per member per month

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per member per month (PMPM)

usual unit of measure for capitation payments that payers provide to providers, both hospitals and physicians. These payments also include ancillary service use.

per member per month

adjective Referring to the dollar amount paid to a provider (hospital or healthcare worker) each month for each person for whom the provider is responsible for providing services. Per member per month forms the basis upon which managed care organisations pay providers under capitation revenue stream or cost for each enrolled member each month.


A system of medical reimbursement wherein the provider is paid an annual fee per covered patient by an insurer or other financial source; the aggregate fees are intended to reimburse all provided services.
See also: managed care
[L.L. capitatio, fr. caput, head]
References in periodicals archive ?
The greatest areas of cost reduction included growth in use of generic gastrointestinal medications, which cut 43 cents per member per month in spending.
2 percent lower rate of pediatric ER visits than non-PCMH practices, and a per member per month cost that is 4.
Per member per month cost reports by physician, specialty, and office were made available in 1990 to give physicians more feedback about the cost effectiveness of their practices.
Avivia Select solutions are available now nationwide and start at less than 50 cents per member per month.
Most industry analysis involves categories such as hospital days per year per 1000 patients or expenses incurred by specialty care per member per month or year.
Average annual premium revenue per member per month growth of 6 to
The facts revealed, however, that Health Plus of Michigan, an HMO, paid the defendant IPA a capitation amount per member per month, retaining approximately 12 percent of that amount as a risk withhold.
According to a new analysis done by Mark Farrah Associates (MFA), medical expenses on a per member per month (PMPM) basis have escalated at nearly 8% per year for the past six years.
HMO Average Commercial Premium Revenue Per Member Per Month, 1994-2006
Based on government capitation rates, the HRM QualityFIRST Index shows that the average per member per month cost of healthcare for the top ten ranking states is $239, while the average for the bottom ten states is $260.