HCPro.com: Capitation Rates and Data

Each issue of this monthly newsletter is jam-packed with PMPM rates, benchmark capitation and comparative information-from determining appropriate physician panel sizes and stop-loss attachment points to evaluating your PMPM rates and withholds.

To view the entire newsletter issue, click the “View Entire Issue” link below

July 2008 (Volume 13, Issue 7)	view entire issue

Examine underlying community trends as one factor in the cost of care
It's no secret that healthcare is a local phenomenon. Physician practice patterns are influenced by the number and type of medical centers, sociodemographic factors, and dominant payer systems in their communities. Actuaries consider these underlying community trends when projecting future healthcare costs in a capitated arrangement, and healthcare providers should do the same when comparing their costs and outcomes to those of their peers.

Benchmark your cap rates against this profitable IPA
As a taste of the in-depth capitation data you'll see in HCPro's 2009 Capitation Survey, a California IPA provided 2007 commercial and Medicare cap rates for a comprehensive group of clinical services for the 2008 Capitation Survey, published by HCPro in January. The data in Figure 4, below, offer insights into the capitation contracting and management strategy of an experienced healthcare organization.

Weigh the balance between healthcare quality and costs
There's no dearth of data when capitated providers look for information about healthcare costs. Trends in U.S. healthcare expenses are widely documented by federal agencies, academic researchers, and policy wonks. Less readily available are data on healthcare quality, especially in relationship to costs, but an annual report from the Rockville, MD-based Agency for Healthcare Research and Quality (AHRQ) helps to fill that gap. And it's free.

Managed Medicare may help seniors avoid preventable hospitalizations through better coordination of care
Considering the war of words raging in the U.S. Congress over the presumed advantage wielded by Medicare Advantage plans over FFS Medicare, it's worth examining the findings of a study by Jayasree Basu, PhD, MBA, senior economist at the Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD, and Lee R. Mobley, PhD, of the Research Triangle Institute in Research Triangle Park, NC, that was published in October 2007 in Medical Care Research and Review.1

Other recently-published articles from Capitation Rates and Data:

Coordinated care benefits children with special needs

Social media provide cost-effective route to patient care

Coordinated care program cuts costs for members with chronic illness

Dartmouth Atlas: Overtreatment still common

PROMETHEUS payment model aims to top capitation

Managed Medicare may help seniors avoid preventable hospitalizations through better coordination of care

Weigh the balance between healthcare quality and costs

Benchmark your cap rates against this profitable IPA

Examine underlying community trends as one factor in the cost of care

Use predictive modeling to improve case management

Evaluate 2009 payment rates for MA plans

Mine your data to target high-risk members

Drug cost data suggest patient copays, compliance linked

Compare your practice to these physician productivity and cost benchmarks

Hospitalist care reduces LOS in various inpatient settings

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