Contractors submitted bids for five capitation
rate components (monthly institutional costs, monthly HCBS costs, monthly acute care costs including mental health services, administration, and profit/risk/contingency).
Business needs require that organizations look at capitation
systems more globally to address a variety of management needs, not solely claims payment.
Instead, overhead and physician salaries consume cash flow from prepaid capitation
expense allocations; Risk sharing arrangements (table); Flow of funds, algorithm - representational example
Recently, the regional and national media had exposed the exploitation by Chennai-based private professional colleges by demanding donations without any receipt in the name of capitation
The selection of areas for each reimbursement method was by the state that invited bids for capitation
contracts to any entity that had the capacity to receive, manage, and execute a capitation
contract for Medicaid mental health services.
rates are based upon the methodology that is used to pay other managed care plans, with payments adjusted for the frailty of this population.
can also include factors that may be beyond the physicians' control, such as hospitalization and prescription drug costs.
Originally, the State planned to implement a prospective risk-adjusted capitation
model for these populations.
is a statistical and, more specifically, actuarial tool.
Using the financial proforma model, sensitivity analysis can be undertaken on key assumptions that drive financial performance, such as the Medicare and Medicaid capitation
rates, enrollment growth, and rate of nursing home admissions.
One way out is for hospital systems to embrace capitation
and try to capture the margin of arbitrage.