Managed Care

Maxy Awards "Book of the Year" 2019 "Witty, occasionally crass, and an unqualified delight." -KIRKUS REVIEWS Is it too much to ask that a managed care facility refund a year's advance payment when your grandfather dies before he can move in? Frank Johnson doesn't think so, which is why the thirty-three-year-old now lives in a nursing home, locked in a chess match feud with management that doesn't occupy nearly enough of his time. When foster kid Elroy is thrust into his life, Frank decides to turn this forced relationship to his advantage - launching a string of absurd decisions, inappropriate behaviors and unexpected glimpses of tenderness that ultimately turn a New Jersey suburb upside down. A laugh-out-loud celebration of bad choices for good causes, Managed Care is an offbeat story about three misfits on the social fringes of suburbia and their ridiculous campaign to introduce an unfiltered version of intimacy to their stale, impersonal community. Because, according to Frank, it's probably what Jesus would have wanted.

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.

A managed care expert overviews the history, structure, regulation, and issues of the complex US health care system. This second edition work was originally published by Aspen in 2002. Much of the information is distilled from another of the doctor's books, The Managed Care Handbook, 4th ed. An extensive glossary is included, but there are no refer

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.

This volume offers solutions to a variety of problems from the perspective of the practising physician. It features contributions from experts in law and business, as well as clinical medicine, and aims to help readers ensure that they provide top-quality care in the 1990s and beyond.

Today's managed care contract arrangements require that the provider understand the mechanics, legal aspects and market share implications of single signature, network-oriented, capitated and discounted fee-for-service payment arrangements. This work provides this information and shows the reader how to: evaluate both payer-proposed and self-authored managed care agreements; position their facility and services to secure and maintain managed care agreements that will yield oportunity for more patients and new business; negotiate a profitable managed care contract using suggested techniques for evaluating the capitation rates provided by prospective payers; and develop a capitation rate from their own data and data supplied by the payer.

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.

State by State Guide to Managed Care Law simplifies and expedites your research by giving you immediate access to key court decisions, state managed care policies and practices, and extensive citations to codes and regulations - for all 50 states. Identify your issue in the index and turn to the page indicated. You'll find current, authoritative information that can help you to: Evaluate baseline quality standards Determine when managed care enrollees have access to providers Establish guidelines for collection and disclosure of financial information Arm yourself to tackle the complicated issue of prescription drugs Ensure that the managed care organization recognizes patients' and providers' due process rights

Contributors from a variety of disciplines, including cardiology, surgery, insurance, law, finance, and business, contribute to this book, which is concerned with taking care of the cardiac patient in the evolving world of managed care.

Provides physicians, administrators, and other health professionals with information on managed care, from its history, forms and practices to detailed information on managed care contracting, physician compensation, monitoring, reporting, management, risk, productivity, and accountability. Annotati

Managed care organizations are paving the way to the future of health care delivery in the United States and countries around the world. As managed care systems evolve, a major concern is quality. Managed Care Quality: A Practical Guide is a collection of applications and experiences gathered from practicing health professionals in the field of managed care. This first "how to" guide was written to help managed care organizations meet the common objective of ensuring the best quality of services and care. Managed Care Quality: A Practical Guide presents successive steps in implementing quality in health care organizations. It introduces the methods, skills, and practices involved in quality health care programs and offers solutions to problems typically encountered in managed care.

Public Health

Written from a practical perspective, Managed Care Pharmacy Practice takes the reader through the issues critical to development and operation of a managed care pharmacy program. The reader will gain new insights into how managed care has altered the delivery of pharmacy services, as well as into the evolving role of pharmacists.Managed Care Pharmacy Practice explains the fundamentals of developing and operating a successful managed care pharmacy benefit, and also supplies insightful guidance on professional careers in the field. This text takes a sequential approach to history, background, program components, program development, operations, and performance measurement, with 25 chapters arranged in three main sections.