Managed health care is one of the most confusing areas any consumer can deal with. Rules and regulations are constantly changing, providers are always merging and changing their offerings, and paperwork abounds. In easy-to-understand language, this book explains how to understand options, how to get treatment for chronic and long-term illnesses, how to get the most care for the least cost, and more.

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 origins of managed health care -- Types of managed care organizations and integrated health care delivery systems -- Network management and reimbursement -- Management of medical utilization and quality -- Internal operations -- Medicare and Medicaid -- Regulation and accreditation in managed care.

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.

Designated a Doody's Core Title! Winner of an AJN Book of the Year Award! A National Nursing Centers Consortium Guide This book provides a step-by-step guide to starting and sustaining a community health center, with an emphasis on nurse-managed centers. The authors share their firsthand knowledge with readers, including information on developing a mission statement, pulling together an advisory board, writing a business plan, and getting funding. The process for obtaining Federally Qualified Health Center Status (and thus federal funding) is described. Of great value is the bookís Appendix, which provides very useful examples. They include sample bylaws, a full policy and procedure manual, physician and nurse practitioner collaborative agreements, job descriptions, a contract with a local agency, and outcome and assessment guidelines. Donna Torrisi is the founder of The Family Practice and Counseling Network in Philadelphia, which provides primary health services to public housing residents; Tine Hansen-Turton is the Executive Director of the National Nursing Centers Consortium. For Further Information, Please Click Here!

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.