W 8, p2

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  1. Payment per capitation
    • monthly payment made to the PCP for each patient they signed up to receive care from them
    • --usually with HMO
  2. Who has more of the risk with capitation?
    HCP- b/c you think $250 a month sounds good if people not sick, but if group of people are really sick, you do a lot of work and still get $250
  3. How do healthcare providers minimize the risk of capitation?
    Choose healthy patients over sick ones
  4. Risk adjusted capitation
    • Higher monthly payment for elderly patients and those w/ chronic illnesses
    • But you will never know how much you will need
  5. Benefits of capitation
    • Have to have a PCP
    • allows for more flexibility at the practice level (virtual visits, email, phone)
  6. British 2 tier system
    • each person have PCP who receive monthly payment per capita
    • specialists referrals from PCP
  7. British tiers
    • health plan
    • PCP
  8. US capitation system tier
    • with HMOs
    • health plan pays payment and capitation rate to IPA (Independent Practice Associations) who then pays all the PCPs and specialists from there (PCP get 0.25 out of $1)
  9. Capitation plus Bonus
    • by denying services bc more money left in pool
    • Pay for performance
    • ---Pay for the outcome
Card Set
W 8, p2
W 8, p2
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