A recent survey reports there is “mounting evidence that hospitals and medical groups are getting comfortable with incentive-based payment structures that reward quality and lower costs.”
Catalyst for Payment Reform “found that 15% of what the participating health insurers spend on medical bills is paid under capitation”—medical providers are paid a flat rate for each patient, which doesn’t change based on the amount of care they require.
Usually, “capitation carries significant risk but also the potential for bigger reward and greater flexibility for providers to pay for whatever care they consider most effective.”
Some say the growth in capitation is uneven and still very limited among providers. However, “Moody's analysts do expect risk-based incentives and capitation to grow…which is why the rating agency last year began to include reporting by payment model in the financial indicators its analysts track.”
Even though some hospitals have opted out of the ACO system created by the Affordable Care Act, it seems some of the changes pushed by the ACA are catching on.
Summary by MedicaGroups.com
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