The Future of the Public's Health in the 21st Century


Book Description

The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.




Unequal Treatment


Book Description

Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.







Capitation


Book Description

Capitation is defined as "a type of risk sharing reimbursement method whereby providers in a plan's network receive fixed periodic payments for health services rendered to plan members". This definition doesn't necessarily mean that hospitals need to lose money. This book provides the tools and techniques for minimizing the financial risk that is associated with this process while maintaining the bottom line.




Negotiating Managed Care


Book Description

For many psychiatrists and other mental health professionals, the clinical review is the most burdensome and disagreeable part of managed care. In that review they are asked, by a representative of the managed care company, to justify their patient's need for care and to defend the treatment they are providing. Clinicians usually feel at a disadvantage in these discussions because they are never quite sure what information the reviewer needs to approve the patient's care. This does not have to be the case. The goal of this book is to teach psychiatrists, mental health professionals, and administrators how reviewers think and how to conceptualize, present, and document clinical care in a manner that greatly increases the likelihood that reviewers will approve their request for care. Beginning with five questions that must be answered in every managed care review, the author discusses the following key topics and many others. Presenting your case to a reviewer -- How to effectively present requests for inpatient, partial hospital, and substance abuse care and avoid common mistakes that decrease the likelihood that your request will be approved. How to answer the four clinical questions that must be addressed in every review even if they are not asked by the reviewer. Negotiating with the reviewer -- How to negotiate with a reviewer who is reluctant to approve the care you request. Writing effective notes -- How to write effective clinical notes in the patient's record that substantiate your request for care and increase the likelihood that it will be approved. Dealing with unethical reviewers -- How to identify and take action against unethical reviewers and managed care companies that are insensitive to your patient's clinical needs. Appealing denials of care -- How to appeal denials of care when you do not agree with the reviewer's decision. These and many other important issues are highlighted in brief vignettes illustrating a clinician's presentation of a patient's case and a typical reviewer's comments. This tremendously useful volume will be welcomed by every mental health care practitioner who must negotiate the current managed care landscape.




The Shadow Negotiation


Book Description

At last, here is a book that shows women how to recognize the Shadow Negotiation -- in which the unspoken attitudes, hidden assumptions, and conflicting agendas that drive the bargaining process play out -- and how to use that knowledge to their advantage. Each time people bargain over issues -- a promotion, a contract with a new client, a bigger role in decision-making -- a parallel negotiation unfolds beneath the surface of the "formal" discussion. Bargainers constantly maneuver to determine whose interests and needs will hold sway, whose opinions will matter, and how cooperative each person will be in reaching an agreement. How the issues are resolved hangs on the actions people take in the shadow negotiation, yet it is in this shadow negotiation that women most often run into trouble. The most productive negotiations take place when strong advocates can connect with each other. Good results depend equally on a bargainer's positioning her ideas for a fair hearing and on being open to the other side's point of view. But traditionally women have not fared well on either front. Often, they let negotiable moments slip by and take the first "no" as a final answer, or their efforts to be responsive to the other side's position are interpreted as accommodation. As a result, women can come away from negotiations with fewer dollars, perks, plum assignments, or less say in decision-making than men. To negotiate effectively, women must pay attention to acts of self-sabotage as well as to the moves others make in the shadow negotiation. By bargaining more strategically, women can establish the terms of their advocacy, their voice, and at the same time encourage the open communication essential to a collaborative discussion in which not only acceptable, but creative, agreements can be worked out. Written by Deborah M. Kolb and Judith Williams, two authorities in the field, The Shadow Negotiation shows women a whole new way to think about the negotiation process. Kolb and Williams identify the common stumbling blocks that women encounter and present a game plan for turning their particular strengths to their advantage. Based on extensive interviews with hundreds of business-women, The Shadow Negotiation provides women with a clear, insightful guide to the hidden machinations that are at work in every bargaining situation.




Negotiating Globally


Book Description

When it was first published in 2001, Negotiating Globally quickly became the basic reference for managers who needed to learn how to negotiate successfully across boundaries of national culture. This thoroughly revised and expanded second edition preserves the structure of the acclaimed first edition and improves upon it, making it even easier to learn how to navigate national culture when negotiating deals, resolving disputes, and making decisions in teams. Rather than offering country-specific protocol and customs, Negotiating Globally provides a general framework to help negotiators anticipate and manage cultural differences. This new edition incorporates the lessons of the latest research with new emphasis on executing a negotiation strategy and negotiating conflict in multicultural teams. The well-received chapter on “Government At and Around the Table” has been expanded and updated with new examples that span the globe. In this comprehensive resource, Jeanne M. Brett describes how to develop a negotiation planning document and shows how to execute the plan. She provides a model that explains how the cultural environment affects negotiators’ interests, priorities, and strategies. She provides benchmarks for distinguishing good deals from poor ones and good negotiators from poor ones. The book explains how resolving disputes is different from making deals and how negotiation strategy can be used in multicultural teams. Negotiating Globally challenges negotiators to expand their repertoire of strategies so that they will be able to close deals, resolve disputes, and get teams to make decisions.




The Managed Care Contracting Handbook


Book Description

Managed care contracting is a process that frustrates even the best administrators. However, to ignore this complexity is to do so at your own expense. You don‘t necessarily need to bear the cost of overpriced legal advice, but you do need to know what questions to ask, what clauses to avoid, what contingencies to cover ... and when to ask a lawyer




Health Insurance and Managed Care


Book Description

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.