What characterizes a capitated payment model?

What characterizes a capitated payment model?

• A. Providers charge per service rendered
• B. Providers receive a fee for each patient enrolled, regardless of services used
• C. Payments are made based on patient satisfaction surveys
• D. Providers are reimbursed for only successful patient outcomes

Answer: (B)

A capitated payment model is characterized by a fixed payment structure where providers receive a predetermined fee for each patient enrolled within a specific time frame, regardless of the number or type of services rendered. This type of model encourages efficiency and preventive care, as providers are incentivized to keep patients healthy and minimize unnecessary services, since their revenue does not depend on the volume of services provided. In this model, the financial risk is shifted from the payer to the provider, who must manage healthcare delivery within the fixed budget per patient. This approach can lead to cost savings and is generally seen in managed care organizations, where the focus is on quality care and patient management over the quantity of services delivered.

A capitated payment model is characterized by a fixed payment structure where providers receive a predetermined fee for each patient enrolled within a specific time frame, regardless of the number or type of services rendered. This type of model encourages efficiency and preventive care, as providers are incentivized to keep patients healthy and minimize unnecessary services, since their revenue does not depend on the volume of services provided.

In this model, the financial risk is shifted from the payer to the provider, who must manage healthcare delivery within the fixed budget per patient. This approach can lead to cost savings and is generally seen in managed care organizations, where the focus is on quality care and patient management over the quantity of services delivered.