decisionhealth Newsletters, Answer Books - 2009 Issue 11 (November)
Capitation / Overview
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Article Overview
This article explains capitation as a managed care payment model and places it in the broader context of HMOs, physician hospital organizations, and other risk-sharing arrangements. It is intended for readers evaluating managed care reimbursement structures and understanding how fixed payments relate to population-based care delivery and cost control.
Why This Topic Matters
Capitation affects how providers are paid, how financial risk is distributed, and how organizations evaluate the predictability and sustainability of managed care arrangements.
What You Will Learn
- The basic structure of capitation as a prospective payment arrangement
- How capitation relates to managed care organizations and provider risk
- Why evaluating capitation requires attention to cost trends and service utilization patterns
- How fixed payment models differ from other reimbursement approaches at a high level
Who Should Read This
- Medical coders
- Billing professionals
- Practice managers
- Revenue cycle staff
- Healthcare administrators
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