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Suggested Chapter Readings To supplement the material in Essentials of Managed Health Care, Fourth Edition, we have provided a list of additional readings for each chapter. Select the appropriate chapter from the drop down box below to view the reading selection(s). Chapter 1: An Overview of Managed Health Care  "Managed
Care Evolution — Where Did It Come from and Where Is It Going?"
Health Care Manager, Vol. 18:2, (pp. 50-57)"Understanding
and Managing Integrated Delivery Networks,"
Health Care Manager, Vol. 18:4, (pp. 41-47)
Chapter 2: Types of Managed Care Plans "Managed
Care Plans and the Organizational Arrangements with Group Practices"
Journal of Ambulatory Care Management, Vol. 19:4, 1996 (pp. 11-17)
Chapter 3: Integrated Health Care Delivery Systems "Integrated
Delivery Systems: Non Fait Accompli"
Managed Care Quarterly Vol. 7:1, 1999 (pp. 29-38)
Chapter 4: Elements of the Management Control and Governance Structure "Governance
of Integrated Delivery Systems/Networks: A Stakeholder Approach"
Health Care Management Review, Vol. 22:1, 1997 (pp. 7-20)
Chapter 5: Examining Common Assertions About Managed Care "Lessons
Learned in Managed Care"
Home Health Care Management & Practice, Vol. 9:2, 1997 (pp. 58-63)
Chapter 6: Primary Care in Managed Health Care Plans "Primary
Care Physicians’ Participation in Managed Care Networks"
Journal of Ambulatory Care Management, Vol. 22:2, 1999 (pp. 27-40)
Chapter 7: Compensation of Primary Care Physicians in Managed Health Care "Addressing
Physician Compensation and Practice Productivity"
Journal of Ambulatory Care Management, Vol. 22:3, 1999 (pp. 47-57)"Incentive-Based
Physician Compensation Models"
Journal of Ambulatory Care Management, Vol. 22:3, 1999 (pp. 36-46)"The
Promise and Pitfalls of Explicitly Rewarding Physicians Based on patient
Insurance"
Journal of Ambulatory Care Management, Vol. 23:1, 2000 (pp. 55-70)
Chapter 8: Contracting and Reimbursement of Specialty Physicians "Designing
and Administering Physician Compensation Plans in Integrated Health Systems"
Physician Compensation Arrangements: Management and Legal Trends,
(pp. 41-60), Daniel K. Zismer, PhD "Specialty
Care Contracting"
Managed Care Contracting: A Guide for Health Care Professionals (pp.
171-203), Wendy Knight
Chapter 9: Negotiating and Contracting with Hospitals and Institutions "Negotiating
Skill for Health Care Professionals"
The Health Care Supervisor, Vol. 14:3, 1996 (pp. 27-32)
Chapter 10: Introduction to Medical Management "The
Paradox of Legitimacy: Physician Executives and the Practice of Medicine"
Health Care Management Review, Vol. 24:4, 1999 (pp. 54-64)
Chapter 11: Managing Basic Medical-Surgical Utilization "Managed
Care, Utilization Management, and Case Management in the Emergency Department"
Topics in Emergency Medicine, Vol 18:4, 1996 (pp.50-57)
Chapter 12: Clinical Services Requiring Authorization "How
HMOs Structure Primary Care Delivery"
Managed Care Quarterly, Vol. 4:4, 1996 (pp.96-105)
Chapter 13: Case Management and Managed Care "Case
Management as a Tool for Clinical Integration"
Advanced Practice Nursing Quarterly, Vol. 4:1, 1998 (pp.9-15)
Chapter 14: Fundamentals and Core Competencies of Disease Management "Developing
Effective Disease State Management Programs"
Home Health Care Management & Practice, Vol. 10:4, 1998 (pp.
11-19)"Critical
Pathways as an Essential Part of a Disease Management Program"
Journal of Nursing Care Quality, Vol. 14:1, 1999 (pp.11-15)"Organizing
Health Care for People with Seizures and Epilepsy"
Journal of Ambulatory Care Management, Vol. 21:2, 1998 (pp.1-17)
Chapter 15: Prescription Drug Benefits in Managed Care "The
Impact of Managed Care on Pharmacy Practice"
Pharmacy Practice Management Quarterly, Vol. 19:4, 2000 (pp.99-116)
Chapter 16: Managed Behavioral Health Care Services "Fundamental
Mechanisms of Managed Behavioral Health Care"
Journal of Health Care Finance, Vol. 24:3, 1998 (pp. 1-15)"Oversight
of Managed Care for Behavioral Health Services"
Journal of Public Health Management and Practice, Vol. 4:1, 1998
(pp. 96-100)"Survey
Results on Behavioral Health Promotion in Managed Primary Health Care"
Journal of Public Health Management and Practice, Vol. 4:1, 1998
(pp.101-109)
Chapter 17: Quality Management in Managed Care "What
is Quality, Who Wants It, and Why?"
Managed Care Quarterly, Vol. 7:4, 1999 (pp. 40-46)"Marketing
Quality and Value to the Managed Care Market"
Topics in Health Information Management, Vol. 19:2, 1998 (pp. 62-69)"HMO
Quality and Financial Performance: Is There a Connection?"
Journal of Health Care Finance, Vol. 24:2, 1998 (pp. 65-77)
Chapter 18: Using Data and Profiling in Medical Management "Using
Data in the Case Management Process"
Journal of Nursing Care Quality, Special Issue no. 1, November 1999,
pp. 86-97.
Chapter 19: Physician Behavior Change in Managed Health Care "Has
Managed Care Changed the Skills Required for Physicians to Practice Medicine?"
Managed Care Quarterly, Vol. 7:4, 1999 (pp. 20-24)
Chapter 20: Information Systems and EDI for MCOs "The
Evolution to Electronic Data Interchange: Are There Benefits at All Stages
of Implementation?"
Hospital Materiel Management Quarterly, Vol. 18:4, 1997 (pp. 79-83)
Chapter 21: Claims and Benefits Administration "An
Examination of Employer-Provided Benefits in the Health Care Industry,"
Health Care Manager, Vol.8:4, (pp. 55-62)
Chapter 22: Member Services and Consumer Affairs "Testing
Strategies for Building Member Loyalty in a Managed Care Organization Serving
Medicare Beneficiaries"
Managed Care Quarterly, Vol. 7:4, 1999 (pp. 15-19)
Chapter 23: Sales and Marketing in Managed Health Care Plans: The Process of Distribution "Becoming
Customer-Driven: One Health System’s Story"
Managed Care Quarterly, Vol. 6:3, 1998 (pp. 28-39)
Chapter 24: The Employer’s View of Managed Health Care "Employee
Reactions to Managed Care"
Health Care Management Review, Vol. 24:2, 1999 (pp. 57-70)"Revisiting
Employee Benefits Managers"
Health Care Management Review, Vol. 24:4, 1999 (pp. 70-79)
Chapter 25: The Impact of Consumerism on Managed Health Care "Health
Care Consumerism, the Information Explosion, and Branding: Why ‘Tis
Better to be the Cowboy than the Cow"
Managed Care Quarterly, Vol. 6:4, 1998 (pp. 33-43)"MCOs
— You’re Using the Wrong Benefits!"
Managed Care Quarterly, Vol. 7:4, 1999 (pp. 34-39)
Chapter 26: External Accreditation of Managed Care Plans "Accreditation
and Managed Care: Partnering for Success"
Topics in Spinal Cord Injury Rehabilitation, Vol. 3:4, 1998 (pp.
74-79)"Health
Plan Accreditation: NCQA, JCAHO, or Both?"
Managed Care Quarterly, Vol. 6:4, 1998 (pp. 52-61)
Chapter 27: Common Operation Problems in Managed Health Care Plans "Increasing
the Level of Integration in Your Provider Organization"
Managed Care Strategies: A Physician Practice Desk Reference (pp.
349-366), George B. Moseley, III
Chapter 28: Operational Finance and Budgeting
"Managing Risk in
Changing Health Care System"
Journal of Health Care Finance, Vol. 22:3, 1996 (pp. 15-22)
Chapter 29: Underwriting and Rating Functions Common to Most Markets "Forecasting
Health Expenditures: Short, Medium, and Long (Long) Term"
Journal of Health Care Finance, Vol. 26:3, 2000 (pp. 56-72)
Chapter 30: Medicare and Managed Care "Medicare
and Medicaid Fraud and Abuse"
Home Health Care Management & Practice, Vol. 10:6, 1998 (pp.
1-10)
Chapter 31: Medicaid Managed Care "Serving
People with Developmental Disabilities in Medicaid Managed Care"
Managed Care Quarterly, Vol. 7:2, 1999 (pp. 23-30)"Medicaid
and Managed Care: Meeting the Reproductive Health Needs of Low-Income Women"
Journal of Public Health Management and Practice, Vol. 4:6, 1998
(pp. 13-22)"Implementing
Medicaid Managed Care: The New York City Story"
Journal of Health Care Finance, Vol. 26:1, 1999 (pp. 1-17)
Chapter 32: Legal Issues in Provider Contracting "Legal
Issues in Managed Care Contracting: Home Health Care in the 1990s"
Home Health Care Management & Practice, Vol. 9:2, 1997 (pp. 22-28)
Chapter 33: Legal Liability Related to Medical Management Activities "Legal
Issues for Case Managers: What You Don’t Know Can Hurt You"
Family & Community Health, Vol. 22:3, 1999 (pp. 78-91)"Educating
Physicians on How to Avoid Liability Related to Utilization Review by Third
Party Payors"
Home Health Care Management & Practice, Vol. 9:6, 1997 (pp. 45-50)
"The
Health Insurance Portability and Accountability Act of 1996: Understanding
the Anti-Kickback Laws"
Journal of Health Care Finance, Vol. 25:2, 1998 (pp. 55-62)"Mental
Health and Substance Abuse Benefits in Carve-Out Plans and the Mental Health
parity Act of 1996"
Journal of Health Care Finance, Vol. 24(3), 1998 (pp. 82-92)"Management
Implications of the Health Insurance Portability and Accountability Act,"
Health Care Manager, Vol. 19:1, 2000 (pp. 44-49)
Chapter 35: State Regulation of Managed Care "Managed
Care Regulations: Impact on Quality?"
Quality Management in Health Care, Vol. 8:2, 2000 (pp. 21-39)
Chapter 36: Managed Care’s Regulatory Evolution: Driving Change in the New Century "Regulating
Managed Care Plans: Is the Telecommunications Industry a Possible Model?"
Managed Care Quarterly, Vol. 6:3, 1998 (pp. 7-16)
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