Paperback / softback
July 4, 2023
9781421446769
English
176
32886
8.50 Inches (US)
5.50 Inches (US)
0.43 Inches (US)
.55 Pounds (US)
$49.95 USD, £41.50 GBP
v2.1 Reference
Electronic book text
July 4, 2023
9781421446776
9781421446769
English
176
32886
8.50 Inches (US)
5.50 Inches (US)
$49.95 USD, £41.50 GBP
v2.1 Reference

Health Plans Unmasked

A Physician's Guide to Working with Health Insurers

An 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 successful contracting strategies
• Alternative payment models and the promises of value-based care

With a career spanning five decades as a practicing pediatrician, chief operating officer of a medical group, chief medical officer of a hospital, and chief medical officer of a health plan, Dr. Lustick provides a straightforward guide to sustainability for provider organizations. Physicians, office managers, and anyone in a health-related field will benefit from his breaking down the role of health plans in our health care ecosystem.

About the Author

Martin Lustick, MD (CANANDAIGUA, NY), is a pediatrician. His career in medicine includes 20 years in clinical practice and leadership roles in a large physician group, a hospital, a nonprofit health plan, and a health care software company.

Endorsements

"Dr Lustick's ability to simplify the seemingly complex and frequently misunderstood inner workings of health insurance makes Health Plans Unmasked a must-read for clinicians, administrators, and insurance industry employees. Deeper understanding of how insurance works is key to driving more efficient multi-stakeholder negotiations/collaborations. If you work in or with health care systems, read this book!"

- Brian Justice, Medical Director, Excellus BlueCross BlueShield; Adjunct Professor, University of Rochester School of Medicine; Chief Innovation Officer, Spine Care Partners

"In Health Plans Unmasked Dr. Lustick provides a rare, unbiased view into the workings of the American health insurance industry. It is an essential read for anyone working to reform and improve our health system. After all, you cannot fix that which you do not understand."

- Betty Rabinowitz, MD, University of Rochester

"A significant work that puts the payment issues for health care in a balanced historical/current context. If you want one book to help you understand payer/provider roles, this is it. Fair and clearly written, this book will be required reading for our residents."

- Ann E. Z. Griepp, MD, Program Director, Psychiatry Residency, Rochester General Hospital
Johns Hopkins University Press
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9781421446769 : health-plans-unmasked-lustick
Paperback / softback
July 4, 2023
$49.95 USD
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Electronic book text
July 4, 2023
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