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 ?
Shape of single head of PMPM was found to be predominantly mammillated and flat topped in the present study.
In conclusion, PMPM should be included in the differential diagnosis of large pericardial effusions and cardiac tamponade and should be suspected in cases of refractory pericardial effusion despite appropriate anti-inflammatory treatment.
For PSNs, PMPM expenditures were the sum of all paid amounts for claims in a given month, including a monthly patient case management fee paid to PSN providers, whereas for HMOs, the PMPM expenditures were simply the monthly risk-adjusted capitated premiums.
For each product and customer, premium revenues and medical care claims (direct) costs are expected to have a linear relationship with the annual average number of members, hence the linear GM PMPM line in Figure 1.
In addition, a slight effect on incremental PMPM costs will be observed, as the difference in number of surviving patients receiving rFVIIa compared with standard care would increase.
Finally, payments for healthcare services PMPM by the Federal Employee Health Benefits Plan (FEHBP) constitute a third cost indicator.
In the second simulation, PMPM charges were truncated at three standard deviations above the mean for each specific ACG.
7 million are impressive, they are a tiny fraction of the more than $17 billion that calculates to exorbitant costs of care PMPM.
Under capitation, hospitals and physicians are paid so much PMPM for a defined population.
For the years 2007 to 2009, pharmaceutical costs on a PMPM basis increased at a lower amount than overall medical cost trends.
A total of 1,787 study practices were used for the adult PMPM cost multivariable model after the following practice exclusions: insufficient sample size (286), missing predictors (45), exceeding IQR thresholds (15), and influential observations (3).