A payment model in healthcare where providers receive a fixed amount of money per patient for a specific period, regardless of the actual services provided. It’s a method used by insurers or healthcare organizations to control costs and incentivize efficient care delivery.
Any healthcare professional or institution that delivers medical services, including physicians, hospitals, clinics, and nursing homes.
The group of patients assigned to a specific healthcare provider or organization under a capitated payment arrangement. Providers are responsible for managing the health and well-being of this panel within the allocated budget.
A mechanism used to account for variations in patient health status within a capitated payment system. It ensures fair compensation for providers by adjusting payments based on the severity of patient illness or other risk factors.
A common method of calculating capitation payments, where the fixed amount is determined for each enrolled member per month. It provides predictability in budgeting and financial planning for healthcare organizations.
Standards used to assess the performance and outcomes of healthcare services provided under capitation. These metrics often include measures of patient satisfaction, clinical effectiveness, and safety to ensure that cost-saving measures do not compromise the quality of care.
The process of organizing and integrating healthcare services to ensure that patients receive the right care at the right time. Capitated payment models incentivize providers to focus on coordination to improve patient outcomes and reduce unnecessary utilization of services.
Strategies employed by healthcare organizations to monitor and control the use of medical services by patients. Under capitation, managing utilization becomes crucial to staying within budget while still meeting the healthcare needs of the patient population.
In some capitated arrangements, providers may be eligible to receive a portion of the savings generated by delivering care more efficiently than anticipated. This creates an incentive for providers to adopt cost-effective practices and preventive care measures.
The practice of spreading financial risk across a group of providers or insurers participating in a capitated payment system. Pooling resources helps mitigate the financial impact of unexpected healthcare costs and ensures stability in the delivery of care.
A healthcare delivery model that emphasizes achieving better outcomes for patients at lower costs. Capitation aligns with value-based care principles by encouraging providers to focus on preventive care, care coordination, and population health management.
The process through which healthcare providers and payers establish the terms and conditions of a capitation agreement. Negotiations often involve discussions about payment rates, quality metrics, risk-sharing arrangements, and other contractual provisions.