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| About the Editor | ||
| Contributors | ||
| Preface | ||
| Acknowledgments | ||
| Pt. I | Introduction to Managed Care | 1 |
| Ch. 1 | An Overview of Managed Care | 3 |
| Ch. 2 | Types of Managed Care Organizations | 17 |
| Ch. 3 | Integrated Health Care Delivery Systems | 31 |
| Ch. 4 | Elements of the Management Control and Governance Structure | 63 |
| Ch. 5 | Examining Common Assertions about Managed Care | 71 |
| Pt. II | The Health Care Delivery System | 83 |
| Ch. 6 | Primary Care in Managed Health Care Plans | 85 |
| Ch. 7 | Compensation of Primary Care Physicians in Managed Health Care | 103 |
| Ch. 8 | Contracting and Reimbursement of Specialty Physicians | 141 |
| Ch. 9 | Negotiating and Contracting with Hospitals, Institutions, and Ancillary Services | 157 |
| Pt. III | Medical Management | 177 |
| Ch. 10 | Care Management and Clinical Integration Components | 179 |
| Ch. 11 | Managing Basic Medical-Surgical Utilization | 197 |
| Ch. 12 | Clinical Services Requiring Authorization | 235 |
| Ch. 13 | Case Management and Managed Care | 249 |
| Ch. 14 | Fundamentals and Core Competencies of Disease Management | 281 |
| Ch. 15 | Prescription Drug Benefits in Managed Care | 293 |
| Ch. 16 | Managed Behavioral Health Care and Chemical Dependency Services | 332 |
| Ch. 17 | Quality Management in Managed Care | 361 |
| Ch. 18 | Using Data and Provider Profiling in Medical Management | 379 |
| Ch. 19 | Physician Behavior Change in Managed Health Care | 419 |
| Pt. IV | Operational Marketing and Management | 439 |
| Ch. 20 | Information Systems in Managed Health Care Plans | 441 |
| Ch. 21 | Claims and Benefits Administration | 461 |
| Ch. 22 | Member Services and Consumer Affairs | 507 |
| Ch. 23 | Sales and Marketing in Managed Health Care Plans: The Process of Distribution | 535 |
| Ch. 24 | The Employer's View of Managed Health Care: Show me the Value | 555 |
| Ch. 25 | The Impact of Consumerism on Managed Health Care | 566 |
| Ch. 26 | Accreditation and Performance Measurement Programs for Managed Care Organizations | 587 |
| Ch. 27 | Common Operational Problems in Managed Health Care Plans | 609 |
| Ch. 28 | Operational Finance and Budgeting | 628 |
| Ch. 29 | Underwriting and Rating Functions Common to Most Markets | 643 |
| Pt. V | Medicare and Medicaid | 655 |
| Ch. 30 | Medicare and Managed Care | 657 |
| Ch. 31 | Medicaid Managed Care | 684 |
| Pt. VI | Regulatory and Legal Issues | 703 |
| Ch. 32 | Legal Issues in Provider Contracting | 705 |
| Ch. 33 | Legal Liability Related to Medical Management Activities | 743 |
| Ch. 34 | The Health Insurance Portability and Accountability Act of 1996 | 764 |
| Ch. 35 | State Regulation of Managed Care | 786 |
| Ch. 36 | Managed Care's Regulatory Evolution: Driving Change in the New Century | 810 |
| Epilogue - Managed Health Care at the Millennium | 822 | |
| Glossary of Terms and Acronyms | 833 | |
| Index | 855 |
| Price | Condition | Delivery | Seller | Action |
| $114.95 | Digital |
| WonderClub |
Irina Gordic
reviewed Essentials of Managed Health Care on March 12, 2014
Essentials of Managed Health Care
The content of the book is fair to good, but the writing is VERY uneven.
(Stands to reason as the chapters were written by a variety of authors - it's too bad some of them are clearly not actually writers.)
Also, wouldn't you think an editor would be a good idea?
Check out some lovely examples of how not to open your chapter:
"To manage successfully a managed care organization or payer organization, the value financial managers provide their organizations starts with their ability to interact with the operational and medical managers, to manage changes in the regulatory environment, and gather timely information to facilitate communication of financial results to the organization and its constituencies to react appropriately to sustain or exceed financial goals...
The focus of this chapter is a review of the components of the financial statements of a payer, key information and the operational procedures that the financial manager will need and rely upon, addresses typical problems that occur in gathering information and provides insight into the challenge of the integrity of information."
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