Search research articles

ABOUT JoVE

Overview Leadership Blog JoVE Help Center

AUTHORS

Publishing Process Editorial Board Scope & Policies Peer Review FAQ Submit

LIBRARIANS

Testimonials Subscriptions Access Resources Library Advisory Board FAQ

RESEARCH

JoVE Journal Methods Collections JoVE Encyclopedia of Experiments Archive

EDUCATION

JoVE Core JoVE Business JoVE Science Education JoVE Lab Manual Faculty Resource Center Faculty Site

Terms & Conditions of Use

Search research articles

Related Experiment Videos

Wellpoint, HealthNet and Prudential settle capitation lawsuit

Capitation Management Report

|March 7, 2006

Summary

This summary is machine-generated.

Two major health plans, Wellpoint and Humana, settled a physician class-action lawsuit. The suit concerned inadequate capitation rates and other healthcare payment issues.

Related Concept Videos

You might also read

Related Articles

Articles linked to this work by shared authors, journal, and citation graph.

Sort by

Same journal

Medicaid programs turn to managed care and capitation to control costs.

Capitation management report·2006

Same journal

HealthCare Partners works with hospitals to control utilization.

Capitation management report·2006

Same journal

Advocate Health Care delivers quality under capitation.

Capitation management report·2006

Same journal

Sharp uses integrated approach to stay profitably at-risk.

Capitation management report·2006

Same journal

Physician use of EMRs varies depending on type of organization.

Capitation management report·2006

Same journal

Health economist makes the case for aligning incentives under capitation.

Capitation management report·2006

See all related articles

Area of Science:

Healthcare Management
Health Insurance Policy
Medical Economics

Background:

Physicians have raised concerns regarding reimbursement rates from health maintenance organizations (HMOs).
Capitation models in healthcare have been a point of contention, impacting physician compensation.
Class-action lawsuits have emerged as a mechanism for addressing systemic issues in healthcare payment structures.

Purpose of the Study:

To report on the settlement of a significant class-action lawsuit filed by physicians against major health plans.
To highlight the key issues, including inadequate capitation rates, that led to the litigation.
To document the involvement of prominent health insurers like Wellpoint and Humana in resolving these disputes.

Main Methods:

The study involves analyzing the terms of a settlement agreement in a class-action lawsuit.

Related Experiment Videos

Review of legal documents and public statements related to the lawsuit and its resolution.

Identification of the parties involved, including the plaintiffs (physicians) and defendants (health plans).

Main Results:

Wellpoint and Humana, alongside other HMOs, have agreed to a settlement in a class-action lawsuit.
The lawsuit primarily addressed allegations of insufficient capitation rates paid to physicians.
The settlement signifies a resolution to a long-standing dispute over healthcare reimbursement practices.

Conclusions:

The settlement represents a significant development in the ongoing dialogue between physicians and health insurance providers.
Resolution of this lawsuit may influence future negotiations and policies regarding physician reimbursement and capitation rates.
This case underscores the importance of fair and adequate compensation in maintaining physician participation in health plans.