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Preparing for full-risk capitation.

A Fine1

  • 1Ernst and Young LLP, Chicago, IL, USA.

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|February 6, 1998
PubMed
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Full-risk capitation requires providers to manage shared financial risks within a network. Understanding payment models and implementing measurement systems are crucial for financial success and effective contract management.

Area of Science:

  • Healthcare Management
  • Health Economics
  • Provider Networks

Background:

  • Full-risk capitation arrangements shift financial accountability to providers, encompassing both individual performance and network-wide outcomes.
  • Successful navigation of these arrangements necessitates a thorough understanding of associated risks and strategic financial management.
  • Providers must select appropriate physician payment models to align incentives and manage costs effectively within the capitated framework.

Purpose of the Study:

  • To outline the essential components for providers entering full-risk capitation.
  • To identify key risk management strategies and physician payment models relevant to capitation.
  • To emphasize the importance of robust measurement and feedback systems in optimizing capitation performance.

Main Methods:

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  • Analysis of existing physician payment models used in full-risk capitation.
  • Review of risk management principles applicable to provider networks.
  • Identification of critical elements for effective measurement and feedback systems.

Main Results:

  • Five principal physician payment models exist: fee-for-service, salary, entrepreneurial, subcapitation, and hospital reimbursement.
  • Effective risk management requires understanding network dynamics and provider interdependencies.
  • Measurement and feedback systems are vital for managing costs, revenue, and contract performance.

Conclusions:

  • Providers assuming full risk must adopt a comprehensive approach to financial and operational management.
  • The choice of physician payment model significantly influences network performance and financial outcomes.
  • Implementing integrated measurement and feedback systems is essential for sustained success in full-risk capitation environments.