Focusing on capitation in healthcare delivery, this text examines: the importance of understanding capitation providers; various managed care models; the transformation of the healthcare market to capitation; how to maximize opportunities by utilizing disease state management techniques; and how reverse capitation should be utilizad by providers and payors.
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David I. Samuels, FHFMA, MPA
David Samuels was born in Los Angeles, California and attended suburban public schools in Encino and Van Nuys, California. Upon graduating from Birmingham High School in 1974, Mr. Samuels originally matriculated at Columbia University and Jewish Theological Seminary of America in New York while pursuing a career in the rabbinate, yet ultimately received his Bachelors of Science in Gerontology and Masters of Public Administration degrees, as well as post-graduate certification in both Health Services Administration and Comprehensive Health Planning, all from the University of Southern California, ending in 1981. Mr. Samuels was appointed to the program faculty of USC's Center of Excellence in Health Care Management of its School of Pharmacy from 1992-1997 and has also held an adjunct appointment with the Masters of Healthcare Administration program within the Health Sciences Department of Chapman University (Orange, CA) from 1992-1998. Mr. Samuels also received a 3-year appointment to the Board of Examiners (BoE) for the Healthcare Financial Management Association's Managed Care Specialty Section (1998-2001), and has also written managed care content for BoE's other specialty groups, including Patient Financial Services, Accounting & Finance, as well as Physician Practice Management.
Over 35 years of healthcare experience has offered Mr. Samuels valuable experience in such positions as Chief Financial Officer of a 30-physician medical group, Director of Product Development for UniHealth America (before it merged with Catholic Healthcare-West), Vice-President of Development for a behavioral healthcare corporation and Management Services Organization representing over 1 million behavioral health lives at the time (and began to wrap-around behavioral health comorbidity management into disease management contracts for specific medical conditions), strategic and senior hospital line management assignments with National Medical Enterprises (which merged into Tenet HealthCare Corporation), as well as serving as Manager of Marketing Services for both UCLA Medical Center and its faculty practice plan. Mr. Samuels also served as a board director of a non-profit health plan serving approximately 135,000 Medicaid lives in Southern California, and co-developed a revenue-cycle business focusing on detecting billable undercharges for hospitals while contracting such services on an at-risk basis. In his work for a revenue cycle consultancy, Mr. Samuels gained expertise in revenue cycle redesign and management, as well as re-engineering the revenue cycle with a focus on improving managed care contractual relationships. Mr. Samuels has also been Principal of his own consulting firm since 1992.
Mr. Samuels' newest book is "Managed Care in the New Millennium: Innovative Financial Modeling for the 21st Century," to be available December 7, 2011 and published by CRC Press. His four prior book credits include "Capitation: New Opportunities in Healthcare Delivery" (McGraw-Hill, 1996) and "The Healthcare Financial Management & Budgeting Toolkit" (McGraw-Hill, 1998), a complete correspondence course in managed care published for HFMA by MGI Management Institute (March 1999) and a complete managed care certification self-study guide published in electronic format by Healthcare Financial Management Educational Foundation (November 2000).
Mr. Samuels received his HFMA Fellowship in 1997, with a specialization in managed care, and is a Past-President of HFMA's Nevada Chapter, having served as its President from November 2008 through June 2010. Mr. Samuels has been an active member of HFMA's Nevada Chapter since 2001, having previously provided 15 years of active service to the Association's Southern California Chapter as well. The Southern California Chapter bestowed one of HFMA's highest honors on David - its Founder's Medal Of Honor Award - in May 2000.
David has two adult children, Aaron (a logistics and financial analyst working in Chicago) and Joshua (a PhD candidate in biomedical engineering at Drexel University in Philadelphia). David's wife of 33 years, Lori, is a registered nurse performing concurrent case management for the Neonatal Intensive Care Unit team's Western Region for Aetna Insurance since November 2010, and has previously performed retrospective medical necessity claims reviews for Aetna during the previous 10 years. Together with her father, Max Simons, Lori and David reside in Porter Ranch, California. When he's not writing or consulting, David serves as a Cantor at his childhood synagogue's High Holiday services, and sings in 4 professional and amateur singing groups, with performances throughout the year.
David Samuels was born in Los Angeles, California and attended suburban public schools in Encino and Van Nuys, California. Upon graduating from Birmingham High School in 1974, Mr. Samuels originally matriculated at Columbia University and Jewish Theological Seminary of America in New York while pursuing a career in the rabbinate, yet ultimately received his Bachelors of Science in Gerontology and Masters of Public Administration degrees, as well as post-graduate certification in both Health Services Administration and Comprehensive Health Planning, all from the University of Southern California, ending in 1981. Mr. Samuels was appointed to the program faculty of USC's Center of Excellence in Health Care Management of its School of Pharmacy from 1992-1997 and has also held an adjunct appointment with the Masters of Healthcare Administration program within the Health Sciences Department of Chapman University (Orange, CA) from 1992-1998. Mr. Samuels also received a 3-year appointment to the Board of Examiners (BoE) for the Healthcare Financial Management Association's Managed Care Specialty Section (1998-2001), and has also written managed care content for BoE's other specialty groups, including Patient Financial Services, Accounting & Finance, as well as Physician Practice Management.
Over 35 years of healthcare experience has offered Mr. Samuels valuable experience in such positions as Chief Financial Officer of a 30-physician medical group, Director of Product Development for UniHealth America (before it merged with Catholic Healthcare-West), Vice-President of Development for a behavioral healthcare corporation and Management Services Organization representing over 1 million behavioral health lives at the time (and began to wrap-around behavioral health comorbidity management into disease management contracts for specific medical conditions), strategic and senior hospital line management assignments with National Medical Enterprises (which merged into Tenet HealthCare Corporation), as well as serving as Manager of Marketing Services for both UCLA Medical Center and its faculty practice plan. Mr. Samuels also served as a board director of a non-profit health plan serving approximately 135,000 Medicaid lives in Southern California, and co-developed a revenue-cycle business focusing on detecting billable undercharges for hospitals while contracting such services on an at-risk basis. In his work for a revenue cycle consultancy, Mr. Samuels gained expertise in revenue cycle redesign and management, as well as re-engineering the revenue cycle with a focus on improving managed care contractual relationships. Mr. Samuels has also been Principal of his own consulting firm since 1992.
Mr. Samuels' newest book is "Managed Care in the New Millennium: Innovative Financial Modeling for the 21st Century," to be available December 7, 2011 and published by CRC Press. His four prior book credits include "Capitation: New Opportunities in Healthcare Delivery" (McGraw-Hill, 1996) and "The Healthcare Financial Management & Budgeting Toolkit" (McGraw-Hill, 1998), a complete correspondence course in managed care published for HFMA by MGI Management Institute (March 1999) and a complete managed care certification self-study guide published in electronic format by Healthcare Financial Management Educational Foundation (November 2000).
Mr. Samuels received his HFMA Fellowship in 1997, with a specialization in managed care, and is a Past-President of HFMA's Nevada Chapter, having served as its President from November 2008 through June 2010. Mr. Samuels has been an active member of HFMA's Nevada Chapter since 2001, having previously provided 15 years of active service to the Association's Southern California Chapter as well. The Southern California Chapter bestowed one of HFMA's highest honors on David - its Founder's Medal Of Honor Award - in May 2000.
David has two adult children, Aaron (a logistics and financial analyst working in Chicago) and Joshua (a PhD candidate in biomedical engineering at Drexel University in Philadelphia). David's wife of 33 years, Lori, is a registered nurse performing concurrent case management for the Neonatal Intensive Care Unit team's Western Region for Aetna Insurance since November 2010, and has previously performed retrospective medical necessity claims reviews for Aetna during the previous 10 years. Together with her father, Max Simons, Lori and David reside in Porter Ranch, California. When he's not writing or consulting, David serves as a Cantor at his childhood synagogue's High Holiday services, and sings in 4 professional and amateur singing groups, with performances throughout the year.
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8 of 8 people found the following review helpful:
5.0 out of 5 stars
excellent overview of capitation for newcomer to subject,
This review is from: Capitation: New Opportunities in Healthcare Delivery (Hardcover)
In reading this book, I found David Samuels to write in a conversational tone, neither talking down to the reader, nor talking over the reader's head. The book is a great resource for the newcomer or beginner in capitated managed care negotiations. I highly recommend it! Nice job David! Maria K. Todd, author of the Managed Care Contracting Handbook and IPA, PHO, MSO Development Strategies also available on Amazon.com
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