Capitation in the 1980s, 90s, and early 2000s was used to restrain health care costs and encourage more efficient care of the patient. The caveat is that the participating primary care physicians received this fixed sum for each insured patient regardless of how much care a patient actually received and actually encouraged underutilization. These unintended consequences, operational constraints, and market pressures led to the lack of these capitation arrangements today.
As health centers move into more value-based care models and risk-sharing contracts that are incorporating more components of capitation, this history leads to an infrastructure that makes it challenging to be successful as health centers take on more risk. This session will offer lessons learned and how these lessons have been applied to move from the 'old' model to today's adaptation of full capitation in an accountable care framework.
Chief Financial Officer,
Miami Beach Community Health Center, Inc.