Anticipating the Move to Managed Care PDF Download

Author: HealthVisions, Inc
Publisher:
ISBN:
Category : Health maintenance organizations
Languages : en
Pages : 23

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Author: Committee on the Future of Primary Care
Publisher: National Academies Press
ISBN: 0309556686
Category : Medical
Languages : en
Pages : 412

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Book Description
Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge base--as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers The scope of primary care. Its philosophical underpinnings. Its value to the patient and the community. Its impact on cost, access, and quality. This volume discusses the needs of special populations, the role of the capitation method of payment, and more. Recommendations are offered for achieving a more multidisciplinary education for primary care clinicians. Research priorities are identified. Primary Care provides a forward-thinking view of primary care as it should be practiced in the new integrated health care delivery systems--important to health care clinicians and those who train and employ them, policymakers at all levels, health care managers, payers, and interested individuals.

Author: George B. Moseley
Publisher: Jones & Bartlett Learning
ISBN: 9780834207356
Category : Group medical practice
Languages : en
Pages : 644

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This book is a guide to strategic training for physicians in an era of managed care. The first half of the book provides a step-by-step process to help physicians take their practices into the new world of integrated delivery systems. The second half of the book covers a variety of key topics such as credentialing, reimbursement systems, and utilization management.

Author: Steven Garber
Publisher: Rand Corporation
ISBN: 0833043862
Category : Medical
Languages : en
Pages : 94

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Book Description
New medical technologies--pharmaceuticals, medical devices, and procedures--often allow great improvements in the outcomes of medical care, but they are also widely believed to be a major cause of increasing costs. Selective adoption of new technologies is crucial in the quest to control health care costs while preserving or enhancing the quality of care. This report focuses on evaluation and adoption of innovative procedures and medical devices by managed care organizations (MCOs). The project had two primary objectives: (1) to understand current MCO processes for making coverage, medical-necessity, and payment decisions and how device developers and manufacturers prepare for and participate in these processes; and (2) to identify ways that private, voluntary action by the managed-care and medical-device industries might improve--for the benefit of society--these processes. The core data are from confidential interviews with eight companies that develop and manufacture medical devices and medical directors of nine MCOs. The findings should be of interest to medical-device developers and manufacturers, managed care organizations, public-policy makers, and researchers and analysts. A major impediment to socially appropriate adoption of emerging medical technologies is limited information about the performance of these technologies in day-to-day medical practice. The authors discuss prospects for improving four elements of information availability: --Developing better information before market introduction --Learning more from experience after market introduction --Evaluating and synthesizing clinical information --Disseminating information. They also discuss several other issues that warrant consideration: --Aligning private incentives of MCOs and payers with social values --Enhancing MCO capabilities to evaluate technologies and make decisions --Improving decisions by physicians --Reducing use of inappropriate or obsolete technologies --Reducing costs of decisionmaking for manufacturers and MCOs --Improving manufacturer understanding of the market environment --Helping MCOs and employers anticipate what is in the pipeline.

Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309175054
Category : Medical
Languages : en
Pages : 394

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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: Nancy W. Veeder
Publisher: Oxford University Press, USA
ISBN: 019513429X
Category : Community mental health services
Languages : en
Pages : 304

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This volume explores policy, programmatic, and research issues in the health and behavioural health care system known as managed care. Discussions include such areas as the evolution of health care from essential social good to a commodity, cost of and access to care, parity of behavioural health services reimbursement and more.

Author: Michael Drury
Publisher: CRC Press
ISBN: 1315348608
Category : Medical
Languages : en
Pages : 237

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First Published in 2018. CRC Press is an imprint of Taylor & Francis, an Informa company.

Author:
Publisher:
ISBN:
Category : Medical care
Languages : en
Pages : 482

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Author: Nicholas A. Cummings
Publisher: Zeig Tucker & Theisen Publishers
ISBN: 9781891944123
Category : Managed care plans (Medical care)
Languages : en
Pages : 480

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Volume II: "Nicholas Cummings has been called a lot of things in his life ... entrepreneur is one of them. The Cummings legacy will be voluminous and manifold. His contributions to the field have spanned the many definitions of practicing psychology – from education to policy, from business to ongoing exploration. He has been predicting trends, cautioning those who would listen, and negotiating the obstacles to efficacious delivery of quality therapeutic services for over half a century. With this book, we pause once again to revisit some of the most important of his projects as an entrepreneur. Editors Thomas, Cummings, and O’Donohue took on a difficult task when they set out to convince Cummings to tell the story behind the story of how and why he created the various organizations selected here. Of course, he balked at the idea of "showing off" these successes, but the editors were finally able to persuade him of the potential benefit to readers. First, there is the revelation of psychologist as entrepreneur and the delicate balance that is required in order to proceed in this direction with integrity and effectiveness. More important, these organizations were for the most part conceived of as being in service to the profession or to its legislators rather than being focused on profits. Their success, therefore, has had more than a little to do with strengthening the ability of the field to move forward even as it is pulled in different directions. In the end, Nick Cummings decided to tell the story behind the story and readers will be very glad he did. Part history, part memoir, this is a fascinating whodunit, and each time you’ll find Nick Cummings ... seeing the need, envisioning a way to meet it, and then doing it!"--

Author: United States. General Accounting Office
Publisher: DIANE Publishing
ISBN: 1428975373
Category : Child welfare
Languages : en
Pages : 108

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