The Managed Health Care Handbook

Cloth cover: 1,408 pages
Size: 10.3" x 7.4"
ISBN 0834217260
9780834217263
Jones & Bartlett
January 2001
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This Handbook is considered to be the standard resource and reference for the managed care industry.

This thoroughly updated book provides a strategic and operational resource for use in planning and decision-making. The Handbook enables readers to fine-tune operation strategies by providing updates on critical managed care issues, insights to the complex managed care environment, and methods to gain and maintain cost-efficient, high quality health services.

With 30 new chapters, it includes advice from managers in the field on how to succeed in every aspect of managed care including:

quality management
claims and benefits administration, and
managing patient demand.

This book includes coverage of these topics:

Overview of Managed Health Care
Types of Managed Care Organizations
Elements of Management Control Structure
Primary Care in Closed and Open Panels
Compensation of Primary Care Physicians in Open Panels
Negotiating and Contracting with Consultants
Negotiating and Contracting with Hospitals and Institutions
Changing Provider Behavior in Managed Care Plans
Controlling Hospital Utilization
Controlling Referrals/Consultant Utilization
Controlling Utilization of Ancillary and Emergency Services
Managed Mental Health and Substance Abuse Services
Pharmaceutical Services in Managed Care
Quality Management
Use of Data and Reports in Medical Management
Authorization Systems
Formal Physician Performance Evaluations
Member Services and Consumer Affairs
Claims and Benefits Administration
Outside Accreditation of Managed Care Plans
Common Operational Problems in Managed Health Care Plans
The Employer's View of Managed Health Care: From a Passive to an Aggressive Role
Marketing Managed Health Care Plans
Operational Finance and Budgeting
Rating and Underwriting
The Federal Employees Health Benefit Program and Managed Care
Medicare and Managed Care
Medicare Risk Contracting: An Industry Perspective
Managed Care for Retirees and the Elderly
Medicaid and Managed Care
CHAMPUS and the Department of Defense
Managed Care Programs
Workers' Compensation Medical Benefits: A Practical Framework for Implementing New Cost Containment Strategies
State Regulation
The Hows and Whys of Federal Qualification and Eligibility
Legal Issues in Provider Contracting
Legal Issues and Antitrust Considerations in the Establishment of Credentialing and Other Selection Criteria
Medical Management and Legal Obligations to Members

(information directly from the publisher)

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