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From The CriticsReviewer: 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.