America's Health Insurance Plans

Publications - Managed Care and Care Management

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: