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Few large institutions have changed as fully and dramatically as the U.S. healthcare system since World War II. Compared to the 1930s, healthcare now incorporates a variety of new technologies, service-delivery arrangements, financing mechanisms, and underlying sets of organizing principles. This book examines the transformations that have occurred in medical care systems in the San Francisco Bay area since 1945. The authors describe these changes in detail and relate them to both the sociodemographic trends in the Bay Area and to shifts in regulatory systems and policy environments at local, state, and national levels. But this is more than a social history; the authors employ a variety of theoretical perspectives—including strategic management, population ecology, and institutional theory—to examine five types of healthcare organizations through quantitative data analysis and illustrative case studies. Providing a thorough account of changes for one of the nation's leading metropolitan areas in health service innovation, this book is a landmark in the theory of organizations and in the history of healthcare systems.

Managed care contracting is a process that frustrates even the best administrators. However, to ignore this complexity is to do so at your own expense. You don’t necessarily need to bear the cost of overpriced legal advice, but you do need to know what questions to ask, what clauses to avoid, what contingencies to cover ... and when to ask a lawyer for help. Decode and analyze reimbursement problems, loopholes, and contract stipulations you are likely to encounter Learn tried-and-true tricks, tools, shortcuts, and techniques to evaluate agreements Negotiate contracts that won’t leave you open to unanticipated expenses Written by Maria K. Todd, a seasoned professional in managed care contracting, this handbook is written for managers, analysts, and finance officers who have the daunting task of negotiating contracts for medical services. It offers an in-depth examination of managed care and its organizations and covers key areas, such as pay-for-performance initiatives, reimbursement methods, contract law basics, and negotiating strategies.The Managed Care Contracting Handbook offers critical details and strategic information as well as resources on everything from HMOs and PPOs to Consumer Driven Health Plans (CDHP), self-funded ERSIA payers, and Medicaid managed care.Fully updates the first edition, which was used widely in the U.S. and overseas. Designed to equip you with the confidence that comes with knowing the right questions to ask and more answers than you are supposed to know, this easy-access resource ― Provides a complete overview of managed care organizations Covers contract law basics Presents material that can be used internationally Discusses Medicaid Managed Care Offers an operational evaluation of a typical managed care agreement Includes sample contracts and important checklists, as well as a glossary

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.The Fifth Edition also offers new or expanded coverage of:· “Moral hazard,” and its application in health insurance and managed care· The ever expanding and evolving payment systems and methodologies used in the U.S. Healthcare System· The role of benefits design along with discussion about medical necessity and its impact on benefits coverage· The impact of limitations on sales, governance and administrative (SG&A) costs and profits · Continued changes in payment mechanisms such as value-based payment under the Medicare Improvement for Patients and Providers Act (MIPPA)· Medicare Part D, the drug benefit and the plans that offer it, as well as the complexities of Medicare Advantage payment plans, Medicaid expansion under ACA, and more.

Medicaid is the primary means for providing medical care to the nation's indigent and disabled populations. Almost 13 percent of all Americans received some form of medical coverage, such as physician services or long-term care, through Medicaid in the early 1990s. The costs continue to rise dramatically, and state governments have become alarmed by the growing share of their budgets that Medicaid consumes.Daniels and his contributors present the efforts of 16 states to reform their Medicaid programs through a system of managed care―programs that seek to control or manage the use by patients of physicians and other heath care services. They present an overview of the inconsistency and paradox of American health care, pointing to the ways each state's unique political and economic variables give rise to individually stylized approaches to the delivery of Medicaid services. The most comprehensive look at state efforts in Medicaid reform, the book will be an invaluable resource for scholars and researchers in the fields of public and health administration, for practitioners, and for policymakers.

How to Beat the System and Get the Health Care You WantAre you spending more time pushing phone buttons to work your way through your managed care organization's menu of options and arguing with case managers than seeing your doctor? Then you need this guide from the ultimate insider--a doctor with more than twenty-five years' experience as a clinician who is also a former adviser to one of the nation's largest health insurers. Here's step-by-step information on how to get the best treatment possible in the current climate of gatekeepers and skyrocketing costs. This book will help you:  Get the hospital and doctor you want--even ones not in your plan  Save money on medical bills  Get second opinions--paid for by your managed care company  Get top referrals and check on the credentials of doctors inside your plan  Make sure you're getting the best treatment for such major medical  conditions as cancer, heart disease, infertility, and pregnancy

Maxy Awards "Book of the Year" 2019Pencraft Awards "Best Fiction Book of 2019"“Witty, occasionally crass, and an unqualified delight.” –KIRKUS REVIEWSIs it too much to ask that a managed care facility refund a year’s advance payment when your grandfather dies before he can move in? Frank Johnson doesn’t think so, which is why the thirty-three-year-old now lives in a nursing home, locked in a chess match feud with management that doesn’t occupy nearly enough of his time.When foster kid Elroy is thrust into his life, Frank decides to turn this forced relationship to his advantage – launching a string of absurd decisions, inappropriate behaviors and unexpected glimpses of tenderness that ultimately turn a New Jersey suburb upside down. A laugh-out-loud celebration of bad choices for good causes, Managed Care is an offbeat story about three misfits on the social fringes of suburbia and their ridiculous campaign to introduce an unfiltered version of intimacy to their stale, impersonal community. Because, according to Frank, it’s probably what Jesus would have wanted.

Providing therapists practical solutions to managed care's erosion of their freedom to practice, this book presents a working blueprint for a private-pay psychotherapy practice. Dana C. Ackley casts out the distortions that have crept into many clinicians' thinking as a result of reliance on third-party reimbursement. Based on his own experience, he shows how you can serve clients--and yourself--better by developing real alternatives to the pressures and bureaucracy of managed care. In clear step-by-step detail, including practical exercises and checklists, sample marketing materials, and payment plans, the volume shows you how to:*Rediscover the economic and clinical value of your work*Discard assumptions that might block your progress*Educate yourself about the needs of potential clients*Market and sell your services effectively*Learn ethical, reasonable business-of-practice skills*Diversify into the rewarding area of psychological consultation to businesses.No matter what your clinical style, theoretical orientation, or practice history, you will benefit from the hard-won lessons Dr. Ackley shares in this book.  

...provides thoroughly updated coverage of such important issues as initiation and termination of treatment, as well as patient evaluation and education...reviews resistance and defense, transference, countertransference, dreams, etc.

Providers who ignore the fundamentals of risk management may be placing their organizations in peril. This book helps leaders of such organizations to develop systems that succeed in controlling managed care risk. Hospitals, physicians, integrated deliver systems (IDSs), and other providers that deliver care face unique challenges of risk that differ from those of most insurers and HMOs. Managing Risk addresses risk issues concerning these diverse provider groups and discusses: Quantifying risks of capitation and other managed care arrangements Using a funds flow model to spread risk How provider information systems (ISs) relate to an organization's ability to manage financial risk. Operational and clinical approaches to managing risk Financial incentive programs for physicians PSOs and the future of health care risk

This book presents an optimistic view of the future of mental health work, while providing a balanced look at both sides of the managed care debate. Managed care is portrayed as part of an evolution requiring the participation of informed therapists. This book is persuasive and practical, providing convenient access to an enormous amount of information clinicians need in order to communicate productively with managed care companies. The author emphasizes how using research findings can help therapists improve the quality of therapy while meeting the demands of managed care. A concise review of the crises confronting therapists and a discussion of some effective responses to them, this book addresses some of the field's pet, untested and possibly indefensible assumptions about how therapy should operate. Beginning by acquainting the reader with the philosophy and history of managed care and moving on to the pros and cons of the system, the book then provides practical information on how to meet the expectations of managed care organizations. Additional sections review general psychotherapy outcome research; using three general treatment strategies; specialized therapies for particular disorders and future trends and innovative practice directions some enterprising clinicians are pursuing. For practicing clinicans and anyone interested in mental health.

Managing Managed Care II: A Handbook for Mental Health Professionals, Second Edition, provides an easy-to-learn, easy-to-use method for documenting and communicating the necessity, appropriateness, and course of treatment for managed care review. Using the Patient Impairment Profile method, practitioners can convincingly convey a clinical rationale for treatment, efficiently track progress over time, and demonstrate favorable patient outcomes.Keeping pace with the evolving and expanding presence of managed care, the authors have extensively revised and enlarged the previous edition. New clinical research on the validity and reliability of the impairment terminology has produced a much-improved, clinically valid, and statistically reliable impairment lexicon. Detailed severity rating qualifiers, reference lists of patient objectives, and a useful glossary have been added. All regulations have also been updated.Managing Managed Care II is reference and valuable resource for mental health practitioners and for the individuals who monitor and review treatment. By providing concise, relevant, and outcome-focused treatment information, practitioners become proactive participants in managed care while adeptly articulating the value and quality of their services.

The most authoritative evidence-based approach to mental health policy and design.   Rooted in research findings that support an evidence-based orientation to treatment and recovery, the sixth edition of Mental Health and Social Policy takes a multidisciplinary approach to mental health and social policy. It examines the nature, origins, distribution, and consequences of disorders, while detailing information on the services, programs, and social policies that have been developed to assist people with mental health problems.   Learning Goals Upon completing this book, readers will be able to: Understand the nature, origins, distribution and consequences of mental disorders. Examine the services, programs, and social policies developed to assist people with mental health problems.

May have some shelf-wear due to normal use. Your purchase funds free job training and education in the greater Seattle area. Thank you for supporting Goodwills nonprofit mission!

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.The Fifth Edition also offers new or expanded coverage of:· “Moral hazard,” and its application in health insurance and managed care· The ever expanding and evolving payment systems and methodologies used in the U.S. Healthcare System· The role of benefits design along with discussion about medical necessity and its impact on benefits coverage· The impact of limitations on sales, governance and administrative (SG&A) costs and profits · Continued changes in payment mechanisms such as value-based payment under the Medicare Improvement for Patients and Providers Act (MIPPA)· Medicare Part D, the drug benefit and the plans that offer it, as well as the complexities of Medicare Advantage payment plans, Medicaid expansion under ACA, and more.

Book is in NEW condition. 1.18

The fifth edition text of Mental Health and Social Policy takes a multidisciplinary approach to mental health and social policy. It covers mental health issues and includes important new epidemiological studies, controlled clinical trials, and other investigations that inform the new thrust for evidence-based mental health services. It also covers cutting-edge new information on disparities in mental health care coverage, pharmaceutical companies and the marketing of drugs, PTSD in the wake of the Iraq war and 9/11, the Surgeon General Report on Mental health, the Bush New Freedom commission, and the criminalization of mental illness.

Book is in Used-Good condition. Pages and cover are clean and intact. Used items may not include supplementary materials such as CDs or access codes. May show signs of minor shelf wear and contain limited notes and highlighting. 0.62

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.The Sixth Edition is a thorough revision that addresses the impact of HR 3590, the Patient Protection and Affordable Care Act, as well as other new laws such as the Genetic Information Non-disclosure Act (GINA).