Introduction1 Introduction PartOne Introduction to Health Insurance and Managed Health Care Chapter1 A History of Managed Health Care and Health Insurance in the United States By Pete Fox and Peter R. Kongstvedt Chapter2 Types of Health Insurers, Managed Health Care Organizations and Integrated Healthcare Delivery Systems By Eric Wagner and Peter R. Kongstvedt Chapter3 Elements of the Management and Governance Structure By Peter R. Kongstvedt PartTwo Network Contracting and Provider Payment Chapter4 The Provider Network By Peter R. Kongstvedt Chapter5 Provider Payment By Peter R. Kongstvedt Chapter6 Legal Issues in Provider Contracting By Mark S. Joffe and Kelli D. Back PartThree Management of Utilization and Quality Chapter7 Basic Utilization and Case Management By Peter R.
Kongstvedt Chapter8 Fundamentals and Core Competencies of Disease Management By David W. Plocher Chapter9 Physician Practice Behavior and Managed Health Care By Jay Want and Peter R. Kongstvedt Chapter10 Data Analysis and Provider Profiling in Health Plans By David W. Plocher & Nancy Garrett Chapter11 Prescription Drug Benefits in Managed Care By Robert P. Navarro, Craig Stern, and Rusty Hailey Chapter12 Introduction to Managed Behavioral Healthcare Organizations By Joann Albright, Deborah Heggie, Anthony M. Kotin, Connie Salgy, Wanda Sullivan, and Fred Waxenberg Chapter13 Disease Prevention in Managed Health Care Plans By Mark Manley Chapter14 Quality Management in Managed Health Care By Pamela B. Siren Chapter15 Accreditation and Performance Measurement Programs in Managed Health Care By Margaret E. O'Kane PartFour Sales, Finance and Administration Chapter16 Marketing and Sales By Richard Birhanzel Chapter17 Enrollment and Billing By Karl V.
Kovacs Chapter18 Claims and Benefits Administration By Donald L. Fowler, Jr. and Elizabeth Pascuzzi Chapter19 Health Care Fraud and Abuse By Christie Moon Chapter20 Member Services By Kevin Knarr and Peter R. Kongstvedt Chapter21 Operational Finance and Budgeting By Dale F. Cook and Christopher Campbell Chapter22 Underwriting and Rating By Michael G. Sturm and Troy M. Filipek Chapter23 Information Systems and Electronic Data Interchange in Managed Health Care By James S. Slubowski PartFive Special Markets Chapter24 Health Plans and Medicare By John K.
Gorman, Jean D. LeMasurier, William A. MacBain, Stephen J. Balcerzak, Wendy K. Burger and Amy Huang Chapter25 Medicaid Managed Health Care By Rodney C. Armstead, Catherine K. Anderson, Elizabeth Cabot Nash Chapter26 The Military Managed Care Health System By M. Nicholas Coppola, Ronald P.
Hudak, Forest S. Kim, Lawrence Fulton, Jeffrey P. Harrison, and Bernie Kerr Chapter27 Managed Care in a Global Context By Jonathan P. Weiner, Emily Adrion, Joanna Case Famadas, Djordje Gikic and Hugh Waters PartSix Laws and Regulations Chapter28 State Regulation of Managed Health Care By Tom Wilder Chapter29 Federal Regulation of Health Insurance and Managed Health Care By Tom Wilder Chapter30 The Patient Protection and Affordable Care Act By Tom Wilder.