AHIP's Center for Insurance Education and Professional Development - Managed Care and Care Management
Skip NavigationHealth insurance education is evolving-and the AHIP Center for Insurance Education and Professional Development is changing to meet the training needs of busy professionals. Now with more content online, expanded course offerings-including the Academy of Healthcare Management's course content-the Center is where professionals go to learn the health insurance industry industry. The Center offers self-study classes, publications, workshops, virtual seminars, and designations covering such topics as anti-fraud, business operations, consumer-driven health care, customer service, disability insurance, employee benefits, health insurance fundamentals, HIPAA, long-term care, managed care and care management, Medicare, Medicaid, Medigap, supplemental insurance, underwriting, network management, health plan finance and risk management, governance and regulation, and more.
America's Health
Insurance Plans 		Health insurance education is evolving-and the AHIP Center for Insurance Education and Professional Development is changing to meet the training needs of busy professionals. Now with more content online, expanded course offerings-including the Academy of Healthcare Management's course content-the Center is where professionals go to learn the health insurance industry industry. The Center offers self-study classes, publications, workshops, virtual seminars, and designations covering such topics as anti-fraud, business operations, consumer-driven health care, customer service, disability insurance, employee benefits, health insurance fundamentals, HIPAA, long-term care, managed care and care management, Medicare, Medicaid, Medigap, supplemental insurance, underwriting, network management, health plan finance and risk management, governance and regulation, and more.

Publications - Managed Care and Care Management

Managed Care: What It Is and How It Works
This introductory publication describes the history and evolution of managed care, focusing on the main types of managed care organizations (MCOs) and integrated health care delivery systems. You’ll become familiar with network management and reimbursement, utilization and quality, Medicare and Medicaid, regulation, and accreditation. Management candidates should take this course to acquire baseline knowledge of key terms, standard practices, and roles of primary stakeholders in health care management.

What You’ll Learn:

  • Fundamental concepts and basic functions of health care management
  • Historical background and development of the health care industry in the United States, including the evolution of preferred provider organizations (PPOs) and health maintenance organizations (HMOs)
  • Operations of traditional health insurance companies
  • Structure and types of health care organizations
  • The roles of stakeholders
  • Overview of pertinent topics, including network management, regulation, accreditation, and medical management
  • Relevant terms, industry issues, case scenarios, and key concepts

Price
$40 AHIP Members; $50 Non-members
To purchase a publication, see the Center’s online catalog.

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Course
This publication is used in tandem with the following course:

Earn a Designation
Center designations that you may be interested in pursuing:

Managed Care: What It Is and How It Works Study Manual
terial presented in the publication Managed Care: What It is and How It Works. It is a valuable resource tool for those taking the examination for the course Managed Care, Part A (The Basics).

What You’ll Learn:

  • Fundamental concepts and basic functions of health care management
  • Historical background and development of the health care industry in the United States, including the evolution of preferred provider organizations (PPOs) and health maintenance organizations (HMOs)
  • Operations of traditional health insurance companies
  • Structure and types of health care organizations
  • The roles of stakeholders
  • Overview of pertinent topics, including network management, regulation, accreditation, and medical management
  • Relevant terms, industry issues, case scenarios, and key concepts

Price
Available in electronic format only. Copy supplied free of charge to students enrolling in the Managed Care, Part A (The Basics) course.
To purchase a publication, see the Center’s online catalog.

Related Publication

Course
This publication is used in tandem with the following course:

Earn a Designation
Center designations that you may be interested in pursuing:

Managed Care: Integrating the Delivery and Financing of Health Care, Part B
Acquire more in-depth knowledge in the field of managed care examining the structure and governance of managed care organizations (MCOs). This publication expands on the basic overview presented in the introductory course, Managed Care, Part A (The Basics) to bring you a clearer focus on functional issues and problems. Various models are used to illustrate how MCOs operate and will broaden your view of activities like contracting, marketing, member services, claims administration, finance, budgeting, and rating.

What You’ll Learn:

  • The organizational structure and governance of MCOs
  • How MCOs operate in the financing and delivery of health care services
  • Illustrations of various activities, including contracting, marketing, member services, network management, claims, finance, budgeting, and rating
  • Legal issues, accreditation, and regulations that apply to the industry
  • Relevant terms, industry issues, case scenarios, and key concepts

Price
$40 AHIP Members; $50 Non-members
To purchase a publication, see the Center’s online catalog.

Related Publication

Course
This publication is used in tandem with the following course:

Earn a Designation
Center designation that you may be interested in pursuing:

Managed Care: Integrating the Delivery and Financing of Health Care, Part B Study Manual
This publication is recommended for anyone who wants to thoroughly master the material presented in the publication Managed Care: Integrating the Delivery and Financing of Health Care, Part B. It is a valuable resource tool for those taking the examination for the course Managed Care, Part B (Management Structure).

What You’ll Learn:

  • The organizational structure and governance of MCOs
  • How MCOs operate in the financing and delivery of health care services
  • Illustrations of various activities, including contracting, marketing, member services, network management, claims, finance, budgeting, and rating
  • Legal issues, accreditation, and regulations that apply to the industry
  • Relevant terms, industry issues, case scenarios, and key concepts

Price
$15 AHIP Members; $15 Non-members
To purchase a publication, see the Center’s online catalog.

Related Publication

Course
This publication is used in tandem with the following course:

Earn a Designation
Center designation that you may be interested in pursuing:


Managed Care: Integrating the Delivery and Financing of Health Care, Part C
This publication describes the continued evolution of health care management, including the impact of regulation and consumer attitudes, and identifies developments the industry has had to address. It examines the role managed care plays in government programs, such as Medicare and Medicaid, and health benefit plans for federal employees and military personnel. Functional aspects of managed care in specialty health areas, like dental, vision, behavioral health, and pharmacy, are also covered.

What You’ll Learn:

  • Factors involved in the restructuring of health care in the 1990s
  • The role of managed care in government programs, such as Medicare and Medicaid
  • How managers and accrediting organizations measure for quality and patient outcomes
  • Ways to improve organizational performance
  • Functional aspects of managed care in specialty health areas
  • Relevant terms, industry issues, case scenarios, and key concepts

Price
$40 AHIP Members; $50 Non-members
To purchase a publication, see the Center’s online catalog.

Related Publication

Course
This publication is used in tandem with the following course:

Earn a Designation
Center designation that you may be interested in pursuing:

Managed Care: Integrating the Delivery and Financing of Health Care, Part C Study Manual
This publication is recommended for anyone who wants to thoroughly master the material presented in the publication Managed Care: Integrating the Delivery and Financing of Health Care, Part C. It is a valuable resource tool for those taking the examination for the course Managed Care, Part C (Trends).

What You’ll Learn:

  • Factors involved in the restructuring of health care in the 1990s
  • The role of managed care in government programs, such as Medicare and Medicaid
  • How managers and accrediting organizations measure for quality and patient outcomes
  • Ways to improve organizational performance
  • Functional aspects of managed care in specialty health areas
  • Relevant terms, industry issues, case scenarios, and key concepts

Price
$15 AHIP Members; $15 Non-members
To purchase a publication, see the Center’s online catalog.

Related Publication

Course
This publication is used in tandem with the following course:

Earn a Designation
Center designation that you may be interested in pursuing:

Medical Management: An Overview
In an easy-to-understand, accessible style, this publication gives you a detailed overview of the history and evolution of health care management. You’ll get a clear definition of medical management, with timelines and descriptions of marketplace demands that led to new models for the financing and delivery of health care services. It will help you identify key initiatives, both public and private, that contributed to medical management, and tools and strategies used to ensure quality, improve access, and manage costs.

What You’ll Learn:

  • Historical perspectives on the development of health care management
  • Early models of health insurance and managed care
  • The definition and drivers of medical management
  • How legislative and regulatory requirements affect the industry
  • Where accreditation and certification fit in
  • Why health care benefit plans emerged
  • Current trends and demands
  • Relevant terms, industry trends, case scenarios, and key concepts

Price
$40 AHIP Members; $50 Non-members
To purchase a publication, see the Center’s online catalog.

Course
This publication is used in tandem with the following course:

Earn a Designation
Center designations that you may be interested in pursuing:

Medical Management: Utilization Management
A balancing act among professionals who work for health insurance plans, hospitals, and other entities, utilization management is centered on the needs of the patient to ensure the right provider, treatment, and site for delivery of services. In this publication, you’ll examine the many aspects of utilization management to see how it is incorporated into a variety of venues and programs, and why it exists today. It also discusses successes and failures, clarifies key issues, and looks at the future of utilization management.

What You’ll Learn:

  • The definition, history, and evolution of utilization management
  • Form and functions of current practice
  • How decision support tools are used
  • The roles of participants
  • Influences on utilization management activities
  • Industry standards
  • Accreditation and certification processes
  • Relevant terms, case scenarios, and key concepts

Price
$40 AHIP Members; $50 Non-members
To purchase a publication, see the Center’s online catalog.

Course
This publication is used in tandem with the following course:

Earn a Designation
Center designation that you may be interested in pursuing:

Medical Management: Call Centers
Here’s a practical overview of the “telehealth” industry—from standard call centers that serve health insurance plan members to more sophisticated systems that provide access to registered nurses who can assist patients with specific health problems. This publication is ideal if you want to learn more about the key role of call centers in integrated care management systems. You’ll get a good look at the nuts and bolts of the business as you examine service and quality issues, the impact of legal and regulatory requirements, and trends in the use of electronic communications by health care consumers.

What You’ll Learn:

  • The steps to take in establishing a call center
  • How to select vendors
  • What to expect with regard to hiring, training, and retaining employees
  • Issues involving service and quality
  • The impact of legal and regulatory requirements
  • Trends in the use of electronic communications by health care consumers
  • Relevant terms, case scenarios, and key concepts

Price
$40 AHIP Members; $50 Non-members
To purchase a publication, see the Center’s online catalog.

Course
This publication is used in tandem with the following course:

Earn a Designation
Center designations that you may be interested in pursuing:

Medical Management: Case Management
Case managers help clients and families navigate health care delivery systems and manage their health care needs. Practitioners come from many disciplines—they are nurses, social workers, rehabilitation counselors, and physicians—and collaborate with other key stakeholders to achieve quality, cost-effective outcomes. This publication lets you dig into the basic concepts of case management, find out about the background of the professionals who provide these services, and discover how case management processes and services function in a modern health care environment.

What You’ll Learn:

  • The definition and basic concepts of case management
  • The role of the case manager, background of the professionals who provide these services
  • The case management processes
  • The organizational structure for delivery of services
  • Related aspects of case management
  • Trends in case management
  • Relevant terms, case scenarios, and key concepts

Price
$40 AHIP Members; $50 Non-members
To purchase a publication, see the Center’s online catalog.

Course
This publication is used in tandem with the following course:

Earn a Designation
Center designation that you may be interested in pursuing:

Medical Management: Disease Management
Disease management is a system of coordinated health care interventions in which patient education and self-care are key components. This is an essential publication for beginners exploring the concept of disease management as well as managers of full-scale operations. It makes a complicated subject easy to absorb.

What You’ll Learn:

  • The definition and basic concepts of disease management
  • The evolution and current function of coordinated care systems
  • The description and use of disease management models
  • The impact of regulation and legislation
  • Relevant terms, case scenarios, and key concepts

Price
$40 AHIP Members; $50 Non-members
To purchase a publication, see the Center’s online catalog.

Course
This publication is used in tandem with the following course:

Earn a Designation
Center designation that you may be interested in pursuing:

Medical Management: Quality Management
Providing the right health care at the right time in a way that produces the most favorable patient outcomes is the objective of quality management. This publication focuses on the essentials, helping you understand why quality management is important, how programs are implemented, and who the key stakeholders are. You’ll learn the fundamental framework of the practice—programs, processes, and procedures health care organizations use to ensure quality services.

What You’ll Learn:

  • The definition and basic concepts of quality management
  • Cost factors and the impact on quality and consumer choice
  • Who stakeholders are
  • How to measure quality
  • Guidelines for patient safety, practice, and performance measures
  • The essential components of a quality management program
  • How to ensure the success of a quality management program
  • Accreditation and its impact on quality
  • Future trends
  • Relevant terms, case scenarios, and key concepts

Price
$40 AHIP Members; $50 Non-members
To purchase a publication, see the Center’s online catalog.

Course
This publication is used in tandem with the following course:

Earn a Designation
Center designations that you may be interested in pursuing:

The Center is changing to meet the needs of busy professionals like you. Now with more content online, expanded course offerings-including the Academy of Healthcare Management's course content-as well as other quick, convenient, and flexible ways to learn, the Center is where professionals go to learn the industry. The Center offers educational programs on such topics as anti-fraud, consumer-driven health care, disability insurance, employee benefits, health insurance fundamentals, HIPAA, long-term care, managed care and care management, Medicare, Medicaid, Medigap, supplemental insurance, underwriting health plan finance and risk management, governance and regulation, and more.

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