Essentials of Managed Health Care, Second Edition / Edition 2

Essentials of Managed Health Care, Second Edition / Edition 2

by Peter R. Kongstvedt
     
 

ISBN-10: 0834209136

ISBN-13: 9780834209138

Pub. Date: 03/28/1997

Publisher: Wolters Kluwer Law & Business

The Second Edition of this popular textbook provides the basic information needed to learn critical concepts of managed care. Derived from the bestselling Managed Health Care Handbook, Third Edition, this text includes everything from types of managed care organizations, negotiating and contracting to controlling utilization and using data reports in medical

Overview

The Second Edition of this popular textbook provides the basic information needed to learn critical concepts of managed care. Derived from the bestselling Managed Health Care Handbook, Third Edition, this text includes everything from types of managed care organizations, negotiating and contracting to controlling utilization and using data reports in medical management.

Product Details

ISBN-13:
9780834209138
Publisher:
Wolters Kluwer Law & Business
Publication date:
03/28/1997
Edition description:
Older Edition
Pages:
572
Product dimensions:
7.07(w) x 10.15(h) x 1.17(d)

Table of Contents

Contents: INTRODUCTION TO MANAGED HEALTH CARE
• An Overview of Managed Care
• Health Care Reform: The Road Lies with Managed Care
• Types of Managed Care Organizations
• Integrated Health Care Delivery Systems
• Elements of the Management Control and Governance Structure
• THE HEALTH CARE DELIVERY SYSTEM
• Primary Care in Closed Panel Plans
• Primary Care in Open Panel Plans
• Compensation of Primary Care Physicians in Open Panel Plans
• Non-Utilization-Based Incentive Compensation for Physicians
• Contracting and Reimbursement of Specialty Physicians
• Negotiating and Contracting with Hospitals and Institutions
• Academic Health Centers and Managed Care
• MEDICAL MANAGEMENT
• Managing Basic Medical-Surgical Utilization
• Disease Management
• Managing Utilization of Ancillary and Emergency Services
• Managed Behavioral Health Care Services
• Quality Management in Managed Care
• Changing Provider Behavior in Managed Care Plans
• Using Data in Medical Management
• SELECTED TOPICS IN HEALTH PLAN OPERATIONAL MANAGEMENT
• Information Systems Operations and Organization Structures
• Authorization Systems
• Operational Finance and Budgeting
• Rating and Underwriting
• Member Services and Consumer Affairs
• Common Operational Problems in Managed Health Care Plans
• PUBLIC SECTOR MANAGED CARE
• Medicare and Managed Care
• Medicaid Managed Care
• REGULATORY AND LEGAL ISSUES
• State Regulation of Managed Care
• Legal Issues in Provider Contracting
• Legal Issues in Integrated Delivery Systems
• What Might the Future Hold?

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