A Study Guide to Essentials of Managed Health Care

by Kongstvedt, Peter R.

• ISBN13: 9780763725341
• ISBN10: 076372534X
• Edition: 4th
• Format: Paperback
• Copyright: 2003-03-01
• Publisher: Jones & Bartlett Learning

Table of Contents

An Overview of Managed Care	1	(2)
Types of Managed Care Organizations	3	(2)
Integrated Health Care Delivery Systems	5	(3)
Elements of the Management Control and Governance Structure	8	(2)
Examining Common Assertions about Managed Care	10	(2)
Primary Care in Managed Health Care Plans	12	(2)
Compensation of Primary Care Physicians in Managed Health Care	14	(3)
Contracting and Reimbursement of Specialty Physicians	17	(2)
Negotiating and Contracting with Hospitals, Institutions, and Ancillary Services	19	(2)
Care Management and Clinical Integration Components	21	(2)
Managing Basic Medical-Surgical Utilization	23	(2)
Clinical Services Requiring Authorization	25	(2)
Case Managed and Managed Care	27	(2)
Fundamentals and Core Competencies of Disease Management	29	(2)
Prescription Drug Benefits in Managed Care	31	(3)
Managed Behavioral Health Care and Chemical Dependency Services	34	(2)
Quality Management in Managed Care	36	(2)
Using Data and Provider Profiling in Medical Management	38	(2)
Physician Behavior Change in Managed Health Care	40	(3)
Information Systems in Managed Health Care Plans	43	(3)
Claims and Benefits Administration	46	(4)
Member Services and Consumer Affairs	50	(2)
Sales and Marketing in Managed Health Care Plans: The Process of Distribution	52	(3)
The Employer's View of Managed Health Care: Show Me the Value	55	(2)
The Impact of Consumerism on Managed Health Care	57	(2)
Accreditation and Performance Measurement Programs for Managed Care Organizations	59	(2)
Common Operational Problems in Managed Health Care Plans	61	(3)
Operational Finance and Budgeting	64	(2)
Underwriting and Rating Functions Common to Most Markets	66	(2)
Medicare and Managed Care	68	(2)
Medicaid Managed Care	70	(2)
Legal Issues in Provider Contracting	72	(2)
Legal Liability Related to Medical Management Activities	74	(2)
The Health Insurance Portability and Accountability Act of 1996	76	(3)
State Regulation of Managed Care	79	(3)
Managed Care's Regulatory Evolution: Driving Change in the New Century	82	(2)
Epilogue---Managed Health Care at the Millennium	84