Health insurance and managed care : what they are and how they work / Peter R. Kongstvedt, MD, FACP, Senior Health Policy Faculty, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia

Author:: Kongstvedt, Peter R. (Peter Reid)
Uniform Title:: Managed care
Published:: Burlington, MA : Jones & Bartlett Learning, [2020]
Edition:: Fifth edition.
Physical Description:: xxx, 324 pages ; 23 cm

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Contents:

Machine generated contents note: -- Chapter1 A History of Managed Health Care and Health Insurance in the United States Chapter2 Health Benefits Coverage, and Types of Health Plans and Payers Chapter3 The Provider Network Chapter4 Provider Payment Chapter5 Utilization Management, Quality Management, and Accreditation Chapter6 Sales, Governance, and Administration Chapter7 Medicare Advantage and Medicaid Managed Care Chapter8 Laws and Regulations in Health Insurance and Managed Care.

Summary:

"The term "managed care" or "managed healthcare" describes a group of activities ostensibly intended to reduce the cost of providing for-profit health care while improving the quality of that care. One of the most common forms of managed care is the use of a panel or network of healthcare providers to provide care to enrollees. Managed care is so ubiquitous in the US, it has become nearly synonymous with health insurance.Health Insurance and Managed Care: What They Are and How They Work 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"--
"Health Insurance and Managed Care: What They Are and How They Work 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. The Fifth Edition is a thorough update that addresses the current status of the Affordable Care Act 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 insurers in many ways. The Fifth Edition also offers new or expanded coverage of: The history of health insurance and managed care; Instability in the public exchange marketing and sales channels; The impact of limitations on sales, governance and administrative (SG&A) costs and profits; Continued changes in Accountable Care Organizations (ACOs); Continued changes in payment mechanisms such as value-based payment under the Medicare Improvement for Patients and Providers Act (MIPPA); Continued consolidation of the health sector market place"--

Subject(s):

ISBN:

9781284152098 paperback
128415209X paperback

Note:

Revision of: Managed care / Peter R. Kongstvedt. 2009. 3rd ed.

Bibliography Note:

Includes bibliographical references and index.

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