Making Managed Healthcare Work

Making Managed Healthcare Work is your comprehensive guide to developing and implementing a new strategic approach to managed care that's practical, performance-based, and results-oriented. Learn how to prepare for, identify, pursue, negotiate and implement a new type of managed care arrangement that can accomplish the objective of delivering quality care at competitive prices.

All children are dependent on others for their care and well-being, but children in foster care are uniquely dependent upon governments and their agencies and services. These children have complex problems rooted in family, social, and environmental conditions, and often need a broad range of health, mental health, and developmental services to overcome the effects of abuse and neglect. This guide will help purchasers of managed health care understand the complex health care and social service needs of children in foster care.

Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.

Concentrating on quantitative methods for proper quality improvement documentation, the authors explain the processes for improving quality assurance among health care providers. Topics covered include group processes, statistical process control, clinical practice guidelines, care management, the l