{"product_id":"health-plans-unmasked-9781421446769","title":"Health Plans Unmasked","description":"\u003cb\u003eBook Synopsis\u003c\/b\u003e\u003cbr\u003eAn insightful overview of health insurers and a guide to sustainability for provider organizations.   Physicians experience ongoing frustrations in their relationships with health plans. Even as they struggle to keep up with accelerating clinical advances, they face daunting challenges from payers that are transitioning from traditional fee-for-service contracts to complex alternative payment models. In Health Plans Unmasked, Martin Lustick, MD, offers insights and guidance for those who face the herculean task of transforming their business practices to achieve financial stability while improving outcomes for their patients.   By explaining both how and why insurance companies behave the way they do, Dr. Lustick helps providers avoid mistakes and take advantage of opportunities for success. He provides information on: The evolution of health care financing in the United States The nuts and bolts of health plan capabilities and the real motives of health plan administrators Tips for su\u003cbr\u003e\u003cbr\u003e\u003cb\u003eTable of Contents\u003c\/b\u003e\u003cbr\u003e\u003cp\u003eForeword\u003cbr\u003eAcknowledgments\u003cbr\u003eSection 1: The Basics\u003cbr\u003e1. Historical Context\u003cbr\u003e2. What is a Health Plan?\u003cbr\u003e3. Medicare\u003cbr\u003e4. Medicaid\u003cbr\u003e5. Commercial Insurance\u003cbr\u003e6. Brokers and Consultants\u003cbr\u003eSection 2: Reimbursement Basics\u003cbr\u003e7. The ABCs of Fee for Service\u003cbr\u003e8. What Happens to a Claim?\u003cbr\u003e9. Payment Errors\u003cbr\u003e10. Health Plan Strategic Concerns\u003cbr\u003e11. Analytics\u003cbr\u003e12. Cost Management Strategies\u003cbr\u003e13. Quality\u003cbr\u003e14. Care Management\u003cbr\u003e15. Health Plan Committees\u003cbr\u003eSection 3: Contracting\u003cbr\u003e16. Health Plan Contracting 101\u003cbr\u003e17. Value-Based Budgeting\u003cbr\u003e18. Incentive Payments\u003cbr\u003e19. Risk Mitigation\u003cbr\u003eSection 4: Opportunities and Obstacles in Value-Based Care\u003cbr\u003e20. Price Transparency\u003cbr\u003e21. Subrogation\u003cbr\u003e22. Pharmacy Benefit Management\u003cbr\u003e23. On Becoming a Payvider\u003cbr\u003eSection 5: A Shifting Paradigm\u003cbr\u003e24. Closing Thoughts\u003cbr\u003eGlossary of Acronyms\u003cbr\u003eIndex\u003c\/p\u003e","brand":"Johns Hopkins University Press","offers":[{"title":"Default Title","offer_id":49408149651799,"sku":"9781421446769","price":37.35,"currency_code":"GBP","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0817\/1739\/5799\/files\/9781421446769.jpg?v=1730501771","url":"https:\/\/bookcurl.com\/products\/health-plans-unmasked-9781421446769","provider":"Book Curl","version":"1.0","type":"link"}