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Capitation

Blue Cross Blue Shield of Massachusetts believes its newly inked provider pact with Caritas Christi Health Care — a community-based hospital network in New England with a network of 1,100 physicians that cares for about 60,000 members — will help bury the industry’s fee-for-service…
Frank Diamond
There was a time when change in the managed care world rolled eastward from California. The Golden State launched public-private initiatives, experimented with payment systems, and forged unique relationships between payers and providers. These days, however, what is cutting edge gets tried in Massachusetts,…
If there's any doubt whether capitation has left a bit of a sour taste in the mouths of physicians and hospitals, a survey issued earlier this year would seem to confirm it. Physician-group involvement in capitation is down by one fifth over a two-year period, while 2 of every 5 hospitals have moved…
Michael D. Dalzell
If there ever was an aspect of managed care so simple in theory, yet so maddeningly complex in practice, it's capitation. Hands down. "It always looks easy when the other guy is doing it," says Gary Janko, president of Access Partners, a Boston-area practice management and information systems consulting…
John Marcille
As we were putting this issue of Managed Care to bed late last month, the U.S. Supreme Court issued an opinion with important implications for our readers. In upholding states' authority to impose third-party review of HMO coverage denials, the high court sought to resolve conflicting decisions by two…
More than half of provider organizations surveyed by Evergreen Re, a national reinsurance consultant and broker, had at least one capitation contract last year — but use of capitation fell dramatically from 1999 to 2000. Perhaps not surprisingly, net profit, as a percentage of capitation revenue,…
While many physicians argue that HMOs are stingy about passing along revenue from premium increases, a new study suggests otherwise. National Health Information, which surveyed 500 provider groups and HMOs that subscribe to its newsletters, found that global capitation rates are up an average of more…
Make no mistake: Capitation — despite the beating its reputation has taken of late — isn't out of fashion. In fact, its prevalence is increasing, with 14 percent more physician groups having some involvement in capitation last year than in 1998. But to succeed under capitation, physicians and other…
Those not-so-long-ago predictions that global capitation would come to define the financing of American medicine haven't come to pass. In fact, the use of capitation has, more or less, hit a plateau in the past couple of years. Meanwhile, a capitation-rate analysis suggests that physicians who accept…