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The origins of managed health care -- Types of managed care organizations and integrated health care delivery systems -- Network management and reimbursement -- Management of medical utilization and quality -- Internal operations -- Medicare and Medicaid -- Regulation and accreditation in managed care.
Health Insurance and Managed Care by Peter R. Kongstvedt Pdf
Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.
A managed care expert overviews the history, structure, regulation, and issues of the complex US health care system. This second edition work was originally published by Aspen in 2002. Much of the information is distilled from another of the doctor's books, The Managed Care Handbook, 4th ed. An extensive glossary is included, but there are no refer
Institute of Medicine,Committee on Quality Assurance and Accreditation Guidelines for Managed Behavioral Health Care
Author : Institute of Medicine,Committee on Quality Assurance and Accreditation Guidelines for Managed Behavioral Health Care Publisher : National Academies Press Page : 394 pages File Size : 47,9 Mb Release : 1997-04-21 Category : Medical ISBN : 9780309175050
Managing Managed Care by Institute of Medicine,Committee on Quality Assurance and Accreditation Guidelines for Managed Behavioral Health Care Pdf
Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.
Understanding Managed Care by Annette U. Rickel,Thomas N. Wise Pdf
A unique series of cases based on a fictional family selecting and using a health plan is presented and a glossary is provided which defines basic concepts frequently encountered in the managed care field.
A Guide to Managed Care Medicine by William N. Tindall Pdf
Provides physicians, administrators, and other health professionals with information on managed care, from its history, forms and practices to detailed information on managed care contracting, physician compensation, monitoring, reporting, management, risk, productivity, and accountability. Annotati
Managed Care Pharmacy Practice, Second Edition offers information critical to the development and operation of a managed care pharmacy program. The text also covers the changes that have taken place within the delivery of pharmacy services, as well as the evolving role of pharmacists.
Managed Care Pharmacy Practice by Robert Navarro Pdf
Written from a practical perspective, Managed Care Pharmacy Practice takes the reader through the issues critical to development and operation of a managed care pharmacy program. The reader will gain new insights into how managed care has altered the delivery of pharmacy services, as well as into the evolving role of pharmacists.Managed Care Pharmacy Practice explains the fundamentals of developing and operating a successful managed care pharmacy benefit, and also supplies insightful guidance on professional careers in the field. This text takes a sequential approach to history, background, program components, program development, operations, and performance measurement, with 25 chapters arranged in three main sections.
Breaking Free of Managed Care by Dana C. Ackley Pdf
Providing therapists practical solutions to managed care's erosion of their freedom to practice, this book presents a working blueprint for a private-pay psychotherapy practice. Dana C. Ackley casts out the distortions that have crept into many clinicians' thinking as a result of reliance on third-party reimbursement. Based on his own experience, he shows how you can serve clients--and yourself--better by developing real alternatives to the pressures and bureaucracy of managed care. In clear step-by-step detail, including practical exercises and checklists, sample marketing materials, and payment plans, the volume shows you how to: *Rediscover the economic and clinical value of your work *Discard assumptions that might block your progress *Educate yourself about the needs of potential clients *Market and sell your services effectively *Learn ethical, reasonable business-of-practice skills *Diversify into the rewarding area of psychological consultation to businesses. No matter what your clinical style, theoretical orientation, or practice history, you will benefit from the hard-won lessons Dr. Ackley shares in this book.
Paul K. Halverson,Arnold D. Kaluzny,Curtis P. McLaughlin,Glen P. Mays
Author : Paul K. Halverson,Arnold D. Kaluzny,Curtis P. McLaughlin,Glen P. Mays Publisher : Jones & Bartlett Learning Page : 504 pages File Size : 52,8 Mb Release : 1998 Category : Health services accessibility ISBN : 0834208970
Glaser and Hamel offer readers an opportunity to step back from the ethical issues connected with modern health care and reflect on what we are doing, how we are doing it, and what impact our actions (and omissions) are having on the common good. While offering a new ethical paradigm that takes into account the three realms of ethical complexity (societal issues, institutional issues, and individual issues), this book offers articles for reflection and self-examination on various aspects of managed care, taking into account specific issues such as rationing, financial incentives, and full disclosure.
Managing the Risks of Managed Care by Barbara J. Youngberg Pdf
The dominance of managed care is spreading quickly and risk managers are suddenly faced with major new challenges. With Managing the Risks of Managed Care, the risk manager will learn about risk management challenges in an integrated delivery system. The book also presents expert analysis on issues like contracting, peer review, ethical dilemmas, antitrust and more.