David I. Samuels

Managed Health Care in the New Millennium (eBook, PDF)

Innovative Financial Modeling for the 21st Century

• Format: PDF

Produktbeschreibung

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.

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Produktdetails

• Verlag: Taylor & Francis
• Seitenzahl: 306
• Erscheinungstermin: 5. Dezember 2011
• Englisch
• ISBN-13: 9781439840313
• Artikelnr.: 57123371

Autorenporträt

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.

Inhaltsangabe

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.