Managed Health Care in the New Millennium: Innovative Financial Modeling for the 21st Century

ISBN-13: 9781439840306 / Angielski / Twarda / 2011 / 306 str.

David I. Samuels

Opis

David Samuels, a leading authority on financial models in healthcare, draws on his multidisciplinary background in all aspects of managed care to provide an expansive yet detailed perspective of this complex field. Grounded in evidence-based modeling, the book s multidisciplinary focus puts the spotlight on core concepts from the standpoints of health plans, hospitals, physician practice, and their respective integrated network models. You ll learn what happened when a country s national health care plan is developed with problematic underwriting, why hospitals will always be victimized at their payer s bargaining table, and even how to improve the current primary care shortage at both 50% less provider costs as well as with triple their members compliance in wellness care. The book gives you the critical tools to stay ahead of the learning curve, engage patients to take responsibility for their own and their family s health status, and improve your differentiation in a RAPIDLY changing marketplace."

Spis treści

An Updated Introduction to Managed Care and Capitation. Understanding Managed Care Industry Operations. Managed Care Provider and Practitioner Operations. Managed Care Organization Quality Benchmarking. Managing the Managed Care Enrollee. Enrollee-Based Financial and Mathematical Prediction Models. Management of Managed Care Information for Modeling Purposes. Managed Care Legal and Regulatory Compliance. Innovative Managed Care Modeling for the 21st Century. Innovative MCO Financial Modeling for the 21st Century.

O autorze

David I. Samuels is the president and CEO of EthiCare Breakthrough Solutions/EthiCare Revenue Cycle Management, Inc., a consulting firm that specializes in sales and marketing activities tied to risk-free/net-recovery relationships and that identifies hospital undercharges by selecting specific charges for which services were rendered but never billed.