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Related Experiment Videos

Managing the transition to capitation.

D S Kolb1, J L Horowitz

  • 1Jennings Ryan & Kolb, Atlanta, GA, USA.

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|January 8, 1995
PubMed
Summary
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Healthcare providers are transitioning from volume-based to value-based care. This shift requires preparing for capitation (fixed, per-capita payments) by enhancing efficiency and managing population health.

Area of Science:

  • Healthcare Management
  • Health Economics
  • Health Policy

Background:

  • The U.S. healthcare system is shifting towards capitation and financial risk-sharing.
  • Providers currently operate under an activity-based payment model rewarding patient volume.
  • The full impact of this transition will unfold over several years.

Purpose of the Study:

  • To outline the interim strategies for healthcare providers during the shift to capitation.
  • To highlight the necessary preparations for adopting a fixed, per-capita payment system.
  • To emphasize the importance of efficiency and population health management in the new payment model.

Main Methods:

  • Analysis of current healthcare payment systems.
  • Review of strategies for managed care contract negotiation.

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  • Assessment of methods to enhance quality and efficiency in healthcare delivery.

    • Main Results:

    • Providers must balance volume-based rewards with preparations for efficiency-based payments.
    • Successful transition requires robust systems for contract negotiation and quality improvement.
    • Taking responsibility for defined populations' health is crucial for future success.

    Conclusions:

    • Healthcare providers need proactive strategies to navigate the transition to capitation.
    • Investing in systems for efficiency and population health management is essential.
    • The shift necessitates a fundamental change in how providers are reimbursed and operate.