Alternatives to traditional capitation in managed care agreements
Kennedy, K.M.; Merlino, D.J.
Healthcare Financial Management Journal of the Healthcare Financial Management Association 52(4): 46-50
1998
ISSN/ISBN: 0735-0732 PMID: 10178064 Document Number: 495768
Risk arrangements typically fall into one of three categories: primary care capitation, professional services capitation, and global, or full-risk, capitation. Yet, in light of various disadvantages associated with these three methods, such as high administrative costs and inappropriate levels of risk assumed by providers, many healthcare payers and providers are experimenting with alternative payment plans. These alternatives include contact capitation arrangements, under which specialists receive a capitation payment on a per referral basis; open-access arrangements, under which patients do not need a gatekeeper referral to see specialists; and capitation arrangements with quality and hospital utilization bonuses, under which specialists and primary care physicians receive a capitation payment plus the potential for bonuses based on quality and utilization criteria.