Download or read book Managing Managed Care written by Institute of Medicine and published by National Academies Press. This book was released on 1997-04-21 with total page 394 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.
Download or read book Managed Competition written by and published by DIANE Publishing. This book was released on 1993-07 with total page 120 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pamphlet from the vertical file.
Download or read book Managed Care Systems and Emerging Infections written by and published by . This book was released on 2000 with total page 113 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Reports on Managed Care written by American Medical Association. Council on Ethical and Judicial Affairs and published by American Medical Association Press. This book was released on 1998 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt: Ethics in the era of managed care This collection of AMA Council Reports from 1990 to 1997 examine a variety of ethical issues concerning managed care. Report topics include financial incentives to limit care, cost containment involving prescription drugs, restrictions on disclosure in managed care contracts, ethical issues in negotiating discounts for specialty care, capitation, and more. An analysis of current issues in medical ethics is also included.
Download or read book Improving the Medicare Market written by Institute of Medicine and published by National Academies Press. This book was released on 1996-11-01 with total page 384 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare beneficiaries are rapidly moving into managed care, as attempts to restrain the growth of this costly entitlement program progress. However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sectorâ€"yet protect them as consumers and patients. This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed careâ€"how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters. The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.
Download or read book Report to the Congress written by Medicaid and Chip Payment and Access Commission and published by Createspace Independent Pub. This book was released on 2013-01-15 with total page 222 pages. Available in PDF, EPUB and Kindle. Book excerpt: This Report, “Report to Congress: The Evolution of Managed Cared in Medicaid,” examines managed care in Medicaid, focusing on the enrollees served, participating plans, spending, payment, access, data, and program accountability. This Report builds upon our March 2011 “Report to the Congress on Medicaid and CHIP,” which provided the foundation for a better understanding of the Medicaid and CHIP programs. It served as a starting point for building the analytic framework the Commission will use to assess access, evaluate payment policy, and determine key data needs in future work. The Commission's authorizing language directs MACPAC to focus its June reports to the Congress on “issues affecting Medicaid and CHIP, including the implications of changes in health care delivery in the United States and in the market for health care services on such programs.” Medicaid finances health care and related services for about 67 million individuals, including more than 30 million low-income children, more than 10 million persons with disabilities, and 6 million low-income seniors with Medicare. Of these 67 million people, there are approximately 49 million low-income individuals enrolled in some form of Medicaid managed care. Understanding Medicaid managed care arrangements is essential to determining how the program fits into U.S. health care. The Commission's June 2011 Report to the Congress is comprised of two major sections: a baseline description of managed care in Medicaid, and Medicaid and CHIP Program Statistics (MACStats), a standing supplement in MACPAC Reports that provides national and state-specific data on enrollees, spending, and program features. The first section of the Report provides a comprehensive resource on what is known about the use of managed care in Medicaid today, both nationally and at the state level. The majority of states use managed care, and these arrangements are likely to become even more prevalent over the coming years. However, Medicaid managed care programs vary considerably among states, as well as within states, across different populations, and geographic locations. This Report describes the enrollees in Medicaid managed care, including children and families, enrollees with disabilities, and those who are dually eligible for Medicaid and Medicare. The current status of enrollment, payment, access, and quality measurement and improvement is examined, as well as the consistency, availability, and timeliness of data needed to adequately evaluate managed care programs and ensure program accountability. The Commission's June 2011 edition of MACStats presents data on all enrollee groups but highlights enrollment, service use, spending, and characteristics of individuals with disabilities. We focus on these high cost, high need enrollees because they account for a substantial portion of the program's spending, although they are a small share of enrollment. This is a key issue for policymakers as they consider options for controlling spending and improving care management for the complex needs of this population. Moving forward, the Commission plans to examine policies to encourage high quality, efficient care for all enrollees in managed care and in traditional fee for service, especially for those who have complex medical conditions. In addition, the Commission is undertaking research and independent data analysis on access to develop an early-warning system as described in our statutory charge. In this effort, we will work to identify provider shortage areas and other factors that may affect access to care for those enrolled in Medicaid and CHIP.
Download or read book Medicaid Managed Care written by United States. General Accounting Office and published by . This book was released on 1995 with total page 44 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Health Insurance and Managed Care written by Peter R. Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2019-02-14 with total page 355 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Medicaid Eligibility Quality Control written by United States. Social and Rehabilitation Service and published by . This book was released on 1975 with total page 462 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Managed Care written by Peter Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2009-10-07 with total page 295 pages. Available in PDF, EPUB and Kindle. Book excerpt: The origins of managed health care -- Types of managed care organizations and integrated health care delivery systems -- Network management and reimbursement -- Management of medical utilization and quality -- Internal operations -- Medicare and Medicaid -- Regulation and accreditation in managed care.
Download or read book Accuracy of Household Reports of Medicare Managed Care Enrollment in the MEPS written by Samuel Zuvekas and published by . This book was released on 2008 with total page 19 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Essentials of Managed Health Care written by Peter Reid Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2003 with total page 918 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Health Care Utilization as a Proxy in Disability Determination written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2018-04-02 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Download or read book Medicaid Managed Care written by United States. General Accounting Office and published by . This book was released on 1997 with total page 36 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Quality Assurance Reporting Requirements written by and published by . This book was released on 1996 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Care Without Coverage written by Institute of Medicine and published by National Academies Press. This book was released on 2002-06-20 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
Download or read book Managing Accountability in Medicaid Managed Care written by and published by . This book was released on 1999 with total page 76 pages. Available in PDF, EPUB and Kindle. Book excerpt:
