Managed Care Success

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Managing Managed Care

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309175054
Total Pages : 394 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Managing Managed Care by : Institute of Medicine

Download or read book Managing Managed Care written by Institute of Medicine and published by National Academies Press. This book was released on 1997-04-21 with total page 394 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.

Case Management

Author : Suzanne K. Powell
Publisher : Lippincott Williams & Wilkins
ISBN 13 : 9780781718837
Total Pages : 548 pages
Book Rating : 4.7/5 (188 download)

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Book Synopsis Case Management by : Suzanne K. Powell

Download or read book Case Management written by Suzanne K. Powell and published by Lippincott Williams & Wilkins. This book was released on 2000 with total page 548 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Second Edition of this comprehensive "how to" text has been completely revised and updated. This text outlines the basics of case management and illustrates some of the pitfalls encountered in the field of case management. The book provides information on the new Case Management Standards, supplies standard definitions and guidelines of case management for the practicing case manager, and presents information on caring for clients in a wide variety of health care settings. New to this edition--chapters focusing on Quality Reviews and Risk Management with a strong emphasis on Continuous Quality Improvement (CQI), ethical and legal issues, and various case studies.

Health Insurance and Managed Care

Author : Peter R. Kongstvedt
Publisher : Jones & Bartlett Learning
ISBN 13 : 128415209X
Total Pages : 355 pages
Book Rating : 4.2/5 (841 download)

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Book Synopsis Health Insurance and Managed Care by : Peter R. Kongstvedt

Download or read book Health Insurance and Managed Care written by Peter R. Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2019-02-14 with total page 355 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.

Managed Competition

Author :
Publisher : DIANE Publishing
ISBN 13 : 9780788100260
Total Pages : 120 pages
Book Rating : 4.1/5 (2 download)

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Book Synopsis Managed Competition by :

Download or read book Managed Competition written by and published by DIANE Publishing. This book was released on 1993-07 with total page 120 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pamphlet from the vertical file.

Managed Care Success

Author : James W. Saxton
Publisher : Jones & Bartlett Learning
ISBN 13 : 9780834210233
Total Pages : 328 pages
Book Rating : 4.2/5 (12 download)

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Book Synopsis Managed Care Success by : James W. Saxton

Download or read book Managed Care Success written by James W. Saxton and published by Jones & Bartlett Learning. This book was released on 1998 with total page 328 pages. Available in PDF, EPUB and Kindle. Book excerpt: The number of malpractice claims And The severity of final judgments could explode under managed care. Physicians and managed care organizations are on a collision course with malpractice when patient expectations are at an all-time high, and pressures of efficiency are constantly increasing. Defensive medicine -- doing procedures or additional tests, To protect the provider will no longer work. Utilization controls will penalize you, and ultimately, limit your practice. So what's the solution? to be successful in this evolving health care environment, you've got to change with it. You've got to be informed, be prepared, and ready to coexist with it. That's precisely why you need Managed Care Success: Reducing Risk While Increasing Patient Satisfaction . You'll learn how to work with -- not against -- managed care.

Nursing Case Management

Author : Suzanne K. Powell
Publisher : Lippincott Williams & Wilkins
ISBN 13 :
Total Pages : 422 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Nursing Case Management by : Suzanne K. Powell

Download or read book Nursing Case Management written by Suzanne K. Powell and published by Lippincott Williams & Wilkins. This book was released on 1996 with total page 422 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Managed Care Systems and Emerging Infections

Author :
Publisher :
ISBN 13 :
Total Pages : 113 pages
Book Rating : 4.:/5 (99 download)

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Book Synopsis Managed Care Systems and Emerging Infections by :

Download or read book Managed Care Systems and Emerging Infections written by and published by . This book was released on 2000 with total page 113 pages. Available in PDF, EPUB and Kindle. Book excerpt:

America's Health Care Safety Net

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 030906497X
Total Pages : 304 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis America's Health Care Safety Net by : Institute of Medicine

Download or read book America's Health Care Safety Net written by Institute of Medicine and published by National Academies Press. This book was released on 2000-09-04 with total page 304 pages. Available in PDF, EPUB and Kindle. Book excerpt: America's Health Care Safety Net explains how competition and cost issues in today's health care marketplace are posing major challenges to continued access to care for America's poor and uninsured. At a time when policymakers and providers are urgently seeking guidance, the committee recommends concrete strategies for maintaining the viability of the safety netâ€"with innovative approaches to building public attention, developing better tools for tracking the problem, and designing effective interventions. This book examines the health care safety net from the perspectives of key providers and the populations they serve, including: Components of the safety netâ€"public hospitals, community clinics, local health departments, and federal and state programs. Mounting pressures on the systemâ€"rising numbers of uninsured patients, decline in Medicaid eligibility due to welfare reform, increasing health care access barriers for minority and immigrant populations, and more. Specific consequences for providers and their patients from the competitive, managed care environmentâ€"detailing the evolution and impact of Medicaid managed care. Key issues highlighted in four populationsâ€"children with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless.

Managed Care: What It Is and How It Works

Author : Peter R. Kongstvedt
Publisher : Jones & Bartlett Publishers
ISBN 13 : 1449649823
Total Pages : 295 pages
Book Rating : 4.4/5 (496 download)

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Book Synopsis Managed Care: What It Is and How It Works by : Peter R. Kongstvedt

Download or read book Managed Care: What It Is and How It Works written by Peter R. Kongstvedt and published by Jones & Bartlett Publishers. This book was released on 2008-09-19 with total page 295 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.

Physician's Managed Care Success Manual

Author : Scott Becker
Publisher :
ISBN 13 :
Total Pages : 420 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Physician's Managed Care Success Manual by : Scott Becker

Download or read book Physician's Managed Care Success Manual written by Scott Becker and published by . This book was released on 1999 with total page 420 pages. Available in PDF, EPUB and Kindle. Book excerpt: Broad changes in the methods of paying for health care services have led to vast changes in the practice of medicine. This book provides the basic tools, including checklists, sample contracts, and key terms a physician needs to take charge of his or her future in the evolving health care system. It explains models and concepts that are available from market to market. More important, this book provides numerous tested strategies for responding to opportunities and the basic principles and means by which to judge situations and proposals. It will guide today's physicians through the managed care maze as they develop business plans and negotiate contracts. * Helps you take and maintain control over patient care by maximizing your autonomy. * Outlines differences in practice type and summarizes the pros and cons of your various options within the managed care environment. * Uses real-life examples throughout, discussing both successes and failures of other entrepreneurial physicians.

Managed Care

Author : Peter Kongstvedt
Publisher : Jones & Bartlett Learning
ISBN 13 : 0763759112
Total Pages : 295 pages
Book Rating : 4.7/5 (637 download)

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Book Synopsis Managed Care by : Peter Kongstvedt

Download or read book Managed Care written by Peter Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2009-10-07 with total page 295 pages. Available in PDF, EPUB and Kindle. Book excerpt: The origins of managed health care -- Types of managed care organizations and integrated health care delivery systems -- Network management and reimbursement -- Management of medical utilization and quality -- Internal operations -- Medicare and Medicaid -- Regulation and accreditation in managed care.

Leading Medicaid Managed Care Plans

Author : Arlene Davidson
Publisher : Taylor & Francis
ISBN 13 : 1351398423
Total Pages : 85 pages
Book Rating : 4.3/5 (513 download)

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Book Synopsis Leading Medicaid Managed Care Plans by : Arlene Davidson

Download or read book Leading Medicaid Managed Care Plans written by Arlene Davidson and published by Taylor & Francis. This book was released on 2017-10-19 with total page 85 pages. Available in PDF, EPUB and Kindle. Book excerpt: Leading Medicaid Managed Care Plans examines leadership actions necessary to successfully operate a Medicaid managed care plan with emphasis on the relationship with the state Medicaid agency the health plan is contracted with. With appropriate operational and governance oversight, and with solid mutually respectful relationships with the state agency, Medicaid health plans are more likely to sustain success and prosperity for the long term. The approach of Leading Medicaid Managed Care Plans builds on key infrastructure elements that need to be in place when contracting with a state agency, and for overall success of the organization. It takes a pragmatic and methodical approach, interspersed with real-life examples of what to do for success and what actions to avoid that frequently lead to failure. This approach is different from most managed care books (Medicaid or otherwise) as those mostly focus on the process of the business (such as details around claims payment, or provider contracting) and ignore the role of the state Medicaid agency and its importance in retaining the contractual relationship. This book differs also on its emphasis on organizational foundational elements and strategic leadership skills necessary to sustain success. The author has years of experience in turning around failing Medicaid managed care plans and observing what they all had in common that contributed to those failures. One common feature was the deterioration of the relationship with the state Medicaid agency they were contracted with, and how close they all came to losing their multi-million dollar businesses. The purpose of this book is to educate and inspire managed care executives and senior leaders who operate Medicaid health plans and to help them understand what elements are needed for successful health plans and a sustainable relationship with the people directing the state Medicaid agency.

Essentials of Managed Health Care

Author :
Publisher : Jones & Bartlett Publishers
ISBN 13 : 1449604641
Total Pages : 715 pages
Book Rating : 4.4/5 (496 download)

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Book Synopsis Essentials of Managed Health Care by :

Download or read book Essentials of Managed Health Care written by and published by Jones & Bartlett Publishers. This book was released on 2013 with total page 715 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.

Managing Outcomes, Process and Cost in a Managed Care Environment

Author : Roey Kirk
Publisher : Jones & Bartlett Learning
ISBN 13 : 9780834209121
Total Pages : 302 pages
Book Rating : 4.2/5 (91 download)

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Book Synopsis Managing Outcomes, Process and Cost in a Managed Care Environment by : Roey Kirk

Download or read book Managing Outcomes, Process and Cost in a Managed Care Environment written by Roey Kirk and published by Jones & Bartlett Learning. This book was released on 1997 with total page 302 pages. Available in PDF, EPUB and Kindle. Book excerpt: Nursing

Making Managed Care Work

Author : Genie James
Publisher : Irwin Professional Publishing
ISBN 13 :
Total Pages : 342 pages
Book Rating : 4.4/5 (91 download)

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Book Synopsis Making Managed Care Work by : Genie James

Download or read book Making Managed Care Work written by Genie James and published by Irwin Professional Publishing. This book was released on 1997 with total page 342 pages. Available in PDF, EPUB and Kindle. Book excerpt: Making Managed Care Work explores the success factors necessary to win in the managed care arena. This practical guide goes beyond cookie-cutter solutions to offer pragmatic ideas and innovative answers. It presents you with the tools you need to develop a multi-faceted strategy that can address immediate financial tensions while also aligning future goals with current objectives. Making Managed Care Work focuses on the critical dimensions of managed care: business development, integrated delivery network design and new-product/service-line definitions. Reading this resource will provide you with the means to organize your strategy and put your goals in focus. It features methodologies - rules to follow when conducting internal diagnosis and evaluating the financial impact of current business strategies; a matrix - to assist in identifying indicators of marketplace change; and case studies - in-depth descriptions of strategies, infrastructures and accomplishments of providers successfully making the leap to the next generation of healthcare, as well as the faulty rationale, hazards and unseen market forces that have hindered failing providers. You must make decisions regarding acute situations where past experience will not give you the answers for the present or future. Making Managed Care Work provides you with researched, intelligent and valuable information that you can use immediately to strategically position yourself on top.

Essentials of Managed Health Care

Author : Peter Reid Kongstvedt
Publisher : Jones & Bartlett Learning
ISBN 13 : 9780763724962
Total Pages : 918 pages
Book Rating : 4.7/5 (249 download)

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Book Synopsis Essentials of Managed Health Care by : Peter Reid Kongstvedt

Download or read book Essentials of Managed Health Care written by Peter Reid Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2003 with total page 918 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Mental Health Providers Guide To Managed Care

Author : Leonard Reich
Publisher : W. W. Norton & Company
ISBN 13 : 9780393705041
Total Pages : 252 pages
Book Rating : 4.7/5 (5 download)

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Book Synopsis Mental Health Providers Guide To Managed Care by : Leonard Reich

Download or read book Mental Health Providers Guide To Managed Care written by Leonard Reich and published by W. W. Norton & Company. This book was released on 2006 with total page 252 pages. Available in PDF, EPUB and Kindle. Book excerpt: For both patients and providers, the words managed care are loaded with negative connotations, synonymous with inefficiency and bureaucracy. Forced to perform a delicate balancing act of offering the best possible care for their clients while carefully adhering to various managed care policies and procedures, providers in particular often wince at the prospect of having to deal with managed care companies, or MCOs. Fearing burdensome paperwork, low reimbursement rates, and denials of care, it's not surprising that a number of mental health professionals choose to limit their involvement with managed care companies-or eliminate it altogether. "My clients are all on different health plans; how can I keep the policies straight?" "Getting services approved is so time-consuming that I'm better off accepting only self-paying clients, aren't I?" "Do the benefits of working with MCOs really outweigh the drawbacks?" The answer, according to two industry insiders, is yes. If you know how to work with the system, the system can work for you. Mental Health Provider's Guide to Managed Care is the first handbook of its kind to offer clinicians a window into the inner-workings of MCOs. Authors Reich and Kolbasovsky candidly draw on their combined 37 years experience in the field to walk readers through all the major elements of how to successfully work within the system: marketing yourself and your practice to an MCO, getting onto a MCO's network, maintaining a good relationship and communicating with MCOs for quick service approval, reducing your liability, understanding your rights and responsibilities, getting paid, and more. Every issue—big and small—is covered, from capitation versus fee-for-service payment arrangements to evaluating which MCOs are a good fit to join, and everything in between. After explaining how to work with the system, the authors reveal how to put the system to work for you. Tips for building your practice through referrals, generating business through doctor collaboration, and understanding future practice opportunities are all covered.By demystifying the complexities of managed care and offering a unique, inside view of the process, this book mitigates the negative connotations associated with MCOs and exposes the hidden benefits of a seemingly burdensome process. Exceedingly reader-friendly and packed with insightful tips and vignettes, Mental Health Provider's Guide to Managed Care is one clinician's guide you won't want to be without.