Essentials of Managed Health Care - 9781449653316

Kongstvedt (health administration and policy, George Mason U.) provides graduate students, health care administrators, policy makers, and those who work in the payer industry with a guide to managed health care. He describes the history of health insurance and managed care in the US and different types of insurers, managed care organizations, and integrated delivery systems, and their governance and management structure. He explains the structure of payer networks, provider payment methods and modifiers, and the elements of a contract between a payer and provider; utilization management and quality; sales, finance, and administration; special markets (Medicare, managed Medicaid, military managed care, and the global setting); and laws and regulations (rewritten for this edition). This edition has new contributors; new chapters on the Patient Protection and Affordable Care Act, physician practice behavior and managed health care, enrollment and billing, and fraud and abuse; rewritten chapters on information systems and electronic data interchange and Medicaid; and a new focus on structure and payment across all types of healthcare delivery systems, with expanded discussion of new elements and dynamics in network contracting and provider payment. Online access to additional course materials is included. Annotation ©2013 Book News, Inc., Portland, OR (booknews.com)