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Making Managed Healthcare Work is your comprehensive guide to developing and implementing a new strategic approach to managed care that's practical, performance-based, and results-oriented. Learn how to prepare for, identify, pursue, negotiate and implement a new type of managed care arrangement that can accomplish the objective of delivering quality care at competitive prices.
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.
Author : Institute of Medicine Publisher : National Academies Press Page : 394 pages File Size : 24,33 MB Release : 1997-04-21 Category : Medical ISBN : 0309175054
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.
National Academies of Sciences, Engineering, and Medicine
Author : National Academies of Sciences, Engineering, and Medicine Publisher : National Academies Press Page : 161 pages File Size : 46,57 MB Release : 2018-04-02 Category : Medical ISBN : 030946921X
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
United States. Congress. House. Committee on Commerce. Subcommittee on Health and the Environment
Author : United States. Congress. House. Committee on Commerce. Subcommittee on Health and the Environment Publisher : Page : 216 pages File Size : 46,23 MB Release : 1998 Category : Medical ISBN :
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.
Author : Institute of Medicine Publisher : National Academies Press Page : 191 pages File Size : 14,51 MB Release : 2003-07-01 Category : Medical ISBN : 030913319X
The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education. These core competencies include patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics. This book recommends a mix of approaches to health education improvement, including those related to oversight processes, the training environment, research, public reporting, and leadership. Educators, administrators, and health professionals can use this book to help achieve an approach to education that better prepares clinicians to meet both the needs of patients and the requirements of a changing health care system.