Understanding Managed Care

Author : Thomas N. Wise,Annette U. Rickel
Publisher : Unknown
Page : 0 pages
File Size : 41,5 Mb
Release : 1999
Category : Medical
ISBN : 3318004987

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Understanding Managed Care by Thomas N. Wise,Annette U. Rickel Pdf

Physicians and allied health care professionals are graduating with in-depth knowledge of disease states and therapeutics, but little, if any practical knowledge of managed care systems. Nevertheless, managed care is so prevalent that in 1998 85% of the US working population was in some form of managed care network and one third of the physicians in practice were enrolled in managed care panels. There are few structured educational opportunities for individuals who are entering health care fields that help in understanding the different managed care systems. Instead, the managed care environment confronts the new physician with an unknown language, a novel management structure, and an expanding scope of rules and regulations. This book is designed to rectify this situation and to serve as a resource for teaching or independent self-paced study. It provides a historical overview, basic structure and components of managed care organizations, and future challenges. 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.

Author : Vicki DeBaca,Western Schools,Barbara J. Youngberg
Publisher : Unknown
Page : 196 pages
File Size : 47,5 Mb
Release : 2003
Category : Health facilities
ISBN : 1578010799

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Understanding Managed Care by Vicki DeBaca,Western Schools,Barbara J. Youngberg Pdf

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 : 49,6 Mb
Release : 1997-04-21
Category : Medical
ISBN : 9780309175050

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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.

Author : Joint Commission Resources, Inc Staff,Joint Commission on Accreditation of Healthcare Organizations
Publisher : Unknown
Page : 16 pages
File Size : 53,5 Mb
Release : 1998-09-01
Category : Managed care plans (Medical care)
ISBN : 086688565X

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Understanding Your Rights in Managed Care Health Plans by Joint Commission Resources, Inc Staff,Joint Commission on Accreditation of Healthcare Organizations Pdf

Author : Louis F. Rossiter
Publisher : Unknown
Page : 408 pages
File Size : 54,7 Mb
Release : 2001
Category : Managed care plans (Medical care)
ISBN : UOM:49015002585611

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Understanding Medicare Managed Care by Louis F. Rossiter Pdf

A reference for health-care executives and physicians as well as managers, administrators, and staff of Medicare managed-care plans, providing a structure for plotting a long-term plan to compete in this market. In addition to describing the economics of the current system, including trends and key players, the book covers strategic planning and marketing, including issues such as pricing and the capitation dollar, benefit design, and techniques of quality and cost control. Finally, the work speculates about future changes in the system and the health-care marketplace and their implications for health plan participation. The author is deputy secretary for Health and Human Resources, Commonwealth of Virginia, and previously was a member of the health economics faculty of Virginia Commonwealth U. Annotation copyrighted by Book News, Inc., Portland, OR

Author : Peter Reid Kongstvedt
Publisher : Jones & Bartlett Learning
Page : 918 pages
File Size : 52,9 Mb
Release : 2003
Category : Medical
ISBN : 0763724963

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Essentials of Managed Health Care by Peter Reid Kongstvedt Pdf

Author : National Academies of Sciences, Engineering, and Medicine,Health and Medicine Division,Board on Health Care Services,Committee on Health Care Utilization and Adults with Disabilities
Publisher : National Academies Press
Page : 161 pages
File Size : 48,8 Mb
Release : 2018-04-02
Category : Medical
ISBN : 9780309469210

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Health-Care Utilization as a Proxy in Disability Determination by National Academies of Sciences, Engineering, and Medicine,Health and Medicine Division,Board on Health Care Services,Committee on Health Care Utilization and Adults with Disabilities Pdf

The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

Author : David I. Samuels
Publisher : CRC Press
Page : 309 pages
File Size : 54,7 Mb
Release : 2011-12-05
Category : Business & Economics
ISBN : 9781439840306

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Managed Health Care in the New Millennium by David I. Samuels Pdf

David Samuels, a leading authority on financial models in healthcare, draws on his multidisciplinary background in all aspects of managed care to provide an expansive yet detailed perspective of this complex field. Grounded in evidence-based modeling, the book’s multidisciplinary focus puts the spotlight on core concepts from the standpoints of health plans, hospitals, physician practice, and their respective integrated network models. You’ll learn what happened when a country’s national health care plan is developed with problematic underwriting, why hospitals will always be victimized at their payer’s bargaining table, and even how to improve the current primary care shortage at both 50% less provider costs as well as with triple their members’ compliance in wellness care. The book gives you the critical tools to stay ahead of the learning curve, engage patients to take responsibility for their own and their family’s health status, and improve your differentiation in a RAPIDLY changing marketplace.

Author : Anonim
Publisher : DIANE Publishing
Page : 120 pages
File Size : 51,5 Mb
Release : 1993-07
Category : Managed care plans (Medical care)
ISBN : 0788100262

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Managed Competition by Anonim Pdf

Pamphlet from the vertical file.

Author : Paul Robert DeMuro
Publisher : Irwin Professional Publishing
Page : 189 pages
File Size : 45,6 Mb
Release : 1995-01-01
Category : Social Science
ISBN : 1557386234

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The Financial Manager's Guide to Managed Care & Integrated Delivery Systems by Paul Robert DeMuro Pdf

A practical, hands-on guide to implementing effective programs for managed care models--from HMOs, PPOs, and capitation contracting, to the different forms of reimbursement and the role of the primary care physician.

Author : Institute of Medicine,Board on Health Care Services,Committee on the Consequences of Uninsurance
Publisher : National Academies Press
Page : 213 pages
File Size : 42,8 Mb
Release : 2002-06-20
Category : Medical
ISBN : 9780309083430

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Care Without Coverage by Institute of Medicine,Board on Health Care Services,Committee on the Consequences of Uninsurance Pdf

Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.

Author : Annette U. Rickel,Thomas N. Wise
Publisher : Karger Medical and Scientific Publishers
Page : 125 pages
File Size : 42,6 Mb
Release : 2000
Category : Health & Fitness
ISBN : 9783805569606

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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.

Author : United States. General Accounting Office. Health, Education, and Human Services Division
Publisher : Unknown
Page : 20 pages
File Size : 49,7 Mb
Release : 1997
Category : Health maintenance organizations
ISBN : UOM:39015042604028

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Medicare HMOs by United States. General Accounting Office. Health, Education, and Human Services Division Pdf

Author : Steven Walfish,Jeffrey E. Barnett,Jeffrey Zimmerman
Publisher : Oxford University Press
Page : 849 pages
File Size : 44,5 Mb
Release : 2017
Category : Psychology
ISBN : 9780190272166

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Handbook of Private Practice by Steven Walfish,Jeffrey E. Barnett,Jeffrey Zimmerman Pdf

Handbook of Private Practice is the premier resource for mental health clinicians, covering all aspects of developing and maintaining a successful private practice. Written for graduate students considering the career path of private practice, professionals wanting to transition into private practice, and current private practitioners who want to improve their practice, this book combines the overarching concepts needed to take a mental health practice (whether solo or in a group) from inception, through its lifespan. From envisioning your practice, to accounting and bookkeeping, hiring staff, managing the practice, and running the business of the practice, a diverse group of expert authors describe the practical considerations and steps to take to enhance your success. Chapters cover marketing, dealing with insurance and managed care, and how to choose your advisors. Ethics and risk management are integrated throughout the text with a special section also devoted to these issues and strategies. The last section features 26 niche practices in which expert practitioners describe their special area of practice and discuss important issues and aspects of their specialty practice. These areas include assessment and evaluation, specialized psychotherapy services, working with unique populations of clients, and more. Whether read cover-to-cover or used as a reference to repeatedly come back to when a question or challenge arises, this book is full of practical guidance directly geared to psychologists, counselors, social workers, and marriage and family therapists in independent practice.

Author : David B. Nash
Publisher : Jones & Bartlett Learning
Page : 280 pages
File Size : 55,6 Mb
Release : 1994
Category : Medical
ISBN : 0834203936

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The Physician's Guide to Managed Care by David B. Nash Pdf

You'll find the practical guidance you need to transition smoothly int o the managed care environment. You'll learn the pros and cons of prac ticing in a managed care setting, the daily life of managed care physi cians, the role of managed care in medical education and health care r eform. Discover how to take advantage of new opportunities and avoid p itfalls, balance cost consideration with clinical decision-making, and understand the case mix systems most frequently used in managed care. Written almost entirely by physicians, The Physician's Guide to Manag ed Care is a must for any physician interested in meeting future chall enges.