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Health Insurance and Managed Care: What They Are and How They Work

Amazon.com Price:  $72.00 (as of 12/05/2019 17:19 PST- Details)

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Description

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 rules of the American managed health care system. Written in transparent and accessible language, this to hand guide offers an historical overview of managed care after which walks the reader in the course of the organizational structures, concepts, and practices of the managed care industry.
The Fourth Edition is a radical update that addresses the affect of the Reasonably priced Care Act during the industry including:
– New underwriting requirements
– New marketing and sales channels
– Limitations on sales, governance, and administrative (SG&A) costs and profits
– New supplier 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

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