Overview

Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.

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9781284152098

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Peter R. Kongstvedt, M.D. is a renowned and highly regarded national expert in the health care industry. Currently, he is Principal of the P.R. Kongstvedt Company, LLC, where he advises health care companies and executives on strategy, operations and effective decision making to enhance corporate, institutional, and executive success. Peter is the editor and primary author of three seminal works on managed care: The Managed Health Care Handbook, which he first wrote in 1985, while the fourth and final edition of this landmark textbook was published in 2000; The Essentials of Managed Health Care, Fifth Edition (published 2007); and Managed Care: What It Is and How it Works, Third Edition (published 2008). These books are widely considered “the bibles” on managed care and are extensively used in post-graduate courses nationwide, in training and educational programs, and within the industry. He also co-authored Best Practices in Medical Management with David Plocher, M.D. in 1998. Peter began his career by practicing general internal medicine in rural southern Illinois at a rural health initiative clinic. After practicing for three years, he moved to Lincoln, Nebraska to be the medical director of a medical group associated with a group-model health maintenance organization. Soon after he became its chief executive officer as well. He continued his successful career as an executive in the managed health care industry, assuming increasingly responsible positions through 1993 when he held the position of executive vice president and chief operating officer at a Blue Cross Blue Shield plan in Washington, DC. In that same year, he became a direct-admit partner at Ernst & Young LLP, and continued his consulting career with global firms such as CapGemini and Accenture until 2008 when he formed the P.R. Kongstvedt Company, LLC. Peter is a highly sought after speaker by industry and trade groups as well as health care companies. He is also a frequent contributor to publications and the media, and has appeared on PBS and CNN as well as local media. Originally from the Midwest, for eighteen years Peter has lived in McLean, Virginia, a suburb of Washington, DC. Peter may be reached through his website:www.kongstvedt.com.

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