Capitation Agreements

The financial risks incurred by economic operators are traditional insurance risks. Supplier revenues are defined and each registered patient requests all of the supplier`s resources. In exchange for fixed remuneration, physicians essentially become registered client insurers, who shed light on their patients` rights at the time of care and assume responsibility for their unknown future health costs. [4] [5] [6] [7] [8] Large suppliers tend to manage risk better than small suppliers because they are better prepared for fluctuations in demand and service costs, but even large suppliers are inefficient risk managers compared to large insurers. Suppliers tend to be small compared to insurers and therefore look more like individual consumers whose annual costs vary much more than those of large insurers as a percentage of their annual cash flow. For example, a head-to-eye care program for 25,000 patients is more convenient than a head-eye program for every 10,000 patients. The smaller the patient list, the greater the variation in annual costs and the more likely the costs are that exceed the supplier`s resources. In very small portfolios of head cards, a small number of expensive patients can dramatically influence a supplier`s total cost and increase the risk of provider insolvency. The amount of the premium payment per person is based on various factors, including the expected average use of members` health and the local cost of medical services. Under the head entrance, there is an incentive to take into account the cost of treatment. The pure head pays a fixed fee per patient, regardless of their degree of disability, which encourages doctors to avoid the most expensive patients. [3] Below is an example of a calendar for the head rate.

It only serves to illustrate and does not imply a standard for comparison purposes. The jargon used by management care organizations for head rate is PMPM (per member, per month). Health care contracts have been created to improve incentives for efficiency, cost control and preventive health care. Since most people involved in a health plan will not use the services within a month, agreements on the use of head administrations should, of course, compensate high-frequency users with plan members who receive little or no health care each month. Since the physician, hospital or health care system is responsible, regardless of the health costs of the registered member, the guarantee theoretically motivates the health care provider to focus on health screenings (mammograms, pap smears, PSA tests), vaccinations, prenatal care and other preventive care that can help keep members healthy , with less reliance on expensive specialists. Most healthcare groups now navigate through a complex mix of reduced fees for Dener (commercial insurance) and on a case-by-case basis (Medicare, plus some commercial insurance) payment. Population-based payments – direct payments to care groups – remain relatively rare. But if it were broader, groups that aggressively reduce waste, as Intermountain did, would benefit financially; revenues collected for the treatment of each patient would remain stable, while their costs would decrease.

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