HealthLeadersMedia.com - Capitation Rates and Data

Capitation Rates and Data, October 2008

Wed, 01 Oct 2008 14:01:00 GMT

Inside: Do the math before taking capitation risk for vaccines Guided Care plan reduces costs for chronically ill seniors E-visits improve efficiency for capitated physicians

Do the math before taking capitation risk for vaccines

Wed, 01 Oct 2008 14:01:00 GMT

Pediatricians have long wrestled with the challenge of deciding whether to accept risk for vaccines in their capitation contracts and, if so, how to structure the cost in their PMPM rates.

Guided Care plan reduces costs for chronically ill seniors

Wed, 01 Oct 2008 14:01:00 GMT

Seniors with chronic illnesses represent an especially challenging subset of patients, especially for capitated Medicare Advantage HMOs.

E-visits improve efficiency for capitated physicians

Wed, 01 Oct 2008 14:01:00 GMT

Payers are recognizing the power of the Internet, and capitated provider organizations stand to benefit.

Coordinated care benefits children with special needs

Mon, 01 Sep 2008 13:34:00 GMT

Children with special healthcare needs (CSHCN) who are enrolled in partially capitated Medicaid managed care plans (MCP) with a case management component are more likely to receive occupational and physical therapy (OT/PT) in their school setting than their counterparts enrolled in Medicaid FFS plans, according to a study published in Health Care Financing Review1, a publication of the Centers for Medicare & Medicaid Services. State Medicaid agencies and health plans should examine the utilization patterns for CSHCN who use these services before adopting either approach.

Social media provide cost-effective route to patient care

Mon, 01 Sep 2008 13:32:00 GMT

If you think you've exhausted every strategy to help control the cost of your capitated member population, here's one you might not have considered: blogging. The emergence of e-mail, online communities, blogs, videos, and other formats for sharing information electronically offers capitated physicians a new, cost-effective route to help manage patient care.

Coordinated care program cuts costs for members with chronic illness

Mon, 01 Sep 2008 13:31:00 GMT

The population of individuals in the United States with multiple chronic illnesses is growing rapidly, yet the traditional FFS delivery model doesn't provide them with optimum care. "Frankly, we do a really poor job managing this group," says Kate O'Malley, RN, MS, a geriatric nurse practitioner who is senior program officer at the California HealthCare Foundation (CHCF) in Oakland, where she works with the CHCF program to improve chronic disease care. "Sometimes, I feel like healthcare delivery is like a conveyor belt. Everybody does their own thing as the patient moves down the conveyor belt, but nobody really integrates the patient's care."

Capitation Rates & Data, September 2008

Mon, 01 Sep 2008 13:29:00 GMT

Inside: Coordinated care program cuts costs for members with chronic illness; California IPA wins even in slowing market; Social media provide cost-effective route to patient care; Coordinated care benefits children with special needs; Dear Valued Subscriber

Dartmouth Atlas: Overtreatment still common

Fri, 01 Aug 2008 16:07:00 GMT

As if to confirm the need for consistency in healthcare delivery advocated by the architects of PROMETHEUS Payment, Inc., researchers at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, NH, reported in April that chronically ill patients who receive more care might not enjoy better outcomes. In addition, existing financial practices simply encourage overuse of treatment, according to The Dartmouth Atlas of Health Care 2008: Tracking the Care of Patients with Severe Chronic Illness. There's no end of interesting benchmarks in The Dartmouth Atlas, which this year focuses on the care delivered to chronically ill Medicare beneficiaries during their last two years of life.

PROMETHEUS payment model aims to top capitation

Fri, 01 Aug 2008 16:06:00 GMT

Providers and payers are increasingly frustrated with the limitations of today's healthcare payment systems. Critics of current models argue that FFS payments provide an incentive to do too much, capitated systems encourage providers to do too little, and consumer-driven health plans often lead consumers to seek little care-or no care at all. In addition, purchasers-everyone from private employers to the Centers for Medicare & Medicaid Services (CMS)-chafe at the limitations of many pay-for-performance programs to demonstrate improved quality. Enter the PROMETHEUS (Provider payment Reform for Outcomes, Margins, Evidence Transparency, Hassle-reduction, Excellence, Understandability, and Sustainability) payment model.

Capitation Rates & Data, August 2008

Fri, 01 Aug 2008 16:04:00 GMT

Inside: PROMETHEUS payment model aims to top capitation; Dartmouth Atlas: Overtreatment still common

Managed Medicare may help seniors avoid preventable hospitalizations through better coordination of care

Tue, 01 Jul 2008 14:54:00 GMT

Considering the war of words raging in the U.S. Congress over the presumed advantage wielded by Medicare Advantage plans over FFS Medicare, it's worth examining the findings of a study by Jayasree Basu, PhD, MBA, senior economist at the Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD, and Lee R. Mobley, PhD, of the Research Triangle Institute in Research Triangle Park, NC, that was published in October 2007 in Medical Care Research and Review.1

Weigh the balance between healthcare quality and costs

Tue, 01 Jul 2008 14:53:00 GMT

There's no dearth of data when capitated providers look for information about healthcare costs. Trends in U.S. healthcare expenses are widely documented by federal agencies, academic researchers, and policy wonks. Less readily available are data on healthcare quality, especially in relationship to costs, but an annual report from the Rockville, MD-based Agency for Healthcare Research and Quality (AHRQ) helps to fill that gap. And it's free.

Benchmark your cap rates against this profitable IPA

Tue, 01 Jul 2008 14:50:00 GMT

As a taste of the in-depth capitation data you'll see in HCPro's 2009 Capitation Survey, a California IPA provided 2007 commercial and Medicare cap rates for a comprehensive group of clinical services for the 2008 Capitation Survey, published by HCPro in January. The data in Figure 4, below, offer insights into the capitation contracting and management strategy of an experienced healthcare organization.

Examine underlying community trends as one factor in the cost of care

Tue, 01 Jul 2008 14:49:00 GMT

It's no secret that healthcare is a local phenomenon. Physician practice patterns are influenced by the number and type of medical centers, sociodemographic factors, and dominant payer systems in their communities. Actuaries consider these underlying community trends when projecting future healthcare costs in a capitated arrangement, and healthcare providers should do the same when comparing their costs and outcomes to those of their peers.

Capitation Rates & Data, July 2008

Tue, 01 Jul 2008 14:47:00 GMT

Inside: Examine underlying community trends as one factor in the cost of care; Benchmark your cap rates against this profitable IPA; Weigh the balance between healthcare quality and costs; Managed Medicare may help seniors avoid preventable hospitalizations through better coordination of care

Use predictive modeling to improve case management

Sun, 01 Jun 2008 19:45:00 GMT

Once the exclusive purview of health plans, predictive modeling has made significant strides in bridging the gap among healthcare constituents. Today, predictive modeling can be used by capitated provider organizations not only to analyze costs and PMPM rates, but also to increase the efficiency of care management. One pernicious problem that drives healthcare costs is the inadequacy of historical data, such as prior cost or inpatient utilization, to accurately forecast members at high risk of future hospitalization.

Evaluate 2009 payment rates for MA plans

Sun, 01 Jun 2008 19:43:00 GMT

Health plans and providers that hold Medicare Advantage (MA) contracts breathed a sigh of relief in April when the Centers for Medicare & Medicaid Services (CMS) disclosed that it will not reduce payments to some MA plans in 2009 to offset increased coding intensity. In its 45-day advance notice of preliminary changes in 2009 payment rates, issued February 22, CMS had proposed to adjust payments to offset the effects of increased coding intensity in approximately 25% of plans whose risk scores are increasing more than twice as fast as Medicare FFS.

Capitation Rates & Data, June 2008

Sun, 01 Jun 2008 19:42:00 GMT

Inside: Evaluate 2009 payment rates for MA plans; Use predictive modeling to improve case management; Examine these benchmarks for provider-owned plans

Mine your data to target high-risk members

Thu, 01 May 2008 15:36:00 GMT

Because they're at risk for the cost of care, capitated provider organizations often employ the same high-level analytics-health risk profiling, health data analysis, and predictive modeling-that are used by health plans. Despite these efforts, gaps in care persist. A recent study by The Segal Company-which also mines medical data to help employers work effectively with health plans to manage the health risk factors of plan participants-found that 20% of a client's health plan costs were due to employee diabetes and hypertension, yet only 15% of diabetics who participate in the client's health plan had received a hemoglobin A1C test during the previous year compared to the National Committee for Quality Assurance (NCQA) national average of 44%.