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What are Capitation Reimbursement Models, Key Strategies?

revcycleintelligence.com · 1,201 words · saved by 1 readers

February 16, 2021 - As the healthcare industry continues to move towards value-based care, more managed care organizations are using capitation reimbursement models to ensure quality of care and manage cost. Compared to traditional fee-for-service models, which pay physicians for the volume of services provided, capitation models pay physicians a fixed amount per patient, per unit of time, whether or not the individual seeks care. Capitation payments are paid prior to care delivery and are determined by the range of services provided, as well as average utilization of those services and local cost of care. Often, payers establish risk pools made up of a percentage of the capitation payment that is withheld from physicians until the end of the year. This shared-savings/shared-risk model incentivizes providers to lower costs by offering them the risk pool funds as a reward for reaching quality measures. On the other hand, if the provider does not meet the payer’s value-based care measure

Getty Images Share this item with your network: By Hannah Nelson, Xtelligent/TechTarget Published: 16 Feb 2021 As the healthcare industry continues to move towards value-based care, more managed care organizations are using capitation reimbursement models to ensure quality of care and manage cost. Compared to traditional fee-for-service models , which pay physicians for the volume of services provided, capitation models pay physicians a fixed amount per patient, per unit of time, whether or not the individual seeks care. Capitation payments are paid prior to care delivery and are determined by

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