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Author: Peter R. Kongstvedt Publisher: Jones & Bartlett Learning ISBN: 128415209X Category : Medical Languages : en Pages : 355
Book Description
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.
Author: Peter R. Kongstvedt Publisher: Jones & Bartlett Learning ISBN: 128415209X Category : Medical Languages : en Pages : 355
Book Description
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.
Author: Annette U. Rickel Publisher: Karger Medical and Scientific Publishers ISBN: 3805569602 Category : Health & Fitness Languages : en Pages : 125
Book Description
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: Institute of Medicine Publisher: National Academies Press ISBN: 0309175054 Category : Medical Languages : en Pages : 394
Book Description
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: Peter Kongstvedt Publisher: Jones & Bartlett Learning ISBN: 0763759112 Category : Education Languages : en Pages : 295
Book Description
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.
Author: Peter R. Kongstvedt Publisher: Jones & Bartlett Publishers ISBN: 1449649823 Category : Medical Languages : en Pages : 295
Book Description
The new Third Edition of Managed Health Care: What It Is and How It Works is a concise introduction to the foundations of the American managed health care system. Written in clear and accessible language, this handy guide offers an historical overview of managed care and then walks the reader through the organizational structures, concepts, and practices of the managed care industry. This thorough revision has been completely updated with all the newest data on this dynamic industry and features all new sections on: pay for performance, consumer directed health plans, new approaches to care management, as well as advances in information technology.
Author: Peter R. Kongstvedt Publisher: Jones & Bartlett Learning ISBN: 1284194639 Category : Medical Languages : en Pages : 355
Book Description
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.
Author: Peter R. Kongstvedt Publisher: Jones & Bartlett Publishers ISBN: 1284043266 Category : Business & Economics Languages : en Pages : 418
Book Description
Health Insurance and Managed Care: What They Are and How They Work (formerly titled Managed Care: What It Is and How It Works) is a concise introduction to the foundations of the American managed health care system. Written in clear and accessible language, this handy guide offers an historical overview of managed care and then walks the reader through the organizational structures, concepts, and practices of the managed care industry. The Fourth Edition is a thorough update that addresses the impact of the Affordable Care Act throughout the industry including: - New underwriting requirements - New marketing and sales channels - Limitations on sales, governance, and administrative (SG&A) costs and profits - New provider organizations such as Patient Centered Medical Homes (PCHMs) and Accountable Care Organizations (ACO’s) - New payment mechanisms such as shared savings with ACOs, and severity-adjusted diagnosis related groups - Changes to Medicare Advantage - Medicaid expansion and reliance on Medicaid managed care
Author: Robert G. Shouldice Publisher: ISBN: Category : Group medical practice Languages : en Pages : 584
Book Description
Main topics: HMO and alternative delivery systems; history, philosophy and legislative activities; Preferred providers organisations; organizational structure of HMOs; competitive medical plans and government contracting; the providers; consumers and purchasers of managed care; Control, quality and utilization of services and accountability; Development and expansion activities; marketing; financial management
Author: Donald A. Barr Publisher: JHU Press ISBN: 1421402971 Category : Medical Languages : en Pages : 659
Book Description
Health care reform has dominated public discourse over the past several years, and the recent passage of the Affordable Care Act, rather than quell the rhetoric, has sparked even more debate. Donald A. Barr reviews the current structure of the American health care system, describing the historical and political contexts in which it developed and the core policy issues that continue to confront us today. This comprehensive analysis introduces the various organizations and institutions that make the U.S. health care system work—or fail to work, as the case may be. A principal message of the book is the seeming paradox of the quality of health care in this country—on the one hand it is the best medical care system in the world, on the other it is one of the worst among developed countries because of how it is organized. Barr introduces readers to broad cultural issues surrounding health care policy, such as access, affordability, and quality. He discusses specific elements of U.S. health care, including insurance, especially Medicare and Medicaid, the shift to for-profit managed care, the pharmaceutical industry, issues of long-term care, the plight of the uninsured, medical errors, and nursing shortages. The latest edition of this widely adopted text updates the description and discussion of key sectors of America’s health care system in light of the Affordable Care Act.
Author: Peter R. Kongstvedt
Author: Peter R. Kongstvedt
Author: Peter Reid Kongstvedt
Author: Annette U. Rickel
Author: Institute of Medicine
Author: Peter Kongstvedt
Author: Peter R. Kongstvedt
Author: Peter R. Kongstvedt
Author: Peter R. Kongstvedt
Author: Robert G. Shouldice
Author: Donald A. Barr