The growth of managed care in the U.S. began with the passing of the Health Maintenance Organization Act of 1973. While managed care established by health maintenance organizations, they are now used by a variety of private health benefit programs. Managed care has grown into a huge presence in the U.S, but it is somewhat controversial because its major aim of reducing medical costs has essentially failed. There is also disagreement as to whether managed care has had any positive impact on the quality of healthcare delivery in the U.S.
There are three main types of managed care plans: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS) plans.
All reports in Managed Care
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Alzheimer’s Disease – The Evaluation & Management of Dementia
3/14/2012 | published by: Apollo Managed Care Consultants
Diagnosis of Alzheimer’s and other dementias, non-pharmaceutical and pharmaceutical management of this common cluster of disabling disorders. References. Web links/other resources.
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$49.00
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Utilization Management & Capitation Strategies
3/1/2012 | published by: Apollo Managed Care Consultants
... other variations of traditional capitation compensation strategies are detailed including those for emergency services. Utilization management program P & Ps. Precertification resources. Numerous forms, audit tools, and benchmarks. Job descriptions. References and resources. Updated 2012.
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$225.00
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Glossary of Managed Care Terms, Abbreviations & Acronynms, 4th ed
3/1/2012 | published by: Apollo Managed Care Consultants
... spelling, use of correct abbreviations, and definition of healthcare-related acronyms for any medical office staff or facility. Managed Care, Medicare, Vision Care plus common legal terms are defined. “Do Not Use” list of medical abbreviations.
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$9.98
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Medical Group Practice: Policies & Procedures
3/1/2012 | published by: Apollo Managed Care Consultants
... record and consent policies and procedures. Designed for modification to adapt to local practices and contract terms. Numerous forms, examples and other helpful tools. Resources include example materials to establish and measure practice metrics including ...
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$275.00
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Disease State Management Strategies II. Clinical Guidelines for Behavioral Healthcare
3/1/2012 | published by: Apollo Managed Care Consultants
... Anxiety/phobias/panic disorders including PTSD, Personality disorders, Impulse control, Conduct, Oppositional defiant disorders and Schizophrenia. Extensive references, resource materials, and related web sites follow each guideline. Useful tools for accreditation and quality improvement strategies. Updated as ...
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$250.00
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Healthcare Trends & Forecasts in 2012: Performance Expectations for the Healthcare Industry
12/23/2011 | published by: Healthcare Intelligence Network
... the 12 months to come. Will 2012 truly be the period of 'economic calm' so desperately sought by physicians, and what mindset is required to implement the new care and reimbursement reforms - ACOs, bundled ...
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$117.00
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Essential Guide to Accountable Care Organizations: Challenges, Risks and Opportunities of the ACO Model
12/1/2011 | published by: Healthcare Intelligence Network
... of the marks for healthcare delivery reform set forth by the Patient Protection and Affordability Act (PPACA) and offer a key opportunity to boost revenue. With the publication of CMS's proposed guidelines for Medicare ACOs ...
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$179.00
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Cape Coral Market Overview
10/10/2011 | published by: HealthLeaders InterStudy
... of hospitals and health insurers. The largest force in the local healthcare industry, Lee Memorial Health System, has moved from consolidating facilities in previous years to actively pursuing growth in mental healthcare services and physician ...
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$887.00
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Care Transitions Toolkit
10/1/2011 | published by: Healthcare Intelligence Network
... the patient experience and provider reimbursement levels. Consequently, CMS is putting $500 million behind its new Community-Based Care Transitions Program (CCTP) demonstration. CCTP is designed to help hospitals improve Medicare patient handoffs between care sites, ...
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$239.00
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2011 Medical Home Performance Benchmarks: Adoption, Utilization and Results
9/1/2011 | published by: Healthcare Intelligence Network
... managers. This resource also identifies ways that funds flowing from the 2010 Patient Protection and Affordable Care Act (PPACA) are enhancing medical home services in the areas of preventive care, care transition management and physician ...
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$199.00
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Benchmarks in Health & Wellness Incentives, 2011 Edition: Data to Drive Health Promotion, Compliance and ROI
6/1/2011 | published by: Healthcare Intelligence Network
... incentives are utilized across the healthcare continuum in 2011. Benchmarks in Health & Wellness Incentives, 2011 Edition: Data to Drive Health Promotion, Compliance and ROI provides actionable information from 156 healthcare organizations on the use ...
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$117.00
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Guide to Reducing Medicare Readmissions, Vol. II
6/1/2011 | published by: Healthcare Intelligence Network
... Medicare Readmissions, Vol. II examines innovative interventions to reduce preventable admissions, rehospitalizations and ER visits by high-utilizing Medicare beneficiaries. This guide looks at four multidisciplinary collaborative interventions aimed at key factors fueling readmissions in this ...
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$279.00
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Managed Healthcare
4/25/2011 | published by: First Research, Inc.
... Blue Cross and Blue Shield Association and Kaiser Permanente. The industry is highly concentrated: the 50 largest companies generate about 75 percent of revenue. COMPETITIVE LANDSCAPE Demand for health insurance products is driven by the ...
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$129.00
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Managing Post-acute Care & Extended Care Services
2/1/2011 | published by: Apollo Managed Care Consultants
... in a subacute unit, SNF, hospice, ambulatory care and/or the home. Review criteria guidelines/benefit ‘interps’. Resources include numerous forms, coverage information, Medicare average LOS by DRG, authoritative references, plus stroke, cardiac and pulmonary rehabilitation guidelines.
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$275.00
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What's Ahead for Managed Care 2011: Directions, Insight, Developments and Strategy
1/27/2011 | published by: Managed Care Information Center
... of the new accountable care organizations, major payer markets are shifting, new developments surround Medicare Advantage plans, and new approaches to managed care contracting and strategy all are part of the managed landscape this year.
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$199.00
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Workplace Wellness Management 2011: New Mandates, New Opportunities, New Directions
1/20/2011 | published by: Managed Care Information Center
... the effectiveness of care. Listen in to this program that identifies the issues of concern in oncology management, outlines the current seven models under discussion/implementation, and reviews the players, pros and issues with each model.
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$199.00
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Managing Physical/Occupational/Speech Therapy & Rehabilitation Care
1/2/2011 | published by: Apollo Managed Care Consultants
... as well as guidelines for adult and pediatric speech-language therapy, therapy-related DME, inpatient rehabilitation unit/hospital admission, continued stay, and discharge. Resources include the Oregon pediatric guidelines for rehab, example protocols, quality monitors, web sites and ...
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$275.00
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Medical Review Criteria for Managing Care
1/2/2011 | published by: Apollo Managed Care Consultants
... benchmarks. Payment criteria. Extensive authoritative references. “The Bible” for health plan and Medicare benefit interpretations. Critical resource for provider education and claims management, as well as traditional UM. The most comprehensive review criteria guideline resource ...
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$675.00
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Glossary of Medical Terms, Abbreviations and Acronyms
1/2/2011 | published by: Apollo Managed Care Consultants
Medicare, Managed Care, Vision Care and healthcare-related Legal terms & acronyms defined. Links to online glossaries.
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$19.99
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Pain - Evaluation & Management
1/2/2011 | published by: Apollo Managed Care Consultants
Guidelines for pain evaluation/management tools and strategies. Anesthesia, complementary & alternative medicine, behavioral issues, pharmacologic therapy, outpatient/inpatient tests & procedures - evidence-based review criteria. References, resources, web links.
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$75.00
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Risk Management and Safety Issues for Medical Practice
1/2/2011 | published by: Apollo Managed Care Consultants
Policies, procedures and information needed to meet many accreditation and certification visit standards, decrease medical liability risk and improve patient care. Consents for Care chapter with example consent forms. AHRQ resources. References and resources.
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$65.00
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Complementary/ Alternative Medicine & Preventive Health Care (‘Wellness’) Guidelines
1/2/2011 | published by: Apollo Managed Care Consultants
CAM resources and clinical guidelines ++ Preventive health care (‘wellness’) guidelines listed by age, sex and the ‘Prevention of coronary artery disease & stroke’ guidelines. References, web sites.
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$99.00
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Guide to Health Risk Assessment and Stratification
1/1/2011 | published by: Healthcare Intelligence Network
... and other unnecessary utilization. In the Guide to Health Risk Assessment and Stratification, 12 industry thought leaders describe the processes of health risk assessment (HRA) and stratification as well as applications and benefits of health ...
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$322.00
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Evaluating Oncology Management Programs - Trends in Payer Oncology Management and What You Need to Know for Success
12/2/2010 | published by: Managed Care Information Center
... the effectiveness of care. Listen in to this program that identifies the issues of concern in oncology management, outlines the current seven models under discussion/implementation, and reviews the players, pros and issues with each model.
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$199.00
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Managed Care and the Pharmaceutical Industry - Top Issues, Health Care Reform, and the Inter-linkages Bringing them Together
12/1/2010 | published by: CBR Pharma Insights, LLC
... of their brand-name drugs. Common ground between the two industries can be difficult to find. Shared goals do exist, though. Both the managed care industry and the pharmaceutical industry have a stake in how prescription ...
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$3,900.00
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