The Managed Health Care Handbook
Peter Reid Kongstvedt
Aspen Publishers, 2001 - Medical - 1408 pages
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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CHAPTER 3TYPES OF MANAGED CARE ORGANIZATIONS
CHAPTER 4INTEGRATED HEALTH CARE DELIVERY SYSTEMS
CHAPTER 5ELEMENTS OF THE MANAGEMENT CONTROL
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ability activities administrative AHCs behavior benefits capitation capitation rate Center Chapter CHCs cians claims clinical contract copayment cost coverage delivery discussed disease management drug e-commerce effective electronic Emergency Medicine employer enrollment Ernst & Young evaluation example functions guidelines health maintenance organization health plan HealthPartners HIPAA HMOs hospital hospitalist IDSs improve incentives increase individual inpatient integrated Internet issues managed health MCOs measures Medicaid medical director medical groups medical management Medicare Medicine ment model HMOs nurse organizations outcomes outpatient patient payers payment percent performance pharmacy pharmacy benefit management physi physicians plan's PPMCs PPOs practice primary problems procedures profiling programs providers referral reimbursement reports require risk SCPs specialist specialty staff standards stop-loss strategies subacute tient tion tive treatment utilization
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