oversight was the result.
Learning Outcome: [LO 1.1]
Feedback: Private health Insurers, Medicare, and Medicaid/Medical Assistance were no longer
able to reimburse for full healthcare costs, partially due to insurance fraud and abuse. Thus,
they needed proof (through access to patients’ health records) to ensure the care rendered on
each visit or hospitalization was medically necessary and reasonable; this caused fraud and
abuse to increase. Consequently, increased oversight was needed to control this.
2. Question: During the 20th century, there was a shift from inpatient care to ambulatory care,
which remains the principal method of care today. Why is that?
Answer: Ambulatory care is a viable option because it reduces the need for long hospital stays
and/or unnecessary testing and provides more convenience for the patient in the form of walk-
in clinics and freestanding surgical facilities.
Learning Outcome: [LO 1.1]
IM 1-4
©
Chapter 1
Complete Solutions Manual for Health Information Management and Technology, 2026 Release
by M. Beth Shanholtzer & Gary W. Ozanich
ISBN: 9781264525744
CHAPTER 1
Healthcare in the United States
LESSON PLANS
Class Preparation: Teaching Focus and Resources
Chapter 1 describes the history of healthcare, outlines new governmental laws and regulations, and
summarizes the roles of the key stakeholders in shaping healthcare transformation. Empowering the
patient with health information is also explained.
Learning Outcomes
1.1 Describe the history of healthcare and the evolving role of patients, providers, insurers, and
regulators in the delivery of healthcare in the United States.
1.2 Outline how new laws and regulations have reshaped healthcare in the United States.
1.3 Summarize the roles of key stakeholders in shaping healthcare transformation in the United States.
1.4 Explain how health information is being used to empower patients.
Class Presentation (also see the teaching notes at the bottom of each slide in “Teaching Mode”)
L.O. 1.1 Describe the history of healthcare and the evolving role of patients, providers, insurers, and
regulators in the delivery of healthcare in the United States.
Slide 1-7 • Timeline and history of the evolution of healthcare.
• Have students define the “stakeholders” in healthcare; how their roles have
changed because of the changes in healthcare?
Slides 1-8 • External forces shaping the history of healthcare (Social Security Act, Medicare,
and 1-9 Medicaid (now Medical Assistance), Hill Burton Act, Medical Practice Act
(licensure), voluntary accrediting agencies such as The Joint Commission or the
Healthcare Facilities Accreditation Program (voluntary) and license to practice
medicine (healthcare providers), and license to operate any type of medical
facilities in the state in which the practice or facility is located.
• The Social Security Act of 1935 and how it changed the practice of medicine and
acute medical care facilities.
L.O. 1.2 Outline how new laws and regulations are reshaping healthcare in the United States.
Slide 1-10 • More recent government healthcare initiatives—how the Affordable Care Act,
HITECH, American Recovery and Reinvestment Act, etc., have changed healthcare
(explain or have the students explain (assuming they’ve read the chapter).
IM 1-1
©
, Shanholtzer 2026 Release, Instructors’ Manual
Chapter 1
Slide 1-11 • Medicare EHR Incentive Program vs. Medicaid Incentive Program—what are the
differences?
Slide 1-12 • The first stage of the original Meaningful Use program began in 2011, followed by
Stage 2 beginning in 2014, and required the meaningful use of electronic data to
advance clinical procedures, and finally Stage 3 focused on improved patient
outcomes; it began in 2016 and ended in 2018. Once the initial stages of MU
ended incentive money for the adoption of an electronic health record was no
longer provided for practices or other facilities that had not adopted the use of an
EMR/EHR.
L.O. 1.3 Summarize the roles of key stakeholders in shaping healthcare transformation in the United
States.
Slide 1-13 Ask students to define “stakeholder” and give examples in healthcare. Discuss how
their roles changed because of the transformation of healthcare discussed in this
chapter.
Healthcare in Transition
• Explain the definition of continuum of care, the role of the Department of
Human Services.
• Have students discuss the benefit(s) or disadvantage(s) to providers as well as
healthcare facilities of using an electronic record.
• What are the benefits (and disadvantages) to providers and healthcare facilities
using an electronic record.
• Have students complete the Thinking it Through questions individually or as a
group, and use for class discussion.
Slide 1-14 • Recap the transition talked about thus far in the text.
• Students have likely not had a reimbursement methods class; describe the basics
of the fee-for-service payment models; explain ICD-10-CM coding and what it has
to do with reimbursement.
• Compare and contrast the different Fee-for-service reimbursement models listed
on the screen.
Slide 1-15 The modified payment reimbursement models –pay for-performance and the
Medicare value-based payment modifier (students will most likely be taking a
Reimbursement Methods course either at the same time as this course or in a future
semester), thus a basic overview or definitions of the above should be discussed.
Modified reimbursement methods/processes use the traditional model of being
charged for each service provided, in some cases, equipment (canes, walkers); these
methods are focused on preventive care and management of disease, for example,
diabetes or chronic obstructive lung disease.
With this model, not all diagnoses are covered, and providers are reimbursed based
on a modified system that is impacted by quality outcomes (the patient improved,
recovered, was helped by the treatment, etc.).
IM 1-2
©
, Shanholtzer 2026 Release, Instructors’ Manual
Chapter 1
The quality measures are difficult to measure and report, not all diseases are covered,
and the provider may be penalized (lose money) for patient nonadherence to their
treatment plan.
Slide 1-16 • Fee-for-value reimbursement model
• Payment process.
• Description of this reimbursement model.
• Changes in patient care (preventive care, health outcomes, proactive
rather than reactive care).
• Issues with this payment model.
L.O. 1.4 Explain how health information is being used to empower patients.
Slide 1-17 • Health information empowering the patient by encouraging patients regarding
preventive measures in the form of following a healthy diet, exercise, and a team
approach to medicine/treatment. In this method, the patient’s care provider, the
patient and/or family members or caregiver use the patient portal and/or
personal health record (PHR), etc., to improve or maintain the patients' health
status.
• Patient Centered Medical Home (PCMH) model is a team approach to healthcare,
especially for patients with chronic conditions; involves family members and
outside caregivers, using the patient portal and/or EMR/EHR; and the patient
taking an active role in their healthcare (if able).
• Maintain and use of Personal Health Records (PHR).
Slide 1-18 • Focal areas of healthcare in the US-healthcare vs. medical care, i.e., coordination
of care and a team approach vs. managing illnesses/diseases vs. treating
diseases/conditions after the patient has become ill.
• The use of mHealth (mobile health using mobile phones, mobile devices and
other wireless devices) in diagnosing and treating patients
For instance, improved continuity of care, focus on wellness vs. disease, use the
electronic health record and/or personal health record for immediate access to
the patient’s past medical history, current medications, etc.
Have students answer the Thinking it Through questions on their own or in small
groups.
Summary Slide
Slide 1-19 • Synopsis of the chapter.
Teaching Tips
IM 1-3
©
, Shanholtzer 2026 Release, Instructors’ Manual
Chapter 1
•Ensure students understand the key terms—suggest flash cards, Jeopardy game, etc.
•Have students articulate why oversight and regulation of the U.S. Healthcare system has
increased throughout the 21st century.
• Have students research the origins of Medicare and Medicaid (now known as Medical
Assistance).
• Discuss the differences between the Medicare and Medicaid EHR Incentive Programs.
• Visit the CMS website (www.CMS.gov) and list requirements and examples of each original
Meaningful Use stage and its progression to Promoting Interoperability.
• Have students select one type of physician specialist and research the requirements beyond that
needed to become a medical doctor.
• Discuss the necessity for greater specificity in reporting healthcare data.
• Compare and contrast the fee-for-service, modified payments, and fee-for-value reimbursement
models.
• Have students create their own personal health records using one of the many free software
applications found on the internet.
• Research one specific mHealth device and discuss the features and benefits of the product.
• Complete the Thinking it Through exercises as the text is covered.
• Assign chapter review questions to be completed as a homework assignment or during class
time.
• Chapter test questions are available in Connect.
ANSWER KEYS
Thinking it Through ANSWER KEY
LO 1.1:
1. Question: Why was it necessary to increase the oversight of healthcare providers and facilities
that billed Medicare, Medical Assistance/Medicaid, and private insurance services for services
rendered to patients?
Answer: As the cost of providing health and medical care increased due to new advances in
medicine, expensive technology, salaries, etc., Medicare, Medical Assistance/Medicaid, and
other third-party insurers could no longer pay the amount billed without ensuring that the care
was medically necessary and reasonable for the patient’s current diagnosis, underlying
conditions, etc. Fraud and abuse have also increased. Thus, the increase in federal, state, and
third-party payer regulation and oversight was the result.
Learning Outcome: [LO 1.1]
Feedback: Private health Insurers, Medicare, and Medicaid/Medical Assistance were no longer
able to reimburse for full healthcare costs, partially due to insurance fraud and abuse. Thus,
they needed proof (through access to patients’ health records) to ensure the care rendered on
each visit or hospitalization was medically necessary and reasonable; this caused fraud and
abuse to increase. Consequently, increased oversight was needed to control this.
2. Question: During the 20th century, there was a shift from inpatient care to ambulatory care,
which remains the principal method of care today. Why is that?
Answer: Ambulatory care is a viable option because it reduces the need for long hospital stays
and/or unnecessary testing and provides more convenience for the patient in the form of walk-
in clinics and freestanding surgical facilities.
Learning Outcome: [LO 1.1]
IM 1-4
©
