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" ... But of course, there is a better pay structure available—and one that aligns with their skillsets. Under capitated payment models, physicians receive a flat fee to provide care for each patient. There’s no incentive to order tests or perform procedures—only to provide excellent care. ... "
" ... Health plans, he explained — specifically those that administer Medicare and Medicaid plans — see the advantages and the upside of investing in SDoH. “This flows right through to their bottom line because they get capitated payments,” he notes, referencing the shift to value-based care and risk-sharing models that prioritize care quality and outcomes. ... "
" ... Just as the patient population and coverage dynamics for ESRD are unique, so too is the way that Medicare pays providers for treating these patients. Where Medicare typically has distinct payment approaches based on setting of care, the government has a specific payment system for the maintenance of dialysis treatment these patients require. Since 2011, CMS has utilized a “bundled” payment approach that provides a capitated payment to dialysis facilities on a per-patient-per treatment basis. This payment includes most services, drugs, supplies, and other costs associated with providing this care, and is intended to drive efficiency and consistency in care across all patients and providers. ... "
" ... The success of the few healthcare organizations that had capitated payment arrangements before Covid-19, allowing for some financial stability amidst widespread uncertainty, will prompt more organizations to create similar contracts. ... "