INTRODUCTION TO MANAGED CARE
An Overview of Managed Health Care
Types of Managed Care Organizations
Elements of Management Control Structure

THE HEALTH CARE DELIVERY SYSTEM
Primary Care in Closed and Open Panels
Compensation of Primary Care Physicians in Open Panels
Negotiating and Contracting with Consultants
Negotiating and Contracting with Hospitals and Institutions

MEDICAL MANAGEMENT
Changing Provider Behavior in Managed Care Plans
Controlling Hospital Utilization
Controlling Referrals/Consultant Utilization
Controlling Utilization of Ancillary and Emergency Services
Managed Mental Health and Substance Abuse Services
Pharmaceutical Services in Managed Care
Quality Management
Use of Data and Reports in Medical Management Authorization Systems
Formal Physician Performance Evaluations

GENERAL MANAGEMENT AND MARKETING
Member Services and Consumer Affairs
Claims and Benefits Administration
Outside Accreditation of Managed Care Plans
Common Operational Problems in Managed Health Care Plans
The Employer's View of Managed Health Care: From a Passive to an Aggressive Role
Marketing Managed Health Care Plans

FINANCE AND UNDERWRITING
Operational Finance and Budgeting
Rating and Underwriting

SPECIAL MARKET SEGMENTS
The Federal Employees Health Benefit Program and Managed Care
Medicare and Managed Care
Medicare Risk Contracting: An Industry Perspective
Managed Care for Retirees and the Elderly
Medicaid and Managed Care
CHAMPUS and the Department of Defense Managed Care Programs
Workers' Compensation Medical Benefits: A Practical Framework for Implementing New Cost Containment Strategies

RELATIONSHIPS WITH GOVERNMENT REGULATORY AGENCIES
State Regulation
The Hows and Whys of Federal Qualification and Eligibility

LEGAL ISSUES
Legal Issues in Provider Contracting
Legal Issues and Antitrust Considerations in the Establishment of Credentialing and Other Selection Criteria
Medical Management and Legal Obligations to Members