Managed care contracting is a must read for professionals working with managed care organizations. Information presented by Garofalo, Horwitz and Reardon explains the nature of managed care, risk management and contracting do’s and don’ts. Bulleted summations of data framed the information in easy to understand groupings making this an outstanding reference document.

Professionals who are consultants to start up managed care organizations, taking on the challenges of a turn-around situation or are melding two organizations together would benefit from the information contained in this book.

Contracting and risk management is at the heart of any provider relationship with managed care. Regardless of which side of the contract you represent, this tool provides not only an overview of the pertinent questions but also fair appraisals of what must be negotiated.

While this book offers many concepts essential for the managed care executive, it also provides invaluable information to the agency executive who wants to have a better understanding of managed care thinking. Garofalo, et al. present the managed care perspective helping executives to identify risk management concepts and plan designs. The implication for informed providers is significant. Providers empowered with this key information will more adequately be able to negotiate contracts forming win-win relationships.

The use of exhibits, sample contracts and flow charts are indispensable tools for executives in behavioral healthcare. Beyond the tools offered, this work helps with the conceptualization of negotiation strategies along with checklists to optimize success.

Sample hospital and physician contracts along with commentary are worth ten times the price of the book. Adding to the value is an outstanding overview of managed care operations. The synthesis represented in the functional requirements of managed care operations makes an excellent checklist for start up or consolidating organizations.

Managed care often is shrouded in secrecy with proprietary information a standard. It is indeed encouraging to see an effort to document ideas that are essential to success in managed care become a part of shared knowledge. Garofalo, Horwitz and Reardon have made an excellent contribution to our industry by empowering healthcare professionals with a concise, precise tool to guide them through the complex nature of managed care.

Wendell J. Montney, Ph.D. is Director of Behavioral Healthcare at Kairos Healthcare, Saginaw, MI. His formal education includes Psychology, Education, and Chemical Dependency. His informal education includes Religion, Theology, Public Health, Managed Care, Current Issues in Medicine and Psychiatry related to Behavioral Healthcare, Organizational Design, Technology, and related Public Policy Issues. Programs at Kairos Healthcare include Intensive Outpatient, Short-term Residential, Intensive Crisis Treatment (Inpatient MH Diversion) and Proactive Development in Partnership with Managed Care.

Categories: MentalHealth, General

Keywords: managed care plans, health administration, business consulting