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Summary
Healthcare providers are shifting to global or full-risk contracts. This move aims to increase their share of capitation payments and gain more control over patient care delivery.
Area of Science:
- Health economics
- Healthcare management
- Provider negotiations
Background:
- Health Maintenance Organizations (HMOs) face provider dissatisfaction due to high profit margins and reduced payments.
- Providers are seeking alternative payment models to improve financial outcomes.
Purpose of the Study:
- To analyze the trend of providers negotiating global or full-risk contracts.
- To understand the motivations behind this shift in healthcare payment structures.
Main Methods:
- Analysis of provider negotiation strategies.
- Review of healthcare payment models and capitation dynamics.
Main Results:
- Providers are increasingly opting for global/full-risk contracts.
- This strategy aims to capture a larger portion of employer-paid capitation dollars.
- Providers also seek enhanced control over healthcare delivery processes.
Conclusions:
- The shift towards full-risk contracting signifies a provider-driven effort to restructure financial and operational control within the healthcare system.
- This trend may lead to significant changes in the relationship between providers and payers.