This course is designed to provide you with the comprehensive concepts of Managed Care. You will review the formative years of Managed Care and study various theories, concepts and models as they relate to Managed Care. The types of Managed Care Organizations and different provider payment models are the building blocks of you developing a Managed Care knowledge base so you can make appropriated management decisions when working in Health Care Delivery. The Insurance Function, in addition to organizational models will be reviewed at length. The understanding of Capitation and other compensation models is vital to your ability to apply the theory of Managed Care to your local market dynamics. Utilization review, Quality and Provider contracting are discussed from the management perspective. Negotiation tactics and changing provider behavior are important components of the course material. Market trends in Medicare and Medicaid Managed Care contracting and development are reviewed from their origination through the current practice.
The financial implications of Case Management, Disease Management and Pharmacy Benefit Management are covered in the course. MCO's relations with Behavioral Health Providers, Home Care, Subacute and Hospice providers are reviewed. Physician behavior, Reimbursement Systems and Information Systems are discussed. Claims processing and Managed Care trends are explained.
Textbook:The Managed Health Care Handbook. Peter R. Kongstvedt, ASPEN, 4th Edition. 2001: ISBN # 0-8342-1726-0.