عنوان

Essentials of managed health care /

1449604641

1449653316

9781449604646

9781449653316

Essentials of managed health care /

[Book]

[edited by] Peter R. Kongstvedt.

6th ed.

Burlington, MA :

Jones and Bartlett Learning,

©2013.

xxv, 688 pages :

illustrations ;

26 cm

Revised edition of: The managed health care handbook. 4th ed. 2001. Also rev. ed. of: Essentials of managed health care. 4th ed. 2001.

Includes bibliographical references and index.

A history of managed health care and health insurance in the United States / Peter D. Fox and Peter R. Kongstvedt -- Types of health insurers, managed health care organizations, and integrated health care delivery systems / Eric R. Wagner and Peter R. Kongstvedt -- Elements of the management and governance structure / Peter R. Kongstvedt -- The provider network / Peter R. Kongstvedt -- Provider payment / Peter R. Kongstvedt -- Legal issues in provider contracting / Mark S. Joffe and Kelli D. Back -- Basic utilization and case management / Peter R. Kongstvedt -- Fundamentals and core competencies of disease management / David W. Plocher -- Physician practice behavior and managed health care / Jay Want and Peter R. Kongstvedt -- Data analysis and provider profiling in health plans / David W. Plocher and Nancy Garrett -- Prescription drug benefits in managed care / Robert P Navarro, Craig S. Stern, and Rusty Hailey -- Introduction to managed behavioral health care organizations / Joanna Albright [and others] -- Disease prevention in managed health care plans / Marc Manely -- Quality management in managed health care / Pamela B. Siren -- Accreditation and performance measurement programs in managed health care / Margaret E. O'Kane -- Marketing and sales / Richard Birhanzel -- Enrollment and billing / Karl V. Kovacs, Scott McDaniel, and Peter R. Kongstvedt -- Claims and benefits administration / Donald L. Fowler, Jr. and Elizabeth A. Pascuzzi -- Health care fraud and abuse / Christie A. Moon -- Member service / Kevin Knarr and Peter R. Kongstvedt -- Operational finance and budgeting / Dale F. Cook and Christopher R. Campbell -- Underwriting and rating / Michael G. Strum and Troy M Filipek -- Information systems and electronic data interchange in managed health care / James S. Slubowski -- Health plans and Medicare / John K. Gorman [and others] -- Medicaid managed health care -- Rodney C. Armstead, Catherine K. Anderson, and Elizabeth Cabot Nash -- The military managed care health system / M. Nicholas Coppola [and others] -- Managed care in global context / Johnathan P. Weiner [and others] -- State regulation of managed health care / Tom Wilder -- Federal regulation of health insurance and managed health care / Tom Wilder -- The Patient Protection and Affordable Care Act / Tom Wilder.

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Peter Kongstvedt provides an authoritative and comprehensive overview of the key strategic, tactical, and operational aspects of managed health care and health insurance. With a primary focus on the commercial sector, the book also addresses managed health care in Medicare, Medicaid, and military medical care. An historical overview and a discussion of taxonomy and functional differences between different forms of managed health care provide the framework for the operational aspects of the industry as well.

Managed care plans (Medical care)-- Management.

Delivery of Health Care-- economics.

Managed Care Programs-- organization & administration.

Managed Care

Managed care plans (Medical care)-- Management.

United States.

2

Kongstvedt, Peter R., (Peter Reid)

20200823023735.0

[Book]

Y