W 8, p2
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Payment per capitation
- monthly payment made to the PCP for each patient they signed up to receive care from them
- --usually with HMO
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
How do healthcare providers minimize the risk of capitation?
Choose healthy patients over sick ones
Risk adjusted capitation
- Higher monthly payment for elderly patients and those w/ chronic illnesses
- But you will never know how much you will need
Benefits of capitation
- Have to have a PCP
- allows for more flexibility at the practice level (virtual visits, email, phone)
British 2 tier system
- each person have PCP who receive monthly payment per capita
- specialists referrals from PCP
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)
Capitation plus Bonus
- by denying services bc more money left in pool
- Pay for performance
- ---Pay for the outcome
What would you like to do?
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