| Document Type
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BL
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| Record Number
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849475
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| Title & Author
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Essentials of managed health care /\ [edited by] Peter R. Kongstvedt.
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| Edition Statement
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6th ed.
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| Publication Statement
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Burlington, MA :: Jones and Bartlett Learning,, ©2013.
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| Page. NO
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xxv, 688 pages :: illustrations ;; 26 cm
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| ISBN
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1449604641
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: 1449653316
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: 9781449604646
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: 9781449653316
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| Notes
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Revised edition of: The managed health care handbook. 4th ed. 2001. Also rev. ed. of: Essentials of managed health care. 4th ed. 2001.
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| Bibliographies/Indexes
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Includes bibliographical references and index.
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| Contents
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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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| Abstract
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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.
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| Subject
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Managed care plans (Medical care)-- Management.
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Managed care plans (Medical care)-- Management.
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| Subject
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Managed Care
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Managed Care Programs-- organization administration.
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| Subject
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Delivery of Health Care-- economics.
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| Subject
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United States.
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| Dewey Classification
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362.1/04258
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| LC Classification
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RA413.E87 2013
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| NLM classification
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2012 F-169
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W 130 AA1E7 2013
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| Added Entry
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Kongstvedt, Peter R., (Peter Reid)
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