per member per month


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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.

cap·i·ta·tion

(kap'i-tā'shŭn)
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]
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References in periodicals archive ?
Since assignment of ACG for enrollees in the Medicaid system for less than 6 months is less reliable we first use only age and sex regression coefficients to predict per member per month expenses for them.
(8) The cost for these veterans calculates to be $497 per member per month (PMPM).
Major Finding: In 2007, the adjusted cost per member per month of plan members with diabetes with commercial insurance was $923 among those who received diabetes education, compared with $1,072 among those who did not.
While the average reimbursement per member per month nationally was $488.45 in 1999, it varied as much as from $676.64 in Broward County, Fla., to $394.42 for Dakota County, Minn.
According to the report, average California capitation rates have fallen from a high of $45 per member per month between 1990 and 1993 to a low of $29 per member per month between 1997 and 1999.
When global capitation payments drop by $50 per member per month, who decides who will absorb the loss?
Congress intervenes, it is probable that most states, in one to three years, will place at least part of their Medicaid population into capitated plans in which providers are paid a flat fee per member per month (PMPM) - or capitation - no matter how much care is rendered.
Yet, a report by the advisory company Avalere Health showed that all prescription drugs accounted for only a $3.29 average increase in per member per month premiums.
The typical health insurer with a big Medicare Advantage operation may have spent about $12 per member per month on sales and marketing in 2014, or about 7.9 percent less than it spent in 2013.
With fewer ER visits, Wyoming Medicaid has reduced ER costs per member per month by more than 20 percent.
The fee drops to $15 per member per month for the second 2 years of the program.
The district will continue to contribute toward teachers' retirement and insurance plans at the same level as last year - $1,100 per member per month.