Managed Care What It Is and How It Works

Name: Managed Care What It Is and How It Works
Price: 9.89 USD
Availability: InStock
ISBN: 9780834220898

ISBN-10: 083422089X

ISBN-13: 9780834220898

Edition: 2nd 2002

Authors: Peter R. Kongstvedt

List price: $34.95

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Description:

Written for the general reader, this handbook describes the origins, varieties, and future prospects of managed care. It also addresses issues like network management, reimbursement, medical utilization and quality, internal operations, Medicare and Medicaid, and regulation and accreditation. Diagrams, graphs, and flow charts illustrate major points. A glossary is provided. Kongstvedt is a doctor. Annotation copyrighted by Book News, Inc., Portland, OR.

Book details

List price: $34.95
Edition: 2nd
Copyright year: 2002
Publisher: Jones & Bartlett Learning, LLC
Binding: Paperback
Pages: 329
Size: 6.00" wide x 9.00" long
Weight: 0.660
Language: English



Preface



The Origins of Managed Care


Managed Care: The Early Years (Pre-1970)


The Adolescent Years of Managed Care: 1970-1985


Managed Care as a Mature Concept: 1985-1995


Managed Care in Recent Times


Conclusion



Types of Managed Care Organizations and Their Structure


Types of Bearing Risk for Medical Costs


Payer-Based Managed Care


Integrated Delivery Systems


Governance and Management of MCOs


Conclusion



Network Management and Reimbursement


General Contracting Issues


Physicians


Hospitals and Institutions


Network Maintenance and Management


Conclusion



Medical Utilization and Quality


Prevention and Wellness


Basic Utilization Management


External Review Programs


Disease and Case Management


Ancillary and Pharmaceutical Services


Quality Management


Total Quality Management


Conclusion



Internal Operations


Marketing and Sales


Enrollment and Billing


Claims


Member Services


Finance and Underwriting


Information Systems


Conclusion



Medicare and Medicaid


Medicare


Reimbursement of Medicare+Choice MCOs


Special Requirements for Medicare+Choice MCOs


Medicaid


Conclusion



Regulation and Accreditation in Managed Care


State Regulation


The Health Insurance Portability and Accountability Act


Self-Insured Employers and the Employee Retirement Income Security Act


Accreditation of Managed Care Organizations


Conclusion


Epilogue: Managed Health Care at the Millennium


Glossary


Index