Managed care contracting is a process that frustrates even the best administrators. However, to ignore this complexity is to do so at your own expense. You don‘t necessarily need to bear the cost of overpriced legal advice, but you do need to know what questions to ask, what clauses to avoid, what contingencies to cover ... and when to ask a lawyer

The dominance of managed care is spreading quickly and risk managers are suddenly faced with major new challenges. With Managing the Risks of Managed Care, the risk manager will learn about risk management challenges in an integrated delivery system. The book also presents expert analysis on issues like contracting, peer review, ethical dilemmas, antitrust and more.

In recent years, State Medicaid agencies and other public sector entities -- in particular, State, county, and local substance abuse and mental health (SA&MH) authorities -- have increasingly been taking the initiative to purchase SA&MH managed care (MC) services from private sector org's. or specialized nonprofit agencies. This is a practical guide for public purchasers and others involved in the design and develop. of MC initiatives involving SA&MH services. Chapters: designing, procuring, and implementing a MC system; coverage; contracting for network services; the mgmt. info. system; quality mgmt.; financial issues; and consumer protections. Bibliography.

However, successful managed care contracting is a daunting challenge, requiring a range of skills from creating an organizational vision and strategy to pricing specific services. Managed Care Contracting provides all the necessary tools to meet the challenge of managed care contracting.

This comprehensive manual will guide home health executives through the maze of capitation/at-risk contracting, the development of operational systems, etc. Contracting strategies, writing proposals, financial issues, and quality management are covered. Sample contracts, agreements, proposals, and spreadsheets will further enhance the manual's usefulness.

Integrating Managed Care and Ethics addresses legal and ethical challenges that arise in managed care and includes a discussion of trends, alluding to recent legislative/ regulatory initiatives, major legal cases, and examines guidance offered through several of the major healthcare trade associations. Its goal is to help the reader develop increased talent, tools, and techniques to help transform challenges and change into more positive outcomes.

The recent, rapid growth of HMOs, PPOs, and other managed care systems makes it imperative that physicians stay abreast of current issues and policies as this health care delivery model becomes more dominant. This 2001 edition contains new and updated information to assist the pediatrician in understanding how managed care works, how it impacts the pediatrics practice, and how to develop a strategic approach to managed care that is consistent with the physician's own professional goals.

State governments in the past decade have had to take on the problem of health care, with mixed results. This collection of 11 essays (of which two are an introduction and conclusion) by academics and policy makers consider the many issues that concern health care in the US and their effects at the state level, including managed care, health insurance expansion, mental health care, public health administration, and bureaucratic reactions to health policy. Hackey teaches health policy and management at Providence College in Rhode Island; Rochefort teaches political science and public administration at Northeastern U. in Boston. c. Book News Inc.