Making Managed Healthcare Work is your comprehensive guide to developing and implementing a new strategic approach to managed care that's practical, performance-based, and results-oriented. Learn how to prepare for, identify, pursue, negotiate and implement a new type of managed care arrangement that can accomplish the objective of delivering quality care at competitive prices.
This book is a guide to strategic training for physicians in an era of managed care. The first half of the book provides a step-by-step process to help physicians take their practices into the new world of integrated delivery systems. The second half of the book covers a variety of key topics such as credentialing, reimbursement systems, and utilization management.
Providing therapists practical solutions to managed care's erosion of their freedom to practice, this book presents a working blueprint for a private-pay psychotherapy practice. Dana C. Ackley casts out the distortions that have crept into many clinicians' thinking as a result of reliance on third-party reimbursement. Based on his own experience, he shows how you can serve clients--and yourself--better by developing real alternatives to the pressures and bureaucracy of managed care. In clear step-by-step detail, including practical exercises and checklists, sample marketing materials, and payment plans, the volume shows you how to: *Rediscover the economic and clinical value of your work *Discard assumptions that might block your progress *Educate yourself about the needs of potential clients *Market and sell your services effectively *Learn ethical, reasonable business-of-practice skills *Diversify into the rewarding area of psychological consultation to businesses. No matter what your clinical style, theoretical orientation, or practice history, you will benefit from the hard-won lessons Dr. Ackley shares in this book.
This executive report takes you step-by-step through the process of developing integrated delivery systems. You'll learn eleven fundamental building blocks for integration and how to apply these methods to redesign and improve your existing processes and systems.
"Transforming Health Care Through Information, Second Edition, builds upon case studies from actual healthcare institutions through all phases of the information system induction process. With the growth of information and focus on healthcare informatics, there remains little, if any, usage of case studies. This comprehensive second edition builds upon the specific examples of case studies to exemplify the various phases of introducing technological advancements into healthcare institutions." "Transforming Health Care Through Information, Second Edition, follows the integration of technological tools from beginning to end, exemplifying and examining the definition of change in this framework, the practical implementation of these changes, economic factors relating to the choice and success of certain systems, leadership styles and management tools, as well as resulting tensions and the management of adverse reactions to the new system once it has been actualized." "This comprehensive collection of case studies and expounding text serves as a learning and teaching tool in the field of healthcare informatics. The case studies allow the reader to learn from the real-life successes and failures of other healthcare professionals and therefore to assess each unique situation to better manage and adapt to pending technological introductions."--BOOK JACKET.
The introduction of the concept of managed care into mental and physical health care appears to be a juggernaut of unparalleled impact. The two extremes of thought about this impact are (I) that managed care is a villainous foe to be resisted in order to bring back the earlier halcyon years of independence in practice decisions with greater reimbursement for psychologists' services or (2) that managed care is a laudatory attempt to restrain health care costs that are out of control and spiraling upward by rooting out mismanagement and reversing financial incentives to provide unnecessary care. The former view calls managed health care such names as "mangled care" and distributes bumper stickers stating "Just Say No to HMOs. " The latter view points to the slowdown of increases in health care expenditures and the enhancement of health care affordability and appropriateness for greater numbers of persons resulting from managed care cost-containment strategies and service review procedures. Mental or behavioral health care has been as strongly impacted as medical care under managed care. Where managed care has forced practitioners' attention to validated procedures and to examining previous wasteful practices, we ap plaud the movement. Where managed care has had adverse impact, we think there needs to be greater public, legal, and regulatory attention to its excesses and abuses.
This resource offers you a unique Building Block system, a proven-effective tool used by organizations to survive and prosper in an era of different reimbursement schemes, from discounted fee-for-service and primary care capitation, to global capitation and percent of premium payment.
Considers three models: consumer flow, dollar flow, and full model in generic system without at-risk contracting; generic system with full capitation and full transfer of utilization risk; and generic system with partial case-rate funding, shared utilization risk and centralized utilization management. The blueprints of state systems covers: consumer flow, dollar flow and full model in Arizona pre- and post-reform systems; Oregon pre- and post-reform systems; and Washington State pre- and post-reform systems, and a comparison of the three state systems.
This text aims to provide answer to questions such as what happens when you get dropped from a managed care panel? How do you get paid? Why can't you get on a managed care panel? This book is an extended question and answer session where issues are tackled from the providers perspective.; Armed with the resources, examples and explanations provided in this book, clinicians will be positioned to make the decisions that contribute to success under managed care.
