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Author: Montague Brown Publisher: Jones & Bartlett Learning ISBN: 9780834205048 Category : Managed care plans (Medical care) Languages : en Pages : 286
Book Description
Here in 25 authoritative articles drawn from the highly respected journal Health Care Management Review, you'll discover what you'll need to lead your organization into the generation of managed care. From short range issues like making existing product lines efficient to the policy logic of building comprehensive, integrated systems, this reference will help managers in a provider, insurer, buyer, or government organization create a successfully integrated organization.
Author: Susan Frager Publisher: John Wiley & Sons ISBN: Category : Medical Languages : en Pages : 292
Book Description
Written by an industry insider, Managing Managed Care offers a candid and unprecedented behind-the-scenes view, with focus on issues of vital importance to today's practitioner: understanding the "participating-provider" contract; challenging fee reductions; writing treatment reports in "managed-care-friendly" language to enhance the likelihood of obtaining continued authorization; the nuts and bolts of "medical necessity"; effectively fighting denials of care; and getting claims paid."--BOOK JACKET.
Author: Suzanne K. Powell Publisher: Lippincott Williams & Wilkins ISBN: 9780781718837 Category : Medical Languages : en Pages : 548
Book Description
The Second Edition of this comprehensive "how to" text has been completely revised and updated. This text outlines the basics of case management and illustrates some of the pitfalls encountered in the field of case management. The book provides information on the new Case Management Standards, supplies standard definitions and guidelines of case management for the practicing case manager, and presents information on caring for clients in a wide variety of health care settings. New to this edition--chapters focusing on Quality Reviews and Risk Management with a strong emphasis on Continuous Quality Improvement (CQI), ethical and legal issues, and various case studies.
Author: William Winston Publisher: Routledge ISBN: 1317939085 Category : Business & Economics Languages : en Pages : 126
Book Description
Survival in the growing managed care environment requires the integration of financial analysis, market appraisal, and administrative management. The authors of Managed Service Restructuring in Health Care provide a unique tool for readers to enable them to make these successful management decisions in restructuring services. The unique approach in this book assists health care managers and prospective managers as they seek to solve the problem of how to deal with health care services that appear to be no longer productive. In Managed Service Restructuring in Health Care, the authors provide a solid theoretical base for what they have developed in MSR (Managed Service Restructuring)--a conscious--not crisis--management tool. They prepare readers for implementing MSR techniques by describing them in detail for their application to readers’situations. MSR approaches to planned health care management, as introduced in this book, help administrators channel scarce resources to the services the community wants and needs most. Facts and cases are offered as examples of when and how MSR techniques have been applied successfully. The authors also include failure cases where, if MSR techniques had been followed, health care providers would have survived in several communities. Incorporate the information in this book to enhance long-range planning and prevent closure of health care services needed by the community. Along with financial and marketing tools necessary for long-range planning, Goldman and Mukherjee list warning signals that alert professionals to the need to review the services and products offered. They also fully explore these areas: Product Life Cycle Boston Consulting Group’s Portfolio of Business (Growth Share Matrix) Product Development Product Planning Public Service of Health Care Providers Centers of Excellence Service Diversification/Consolidation Investment/Disinvestment Criteria Marketing in Competitive Environment for Health Services Health care managers, hospital administrators, and students in health services management programs can benefit from the focus on conscious planning in Managed Service Restructuring in Health Care. While many of the examples take place within acute care hospitals, the MSR approach and this book are designed to assist any health care administrator or manager. With knowledge of when and how services can be prolonged, professionals can more effectively lead their health care provider into a more competitive environment. The analyses used in the book should enhance many readers’knowledge of basic marketing and financial principles and theories important to restructuring and providing health services today.
Author: Genie James Publisher: Irwin Professional Publishing ISBN: Category : Business & Economics Languages : en Pages : 342
Book Description
Making Managed Care Work explores the success factors necessary to win in the managed care arena. This practical guide goes beyond cookie-cutter solutions to offer pragmatic ideas and innovative answers. It presents you with the tools you need to develop a multi-faceted strategy that can address immediate financial tensions while also aligning future goals with current objectives. Making Managed Care Work focuses on the critical dimensions of managed care: business development, integrated delivery network design and new-product/service-line definitions. Reading this resource will provide you with the means to organize your strategy and put your goals in focus. It features methodologies - rules to follow when conducting internal diagnosis and evaluating the financial impact of current business strategies; a matrix - to assist in identifying indicators of marketplace change; and case studies - in-depth descriptions of strategies, infrastructures and accomplishments of providers successfully making the leap to the next generation of healthcare, as well as the faulty rationale, hazards and unseen market forces that have hindered failing providers. You must make decisions regarding acute situations where past experience will not give you the answers for the present or future. Making Managed Care Work provides you with researched, intelligent and valuable information that you can use immediately to strategically position yourself on top.
Author: Richard V. Stenson Publisher: Bookpartners ISBN: 9781581510300 Category : Medical Languages : en Pages : 386
Book Description
Options for physicians working within the prepaid medicine system make sense when you understand the pros and cons, strategies, and structures analyzed in this guide to the new managed care environment. -- Evolution of the managed care movement -- Myths about organizational requirements for managed care success -- Pros and cons of solo practice versus IPA, PHO, or group practice -- Working for a hospital or HMO -- Entrepreneurial, legal, and regulatory characteristics of each model -- Best opportunities for primary care and specialist physicians -- The ideal physician organization for managed care -- Future winners and losers, quality of care, reform, and Wall Street Analyze the cost and benefits of practice and managed care proposals, because an informed choice makes good medicine work.
Author: William Winston Publisher: Routledge ISBN: 1317822927 Category : Medical Languages : en Pages : 208
Book Description
Managed care is rapidly making traditional marketing strategies for mental health services obsolete. Here is the definitive book that helps professionals understand contemporary market forces and how to reshape marketing strategies in an increasingly competitive environment.Marketing Mental Health Services to Managed Care begins by demystifying the seemingly bewildering world of managed care systems. It enables the reader to become a fully informed partner in providing services for managed care systems. In an era in which many professionals are affiliated with one or more managed care networks, this book guides clinicians toward greater control of their professional futures by providing the steps necessary to develop a successful managed care oriented practice strategy. It will be especially helpful to the newcomer to practice in the 1990s or the seasoned practitioner interested in increasing referrals from managed care systems.Readers of this highly practical new book learn how to analyze the market for clinical services, how to plan and develop services for the managed care market, and how to sell professional services in an era dominated by active payor entities. The increased importance of automation, group practices, and effective office management skills are discussed. Although of particular value to outpatient practitioners, Marketing Mental Health Services to Managed Care also discusses marketing strategies and revenue generating ideas for inpatient mental health and substance abuse treatment facilities. Program managers, administrators, and marketing professionals in the hospital industry will find this book a valuable investment.Of special interest to all readers are chapters addressing the impact of managed care systems--with their focus on accountability, cost-effectiveness, and quality--upon traditional clinical paradigms. Brief therapy skills and techniques are discussed by these two veteran clinicians and writers. Emerging clinical innovations and effective reimbursement strategies are also discussed in this remarkable new book. A resource section, managed care company directory, and a glossary of terms make this a practical guidebook of long-lasting value to professionals from many disciplines. College professors and graduate students will also find Marketing Mental Health Services to Managed Care a valuable introduction to marketing professional services in the managed care dominated marketplace for healthcare today.