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I just reviewed an article by the HFMA in the semi-annual Leadership publication. In it is a case study of global capitation of patients health care costs. The reported programs were initiated by the Blue Cross Blue Shield organization in Massachusetts.
In these programs the primary care physicians groups control the entire care delivery process and are paid for everything in one lump sum; they in turn contract with specialists and hospitals for medical services.
There are rewards for quality metrics performance, i.e. bonuses for lower hospital acquired infections. Also, the primary care group is able to retain any funds not spent on care.
So, while Medicare is testing bundled payment for 3 years, private payers are doing their own 3 and 5 year contracted pilot programs. You have heard me describe this in classes on numerous occasions and there are more examples out there than just this article.
So what?
Global capitation is back, but with a new twist. Showing how technology can improve process efficiency, effectiveness, and outcomes will become even more critical in the period ahead.
Contact me if you want to take a look at the article. I will point you to a place to get your own, or we can discuss