Financial viability in a capitated
payment model depends on the physician's having a sufficiently large number of patients, and especially a large number of healthy patients who need little or no continuing care.
Team-based care and the ability to distribute tasks to appropriately trained and coordinated staff members, coupled with the workflows and information technologies to drive performance, especially in a bundled or capitated
payment environment, can offer nonprofit providers opportunities for some of the flexibility and innovation seen in the private sector.
IN THE 1980S, AUSTIN REGIONAL CLINIC, A network of Texas physician groups, was a fully capitated
program serving 80,000 people.
The researchers also assumed that when practices transition to a capitated
system many of them also adopt a primary care medical home (PCMH) model that often includes changes in staffing ratios almost always resulting in a higher staff to physician ratio.
* Developing a capitated
funding model to deliver outcomes based mental health services
As a final alternative, the group suggested that the current payment improvement models be expanded to the entire Medicaid population, without incorporating any model using MCOs or capitated
To guard against one problem that cropped up in the 1990s -- complaints that some capitated
physicians were keeping patients from getting necessary care -- the ACO programs are supposed to reward the ACOs for providing good care as well as for providing efficient care.
My guess is that many doctors who succeed at setting up capitated
concierge practices will end up skimping on care or rationing care by letting office waiting rooms fill up.
The Medicare program also should improve its oversight of its Special Needs Plans, which make capitated
payments for the care of about 1 million dual-eligible patients with conditions such as end-stage renal disease, the report said.
As part of its charge, the innovation center will develop and evaluate pilot projects for new and old payment ideas that include accountable care organizations, patient-centered medical homes, bundled payments, and capitated
contracts proliferated in many parts of the country during the managed care era over a decade ago.
NEWS: Some of the concepts--such as medical homes and capitated
payments--have been tested before.