Essentials of Managed Health Care

Introduction  1  Introduction
  Part  One  Introduction to Health Insurance and Managed Health Care
    Chapter  1  A History of Managed Health Care and Health Insurance in the United States By Pete Fox and Peter R. Kongstvedt
    Chapter  2  Types of Health Insurers, Managed Health Care Organizations and Integrated Healthcare Delivery Systems By Eric Wagner and Peter R. Kongstvedt
    Chapter  3  Elements of the Management and Governance Structure By Peter R. Kongstvedt
  Part  Two  Network Contracting and Provider Payment
    Chapter  4  The Provider Network By Peter R. Kongstvedt
    Chapter  5  Provider Payment By Peter R. Kongstvedt
    Chapter  6  Legal Issues in Provider Contracting By Mark S. Joffe and Kelli D. Back
  Part  Three  Management of Utilization and Quality
    Chapter  7  Basic Utilization and Case Management	By Peter R. Kongstvedt
    Chapter  8  Fundamentals and Core Competencies of Disease Management By David W. Plocher
    Chapter  9  Physician Practice Behavior and Managed Health Care By Jay Want and Peter R. Kongstvedt
    Chapter  10  Data Analysis and Provider Profiling in Health Plans By David W. Plocher & Nancy Garrett
    Chapter  11  Prescription Drug Benefits in Managed Care By Robert P. Navarro, Craig Stern, and Rusty Hailey
    Chapter  12  Introduction to Managed Behavioral Healthcare Organizations By Joann Albright, Deborah Heggie, Anthony M. Kotin, Connie Salgy, Wanda Sullivan, and Fred Waxenberg
    Chapter  13  Disease Prevention in Managed Health Care Plans By Mark Manley
    Chapter  14  Quality Management in Managed Health Care By Pamela B. Siren
    Chapter  15  Accreditation and Performance Measurement Programs in Managed Health Care By Margaret E. O\'Kane
  Part  Four  Sales, Finance and Administration
    Chapter  16  Marketing and Sales By Richard Birhanzel
    Chapter  17  Enrollment and Billing By Karl V. Kovacs
    Chapter  18  Claims and Benefits Administration By Donald L. Fowler, Jr. and Elizabeth Pascuzzi
    Chapter  19  Health Care Fraud and Abuse By Christie Moon
    Chapter  20  Member Services By Kevin Knarr and Peter R. Kongstvedt
    Chapter  21  Operational Finance and Budgeting By Dale F. Cook and Christopher Campbell
    Chapter  22  Underwriting and Rating By Michael G. Sturm and Troy M. Filipek
    Chapter  23  Information Systems and Electronic Data Interchange in Managed Health Care By James S. Slubowski
  Part  Five  Special Markets
    Chapter  24  Health Plans and Medicare By John K. Gorman, Jean D. LeMasurier, William A. MacBain, Stephen J. Balcerzak, Wendy K. Burger and Amy Huang
    Chapter  25  Medicaid Managed Health Care By Rodney C. Armstead, Catherine K. Anderson, Elizabeth Cabot Nash
    Chapter  26  The Military Managed Care Health System By M. Nicholas Coppola, Ronald P. Hudak, Forest S. Kim, Lawrence Fulton, Jeffrey P. Harrison, and Bernie Kerr
    Chapter  27  Managed Care in a Global Context By Jonathan P. Weiner, Emily Adrion, Joanna Case Famadas, Djordje Gikic and Hugh Waters
  Part  Six  Laws and Regulations
    Chapter  28  State Regulation of Managed Health Care By Tom Wilder
    Chapter  29  Federal Regulation of Health Insurance and Managed Health Care By Tom Wilder
    Chapter  30  The Patient Protection and Affordable Care Act By Tom Wilder