capitation

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.

Capitation 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.

The capitation 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 rates.

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 basis.

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.