Part I: Introduction to Managed Care

Chapter 1. An Overview of Managed Care
Chapter 2. Types of Managed Care Organizations
Chapter 3. Integrated Health Care Delivery Systems
Chapter 4. Elements of the Managerial Control and Governance Structure
Chapter 5. Examining Common Assertions about Managed Care

Part II: The Health Care Delivery System

Chapter 6. Primary Care in Managed Health Care Plans
Chapter 7. Compensation of Primary Care Physicians in Managed Health Care
Chapter 8. Contracting and Reimbursement of Specialty Physicians
Chapter 9. Negotiating and Contracting with Hospitals, Institutions, and Ancillary Services

Part III: Medical Management

Chapter 10. Care Management and Clinical Integration
Chapter 11. Managing Basic Medical-Surgical Utilization
Chapter 12. Clinical Services Requiring Authorization
Chapter 13. Case Management and Managed Care
Chapter 14. Fundamentals and Core Competencies of Disease Management
Chapter 15. Prescription Drug Benefits in Managed Care
Chapter 16. Managed Behavioral Health Care and Chemical Dependency Services
Chapter 17. Quality Management in Managed Care
Chapter 18. Using Data Provider Profiling in Medical Management
Chapter 19. Physician Behavior Change in Managed Health Care

Part IV: Operational Marketing and Management

Chapter 20. Information Systems in Managed Health Care Plans
Chapter 21. Claims and Benefits Administration
Chapter 22. Member Services and Consumer Affairs
Chapter 23. Sales and Marketing in Managed Health Care Plans: The Process of Distribution
Chapter 24. The Employer's View of Managed Health Care: Show Me the Value
Chapter 25. The Impact of Consumerism on Managed Health Care
Chapter 26. Accreditation and Performance Measurement Programs for Managed Care Organizations
Chapter 27. Common Operational Problems in Managed Health Care Plans
Chapter 28. Operational Finance and Budgeting
Chapter 29. Underwriting and Rating Functions Common to Most Markets

Part V: Medicare and Medicaid

Chapter 30. Medicare and Managed Care
Chapter 31. Medicaid Managed Care

Part V: Regulatory and Legal Issues

Chapter 32. Legal Issues in Provider Contracting
Chapter 33. Legal Liability Related to Medical Management Activities
Chapter 34. The Health Insurance Portability and Accountability Act of 1996
Chapter 35. State Regulation of Managed Care
Chapter 36. Managed Care's Regulatory Evolution: Driving Change in the New Century

Epilogue: Managed Health Care at the Millennium