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Essentials of Managed Health Care, Fifth Edition

Author(s): Peter R. Kongstvedt, MD
Details:
  • ISBN-13: 9780763764401
  • Paperback    840 pages      © 2007
Price: International Sales $163.95 US List
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Overview

Instructor Resources: Instructor's Manual, TestBank

 

New Sixth Edition Available April 2012

 

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.

 

This revision includes updates to all chapters, as well as:

  • New chapters on disease management, case management, pharmacy benefits management, behavioral health management, prevention, and the use of data and analysis in care management.
  • New chapters on claims administration, sales and marketing, healthcare consumerism, and the employer’s view of managed health care.
  • Completely revised chapter on the new Medicare/Medicaid laws and programs.
  • New chapters on the military health system and managed care in a global context.
  • New chapter on HIPAA.

ShowTable of Contents

Part  1  Introduction to Managed Health Care
  Chapter  1  The Origins of Managed Health Care
  Chapter  2  Types of Managed Care Plans and Integrated Healthcare Delivery Systems
  Chapter  3  Elements of the Management Control and Governance Structure
  Chapter  4  Common Myths and Assertions about Health Plans
Part  2  The HealthCare Delivery System
  Chapter  5  Physician Networks in Managed Health Care
  Chapter  6  Basic Compensation of Physicians in Managed Health Care
  Chapter  7  Hospitals, Facilities, and Ancillary Services
  Chapter  8  Performance-Based Incentives in Managed Health Care: Pay-for-Performance
Part  3  Medical Management
  Chapter  9  Managing Basic Medical-Surgical Utilization
  Chapter  10  Fundamentals and Core Competencies of Disease Management
  Chapter  11  Case Management
  Chapter  12  Prescription Drug Benefits in Managed Health Care
  Chapter  13  Introduction to Managed Behavioral Healthcare Organizations
  Chapter  14  The Role of Health Plans in Preventing Disease
  Chapter  15  Quality Management in Managed Care Siren
  Chapter  16  Data Analysis and Profiling in Health Plans
Part  4  Operational Management and Marketing
  Chapter  17  Information Technology in the Healthcare Organization
  Chapter  18  Claims Administration
  Chapter  19  Member Services
  Chapter  20  Healthcare Consumerism
  Chapter  21  Sales and Marketing Birhanzel
  Chapter  22  The Employer’s View of Managed Health Care
  Chapter  23  Accreditation and Performance Measurement Programs for Managed Care Organizations
  Chapter  24  Operational Finance and Budgeting
  Chapter  25  Underwriting and Rating Functions
Part  5  Special Markets
  Chapter  26  Medicare and Managed Care
  Chapter  27  Medicaid Managed Care
  Chapter  28  The Military Managed Healthcare System
  Chapter  29  Managed Care in a Global Context
Part  6  Legal and Regulatory Issues
  Chapter  30  Legal Issues in Provider Contracting
  Chapter  31  ERISA
  Chapter  32  HIPAA
  Chapter  33  State Regulation of Managed Care
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ShowAbout the Author(s)

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: www.kongstvedt.com. 

Additional Titles by this Author

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ShowReviews

  • "This is a valuable addition to the body of literature on managed care. Like its predecessors, this one is destined to be a frequently consulted resource in libraries, academic programs, healthcare organizations, and other healthcare professional settings."

    —Doody's Book Review Service, May 2008, Doody's Weighted Numerical Score: 98 - 5 Stars!

     

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