Managed Care


Providers gain capitation ground

MANAGED CARE March 2000. © MediMedia USA

Providers gain capitation ground

MANAGED CARE March 2000. ©2000 MediMedia USA

Collecting information is one thing; interpreting it is another. National Health Information polled 466 provider groups; among the questions was, "If you have renegotiated a contract in the last 12 months, has the capitation rate increased, decreased, or stayed the same?" Answers given by providers contracting with HMOs seem to indicate that those physicians are seeing better days, but you shouldn't jump to conclusions.

"If a provider group rode the arbitrage to wild success one year and had massive profits, then its rate is going to go down the following year," says NHI President David Schwartz. "Something's going to change in that contract so that the HMO is not allowing the provider to win as big.

"On the other hand, if the provider group fails and loses money during the contract year, it's going to come back and say 'Look, if you want us to continue as an entity serving your members, we're going to absolutely need this much money to make it work,'" he continues. "So, I think a lot of the increases reported in the 1999 survey are reactions to poor performance among provider groups."

The only provider category that saw an overall decrease in its average capitation rate was hospitals — perhaps reflecting a growing perception among both providers and payers that hospital capitation may not be workable over the long run.

Capitation snapshot




Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014