Part 1 Introduction to Managed Health Care
Chapter 1 The Origins of Managed Health Care
Chapter 2 Types of Managed Care Plans and Integrated Healthcare Delivery Systems
Chapter 3 Elements of the Management Control and Governance Structure
Chapter 4 Common Myths and Assertions about Health Plans
Part 2 The HealthCare Delivery System
Chapter 5 Physician Networks in Managed Health Care
Chapter 6 Basic Compensation of Physicians in Managed Health Care
Chapter 7 Hospitals, Facilities, and Ancillary Services
Chapter 8 Performance-Based Incentives in Managed Health Care: Pay-for-Performance
Part 3 Medical Management
Chapter 9 Managing Basic Medical-Surgical Utilization
Chapter 10 Fundamentals and Core Competencies of Disease Management
Chapter 11 Case Management
Chapter 12 Prescription Drug Benefits in Managed Health Care
Chapter 13 Introduction to Managed Behavioral Healthcare Organizations
Chapter 14 The Role of Health Plans in Preventing Disease
Chapter 15 Quality Management in Managed Care Siren
Chapter 16 Data Analysis and Profiling in Health Plans
Part 4 Operational Management and Marketing
Chapter 17 Information Technology in the Healthcare Organization
Chapter 18 Claims Administration
Chapter 19 Member Services
Chapter 20 Healthcare Consumerism
Chapter 21 Sales and Marketing Birhanzel
Chapter 22 The Employer’s View of Managed Health Care
Chapter 23 Accreditation and Performance Measurement Programs for Managed Care Organizations
Chapter 24 Operational Finance and Budgeting
Chapter 25 Underwriting and Rating Functions
Part 5 Special Markets
Chapter 26 Medicare and Managed Care
Chapter 27 Medicaid Managed Care
Chapter 28 The Military Managed Healthcare System
Chapter 29 Managed Care in a Global Context
Part 6 Legal and Regulatory Issues
Chapter 30 Legal Issues in Provider Contracting
Chapter 31 ERISA
Chapter 32 HIPAA
Chapter 33 State Regulation of Managed Care