TY  - BOOK
AU  - Kongstvedt,Peter R.
TI  - Essentials of managed health care
SN  - 0763724963 (pbk.)
AV  - RA413 .E87 2003
U1  - 362.1/04258 21
CY  - Sudbury, Mass.
PB  - Jones and Bartlett Publishers, c2003.
KW  - Managed care plans (Medical care)
KW  - Management
KW  - Delivery of Health Care
KW  - economics
KW  - United States
KW  - Managed Care Programs
KW  - organization & administration
KW  - Gezondheidszorg
KW  - gtt
N1  - Includes bibliographical references and index; 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. 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. 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. 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. Medicare and Medicaid. Medicare and managed care -- Medicaid managed care. 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
ER  -