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Essentials of Managed Health Care / With Study Guide

Essentials of Managed Health Care / With Study Guide - 4th edition

ISBN13: 978-0763725792

Cover of Essentials of Managed Health Care / With Study Guide 4TH 01 (ISBN 978-0763725792)
ISBN13: 978-0763725792
ISBN10: 076372579X
Cover type:
Edition/Copyright: 4TH 01
Publisher: Aspen Publishers
Published: 2001
International: No

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Essentials of Managed Health Care / With Study Guide - 4TH 01 edition

ISBN13: 978-0763725792

Peter R. Kongstvedt

ISBN13: 978-0763725792
ISBN10: 076372579X
Cover type:
Edition/Copyright: 4TH 01
Publisher: Aspen Publishers

Published: 2001
International: No
Summary

The fourth edition of this popular textbook provides the basic information needed to learn critical concepts of managed care. Derived from the best-selling Managed Health Care Handbook, Fourth Edition, this text presents basic information on all the critical concepts of managed care; compares myths about managed care to actual facts; progresses from introductory material on the types of managed care organizations to negotiating and contracting, controlling utilization, and using data reports in medical management; illuminates the regulatory landscape, with careful attention to both federal and state law, as well as the legislative environment. Learning objectives open each chapter; useful tables and charts summarize key information at a glance; study questions encourage thoughtful analysis; includes a glossary of terms and common acronyms.

Table of Contents

Managed Health Care Handbook, Fourth Edition Contents:

INTRODUCTION TO MANAGED CARE

An Overview of Managed Care
Types of Managed Care Organizations
Integrated Health Care Delivery Systems
Elements of the Management Control and Governance Structure
Examining Common Assertions About Managed Care

THE HEALTH CARE DELIVERY SYSTEM

Primary Care in Managed Health Care Plans
Compensation of Primary Care Physicians in Managed Care
Contracting and Reimbursement of Specialty Physicians
Negotiating and Contracting with Hospitals, Institutions, and Ancillary Services

MEDICAL MANAGEMENT

Care Management and Clinical Integration Components
Managing Basic Medical-Surgical Utilization
Clinical Services Requiring Authorization
Case Management and Managed Care
Fundamentals and Core Competencies of Disease Management
Prescription Drug Benefits in Managed Care
Managed Behavioral Health Care and Chemical Dependency Services
Quality Management in Managed Care
Using Data and Provider Profiling in Medical Management

OPERATIONAL MARKETING AND MANAGMENT

Physician Behavior Change in Managed Health Care
Information Systems in Managed Health Care Plans
Claims and Benefits Administration
Member Services and Consumer Affairs
Sales and Marketing in Managed Health Care Plans: The Process of Distribution
The Employer's View of Managed Health Care: Show Me the Value
The Impact of Consumerism on Managed Care
Accreditation and Performance Measurement Programs for Managed Care Organizations
Common Operational Problems in Managed Health Care Plans
Operational Finance and Budgeting
Underwriting and Rating Functions Common to Most Markets

MEDICARE AND MEDICAID

Medicare and Managed Care
Medicaid Managed Care

REGULATORY AND LEGAL ISSUES

Legal Issues in Provider Contracting
Legal Liability Related to Medical Management Activities
The Health Insurance Portability And Accountability Act of 1996
State Regulation of Managed Care
Managed Care's Regulatory Evolution: Driving Change in the New Century

Epilogue--Managed Health Care at the Millenium
Glossary of Terms and Acronyms
Index

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Other Editions for Essentials of Managed Health Care / With Study Guide

Cover of Essentials of Managed Health Care - With Study Guide 5th edition

Essentials of Managed Health Care - With Study Guide - 5th edition

ISBN13: 978-0763764401
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