Public Managed Care Models And Cost Containment

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.

This article identifies the impact of managed-care reforms on the utilization of medical services within the military health-services system. The data come from a recent demonstration project that substituted a health maintenance organization (HMO) and preferred provider organization (PPO) for traditional fee-for-service (FFS) arrangements. Results from a semiparametric model indicate that the generosity of benefits in the HMO increased demand for ambulatory services. Unlike the private-sector experience with managed care, aggressive utilization review did not significantly curtail inpatient stays. These results vitiate the presumed effectiveness of reform strategies that rely on large, geographically diffused managed-care networks to contain public-sector health costs.

An examination of employers' recent experience with managed care in terms of cost control & employee perspectives. Charts, tables & graphs.

Given the recent and rapid developments in the delivery of health care in the United States, never has it been more important to have the most up-to-date resources for teaching students about this complex and dynamic industry. Now in its Fifth Edition, Delivering Health Care in America offers the most current and comprehensive overview of the basic structures and operations of the U.S. health system--from its historical origins and resources, to its individual services, cost, and quality. Using a unique systems approach, this bestselling text brings together an extraordinary breadth of information into a highly accessible, easy-to-read resource that clarifies the complexities of health care organization and finance, while presenting a solid overview of how the various components fit together. New to this Edition: New material on U.S. health reform New material on health reform in other countries New material on Healthy People 2020 New information on CMS s innovative healthcare delivery New information on community health centers Introduction of the medical home concept Data update throughout the book Latest research findings as applicable Enhanced content on The Patient Protection and Affordability Act of 2010 Enhanced content on clinical guidelines Enhanced content on public health system and services Enhanced content on vulnerable populations Enhanced content on primary care from the Global Perspective Revised perspectives on the future of health care in America Instructor Resources: Transition Guide, Instructor's Manual, PowerPoint Presentations, TestBank Student Resources: Glossary, Flash Cards, Crosswords, Matching Questions, Web Links"

This is an indispensable reference for all professionals involved in the design, implementation, financing, or operation of a managed care program, written in the classic answer book format. You'll find extensive sections providing basic understanding of managed care, cost containment strategies, and advice on organization and implementation of programs. The topic is covered from the ground up, with crucial questions and authoritative, up-to-date answers on every facet of managed care, including such valuable features as: Contract negotiation strategies and dispute resolution techniques Maximizing utilazation review and outcomes assessment Techniques for managed care implementation and administration Plus payer and provider contracting; advice on legal and regulatory considerations; important issues covered from both purchaser's and provider's perspectives; and discussion on information technology and telemedicine.

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.

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.