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.

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 ?
25 per member per month for every enrollee in a commercial insured medical plan or a self-funded employer health plan.
Could PPACA reinsurance pay $20 per member per month?
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.
Performance appraisal as a modifier of physician behavior
A Medical Expense Report, profiling each individual Primary Care Physician's cost per member per month (PMPM), is provided to the PCPs on a monthly basis, using cumulative accounting for the year.
What is quality, and how is it measured?
Drug costs that were historically priced at 6-$8 per member per month (PNFM) in the early 1980s have risen to $13 PUFM in some locations and insured groups.
Drug utilization: what is to be done?
Programs start at less than 50 cents per member per month and are derived from 60 years of direct patient care from Kaiser Permanente
Avivia Health Launches New Suite of Affordable Disease Management and Wellness Programs
Offices are provided with a statement of their utilization in terms of hospital days per 1,000 members per year and specialty and emergency costs in dollars per member per month (table 1, page 16) and of their utilization performance in comparison to all similar primary offices (figure 2, page 15).
Integration of quality assessment and physician incentives
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.
Measuring the quality of ambulatory care
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.
Health Insurers' Medical Expense Trend Stabilized According to Mark Farrah Associates
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.
Physician fee-setting requires scrutiny

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