Managing Managed Care

Managing Managed Care PDF Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309175054
Category : Medical
Languages : en
Pages : 394

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Book Description
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.

Managing Managed Care

Managing Managed Care PDF Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309175054
Category : Medical
Languages : en
Pages : 394

Get Book Here

Book Description
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.

Managed Care Quality

Managed Care Quality PDF Author: A. F. Al-Assaf
Publisher: CRC Press
ISBN: 1000162141
Category : Law
Languages : en
Pages : 294

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Book Description
Managed care organizations are paving the way to the future of health care delivery in the United States and countries around the world. As managed care systems evolve, a major concern is quality. Managed Care Quality: A Practical Guide is a collection of applications and experiences gathered from practicing health professionals in the field of managed care. This first "how to" guide was written to help managed care organizations meet the common objective of ensuring the best quality of services and care. Managed Care Quality: A Practical Guide presents successive steps in implementing quality in health care organizations. It introduces the methods, skills, and practices involved in quality health care programs and offers solutions to problems typically encountered in managed care.

Improving the Medicare Market

Improving the Medicare Market PDF Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309175364
Category : Medical
Languages : en
Pages : 384

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Book Description
Medicare beneficiaries are rapidly moving into managed care, as attempts to restrain the growth of this costly entitlement program progress. However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sectorâ€"yet protect them as consumers and patients. This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed careâ€"how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters. The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.

A Health Care Quality Improvement System for Medicaid Managed Care

A Health Care Quality Improvement System for Medicaid Managed Care PDF Author:
Publisher:
ISBN:
Category : Government publications
Languages : en
Pages : 114

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Book Description


Health Insurance and Managed Care

Health Insurance and Managed Care PDF Author: Peter R. Kongstvedt
Publisher: Jones & Bartlett Learning
ISBN: 128415209X
Category : Medical
Languages : en
Pages : 355

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Book Description
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.

Medicaid Eligibility Quality Control

Medicaid Eligibility Quality Control PDF Author: United States. Social and Rehabilitation Service
Publisher:
ISBN:
Category : Medicaid
Languages : en
Pages : 460

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Book Description


A Primer on Assessing Managed Care Quality

A Primer on Assessing Managed Care Quality PDF Author: Barbara Tymann
Publisher:
ISBN:
Category : Managed care plans (Medical care)
Languages : en
Pages : 56

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Book Description


The Economic Evolution of American Health Care

The Economic Evolution of American Health Care PDF Author: David Dranove
Publisher: Princeton University Press
ISBN: 1400824680
Category : Medical
Languages : en
Pages : 220

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Book Description
The American health care industry has undergone such dizzying transformations since the 1960s that many patients have lost confidence in a system they find too impersonal and ineffectual. Is their distrust justified and can confidence be restored? David Dranove, a leading health care economist, tackles these and other key questions in the first major economic and historical investigation of the field. Focusing on the doctor-patient relationship, he begins with the era of the independently practicing physician--epitomized by Marcus Welby, the beloved father figure/doctor in the 1960s television show of the same name--who disappeared with the growth of managed care. Dranove guides consumers in understanding the rapid developments of the health care industry and offers timely policy recommendations for reforming managed care as well as advice for patients making health care decisions. The book covers everything from start-up troubles with the first managed care organizations to attempts at government regulation to the mergers and quality control issues facing MCOs today. It also reflects on how difficult it is for patients to shop for medical care. Up until the 1970s, patients looked to autonomous physicians for recommendations on procedures and hospitals--a process that relied more on the patient's trust of the physician than on facts, and resulted in skyrocketing medical costs. Newly emerging MCOs have tried to solve the shopping problem by tracking the performance of care providers while obtaining discounts for their clients. Many observers accuse MCOs of caring more about cost than quality, and argue for government regulation. Dranove, however, believes that market forces can eventually achieve quality care and cost control. But first, MCOs must improve their ways of measuring provider performance, medical records must be made more complete and accessible (a task that need not compromise patient confidentiality), and patients must be willing to seek and act on information about the best care available. Dranove argues that patients can regain confidence in the medical system, and even come to trust MCOs, but they will need to rely on both their individual doctors and their own consumer awareness.

The Future of Long-Term Care

The Future of Long-Term Care PDF Author: Pablo Villalobos Dintrans
Publisher: Nova Science Publishers
ISBN: 9781536193961
Category : Medical
Languages : en
Pages : 0

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Book Description
"Population aging is challenging countries around the globe to adapt their public policy responses to the new world. Long-term care is a relevant topic today both because of the rapid growth in long-term care needs in every country and the lack of responses from governments. The Future of Long-term Care explores some issues related to the implementation of long-term care responses in different countries. Looking at six different cases, the book highlights the need to foster an urgent debate in the area, as well as emphasizing the need for action in the coming years. The examples analyzed show common problems faced by countries trying to respond to their people's needs, as well as the dissimilar stages, contexts, and paths followed by each one in the endeavour for providing long-term care services to the population. Whether the analysis is carried out in countries with well-established long-term care systems or in places where the debate is just starting, the book proves that this is an area in which many challenges remain. Learning lessons from others is important but providing a space for countries to frame their problems and propose their solutions is crucial. This book contributes to fill this gap and contribute to a debate that is just starting in many places around the world"--

Mixed Methods in Health Sciences Research

Mixed Methods in Health Sciences Research PDF Author: Leslie Curry
Publisher: SAGE Publications
ISBN: 1483347141
Category : Social Science
Languages : en
Pages : 376

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Book Description
Mixed Methods in Health Sciences Research: A Practical Primer, by Leslie Curry and Marcella Nunez-Smith, presents key theories, concepts, and approaches in an accessible way. Packed with illustrations from the health sciences literature, this ready-to-use guidebook shows readers how to design, conduct, review, and use mixed methods research findings. Helpful checklists, figures, tables, templates, and much more give readers examples that will elevate the quality of their research, facilitate communication about their methods, and improve efficiency over the course of their projects. Real-world examples and insights from mixed methods researchers provide unique perspectives on every aspect of mixed methods research. This book successfully pulls together foundational mixed methods principles, synthesizes the knowledge base in the field, and translates it for a health science researcher audience. “The content is highly applicable to real life research teams in the areas of clinical research, health services research, and implementation science, providing sound content and practical advice. The authors have synthesized and pull key concepts from a variety of sources to provide a concise resource.” —Linda M. Herrick, South Dakota State University “Everything from the references, to the topics, checklists, conceptual graphic representations, and organizers, interviews, and resources, all contribute to the content and aid with understanding and/or application. … It addresses specific MM research as it pertains to health sciences in a way that other texts just do not even attempt.” —Denise L. Winsor, University of Memphis “[This text is] a very pragmatic approach to mixed methods research; excellent resources, tables, and figures [are] provided, along with cases and examples of value to researchers and grant reviewers. Its relevance to practice, education, and research, as well as to potential policy implications, is a strong focus that would make this a valued textbook for any researcher!” ? —Karen Devereaux Melillo, University of Massachusetts Lowell “The text is cutting edge. It leads the way with its focus on team dynamics. [The authors] succeed in making the book relevant and practical. They also articulate a number of key insights in the area of mixed methods that rarely get addressed, such as teams and conflict. Great read with a lot of good, practical information for mixed methods researchers at all levels. The practical approach of this text makes it an innovative and valuable resource.” —John G. Schumacher, University of Maryland