Managed Health Care in the New Millennium: Innovative Financial Modeling for the 21st Century
Autor David I. Samuelsen Limba Engleză Hardback – 5 dec 2011
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.
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Specificații
ISBN-13: 9781439840306
ISBN-10: 143984030X
Pagini: 306
Ilustrații: 3 b/w images and 49 tables
Dimensiuni: 152 x 229 x 23 mm
Greutate: 0.59 kg
Ediția:Revised
Editura: Taylor & Francis
Colecția Productivity Press
Locul publicării:Oxford, United Kingdom
ISBN-10: 143984030X
Pagini: 306
Ilustrații: 3 b/w images and 49 tables
Dimensiuni: 152 x 229 x 23 mm
Greutate: 0.59 kg
Ediția:Revised
Editura: Taylor & Francis
Colecția Productivity Press
Locul publicării:Oxford, United Kingdom
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Public țintă
Professional Practice & DevelopmentCuprins
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.
Notă biografică
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.
Recenzii
Managed Health Care in the New Millennium is elegant in both the simplicity of its premise, as well as the detail in which David Samuels lays out a prescription for navigating the uncharted, murky waters of Health Care’s future. His rational, plausible take on the complex problems, and possible solutions, while not offered as a panacea for an industry in turmoil, is fresh and bold. For once, consumers are not ignored as hapless victims, or un-savvy consumers. Instead, they are given practical tools and a voice, which may just be the future path to simultaneously cut costs and improve the quality of the care they so well deserve. Well done David!
—Andre B. Van Niekerk, PhD, Dean, School of Business, Woodbury University, President, (LBR) Luxury Branding Research, Los Angeles
Managed Care in the New Millennium is more than a very readable future history of managed healthcare. It’s a call to action for those who must make decisions on how healthcare services should be delivered and how the financing on managed care should be carefully structured towards common medical and financial goals. Managed Care in the New Millennium should be required reading for everyone needing to understand how managed healthcare worked in the past, is now "working" in the present and how managed care will evolve in the future. Mr. Samuels presents valuable information for medical and hospital administrators, healthcare insurance companies, legislators, human resource managers, consultants, and individual patients that is long overdue.
—Lawrence R. Lievense, FHFMA, FACMPE, Healthcare FINANCIAL Experts, Inc.,
David Samuels’ book comes to the market just in time for health plans, physicians and hospitals to consider new options in a post reform environment. An expert in reimbursement and the mathematical fundamentals of prospective payment for over three decades, David has updated his original book, Capitation, in line with the refocused needs of providers and payers to collaborate over value instead of fighting one another over manipulated fees schedules and volume. In short order we get a 15-year update on where managed care went wrong in its reimbursement and how the use of performance data and more thoughtful application of care management techniques can build accountability into a mutual framework of payment and service for purchasers and providers. The author then goes one step further into offering innovation upon a theme to expand the thinking and capabilities of providers and purchasers to share savings and put in place key performance indicators using predictable formulas. David’s work can help many healthcare executives do a better job of understanding and planning for the future. We recommend his publications to our clients and believe his innovation offers insight into what accountable care means and how the consumer will eventually benefit through a more rational and defined care system.
—William J De Marco MA, CMC, President and Chief Executive Officer, De Marco & Associates, Inc.
David Samuels offers great insight into the health care insurance markets and the enormous potential of capitation to contribute to the solutions our Nation so sorely needs. Capitation will inevitably impact the industry's evolution and I know of no more comprehensive and detailed a depiction of its strengths and opportunities than Managed Health Care in the New Millennium.
—Carl Heard, MD, MMM, Independent Locums Physician, Consultant for Medical Management
—Andre B. Van Niekerk, PhD, Dean, School of Business, Woodbury University, President, (LBR) Luxury Branding Research, Los Angeles
Managed Care in the New Millennium is more than a very readable future history of managed healthcare. It’s a call to action for those who must make decisions on how healthcare services should be delivered and how the financing on managed care should be carefully structured towards common medical and financial goals. Managed Care in the New Millennium should be required reading for everyone needing to understand how managed healthcare worked in the past, is now "working" in the present and how managed care will evolve in the future. Mr. Samuels presents valuable information for medical and hospital administrators, healthcare insurance companies, legislators, human resource managers, consultants, and individual patients that is long overdue.
—Lawrence R. Lievense, FHFMA, FACMPE, Healthcare FINANCIAL Experts, Inc.,
David Samuels’ book comes to the market just in time for health plans, physicians and hospitals to consider new options in a post reform environment. An expert in reimbursement and the mathematical fundamentals of prospective payment for over three decades, David has updated his original book, Capitation, in line with the refocused needs of providers and payers to collaborate over value instead of fighting one another over manipulated fees schedules and volume. In short order we get a 15-year update on where managed care went wrong in its reimbursement and how the use of performance data and more thoughtful application of care management techniques can build accountability into a mutual framework of payment and service for purchasers and providers. The author then goes one step further into offering innovation upon a theme to expand the thinking and capabilities of providers and purchasers to share savings and put in place key performance indicators using predictable formulas. David’s work can help many healthcare executives do a better job of understanding and planning for the future. We recommend his publications to our clients and believe his innovation offers insight into what accountable care means and how the consumer will eventually benefit through a more rational and defined care system.
—William J De Marco MA, CMC, President and Chief Executive Officer, De Marco & Associates, Inc.
David Samuels offers great insight into the health care insurance markets and the enormous potential of capitation to contribute to the solutions our Nation so sorely needs. Capitation will inevitably impact the industry's evolution and I know of no more comprehensive and detailed a depiction of its strengths and opportunities than Managed Health Care in the New Millennium.
—Carl Heard, MD, MMM, Independent Locums Physician, Consultant for Medical Management
Descriere
Thoroughly exploring how capitation has evolved domestically and internationally in recent years, this book discusses actuarial assumptions and the difficulties in payers’ transitions from community-based underwriting to experience-based ratings. It explores what the future holds in the areas of clinical pathways and population-based risk assumption tools and approaches. It covers what happens when the underlying actuarial and risk assumptions are ignored or trivialized. The author also discusses the challenges capitation-based pricing faces from an international perspective, including Latin America and the Caribbean.