Essentials of Managed Health Care, Sixth Edition
- 27h 56m
- Peter R. Kongstvedt
- Jones and Bartlett Learning
- 2012
As the most widely-used textbook on managed care, Essentials of Managed Health Care 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. The Sixth Edition is a thorough revision that addresses the impact of HR 3590, the Patient Protection and Affordable Care Act, as well as other new laws such as the Genetic Information Non-disclosure Act (GINA).
About the Author
Dr. Peter R. Kongstvedt is an independent strategic advisor and a Senior Health Policy Faculty member in the Department of Health Administration and Policy at George Mason University. With over 30 years of industry experience as both a senior-level executive and with global consulting firms, he is a well-known national authority on the healthcare industry, with particular expertise in health insurance and managed health care. Dr. Kongstvedt is also the author of Managed Care, What it Is and How it Works, and recently created an online multimedia training program on health insurance and managed care. Prior to passage of health reform, he consulted with and made several appearances on The CBS Evening News and also appeared on NBC's Today Show.
He is principal of the P.R. Kongstvedt Company, LLC, and Kongstvedt Learning Solutions, LLC, in McLean, Virginia.
In this Book
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A History of Managed Health Care and Health Insurance in the United States
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Types of Health Insurers, Managed Health Care Organizations, and Integrated Health Care Delivery Systems
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Elements of the Management and Governance Structure
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The Provider Network
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Provider Payment
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Legal Issues in Provider Contracting
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Basic Utilization and Case Management
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Fundamentals and Core Competencies of Disease Management
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Physician Practice Behavior and Managed Health Care
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Data Analysis and Provider Profiling in Health Plans
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Prescription Drug Benefits in Managed Care
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Introduction to Managed Behavioral Health Care Organizations
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Disease Prevention in Managed Health Care Plans
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Quality Management in Managed Health Care
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Accreditation and Performance Measurement Programs in Managed Health Care
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Marketing and Sales
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Enrollment and Billing
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Claims and Benefits Administration
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Health Care Fraud and Abuse
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Member Services
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Operational Finance and Budgeting
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Underwriting and Rating
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Information Systems and Electronic Data Interchange in Managed Health Care
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Health Plans and Medicare
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Medicaid Managed Health Care
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The Military Managed Care Health System
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Managed Care in a Global Context
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State Regulation of Managed Health Care
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Federal Regulation of Health Insurance and Managed Health Care
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The Patient Protection and Affordable Care Act
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