Survey: Not All Physicians Lose Under Capitation Contracts

The survey found that professional and primary care capitation are the most attractive to providers, whereas global risk is the least attractive. Primary care and professional capitation are the most frequent contract types; global and carve-out contracts lag behind.

On the topic of how to influence physicians' behavior, the highest percentage of respondents said they have referrals and prior authorizations to control utilization, with physician bonus payments as the second most popular. P4P and group bonus payments were each used by less than 10% of respondents.

"Managing capitation really requires a culture and a system of incentives that reward physicians for managing health. Many group practices have mixed incentives between traditional fee-for-service and capitation arrangements. To successfully manage risk, there must be an underlying culture and commitment to capitation," says Halverson.

Half of risk-contracting respondents said they purchase stop-loss insurance to protect individual doctors from adverse contract performance, with the most common form of insurance an individual policy purchased from a separate reinsurance carrier.

Most groups perform multiple types of audits and analyses to ensure contract performance and health plan compliance, with adherence to contracted rates and coding audits the most frequently used methods.

Although more than 50% of risk-contracting respondents reconcile patient eligibility with premiums to ensure proper reimbursement, many organizations do not perform any type of premium audit.