[PDF⚡BOOK] Health Insurance and Managed Care: What They Are and How They Work full free

Health Insurance and Managed Care: What They
Are and How They Work
Product details
Publisher : Jones & Bartlett Learning; 5th edition (February 28, 2019)
Language : English
Paperback : 324 pages
ISBN-10 : 128415209X
ISBN-13 : 978-1284152098
Item Weight : 1.25 pounds
Dimensions : 7 x 0.9 x 9 inches
Best Sellers Rank: #332,357 in Books (See Top 100 in Books)
#23 in Health Risk Assessment (Books)
#39 in Nursing Long-Term Care
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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.
Health Insurance and Managed Care: What They Are and How They Work by Peter R.
Kongstvedt

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