Capitation is defined as "a type of risk sharing reimbursement method whereby providers in a plan's network receive fixed periodic payments for health services rendered to plan members". This definition doesn't necessarily mean that hospitals need to lose money. This book provides the tools and techniques for minimizing the financial risk that is associated with this process while maintaining the bottom line.

Here's a challenge to conventional wisdom that will change the way you think about capitation. This hands-on resource is a collection of articles detailing the most advanced methods used by leading healthcare operational experts on how to provide high-quality care at less cost; manage financial risk more efficiently; design operational, clinical and information systems to meet the needs of patients, practitioners and managed care organizations; structure financial incentives to promote successful collaborations and make the transition from fee-for-service to risk-sharing arrangements. You'll find practical examples of how to build the trust necessary to create win-win solutions to problems that arise between competing yet interdependent interests of the various stakeholders. Edited by Peter Boland, PhD, and based on a "best practices" approach, each of the articles in the book illustrate compensation methodologies that have been successfully implemented with the support of physicians and hospitals.

An overview for readers who are familiar with capitation basics but not experienced in the operational, institutional, and administrative complications involved in capitated care. Lays out the case for why capitation will continue as a payment system, then explores adaptive strategies employed in ma

The fourth book in the Healthcare Payment System series, Cost-Based, Charge-Based, and Contractual Payment Systems compares cost-based systems, charge-based payment approaches, and contractually-based payment processes with fee-schedule payment systems and prospective payment systems. Supplying readers with a clear understanding of important background material on the different types of healthcare providers, it covers the basics of cost-based, charge-based, and contractual payment systems. The book illustrates essential concepts with a series of simple case studies—making it ideal for anyone interested in learning more about the specific systems and processes used for payment in healthcare services. It discusses Medicare cost-based payment systems, Medicare payment approaches, and includes an appendix that outlines the various Medicare payment systems. Demystifying contractual language, it outlines managed care contracts and also: Delves into the intricacies involved with adjudication of claims Considers capitated payment systems Addresses healthcare costs and cost-based reimbursement systems Examines charge-based and contractual payment systems Describes where healthcare payment systems are headed in the future Since compliance is inherent throughout the process of providing services, filling claims, and receiving payment, the book examines the range of compliance concerns, including statutory, contractual, and overpayment issues. Using numerous examples to illustrate the processes used for capitated contract arrangements, the book includes coverage of claim adjustment, managed care contracts, and the various combinations of payment systems used by third-party administrators.

This thoroughly revised and updated book provides a strategic and operational resource for use in planning and decision-making. The Handbook enables readers to fine-tune operation strategies by providing updates on critical managed care issues, insights to the complex managed care environment, and methods to gain and maintain cost-efficient, high quality health services. With 30 new chapters, it includes advice from managers in the field on how to succeed in every aspect of managed care including: quality management, claims and benefits administration, and managing patient demand. The Handbook is considered to be the standard resource for the managed care industry.