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Leading Medicaid Managed Care Plans - A State Relationship Perspective (Paperback)
Loot Price: R1,900
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Leading Medicaid Managed Care Plans - A State Relationship Perspective (Paperback)
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Leading Medicaid Managed Care Plans examines leadership actions
necessary to successfully operate a Medicaid managed care plan with
emphasis on the relationship with the state Medicaid agency the
health plan is contracted with. With appropriate operational and
governance oversight, and with solid mutually respectful
relationships with the state agency, Medicaid health plans are more
likely to sustain success and prosperity for the long term. The
approach of Leading Medicaid Managed Care Plans builds on key
infrastructure elements that need to be in place when contracting
with a state agency, and for overall success of the organization.
It takes a pragmatic and methodical approach, interspersed with
real-life examples of what to do for success and what actions to
avoid that frequently lead to failure. This approach is different
from most managed care books (Medicaid or otherwise) as those
mostly focus on the process of the business (such as details around
claims payment, or provider contracting) and ignore the role of the
state Medicaid agency and its importance in retaining the
contractual relationship. This book differs also on its emphasis on
organizational foundational elements and strategic leadership
skills necessary to sustain success. The author has years of
experience in turning around failing Medicaid managed care plans
and observing what they all had in common that contributed to those
failures. One common feature was the deterioration of the
relationship with the state Medicaid agency they were contracted
with, and how close they all came to losing their multi-million
dollar businesses. The purpose of this book is to educate and
inspire managed care executives and senior leaders who operate
Medicaid health plans and to help them understand what elements are
needed for successful health plans and a sustainable relationship
with the people directing the state Medicaid agency.
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