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Essentials of Managed Health Care, Sixth Edition

Author(s): Peter R. Kongstvedt, MD
  • ISBN-13: 9781449653316
  • ISBN-10:1449653316
  • Product With Access Code    694 pages      © 2013
Price: $167.95 US List
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Instructor Resources Available Now: Instructor's Manual, PowerPoints, Study Guide, TestBank; Transition Guide

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.

  • New contributors
  • New chapter on the Patient Protection and Affordable Care Act of March 2010
  • New chapter on enrollment and billing
  • New chapter on fraud and abuse
  • Completely re-written chapter on information systems and electronic data interchange
  • Completely re-written chapter on Medicaid Managed Health Care
  • Complete restructuring of section 2 with a new focus on structure and payment across all types of health care delivery systems
  • New chapter on physician practice behavior and managed health care
Introduction  1  Introduction
  Part  One  Introduction to Health Insurance and Managed Health Care
    Chapter  1  A History of Managed Health Care and Health Insurance in the United States By Pete Fox and Peter R. Kongstvedt
    Chapter  2  Types of Health Insurers, Managed Health Care Organizations and Integrated Healthcare Delivery Systems By Eric Wagner and Peter R. Kongstvedt
    Chapter  3  Elements of the Management and Governance Structure By Peter R. Kongstvedt
  Part  Two  Network Contracting and Provider Payment
    Chapter  4  The Provider Network By Peter R. Kongstvedt
    Chapter  5  Provider Payment By Peter R. Kongstvedt
    Chapter  6  Legal Issues in Provider Contracting By Mark S. Joffe and Kelli D. Back
  Part  Three  Management of Utilization and Quality
    Chapter  7  Basic Utilization and Case Management By Peter R. Kongstvedt
    Chapter  8  Fundamentals and Core Competencies of Disease Management By David W. Plocher
    Chapter  9  Physician Practice Behavior and Managed Health Care By Jay Want and Peter R. Kongstvedt
    Chapter  10  Data Analysis and Provider Profiling in Health Plans By David W. Plocher & Nancy Garrett
    Chapter  11  Prescription Drug Benefits in Managed Care By Robert P. Navarro, Craig Stern, and Rusty Hailey
    Chapter  12  Introduction to Managed Behavioral Healthcare Organizations By Joann Albright, Deborah Heggie, Anthony M. Kotin, Connie Salgy, Wanda Sullivan, and Fred Waxenberg
    Chapter  13  Disease Prevention in Managed Health Care Plans By Mark Manley
    Chapter  14  Quality Management in Managed Health Care By Pamela B. Siren
    Chapter  15  Accreditation and Performance Measurement Programs in Managed Health Care By Margaret E. O'Kane
  Part  Four  Sales, Finance and Administration
    Chapter  16  Marketing and Sales By Richard Birhanzel
    Chapter  17  Enrollment and Billing By Karl V. Kovacs
    Chapter  18  Claims and Benefits Administration By Donald L. Fowler, Jr. and Elizabeth Pascuzzi
    Chapter  19  Health Care Fraud and Abuse By Christie Moon
    Chapter  20  Member Services By Kevin Knarr and Peter R. Kongstvedt
    Chapter  21  Operational Finance and Budgeting By Dale F. Cook and Christopher Campbell
    Chapter  22  Underwriting and Rating By Michael G. Sturm and Troy M. Filipek
    Chapter  23  Information Systems and Electronic Data Interchange in Managed Health Care By James S. Slubowski
  Part  Five  Special Markets
    Chapter  24  Health Plans and Medicare By John K. Gorman, Jean D. LeMasurier, William A. MacBain, Stephen J. Balcerzak, Wendy K. Burger and Amy Huang
    Chapter  25  Medicaid Managed Health Care By Rodney C. Armstead, Catherine K. Anderson, Elizabeth Cabot Nash
    Chapter  26  The Military Managed Care Health System By M. Nicholas Coppola, Ronald P. Hudak, Forest S. Kim, Lawrence Fulton, Jeffrey P. Harrison, and Bernie Kerr
    Chapter  27  Managed Care in a Global Context By Jonathan P. Weiner, Emily Adrion, Joanna Case Famadas, Djordje Gikic and Hugh Waters
  Part  Six  Laws and Regulations
    Chapter  28  State Regulation of Managed Health Care By Tom Wilder
    Chapter  29  Federal Regulation of Health Insurance and Managed Health Care By Tom Wilder
    Chapter  30  The Patient Protection and Affordable Care Act By Tom Wilder

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
Additional Titles by this Author

The following instructor resources are available to qualified instructors for download

ISBN-13: 9781449653316

Angel ready Test Bank
BlackBoard ready Test Bank
Desire to Learn ready Test Bank
Instructor Manual
Moodle ready Test Bank
Slides in PowerPoint Format
Test Bank
Transition Guide

Express PDF Essentials of Managed Health Care, Sixth Edition

ISBN-13: 9781284050424 ISBN-10: 1284050424

Express PDF Essentials of Managed Health Care, Sixth Edition. Please note that mobile devices do not support ExpressPDF at this time.


Bundle: Essentials of Managed Health Care, 6E with Navigate 2 Scenario for Health Care Ethics

Bundle ISBN: 9781284169232
This value bundle includes a hard copy of Essentials of Managed Health Care, 6E, packaged with an access code card that gives you online entry to Navigate 2 Scenario for Health Policy.


Bundle ISBN: 9781284043570
This bundle includes the text Essentials of Managed Health Care, Sixth Edition and access to the online course, Navigate: Introduction to Managed Health Care.

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