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Managed Care: What It Is and How It Works, Third Edition

Author(s): Peter R. Kongstvedt, MD
  • ISBN-13: 9780763759117
  • Paperback    275 pages      © 2009
Price: International Sales $111.95 US List
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Instructor Resources: PowerPoints


The new Third Edition of Managed 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.

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1  The Origins of Managed Health Care
2  Types of Managed Care Organizations and Integrated Health Care Delivery Systems
3  Network Management and Reimbursement
4  Management of Medical Utilization and Quality
5  Internal Operations
6  Medicare and Medicaid
7  Regulation and Accreditation in Managed Care

Peter R. Kongstvedt, MD

Peter R. Kongstvedt, M.D. is a renowned and highly regarded national expert in the health care industry.  Currently, he is Principal of the P.R. Kongstvedt Company, LLC, where he advises health care companies and executives on strategy, operations and effective decision making to enhance corporate, institutional, and executive success.  

Peter is the editor and primary author of three seminal works on managed care:  The Managed Health Care Handbook, which he first wrote in 1985, while the fourth and final edition of this landmark textbook was published in 2000; The Essentials of Managed Health Care, Fifth Edition (published 2007); and Managed Care: What It Is and How it Works, Third Edition (published 2008).  These books are widely considered “the bibles” on managed care and are extensively used in post-graduate courses nationwide, in training and educational programs, and within the industry. He also co-authored Best Practices in Medical Management with David Plocher, M.D. in 1998.

Peter began his career by practicing general internal medicine in rural southern Illinois at a rural health initiative clinic. After practicing for three years, he moved to Lincoln, Nebraska to be the medical director of a medical group associated with a group-model health maintenance organization.  Soon after he became its chief executive officer as well.

He continued his successful career as an executive in the managed health care industry, assuming increasingly responsible positions through 1993 when he held the position of executive vice president and chief operating officer at a Blue Cross Blue Shield plan in Washington, DC. In that same year, he became a direct-admit partner at Ernst & Young LLP, and continued his consulting career with global firms such as CapGemini and Accenture until 2008 when he formed the P.R. Kongstvedt Company, LLC.

Peter is a highly sought after speaker by industry and trade groups as well as health care companies. He is also a frequent contributor to publications and the media, and has appeared on PBS and CNN as well as local media.

Originally from the Midwest, for eighteen years Peter has lived in McLean, Virginia, a suburb of Washington, DC. Peter may be reached through his website: 

Additional Titles by this Author
  • "[An] excellent overview for health care managers."

    --Ronald Hudspeth, Adjunct Professor, Dallas Baptist University

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PowerPoint Lecture Slides


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ISBN-13: 9780763759117

Slides in PowerPoint Format