Contracting in a Managed Care Environment: Market-Based Approaches / Edition 1

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Editorial Reviews

Doody's Review Service
Reviewer: Keith G Seashore, BS (UniNet Healthcare Network)
Description: This book reviews strategies for providers to consider under managed care.
Purpose: The purpose is to provide insight on how providers need to develop a managed care strategy. It discusses all the relevant issues around managed care to help providers develop a strategy. This book is very worthy. Managed care is an important topic in the healthcare industry and can have a profound effect on providers. The book meets the author's objectives.
Audience: In my judgement, the book is written for management involved in developing a managed care strategy, specfically, CFO's, CEO's, managed care management, and staff. I believe the author intended the audience to be the same group, as well as other management level postions in a healthcare or payor environment.
Features: This book covers the history of managed care, its purpose, and all the current issues surrounding how payors and providers and consumers fit in the puzzle. Additionally, it discusses important managed care concepts such as negotiating, pricing, fee schedules, capitation, risk-sharing, etc. The book is very good in discussing key managed care principles and relating them to practical matters. The authors appear to have first hand knowledge of the issues. The charts and graphs are very basic and although they don't grab the attention of the reader, they are effective in illustrating their points. I would like to see the book provide more insight on how to develop and set up a managed care compliance department to audit payments and deal with denials.
Assessment: The book is impressive. It covers many practical and thought provoking issues with which I have had personal experience. This is one of the best books I have seen on managed care.
From The Critics
This book examines managed care as a marketing issue and provides advice on tactical, operational, financial, and organizational aspects of managed care. It helps provider organizations decide what type of managed care plan will help them achieve their strategic goals, tells how to determine what competitive advantages they have to offer that plan, and shows how to build a relationship with the plan. Bonney is board certified in healthcare management and a fellow in the American College of Healthcare Executives; Smith works in strategic planning and managed care in a health system in Georgia. Annotation c. Book News, Inc., Portland, OR (booknews.com)

3 Stars from Doody
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Product Details

  • ISBN-13: 9781567931693
  • Publisher: Health Administration Press
  • Publication date: 10/1/2001
  • Edition description: AMERICAN COLLEGE OF HEALTHCARE EXEC
  • Edition number: 1
  • Pages: 286
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.70 (d)

Table of Contents

Preface
1 Introduction 1
2 Pricing Considerations 13
3 Evolving Conditions of Belief and Experience 37
4 Reasonably Allocating Funds and Risk 103
5 Negotiation of Effective Contracts 157
6 Infrastructure Necessary for the Next Millennium 183
7 The Future of Managed Care Contracting and Healthcare Services 247
Appendix 257
Index 277
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