The Managed Health Care HandbookPeter Reid Kongstvedt 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. |
Contents
CHAPTER 3TYPES OF MANAGED CARE ORGANIZATIONS | 28 |
CHAPTER 4INTEGRATED HEALTH CARE DELIVERY SYSTEMS | 42 |
Acquisition of Physician Practices | 64 |
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Common terms and phrases
ability benefits capitation capitation rate centers Chapter CHCs cians claims clinical common compensation contract copayment cost coverage delivery systems discussed disease management drug Emergency Medicine employer enrollees enrollment Ernst & Young evaluation example federal funds health maintenance organization health plan hospital IDSs incentives increase individual inpatient integrated issues managed care plans managed health managed health care medi Medicaid medical director medical groups medical management Medicare ment model HMOs negotiating nurse organizations outcomes outpatient panel participating patient payers payment percent performance pharmacy physi physicians plan's PMPM pool PPMCs PPOs practice primary problem procedures programs providers referral reimbursement require revenue risk pools role specialist specialty staff model stop-loss strategy subacute subacute care tient tion tive treatment utilization