Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer. The Fifth Edition also offers new or expanded coverage of: • “Moral hazard,” and its application in health insurance and managed care • The ever expanding and evolving payment systems and methodologies used in the U.S. Healthcare System • The role of benefits design along with discussion about medical necessity and its impact on benefits coverage • The impact of limitations on sales, governance and administrative (SG&A) costs and profits • Continued changes in payment mechanisms such as value-based payment under the Medicare Improvement for Patients and Providers Act (MIPPA) • Medicare Part D, the drug benefit and the plans that offer it, as well as the complexities of Medicare Advantage payment plans, Medicaid expansion under ACA, and more.
✔ Author(s): Peter R. Kongstvedt
✔ Title: Health Insurance and Managed Care: What They Are and How They Work
✔ Rating : 4.6 out of 5 base on (147 reviews)
✔ ISBN-10: 128415209X
✔ Language: English
✔ Format ebook: PDF, EPUB, Kindle, Audio, HTML and MOBI
✔ Device compatibles: Android, iOS, PC and Amazon Kindle
Readers' opinions about Health Insurance and Managed Care by Peter R. Kongstvedt
Lola Frye
Travel back in time with a historical epic that vividly recreates a bygone era. The author's meticulous research and engaging prose transport you to another world. Complex characters and intricate plots keep you enthralled from beginning to end. Each chapter reveals new insights into the period's culture and society. It's a captivating blend of history and fiction. Ideal for history buffs and lovers of epic sagas.
Louise Russell
Immerse yourself in a richly detailed fantasy world where heroes and villains clash in epic battles. The author's intricate plotting and dynamic characters create a compelling narrative. Each twist and turn in the story keeps you hooked from start to finish. The vivid descriptions and imaginative world-building transport you to another realm. It's a thrilling adventure that captures the essence of epic fantasy. Perfect for fans of high-stakes adventures.
Courtney May
Unravel the secrets of a small town with a dark past in this gripping thriller. The author's atmospheric writing and suspenseful plot make for a page-turner. Each character's hidden motives and secrets add to the tension. The twists and surprises keep you guessing until the very end. It's a chilling and captivating read that you won't want to put down. Perfect for fans of mystery and suspense.
