Essentials of Managed Health Care, Second Edition / Edition 2

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1997 Trade paperback 2nd ed. New. Trade paperback (US). Glued binding. 572 p. Audience: General/trade.

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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.

The book contains black-and-white illustrations.

This popular textbook provides the basic information needed to learn critical concepts of managed care. Derived from the best-selling Managed Health Care Handbook, 4th Edition, this text includes everything from types of managed care organizations, negotiating and contracting to controlling utilization and using data reports in medical management.

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Editorial Reviews

Doody's Review Service
Reviewer: Margaret M. Murphy, RN, PhD (Empowering Change)
Description: This book provides a detailed description of the history and current trends in healthcare policy as they affect the development of managed healthcare in the United States. In addition, the operational, financial, legal, and regulatory issues affecting managed care systems and organizations are addressed. Potential sources of problems and specific solutions that could be used to abate the problems and enhance the functions and outcomes of managed healthcare are emphasized.
Purpose: This book is appropriately designed as a text for postgraduate study.
Audience: It would be useful for students of healthcare administration, organizational design, and finance. However, it would also be of benefit to healthcare professionals who are likely to be employed by or working with managed healthcare organizations or systems.
Features: This second edition makes extensive use of current experience, data, and resources. The tables and exhibits are reflective of the latest information available on national and selected state/regional levels. The references and suggested additional readings are of recent vintage and enhance the expert resources available to the reader. The design is an educational one, with learning objectives heading each chapter, followed by study questions and references at the end of the chapter. This format assists the reader to focus on the essential content contained in each chapter. In addition, the glossary provided assists the reader with technical terms and the myriad of acronyms used throughout the text.
Assessment: This book is well designed and developed in an organized and logical manner. It is well worth consideration as a text for graduate study. Moreover, it would serve as an excellent basic reference text for healthcare professionals working in today's changing healthcare environment.
Daniel K. Bixler
This is the latest edition of the editor's popular text, a companion to his now classic The Managed Health Care Handbook, 4th edition (Aspen Publishers, Inc. 2000). In this book he reviews key concepts of the evolving managed care system in America. The book is organized into six parts, and the editor offers a broad, if not deep, discussion of most relevant issues in managed care. The editor offers this work to provide the reader with a solid understanding of the fundamental concepts, purposes, organization, and function of managed healthcare. The book is geared toward physicians and others exploring the world of managed care and managers in any healthcare sector. It is appropriate for graduate students in healthcare administration. The content ranges far and wide in the managed care field. In Part I the basics of the managed care system are included, both facts and myths. In Part II contributors explore the organization and financing of healthcare delivery and in Part III they explain the various tactics used to manage the access to, cost of, and quality of healthcare. In Part IV details of the marketing and management for a managed care organization are presented. Part V is an illumination of recent trends in managing the care of Medicaid and Medicare patients. Finally, in Part VI contributors explore the current legal and regulatory environment of healthcare. In each chapter the reader is guided with study objectives, study questions, and an up-to-date bibliography. Chapters are cross-referenced to each other and to the parent text. There are black-and-white illustrations, useful tables and graphs, and a glossary of terms and acronyms. The editor describes theU.S. healthcare system as a "complexly adapting system." The information in this text is needed to reach beyond the notion of managed care as a "simplistic monolith," or as the final answer for our current dilemmas. This is a comprehensive primer on the subject of managed care. As with the other books in this series, in this new edition the editor once again strives to keep up with the fluid nature of managed care. His works have become the standard by which similar books will be measured.
Margaret M. Murphy
This book provides a detailed description of the history and current trends in healthcare policy as they affect the development of managed healthcare in the United States. In addition, the operational, financial, legal, and regulatory issues affecting managed care systems and organizations are addressed. Potential sources of problems and specific solutions that could be used to abate the problems and enhance the functions and outcomes of managed healthcare are emphasized. This book is appropriately designed as a text for postgraduate study. It would be useful for students of healthcare administration, organizational design, and finance. However, it would also be of benefit to healthcare professionals who are likely to be employed by or working with managed healthcare organizations or systems. This second edition makes extensive use of current experience, data, and resources. The tables and exhibits are reflective of the latest information available on national and selected state/regional levels. The references and suggested additional readings are of recent vintage and enhance the expert resources available to the reader. The design is an educational one, with learning objectives heading each chapter, followed by study questions and references at the end of the chapter. This format assists the reader to focus on the essential content contained in each chapter. In addition, the glossary provided assists the reader with technical terms and the myriad of acronyms used throughout the text. This book is well designed and developed in an organized and logical manner. It is well worth consideration as a text for graduate study. Moreover, it would serve as an excellent basic referencetext for healthcare professionals working in today's changing healthcare environment.
Booknews
Provides practical knowledge and advice on the complexities of managed care. Part I overviews the history of managed health care and describes basic types of managed care plans and integrated health care delivery systems. Part II reviews basic provider sectors and how managed care works within them, and Part III addresses how managed care actually manages health care. Part IV looks at nonmedical operations of a health plan, and Part V covers Medicare and Medicaid. Part VI offers a brief overview of legal and regulatory topics. Learning features include chapter objectives, a glossary, and study questions. This is a companion to the parent text, . The editor is a partner in an international accounting and consulting firm. Annotation c. Book News, Inc., Portland, OR (booknews.com)

5 Stars! from Doody
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Product Details

  • ISBN-13: 9780834209138
  • Publisher: Wolters Kluwer Law & Business
  • Publication date: 3/28/1997
  • Edition description: Older Edition
  • Edition number: 2
  • 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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