Managed Care: What It Is and How It Works
The new Third Edition of Managed Health Care: What It Is and How It Works is a concise introduction to the foundations of the American managed health care system. Written in clear and accessible language, this handy guide offers an historical overview of managed care and then walks the reader through the organizational structures, concepts, and practices of the managed care industry. This thorough revision has been completely updated with all the newest data on this dynamic industry and features all new sections on: pay for performance, consumer directed health plans, new approaches to care management, as well as advances in information technology.
The Origins of Managed Health Care
Types of Managed Care Organizations and Integrated Health Care Delivery Systems
Network Management and Reimbursement
Management of Medical Utilization and Quality
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accreditation amount ancillary services apply behavioral health CAHPS capitation CDHPs Chapter charges claims clinical coinsurance committee common consumers contract copayment coverage covered deductible Diagnosis-Related Groups discussed drug benefit employer enrollees enrollment entity ERISA example external review federal function grievance group health health benefits plan health insurance health maintenance organization health plan Healthcare HEDIS HIPAA HMOs hospital hospitalist IDSs individual inpatient insurance company laws managed care plans managed health managed health care MCO’s Medicaid medical costs medical expenses medical group medical services Medicare Advantage Medicare and Medicaid national provider identifier NCQA outpatient patient payment percent physicians policies PPMCs PPOs practice preferred provider organizations premium procedures programs providers PSOs q Understand quality management rates regulations reimbursement requirements risk for medical self-insured standards term tion types of MCOs usually utilization management