Essentials of managed health care / [edited by] Peter R. Kongstvedt.

Format:

Book

Contributor:

Kongstvedt, Peter R. (Peter Reid)

Language:

English

Subjects (All):

Managed care plans (Medical care)--Management.

Managed care plans (Medical care).

Managed Care Programs--organization & administration.

United States.

Delivery of Health Care--economics.

Medical Subjects:

Managed Care Programs--organization & administration.

United States.

Delivery of Health Care--economics.

Physical Description:

xxi, 841 pages : illustrations ; 26 cm

Edition:

Fifth edition.

Place of Publication:

Sudbury, Mass. : Jones and Bartlett Publishers, [2007]

Summary:

As the most widely-used textbook on managed care, Essentials of Managed Health Care, Fifth Edition, provides an authoritative and comprehensive overview of the key strategic, tactical, and operational aspects of managed health care and health insurance in the commercial sector, as well as Medicare, Medicaid, and military medical care. With learning objectives for each chapter, a glossary of terms and common acronyms, study questions, tables and charts, and the expert guidance of Peter R. Kongstvedt, Essentials of Managed Health Care, Fifth Edition, is the perfect introduction to the key concepts of managed care.

This revision includes updates to all chapters, as well as: New chapters on disease management, case management, pharmacy benefits management, behavioral health management, prevention, and the use of data and analysis in care management. New chapters on claims administration, sales and marketing, healthcare consumerism, and the employer's view of managed health care. A completely revised chapter on the new Medicare/Medicaid laws and programs. New chapters on the military health system and managed care in a global context. A new chapter on HIPAA.

Contents:

Keeping Current xxi

Part 1 Introduction to Managed Health Care 1

Chapter 1 The Origins of Managed Health Care / Peter D. Fox, Peter R. Kongstvedt 3

Chapter 2 Types of Managed Care Plans and Integrated Healthcare Delivery Systems / Eric R. Wagner, Peter R. Kongstvedt 19

Chapter 3 Elements of the Management Control and Governance Structure / Peter R. Kongstvedt 41

Chapter 4 Common Myths and Assertions about Health Plans / Brian J. McKenna 51

Part 2 The Healthcare Delivery System 61

Chapter 5 Physician Networks in Managed Health Care / Peter R. Kongstvedt 63

Chapter 6 Basic Compensation of Physicians in Managed Health Care / Peter R. Kongstvedt 93

Chapter 7 Hospitals, Facilities, and Ancillary Services / Peter R. Kongstvedt 135

Chapter 8 Performance-Based Incentives in Managed Health Care: Pay-for-Performance / Peter R. Kongstvedt 165

Part 3 Medical Management 187

Chapter 9 Managing Basic Medical-Surgical Utilization / Peter R. Kongstvedt, Kimberley A. Mentzer 189

Chapter 10 Fundamentals and Core Competencies of Disease Management / David W. Plocher 233

Chapter 11 Case Management / Patricia Metzger 247

Chapter 12 Prescription Drug Benefits in Managed Health Care / Robert P. Navarro, Rusty Hailey 269

Chapter 13 Introduction to Managed Behavioral Healthcare Organizations / Joann Albright, Deborah Heggie, Anthony M. Kotin, Lawrence Nardozzi, Fred Waxenberg 297

Chapter 14 The Role of Health Plans in Preventing Disease / Marc Manley 317

Chapter 15 Quality Management in Managed Care / Pamela B. Siren 335

Chapter 16 Data Analysis and Profiling in Health Plans / David W. Plocher, Nancy Garrett 349

Part 4 Operational Management and Marketing 371

Chapter 17 Information Technology in the Healthcare Organization / Thomas Riley, Kelly Hanratty Butler 373

Chapter 18 Claims Administration / Donald L. Fowler Jr., Elizabeth Pascuzzi 387

Chapter 19 Member Services / Kevin Knarr, Peter R. Kongstvedt 443

Chapter 20 Healthcare Consumerism / Elizabeth Bierbower 473

Chapter 21 Sales and Marketing / Richard F. Birhanzel 491

Chapter 22 The Employer's View of Managed Health Care / Michael J. Taylor 505

Chapter 23 Accreditation and Performance Measurement Programs for Managed Care Organizations / Margaret E. O'Kane 521

Chapter 24 Operational Finance and Budgeting / Dale E. Cook 553

Chapter 25 Underwriting and Rating Functions / Michael G. Sturm, Troy M. Filipek 571

Part 5 Special Markets 581

Chapter 26 Medicare and Managed Care / Carlos J. Zarabozo, Sidney J. Lindenberg 583

Chapter 27 Medicaid Managed Care / Robert E. Hurley, Stephen A. Somers 619

Chapter 28 The Military Managed Healthcare System / M. Nicholas Coppola, Jeffrey P. Harrison, Bernie Kerr, Dawn Erckenbrack 633

Chapter 29 Managed Care in a Global Context / Jonathan P. Weiner, Joanna Case Famadas, Hugh Waters, Djordje Gikic 655

Part 6 Legal and Regulatory Issues 675

Chapter 30 Legal Issues in Provider Contracting / Mark S. Joffe, Kelli D. Back 677

Chapter 31 ERISA / Jacqueline M. Saue, Gregg H. Dooge 725

Chapter 32 HIPAA / Leigh C. Riley, Peter R. Kongstvedt 753

Chapter 33 State Regulation of Managed Care / Donna Horoschak, Samantha Silva 765.

Notes:

Rev. ed. of: The managed health care handbook. 4th ed. 2001. Also rev. ed. of: Essentials of managed health care. 4th ed. 2001.

Includes bibliographical references and index.

ISBN:

0763739839

9780763739836

OCLC:

71243955