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

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 foundations of the American managed health care system. Written in clear and accessible language, this handy guide offers an historical overview of managed care and then walks the reader through the organizational structures, concepts, and practices of the managed care industry.
The Fourth Edition is a thorough update that addresses the impact of the Affordable Care Act throughout the industry including:
- New underwriting requirements
- New marketing and sales channels
- Limitations on sales, governance, and administrative (SG&A) costs and profits
- New provider 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

• Health Economics and Financing
• Essentials of Managed Health Care (Essentials of Managed Care)
• Shortell and Kaluzny's Healthcare Management: Organization Design and Behavior
• Essentials of Health Care Marketing
• The Strategic Management of Health Care Organizations
• Long-Term Care: Managing Across the Continuum
• Dunn & Haimann's Healthcare Management
• Healthcare Finance: An Introduction to Accounting and Financial Management
• Legal Aspects of Health Care Administration
• Fundamentals of Human Resources in Healthcare (Gateway to Healthcare Management)