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Health Insurance and Managed Care
Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.
The Managed Health Care Handbook
Considered the 'bible' of the managed care industry, this third edition is greatly expanded with 30 new chapters and extensively updated-- double the size of the last edition! the Managed Health Care Handbook is a key strategic and operational resource for use in planning and decision-making. it includes first-hand advice from experienced managers on how to succeed in every aspect of managed care: quality management, claims and benefits administration, managing patient demand, As well as risk management, subacute care, physician compensation and much more! This seminal resource is a must for providers, purchasers, and payersfor everyone involved in the managed care industry.
Managed Care
The origins of managed health care -- Types of managed care organizations and integrated health care delivery systems -- Network management and reimbursement -- Management of medical utilization and quality -- Internal operations -- Medicare and Medicaid -- Regulation and accreditation in managed care.
Essentials of Managed Health Care
Peter Kongstvedt provides an authoritative and comprehensive overview of the key strategic, tactical, and operational aspects of managed health care and health insurance. With a primary focus on the commercial sector, the book also addresses managed health care in Medicare, Medicaid, and military medical care. An historical overview and a discussion of taxonomy and functional differences between different forms of managed health care provide the framework for the operational aspects of the industry as well.
Health Care Finance and the Mechanics of Insurance and Reimbursement
Health Care Finance and the Mechanics of Insurance and Reimbursement stands apart from other texts on health care finance or health insurance, in that it combines financial principles unique to the health care setting with the methods and process for reimbursement (including coding, reimbursement strategies, compliance, financial reporting, case mix index, and external auditing). It explains the revenue cycle in detail, correlating it with regular management functions; and covers reimbursement from the initial point of care through claim submission and reconciliation. Thoroughly updated for its second edition, this text reflects changes to the Affordable Care Act, Managed Care Organizations, new coding initiatives, new components of the revenue cycle (from reimbursement to compliance), updates to regulations surrounding health care fraud and abuse, changes to the Recovery Audit Contractors (RAC) program, and more.
Managed Care Pharmacy Practice
Managed Care Pharmacy Practice, Second Edition offers information critical to the development and operation of a managed care pharmacy program. The text also covers the changes that have taken place within the delivery of pharmacy services, as well as the evolving role of pharmacists.
Managing Client Care
Providing a focus on the knowledge and skills needed to become a successful first-line manager, this unique text emphasizes successful client care by addressing the role of nurses in managing quality and the available resources needed. It also discusses each of the essential components of the manager of care role, as well as the basic or core competencies required of staff nurses inherent in the direct care of clients. Thoroughly revised and updated, this 3rd edition reflects the numerous changes related to evolving management concepts - including understanding the health care system, using personal strengths most effectively, and nurturing professional integrity. Content focuses on client c...
Managing Services
The rapid increase in global services during the last few decades is without doubt one of the most challenging social, cultural, political, and especially economic, forces of our time. Services have supplanted agriculture, manufacturing and resources, as the primary source of international competitive advantage in many countries, providing wealth, employment, and almost unlimited future opportunities for growth, whether in traditional or more innovative forms. This book explores the strategic management of services through an Integrated Services Management Model which links operational, marketing, financial and human resource management functions, within a broad and diverse collection of international, regional, and local service contexts. It contains numerous case examples, student projects and exercises, designed to illustrate common problems and innovative approaches, with a particular focus on the Asia Pacific and Australasian regions.
Health Insurance
History of Health Insurance in the United States -- The Affordable Care Act -- A Summary of Insurance Coverage -- The Demand for Insurance -- Adverse Selection -- Underwriting and Rate Making -- Risk Adjustment -- Moral Hazard and Prices -- Utilization Management -- Managed Care, Selective Contracting, and the Insurance Industry -- Provider Consolidation, Monopsony Power, and the Managed Care Backlash -- Insurance Market Structure, Conduct, and Performance -- Premium Sensitivity and Health Insurance -- Compensating Differentials -- Taxes and Employer-Sponsored Health Insurance -- Employers as Agents -- Health Savings Accounts and Consumer-Directed Health Plans -- The Small-Group Market -- The Individual Insurance Market -- Health Insurance Regulation -- High-Risk Pools -- An Overview of Medicare -- Retiree Coverage -- Medicaid, Crowd-Out, and Long-Term Care Insurance.
