Essentials of Managed Health Care

5th Edition
Softcover: 800 pages
ISBN 0763739839
9780763739836
Jones & Bartlett
March 2007
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This is the most comprehensive and widely-used book on managed care. This new edition of the authoritative text provides practical knowledge and advice to help you master the complexities of managed care today.

With learning objectives for each chapter, a glossary of terms and common acronyms, study questions, tables and charts, and the expert guidance of Peter R. Kongstvedt, Essentials of Managed Health Care is a perfect introduction to the key concepts of managed care.

This revision includes updates to all chapters, as well as new sections on the most relevant topics in managed care today such as: pay for performance, consumer-directed healthcare plans, payor/provider collaboration, and electronic enablement of clinical activities supported by health plans. The chapter on Medicare has been completely revised to reflect the recent Medicare Prescription Drug Act.

Derived from the best-selling Managed Health Care Handbook, this text presents basic information on all the critical concepts of managed care; compares myths about managed care to actual facts; progresses from introductory material on the types of managed care organizations to negotiating and contracting, controlling utilization, and using data reports in medical management; illuminates the regulatory landscape, with careful attention to both federal and state law, as well as the legislative environment. Learning objectives open each chapter; useful tables and charts summarize key information at a glance; study questions encourage thoughtful analysis; includes a glossary of terms and common acronyms. Topics covered include:

Introduction to Managed Health Care
- The Origins of Managed Health Care, Peter D. Fox & Peter R. Kongstvedt
- Types of Managed Care Plans and Integrated Healthcare Delivery Systems, Eric R. Wagner & Peter R. Kongstvedt
- Elements of the Management Control and Governance Structure, Peter R. Kongstvedt
- Common Myths and Assertions About Health Plans, Brian McKenna
The Health Care Delivery System
- Physician Networks in Managed Health Care, Peter R. Kongstvedt
- Basic Compensation of Physicians in Managed Health Care, Peter R. Kongstvedt
- Hospitals, Facilities, and Ancillary Services, Peter R. Kongstvedt
- Performance-Based Incentives in Managed Health Care: Pay-for-Performance, Peter R. Kongstvedt
Medical Management
- Managing Basic Medical-Surgical Utilization, Peter R. Kongstvedt and Kimberley O’Keefe
- Fundamentals and Core Competencies of Disease Management, David W. Plocher
- Case Management, Patricia Metzger
- Prescription Drug Benefits in Managed Health Care, Robert P. Navarro
- Introduction to Managed Behavioral Health Care Organizations, Joann Albright, Deborah Heggie, Anthony M. Kotin, Lawrence Nardozzi, and Fred Waxenberg, Ph.D.
- The Role of Health Plans in Preventing Disease, Marc Manley
- Quality Management in Managed Care, Pamela Siren
- Data Analysis and Profiling in Health Plans, David Plocher and Nancy Garrett

“Essentials of Managed Health Care is a useful and well-researched guide for healthcare professionals…the book provides an exhaustive discussion of the challenges of managing healthcare systems under capitation and prospective payment systems." - Anthony F. Lewis, MA

(information from the publisher)

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