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

Health Insurance and Managed Care: What They Are and How They Work offers a concise introduction to the intricate workings of health insurance and managed care within the American healthcare system. This essential guide, written in clear and accessible language, provides a comprehensive historical overview, leading readers through the organizational structures, concepts, and practices of the health insurance and managed care industry.

The Fifth Edition presents a thorough update, addressing the current status of The Patient Protection and Affordable Care Act (ACA) and the political pressures influencing its implementation. This updated edition delves into the evolving provider payment models and medical management methodologies impacting managed care plans and insurers.

• Moral Hazard and its relevance in health insurance
• The ever-expanding U.S. Healthcare payment systems and methodologies
• The role of benefits design, including discussions on medical necessity and its impact on benefits coverage
• Impact of limitations on sales, governance, and administrative (SG&A) costs and profits
• Changes in payment mechanisms, such as value-based payment under the Medicare Improvement for Patients and Providers Act (MIPPA)
• Complexities of Medicare Advantage payment plans, Medicaid expansion under ACA, and more

This authoritative resource is ideal for healthcare professionals, policy makers, and anyone interested in understanding the dynamic landscape of health insurance and managed care. With its blend of historical context and contemporary analysis, this book is an invaluable tool for navigating today’s healthcare challenges.
Authors:
Peter R. Kongstvedt (Author)
Edition:
5th
Publication Date:
February 14, 2019