Best Practices in Medical Management: The Managed Health Care Handbook Series / Edition 1

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Overview

A breakthrough publication for medical directors, practitioners, nurse managers, regulators, academicians, and anyone who needs a broad understanding of how managed care actually manages care! In this state-of-the-art resource, you'll find discussion and models for all the processes necessary to develop a fully comprehensive care management program. With 44 chapters covering every aspect of a leading-edge system, and contributions from a top-notch roster of industry leaders, Best Practices in Medical Management gives you a firm foundation for success.

The book contains black-and-white illustrations.

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Editorial Reviews

Doody's Review Service
Reviewer: Francine Sparby, RN, MS (University of Colorado Health Sciences Center)
Description: The editors of this book take medical care management, case management, and managed care into the next millennium. They describe the missing components in our current system, the most important of which is more emphasis on best practices in prevention and alternative care in a complete comprehensive delivery system.
Purpose: The purpose, as described in the preface, is to provide a comprehensive but reasonable overview of many best practices in medical or clinical care management as they are applied in managed healthcare. The intent is to also demonstrate a wide range of activities within the field of best practices of professionals at the highest level, concentrating on taking the patient through the continuum of healthcare instead managing an episode of treatment. Based on the review, I find that the editors do meet their objectives. This is a needed book because the editors provide us with valuable information for managing the patient over the continuum of healthcare that is not currently provided for in most instances today.
Audience: The book is written for most clinical practitioners, students, and residents. The editors target those directly providing healthcare services and the professionals managing the patients. The editors are credible authorities in the subject matter. The contributors also have a rich history of experience, research, and publications in the subject matter.
Features: The editors focus on the demonstration of best practices in the "how" of clinical management in a managed care setting with very specific disease illustrations and activities. Through these illustrations and activities they concentrate more on an advanced, complete, integrated delivery system with a positive preventive approach through extensive screens, care management integration, and data outcome management. They describe the "how" in comprehensive algorithms and high-risk screens. I found the best subject areas in the book to be the complementary and alternative medicine structure for integration that concentrates on prevention and holistic managed care.
Assessment: The editors describe a very comprehensive approach to care management, incorporating very practical tools and processes to help manage the whole patient across the continuum with a very proactive, preventative, and holistic emphasis.
Francine Sparby
The editors of this book take medical care management, case management, and managed care into the next millennium. They describe the missing components in our current system, the most important of which is more emphasis on best practices in prevention and alternative care in a complete comprehensive delivery system. The purpose, as described in the preface, is to provide a comprehensive but reasonable overview of many best practices in medical or clinical care management as they are applied in managed healthcare. The intent is to also demonstrate a wide range of activities within the field of best practices of professionals at the highest level, concentrating on taking the patient through the continuum of healthcare instead managing an episode of treatment. Based on the review, I find that the editors do meet their objectives. This is a needed book because the editors provide us with valuable information for managing the patient over the continuum of healthcare that is not currently provided for in most instances today. The book is written for most clinical practitioners, students, and residents. The editors target those directly providing healthcare services and the professionals managing the patients. The editors are credible authorities in the subject matter. The contributors also have a rich history of experience, research, and publications in the subject matter. The editors focus on the demonstration of best practices in the "how" of clinical management in a managed care setting with very specific disease illustrations and activities. Through these illustrations and activities they concentrate more on an advanced, complete, integrated delivery system with a positivepreventive approach through extensive screens, care management integration, and data outcome management. They describe the "how" in comprehensive algorithms and high-risk screens. I found the best subject areas in the book to be the complementary and alternative medicine structure for integration that concentrates on prevention and holistic managed care. The editors describe a very comprehensive approach to care management, incorporating very practical tools and processes to help manage the whole patient across the continuum with a very proactive, preventative, and holistic emphasis.
Booknews
Describes ideal practices in managing the whole range of activities involved in providing health care to members of a managed care organization, including preventive care for well members, identifying health risks or latent clinical disease, and helping with self-care. A broad rather than exhaustive treatment limited to clinical care management in a managed care setting, with little or no mention of networks, reimbursement, medical group management, human resource issues, or other topics. Some chapters have been updated and recycled from 1996 third edition of . Annotation c. by Book News, Inc., Portland, Or.

5 Stars! from Doody
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Product Details

  • ISBN-13: 9780834210905
  • Publisher: Jones & Bartlett Learning, LLC
  • Publication date: 9/24/1998
  • Series: Managed Health Care Handbook Series
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 675

Table of Contents

Contributors
Preface
Ch. 1 Introduction to Advanced Care Management and Its Implementation 1
Pt. I Member Health Risk Assessment 19
Ch. 2 Introduction to Health Risk Appraisals 21
Ch. 3 Choosing and Using a Health Risk Appraisal Instrument 29
Pt. II Primary Prevention 35
Ch. 4 Prevention in Managed Care 37
Ch. 5 Taking Advantage of the Clinical Setting for Prevention 45
Ch. 6 Outreach from the Managed Care Organization to the Population 55
Ch. 7 Delivering Clinical Preventive Services to Underserved and Immigrant Populations 63
Pt. III Special Preventive Programs for Selected High-Risk Behaviors 75
Ch. 8 Smoking Cessation: New Approaches Blend Marketing Theory with Emerging Technologies 77
Ch. 9 Preventing Unwanted and Unplanned Pregnancies 91
Pt. IV Self-Care and Health Advisory Services 97
Ch. 10 Medically Directed, Delegated Self-Care 99
Ch. 11 Nurse Advice Services 117
Pt. V Emergency Department Services 125
Ch. 12 Efficient Use of Emergency Medicine Services 127
Ch. 13 The Fast Track Emergency Department 135
Ch. 14 Chest Pain Centers 139
Pt. VI Acute Inpatient Care 151
Ch. 15 Managing Basic Medical-Surgical Utilization 153
Ch. 16 The Hospitalist Model: A Method for Managing Inpatient Care 179
Ch. 17 Case Management and Managed Care 187
Ch. 18 Critical Paths: Linking Care and Outcomes for Patients, Clinicians, and Payers 219
Pt. VII Ambulatory Care 239
Ch. 19 Management of Clinical Services in the Clinician's Office 241
Ch. 20 Clinical Services Requiring Authorization 249
Ch. 21 Guideline Use for Ambulatory Procedures 261
Pt. VIII Post-Acute Care Settings 267
Ch. 22 Home Health Care 269
Ch. 23 Subacute Care 283
Ch. 24 Hospice Care in the United States: Issues and Emerging Trends 295
Pt. IX Ancillary Services 307
Ch. 25 Ancillary Diagnostic and Therapeutic Services 309
Ch. 26 Pharmaceutical Services in Managed Care 317
Pt. X Disease Management and Selected Clinical Conditions in Disease Management 337
Ch. 27 Fundamentals and Core Competencies of Disease Management 339
Ch. 28 Disease Management of Congestive Heart Failure 349
Ch. 29 Diabetes Disease Management 363
Ch. 30 Asthma Disease Management 377
Ch. 31 Disease Management and Return on Investment 397
Ch. 32 Managed Behavioral Health Care and Chemical Dependency Services 407
Pt. XI Clinical Quality and Outcomes Measurement and Management 433
Ch. 33 Quality Management in Managed Care 435
Ch. 34 Introduction to the Measurement of Clinical Outcomes 461
Ch. 35 Crafting Valid, Relevant Measures of Clinical Performance 479
Ch. 36 Introduction to the Management of Clinical Outcomes 501
Pt. XII Use of Information in Care Management 511
Ch. 37 Using Data in Medical Management 513
Ch. 38 Provider Profiling 525
Pt. XIII Changing Behavior in Managed Care 533
Ch. 39 Physician Behavior Change in Managed Care Plans 535
Ch. 40 Member Behavior Change 549
Pt. XIV Complementary and Alternative Medicine 567
Ch. 41 Complementary and Alternative Medicine 569
Ch. 42 Structure for CAM Integration 587
Pt. XV Clinical Managed Care in Government Programs 611
Ch. 43 Medicaid Managed Care 613
Ch. 44 Medical Management in the Medicare Population 623
Glossary of Terms and Acronyms 637
Index 659
About the Editors 675
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