Risk-based capital requirements may be a boon to capitation

Don't count capitation out yet. Especially not when state-imposed risk based capital requirements make it attractive. See how the numbers play out.

Get your fair share of HMO premium increases

Data Insight: The latest InterStudy HMO statistics show that premiums are up, administrative costs are down, and membership is falling slightly. Do these trends mean more money is on the way for physician groups?

Capitation not dead, but its percent of total revenue may decrease in next five years

Contrary to popular opinion, capitation is still being used extensively, but its percentage of total revenue may decline somewhat in the next five years, according to a new Evergreen Re survey.

Wisconsin health plan cap rates reflect industrywide increases

Data Insight: Here's another set of anecdotal PMPM rates from a respondent to the 2000 Capitation Survey.

Changes in inpatient psychiatric utilization and quality of care performance measures in a capitated HMO population, 1989-1999

Managed behavioral health care approaches have significantly reduced inpatient utilization and related cost of care, but the relationship between decreased utilization and cost of care to changes in quality of care performance over time remains in question. The trends in utilization and quality of care performance measures over the course of 10 years of the Tufts Health Plan Designated Facility Program, a model health maintenance organization capitated program for inpatient behavioral health care, are presented. The results indicate that substantial decreases in inpatient utilization were sustained while quality of care measures improved over time. The data support the Tufts Health Plan Designated Facility Program as a successful means of balancing cost containment with quality of care.

Shifting to capitation in primary care: what might the impact be in New Zealand?

Primary medical care in New Zealand has traditionally been delivered by general practitioners and funded by a mix of fee-for-service government subsidies, user part-charges and private payments. In 1998, New Zealand's national purchaser of publicly-funded health care, the Health Funding Authority, proposed to pay health service organisations capitation fees per enrolled patient, as well as fees-for-service for immunisations and some performance-related payments. This article considers the implications, drawing on theory and research from New Zealand and elsewhere, of different methods for paying general practitioners and other primary care professionals. The main focus is on whether giving a greater emphasis to capitation will lead to a fairer distribution of resources and better access to services for those groups of people who are not well served by the current system.

California medical group wins big even in tight contracting market

Hill Physicians Medical Group is one of the most highly regarded provider organizations doing capitated deals in the cut throat northern California market. What makes this group tick?

Growing importance of capitation in Switzerland

Since its liberalization the Swiss health insurance market has shown risk selection activities of the insurance funds, which call for risk adjustment. Because risk selection continues to be profitable under the current risk adjustment formula, fast growing HMO and PPO plans are (mis)used to attract good risks rather than to contain costs. For fear of being replaced by one centralised fund, social health insurers are themselves proposing improvements of the risk adjustment formula, to be applied to funds. The revised formula proposed in this paper, applicable among funds for risk adjustment and to gate-keeping models to calculate fair capitation, explains 12.4% of the variance of health care expenditure, halves profits from risk selection, and uses only the (few) data that are available in Switzerland.