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Capitation is at the Door; Will You Be The One Who Knocks?

Philip Betbeze, for HealthLeaders Media, November 22, 2013

Again, the idea is that by using its network and its full-time physicians to manage care and coordinate it better, this health system will be able to limit any revenue drain. But it's still a risk based on how well they manage that population's health. The details are different, but do the incentives and disincentives sound familiar?

What all of the CFOs expressed in our discussions regarding capitation-based reimbursement is the need for either a system-owned owned health plan or a long-term partnership with an existing payer that evolves based on changing benchmarks.

It goes without saying that such organizations would have to have excellent clinical integration—and that means not just on the inpatient side—but with physician practices, skilled nursing facilities, and even federally qualified health centers.

Even with shared risk programs, capitation will be the vehicle to eventually move providers, whether they're a physician practice, a hospital or health system, or some combination of the three, into a contract that forces them to take on more risk for outcomes.

Commercial insurers can come knocking on your door, or you could be the one who knocks. Which position would you rather take?


Philip Betbeze is senior leadership editor with HealthLeaders Media.
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