Capitation Healthcare delivery model where physicians and other healthcare providers such as clinics and hospitals receive a certain amount agreed by the patient within a specified period of time. It is paid in advance for a specified period of time whether the member will take care of it. Ideally, patients who have very little use will naturally balance with higher use of patients. These are fixed, pre-arranged monthly payments received from a physician, clinic, or hospital for a patient listed in a health plan or per capita. Monthly payments are calculated one year in advance and remain fixed for this year regardless of how many times the patient needs the service. In the capitation model, suppliers are paid per month (PMPM) for each enrolled patient or per member. This is called the capitated rate or capitation premium, sometimes referred to as the “cap”.
Title delivery rates are developed through local costs and average use of services, and therefore may vary from one region of the country to another. Many plans place risk pools as a percentage of capitation payments. If healthcare providers perform well in the previous year (i.e. they do not use more than the total amount of asylum seekers), the pair may leave an additional amount to physicians at the end of the year. However, if the services rendered end up costing more than the agreed amount, the money to be paid for the loss may be retained in the “risk pool”. Ability to explore cost-effective care processes to deliver maximum results without relying on face-to-face services to generate a bill for services. The amount of capitation will be determined, in part by the number of services rendered and will vary from health plan to health plan. Most captioning plans for primary care services include primary areas of healthcare. Greater physician accountability, which can limit the provision of unnecessary care or costly procedures and reduce outpatient costs. The concern is that this model has a tendency for providers to provide more services to maximize their revenue and some of these services may be unnecessary or inappropriate, resulting in inflated costs without improving the quality of care or patient health outcomes.
At the same time, to ensure that patients do not receive sub-optimal care through under-use of healthcare services, insurance companies measure resource utilization rates in physician practice. These reports are publicly available and can be linked to financial rewards such as bonuses. The concern is that this model has a tendency for providers to provide more services to maximize their revenue and some of these services may be unnecessary or inappropriate, resulting in inflated costs without improving the quality of care or patient health outcomes.
