Managed Care: What It Is and How It Works

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Jones & Bartlett Publishers, Oct 7, 2009 - Medical - 275 pages
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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.
 

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Contents

The Origins of Managed Health Care
1
Types of Managed Care Organizations and Integrated Health Care Delivery Systems
17
Network Management and Reimbursement
55
Management of Medical Utilization and Quality
95
Internal Operations
119
Medicare and Medicaid
155
Regulation and Accreditation in Managed Care
175
Glossary of Terms and Acronyms
207
Index
251
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