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Health Insurance and Managed Care, Fourth Edition
What They Are and How They Work

Author(s): Peter R. Kongstvedt, MD
  • ISBN-13: 9781284043259
  • Product With Access Code    398 pages      © 2016
Price: $100.95 US List
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Health Insurance and Managed Care: What They Are and How They Work (formerly titled 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.

As so many consumers recognize any form of a health benefit plan as "health insurance" this new edition makes explicit the fact that health insurance and managed care are one and the same.

The Fourth Edition is a thorough update that addresses the impact of the Affordable Care Act throughout the industry including:

  • New underwriting requirements
  • New marketing and sales channels
  • Limitations on sales, governance, and administration (SG&A) costs and profits
  • New provider organizations such as Patient Centered Medical Homes (PCHMs) and Accountable Care Organizations (ACO’s)
  • New payment mechanisms such as shared savings with ACOs, and severity-adjusted diagnosis related groups
  • Changes to Medicare Advantage
  • Medicaid expansion and reliance on Medicaid managed care
  About the Author
  Keeping Current
  Chapter  1  A History of Managed Health Care and Health Insurance in the United States
  Chapter  2  Health Benefits Coverage and Types of Health Plans
  Chapter  3  The Provider Network
  Chapter  4  Provider Payment
  Chapter  5  Utilization Management, Quality Management, and Accreditation
  Chapter  6  Sales, Governance and Administration
  Chapter  7  Medicare and Medicaid
  Chapter  8  Laws and Regulations in Managed Care

Peter R. Kongstvedt, MD

Dr. Peter Kongstvedt is an indepenent strategic advisor, and a Senior Health Policy Faculty member in the Department of Health Administration and Policy at George Mason University. He is a well known national authority on the health care industry with particular expertise in health insurance and managed health care, with over 30 years of industry experience as both a senior-level executive and with global consulting firms. Dr. Kongstvedt is also the author of Managed Care, What it Is and How it Works, (Jones & Bartlett),  and recently created an online multimedia training program on health insurance and managed care. Prior to passage of health reform, he consulted to and made several appearances on The CBS Evening News, and also appeared on NBC’s Today Show.

He is principal of the P.R. Kongstvedt Company, LLC and Kongstvedt Learning Solutions, LLC in McLean, VA and may be reached through his website at
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ISBN-13: 9781284043259

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