The Managed Health Care Handbook
Peter Reid Kongstvedt
Aspen Publishers, 1996 - Managed care plans (Medical care) - 1045 pages
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.
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Future Issues Facing Managed Care
CHAPTER 3TYPES OF MANAGED CARE ORGANIZATIONS
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ability activities administrative assessment basis benefits capitation capitation rate Chapter CHCs cians claims clinical community rating contract cost coverage critical paths delivery system diagnosis-related groups discussed drug enrollees enrollment Ernst & Young evaluation example factors federal FEHBP function guidelines HCFA health maintenance organizations health plan hospital improvement incentive independent practice association individual inpatient issues managed care organizations managed care plans Medicaid medical director Medicare risk ment model HMOs nursing operations outcomes outpatient patient payers payment percent performance pharmacy physi physicians plan's PMPM PPOs practice preferred provider organizations premium primary problems procedures providers reengineering referral reimbursement reports responsibility result revenue risk pools specialists specialty specialty network staff model standards subacute tion tive treatment underwriting utilization management vider