The Managed Health Care Handbook

Front Cover
Jones & Bartlett Learning, 2001 - Medical - 1408 pages
2 Reviews
This thoroughly revised and 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. The Handbook is considered to be the standard resource for the managed care industry.
  

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Contents

Ibid 17 K N Lohr et al Chronic Disease in a General Adult
13
CHAPTER 3TYPES OF MANAGED CARE ORGANIZATIONS
28
CHAPTER 4INTEGRATED HEALTHCARE DELIVERY SYSTEMS
42
CHAPTER 5ELEMENTS OF THE MANAGEMENT CONTROL
73
CHAPTER 6EXAMINING COMMONASSERTIONS ABOUT MANAGED CARE
81
PART IITHE HEALTHCARE DELIVERY SYSTEM
91
CHAPTER 8COMPENSATION OF PRIMARY CARE PHYSICIANS
110
Health Care Financing Administration HCFA
133
CHAPTER 41SALES AND MARKETING IN MANAGED
798
CHAPTER 42THE EMPLOYERS VIEW OF MANAGED
817
CHAPTER 43THE IMPACT OF CONSUMERISM ON MANAGED HEALTHCARE
828
CHAPTER 44ACCREDITATION AND PERFORMANCE MEASUREMENT
849
CHAPTER 45RISK MANAGEMENT IN MANAGED CARE
871
CHAPTER 46COMMON OPERATIONAL PROBLEMS IN MANAGED
886
Du Davis K Collins K S and Morris C 1991 Managed Care
896
PART VFINANCE AND UNDERWRITING
905

CHAPTER 9PHYSICIAN COMPENSATION IN MEDICAL GROUPS
147
CHAPTER 10NONUTILIZATIONBASED INCENTIVE
166
CHAPTER 11CONTRACTING AND REIMBURSEMENT
175
CHAPTER 12NEGOTIATING AND CONTRACTING WITH
191
CHAPTER 13ACADEMICHEALTH CENTERS AND MANAGED CARE
206
Industry Report Academic Medical Centers and Managed Care Uneasy
227
CHAPTER 15COMPLEMENTARY AND ALTERNATIVE MEDICINE
245
PART IIIMEDICAL MANAGEMENT
265
Management System
281
CHAPTER 18MANAGING BASIC MEDICALSURGICAL UTILIZATION
294
CHAPTER 19CLINICAL SERVICES REQUIRING AUTHORIZATION
331
CHAPTER 20ANCILLARY DIAGNOSTIC AND THERAPEUTIC SERVICES
344
CHAPTER 21THE EMERGENCY DEPARTMENT AND MANAGED CARE
351
CHAPTER 22CASE MANAGEMENT AND MANAGED CARE
371
CHAPTER 23FUNDAMENTALS AND CORE COMPETENCIES
402
CHAPTER 24PRESCRIPTION DRUG BENEFITS IN MANAGED CARE
413
CHAPTER 25MANAGED BEHAVIORAL HEALTHCARE
451
CHAPTER 26HOME HEALTHCARE
480
CHAPTER 27SUBACUTE CARE WITHIN THE MANAGED
496
CHAPTER 28HOSPICE AND ENDOFLIFE CARE
508
LINKING OUTCOMES
521
CHAPTER 30QUALITY MANAGEMENT IN MANAGED CARE
539
CHAPTER 31MEASURING AND MANAGING OF CLINICAL OUTCOMES
556
CHAPTER32USING DATA AND PROVIDER PROFILING IN MEDICAL
579
CHAPTER 33PHYSICIAN BEHAVIORCHANGE IN MANAGED
618
CHAPTER 34MEMBER BEHAVIORCHANGE
637
PART IVOPERATIONAL MARKETING AND MANAGEMENT
655
CHAPTER 36INFORMATION SYSTEMS AND ELECTRONIC COMMERCE
676
CHAPTER 37ELECTRONIC COMMERCE IN MANAGED HEALTHCARE
694
CHAPTER 38CLAIMS AND BENEFITS ADMINISTRATION
710
CHAPTER 39OTHERPARTY LIABILITY AND COORDINATION
755
CHAPTER 40MEMBER SERVICES AND CONSUMERAFFAIRS
771
CHAPTER 48TAX ISSUES RELATING TO HEALTHRISKBEARINGENTITIES
922
CHAPTER 49UNDERWRITING AND RATING FUNCTIONS
945
CHAPTER 50UNDERWRITING AND RATING FUNCTIONS BY MARKET
952
CHAPTER 51ACTUARIAL SERVICES IN AN INTEGRATED DELIVERY SYSTEM
971
CHAPTER 52OPERATIONAL UNDERWRITING IN MANAGED CARE
977
CHAPTER 53PROVIDER EXCESS LOSS COVERAGE
1000
PART VISPECIAL MARKET SEGMENTS
1041
CHAPTER 55MEDICARE AND MANAGED CARE
1060
THE HEALTH PLANS VIEW
1086
CHAPTER 57MEDICAID MANAGED CARE
1105
CHAPTER 58CHAMPUS AND THE DEPARTMENT OF DEFENSE
1124
CHAPTER 59MANAGED CARE ORGANIZATIONS IN RURAL AREAS
1133
CHAPTER 60MANAGED CARE DENTAL BENEFITS
1146
PART VIIREGULATORY AND LEGAL ISSUES
1163
ATTACKING
1203
Physician Unions
1211
Conclusion
1219
Negligence Actions Related to Medical Management Activities
1229
CHAPTER 65LEGAL ISSUES IN INTEGRATED DELIVERY SYSTEMS
1241
CHAPTER 66ERISA AND MANAGED CARE
1257
CHAPTER 67THE HEALTH INSURANCE PORTABILITY
1285
New Access Initiatives
1293
HIPAA Administration and Enforcement
1299
CHAPTER 68HEALTH PLAN CORPORATE COMPLIANCE PROGRAMS
1306
CHAPTER 69STATE REGULATION OF MANAGED CARE
1322
EPILOGUEMANAGED HEALTHCARE AT THE MILLENNIUM
1346
GLOSSARY OF TERMS AND ACRONYMS
1357
INDEX
1378
886
1389
905
1397
917
1403
Copyright

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