Essentials of Managed Health Care, 5th Edition

by Peter R. Kongstvedt

As the most widely-used textbook on managed care, Essentials of Managed Health Care provides an authoritative and comprehensive overview of the key strategic, tactical, and operational aspects of managed health care and health insurance. With a primary focus on the commercial sector, the book also addresses managed health care in Medicare, Medicaid, and military medical care. An historical overview and a discussion of taxonomy and functional differences between different forms of managed health care provide the framework for the operational aspects of the industry as well. This revision includes updates to all chapters, as well New chapters on disease management, case management, pharmacy benefits management, behavioral health management, prevention, and the use of data and analysis in care management. New chapters on claims administration, sales and marketing, healthcare consumerism, and the employer s view of managed health care. Completely revised chapter on the new Medicare/Medicaid laws and programs. New chapters on the military health system and managed care in a global context. New chapter on HIPAA.

Genres: Health Care

Paperback

First published December 13, 1994

Reviews

[Andrew Taylor · Rating 4 out of 5]

Comprehensive to the point of redundancy and exhaustion. It really has full breadth of material, though it could have gone more in depth on underwriting and actuarial science as it goes so painfully in depth into so many other, less important, aspects of health care. But that's my slant as I was reading it from the perspective of a new payer organization employee, so understanding those more in depth would have been helpful. I'm giving it 4 stars because I wanted something with a lot of content, and this delivered, but the delivery of said material has quite a lot of room from improvement

[Aany Tazmin · Rating 3 out of 5]

The content of the book is fair to good, but the writing is VERY uneven.

(Stands to reason as the chapters were written by a variety of authors - it's too bad some of them are clearly not actually writers.)

Also, wouldn't you think an editor would be a good idea?

Check out some lovely examples of how not to open your chapter:

"To manage successfully a managed care organization or payer organization, the value financial managers provide their organizations starts with their ability to interact with the operational and medical managers, to manage changes in the regulatory environment, and gather timely information to facilitate communication of financial results to the organization and its constituencies to react appropriately to sustain or exceed financial goals...

The focus of this chapter is a review of the components of the financial statements of a payer, key information and the operational procedures that the financial manager will need and rely upon, addresses typical problems that occur in gathering information and provides insight into the challenge of the integrity of information."

[Chris · Rating 5 out of 5]

Excellent comprehensive overview of the complex acronym-cluttered landscape of managed care. Like the "Handbook of Managed Care" by the same author, but with a few chapters omitted.