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.

You'll find the practical guidance you need to transition smoothly int o the managed care environment. You'll learn the pros and cons of prac ticing in a managed care setting, the daily life of managed care physi cians, the role of managed care in medical education and health care r eform. Discover how to take advantage of new opportunities and avoid p itfalls, balance cost consideration with clinical decision-making, and understand the case mix systems most frequently used in managed care. Written almost entirely by physicians, The Physician's Guide to Manag ed Care is a must for any physician interested in meeting future chall enges.

An overview of managed care created to assist physicians in adapting to the new environment.

Over the last two decades, managed care has overtaken the traditional fee for service insurance structures. By 1998, fee for service business had become almost a novelty. Managed care, with its aggressive utilization management techniques and added paperwork requirements, had not been embraced by physicians and consumers. There came the managed care backlash. The assault by physicians and patients on managed care did not halt the growth of managed care, but it did change the composition of the managed care market. The most aggressive form of managed care, HMO, retracted while the less restrictive forms of managed care, such as PPO and POS, flourished. How do physicians personally respond to managed care? This research utilizes large scale national survey data to look into physicians' work effort within a managed care environment. The information should be useful for considering physician response and work force issues in policy changes that could potentially change existing market structure, especially for national policy makers as well as citizens participating in discussions on health care reform in the United States.

Peter Kongstvedt 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 new Third Edition of Managed Health Care: What It Is and How It Works is a concise introduction to the foundations of the American managed health care system. Written in clear and accessible language, this handy guide offers an historical overview of managed care and then walks the reader through the organizational structures, concepts, and practices of the managed care industry. This thorough revision has been completely updated with all the newest data on this dynamic industry and features all new sections on: pay for performance, consumer directed health plans, new approaches to care management, as well as advances in information technology.

This collection provides a philosophical and historical analysis of the development and current situation of managed care. It discusses the relationship between physician professionalism and patient rights to affordable, high quality care. Its special feature is its depth of analysis as the philosophical, social, and economic issues of managed care are developed. It will be of interest to educated readers in their role as patients and to all levels of medical and health care professionals.