Managed Care Strategies 1997

This book is a guide to strategic training for physicians in an era of managed care. The first half of the book provides a step-by-step process to help physicians take their practices into the new world of integrated delivery systems. The second half of the book covers a variety of key topics such as credentialing, reimbursement systems, and utilization management.

Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.

Of all the recent changes in health care, none have more dramatically affected both patients and care providers than managed care. Not only has it altered the way we pay for health care but also it has compelled a change in the way we approach health care, focusing increasingly on preventive care to reduce costs. In Managed Care, Dr. Margaret M. Conger and her colleagues examine the impact of managed care on nursing as a profession and nurses as individual caregivers. Organized into three sections, Managed Care looks at the nature of managed care, nursing strategies in acute care hospitals, and nursing strategies in community settings. Section I examines the evolution of managed care, definitions, and issues informing this method of service delivery, and nursing involvement in quality of care and case management. In Section II, the authors look at acute care settings, discussing the use of nurse extenders, advanced practice nursing, case management, automated clinical pathways, and outcome research. Section III addresses the community settings and explores case management, advanced practice roles in community health clinics, and collaboration in primary care settings. Managed Care will serve as an excellent course text on nursing and managed care, as well as being a useful introduction and shelf reference for professional nurses at all levels.

Managed Care Services explores the complexities of managed health and behavioral health care systems in relation to policy, program, and research issues. It focuses on the dramatic consequences of the transformation of health care delivery from an essential social good to a commodity totally dependent on the marketplace. The book begins with a foreword by James J. Callahan Jr., a leading authority in the field, and includes an interdisciplinary group of authors who address multiple fields of practice. A common theme throughout the book is the inadequacy of service for such high-risk groups as children, the elderly, the mentally ill, the disabled, the chronically ill, substance abusers, and minorities of color. These at-risk groups include, but are not limited to, the vast numbers of un- and underinsured people in the United States. Specific topics covered in the book include cost of access to care; parity of behavioral health care services reimbursement; health services utilization patterns; education of health care professionals and professional autonomy; care management; and ethical issues arising from the structure of managed care administrative and organizational systems. The importance of research, especially program outcome assessments, is also emphasized. Managed Care Services provide a broad overview of "macro" managed care issues and is an invaluable resource for students and professionals interested in the intersection of social work and health care.

This comprehensive text offers a broad view of health care policy, health services delivery and organization, and health care management. Drawing on the insights of over 100 scholars and leading practitioners, it highlights organizational changes reflected in health care mergers, networks, and affiliations and describes the role of funding agencies in the direct provision of services. Providing over 2350 references, tables, and drawings, the book charts the influences of managed care on provisions, funding, and the configuration of providers and services, and portrays the increasingly influential and challenging role of health administrators.