Essentials of managed health care /
| Other Authors: | |
|---|---|
| Format: | Book |
| Language: | English |
| Published: |
Gaithersburg, Md. :
Aspen Publishers,
2001.
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| Edition: | Fourth edition. |
| Subjects: |
Table of Contents:
- Pt. 1. Introduction to managed care
- An overview of managed care
- Types of managed care organizations
- Integrated health care delivery systems
- Elements of the management control and governance structure
- Examining common assertions about managed care
- Pt. 2. The health care delivery system
- Primary care in managed health care plans
- Compensation of primary care physicians in managed health care
- Contracting and reimbursement of specialty physicians
- Negotiating and contracting with hospitals, institutions, and ancillary services
- Pt. 3. Medical management
- Care management and clinical integration components
- Managing basic medical-surgical utilization
- Clinical services requiring authorization
- Case management and managed care
- Fundamentals and core competencies of disease management
- Prescription drug benefits in managed care
- Managed behavioral health care and chemical dependency services
- Quality management in managed care
- Using data and provider profiling in medical management
- Physician behavior change in managed health care
- Pt. 4. Operational marketing and management
- Information systems in managed health care plans
- Claims and benefits administration
- Member services and consumer affairs
- Sales and marketing in managed health care plans: the process of distribution
- The employer's view of managed health care: show me the value
- The impact of consumerism on managed health care
- Accreditation and performance measurement programs for managed care organizations
- Common operational problems in managed health care plans
- Operational finance and budgeting
- Underwriting and rating functions common to most markets
- Pt. 5. Medicare and Medicaid
- Medicare and managed care
- Medicaid and managed care
- Pt. 6. Regulatory and legal issues
- Legal issues in provider contracting
- Legal liability related to medical management activities
- The Health Insurance Portability and Accountability Act of 1996
- State regulation of managed care
- Managed care's regulatory evolution: driving change in the new century
- Epilogue: Managed health care at the millennium.