In 1994 and 1995, rates paid to ALTCS contractors were developed based on bids on each of 11 capitation
rate components: monthly institutional costs, monthly HCBS costs, HCBS/institutional mix, Medicare or third-party liability, patient share of cost, capitation
lag, case-management costs, administration costs, mental health services costs, acute care services costs, and profit (for private contractors).
With increased pressures to reduce the cost of both administration of managed care organizations and their associated medical costs as well as the need to improve clinical and business decision making, core capitation
systems alone cannot suffice to meet the needs of managed care organizations.
The HMO estimates (based on actuarial studies) that 40% of the capitation
payment will be needed to fund the cost of outside specialists.
Toolbox - Introduction; Behavioral Health Services; Capitation
fundamentals; Direct access to specialty care (self-referral); Capitation
Pros and Cons
Even after faring well and scoring commendable marks, most of these students don't get admission into their preferred course and colleges since the one paying donation and capitation
fees manages it.
This CEA compares FFS with two different capitation
models using a study conducted alongside the Colorado Medicaid Capitation
Pilot Program (Bloom et al.
Colorado HMOs had made extensive use of capitation
payment arrangements with provider groups, particularly for Medicare plans.
Meanwhile, the key to understanding how the program can achieve financial success lies in understanding how the PACE monthly capitation
is established today.
As a result, some industry analysts say the tools of managed care, such as capitation
and financial incentives, are no longer effective in controlling costs.
risk-adjustment payment model implemented by Minnesota to this point is distinguished by three key characteristics: (1) the risk-assessment model is concurrent or retrospective; (2) capitation
rates assigned to health plan enrollees are risk adjusted based on historical, health plan level risk scores; and (3) the implementation of capitation
risk adjustment is being gradually phased-in over time.
In general, the geometric expansion in the menu of services offered by EAPs has not resulted in commensurate increases in capitation
General assumptions include critical assumptions, such as net monthly enrollment growth, average daily attendance at the PACE center, capitation
rates and inflation factors, and capital requirements for building the PACE center.
The networks are compensated on a capitation
The false promise of capitation
is revealed when populations move, change plans annually or demand new technology not offered by last year's actuaries.
Some 78 percent of respondents to the 2000 Capitation
Survey report that they are either seeking more capitation
or are maintaining their current level of risk agreements.