Capitation
Global or by Specialty
Value Delivery for population-based payment models:
The 2iM.Analytics platform assists in the implementation of payment models for the services of health plan operators, contracted in the form of payment for life, in a specific coverage area.
The remuneration per life/month requires risk adjustment according to the epidemiological profile of the assisted population
It is traditionally a prospective model of payment based on populations, where the provider receives a value for assisted life in its area of reach to provide comprehensive services to patients.
It is essential that the payment be adjusted by risk, that is, considering the epidemiological characteristics of the population for which the provider will be responsible.
Profiles and Application Conditions
Primary Care
Authors argue that this is the ideal model for remunerating assistance at the level of primary care.
Specialties
2iM has experience in implementing this model for certain specialties such as orthopedics, cardiology, psychiatry, ophthalmology, among others.
Great Financier
Model indicated for contracts with ACOs (Accountable Care Organizations), which are groups of doctors, hospitals or other providers that organize themselves to provide high quality and coordinated care for their patients, usually linked to a large public or private financier.
What are the positive points?
- Tranfer the responsibility to doctors to consider the costs of treatment options.
- Encourage the reduction of waste, as the savings generated remain with the providers.
- Create financial incentives to reduce costs and improve outcomes and the patient experience.
- Encourage the use of evidence-based clinical protocols.
What are the points of attention?
- Providers are used to serving patients and not managing populations, so it is essential that providers understand this.
- Accountability is to the population group and not directly to a specific patient, so care must be taken with undertreatment and risk selection, classic problems seen in prospective payment models.
- It is vital to establish performance or value metrics associated with remuneration, based on epidemiological calculations of the prevalence and incidence of diseases and events in certain groups. The option of contracting for Capitation in isolation, that is, without an additional payment for Value, can become a problem.