Managed Care: What It Is and How It Works

American Journal of Pharmaceutical Education, Fall 1999 by Schafermeyer, Kenneth W

WENDY KNIGHT Managed Care: What It Is and How It Works. Gaithersburg MD: An Aspen Publication, 1998. xi 267 pp., 16 figs., 12 tbls., $29.00.

In this appropriately titled book Wendy Knight takes a complex topic and presents it in a logical, coherent manner. While Knight has extensive experience working with and writing about managed health care, she doesn't try to impress readers with her scope of knowledge by expounding in mind-numbing detail. Readers will, nevertheless, be impressed with the skillful, concise and smooth-flowing narrative and the scrupulous objectivity maintained throughout the book-the author is neither a cheerleader for managed care nor a cynical critic. The book's preface says that this is "an introductory book for professionals who are unfamiliar with managed care" and that the text is a "broad overview without excessive detail." These objectives are accomplished beautifully.

The book first describes the evolution of managed care then goes on to describe the various elements of the managed care industry. Provider networks and provider interactions are discussed in appropriate detail in Chapter 3. Chapter 4 provides valuable insight into the roles of both public and private health care purchases, including groups often neglected in managed care discussions, small businesses, employer coalitions, labor unions, CHAMPUS, Tricare and government employee contracts. The expansion of managed care coverage in both Medicaid and Medicare is discussed in a comprehensive manner without getting lost in unnecessary bureaucratic details. Other chapters cover utilization management and legal/regulatory issues. The chapter on quality of care is outstanding and may be one of the most thorough and practical discussions to be found on the topics of measuring, ensuring and improving the quality of health care.

This would be an excellent textbook for an undergraduate or graduate course in health systems management. Learning objectives and definitions of key terms at the beginning of each chapter are helpful. Even more beneficial are the excellent discussion questions at the end of each chapter and the numerous exercises interspersed throughout the text.

I have only two minor criticisms for this book. First, Chapter 1 uses some managed care terminology that will be unfamiliar to many students. Since the book does not have a comprehensive glossary, students may be somewhat lost until the jargon is adequately defined in the second chapter. The instructor can help students by defining these terms or by simply requesting that Chapter 2 be read first. The second criticism is that some excellent figures and tables are included without much discussion, Instructors may want to supplement the text by discussing these illustrations in more detail. Since the book is designed to be an introduction to managed care, it, by necessity@ omits details that some instructors may want to cover. Given adequate time, instructors could enhance the learning experience by adding lectures on basic principles of health economics, risk management, health care financing and trends in health care reform.

This is not a book about managed care pharmacy. In fact, ancillary health care services such as emergency care, behavioral health and prescriptions are mentioned only briefly. But, paradoxically, this is actually one of the strengths of this book-it doesn't focus on pharmacy. Since prescription drugs represent only about ten percent of managed care expenditures, one must first understand the industry, purchasers, major providers and strategies used to manage cost, utilization and quality in order to understand the role of pharmacy in managed health care.

This book will not he of interest to senior managers in managed care organizations or others with extensive managed care experience. Individuals who want to know managed care in great detail should read Peter Kongstvedt's Managed Health Care Handbook (An Aspen Publication, 1996, 1,044 pp., $99.00). Wendy Knight's book, however, is strongly recommended for health care students and practitioners who want to know what managed health care is and how it works.

Kenneth W. Schafermeyer

St. Louis College of Pharmacy