title: Integrating payer and provider risk through capitation.
abstract: Capitation payment mechanisms promote conservative use of medical resources by transferring risk to the decision maker, the physician. However, there is another view of capitation: defining common risk between provider-driven organizations (i.e., physician/hospital organizations (PHOs) or integrated delivery systems (IDS), and risk-managing entities such as HMOs or insurance companies. This article discusses a strategy to align provider and risk manager incentives to share the risks and rewards for a total book of business or population.
authors.affiliation: Independence Blue Cross Family of Companies, Philadelphia, PA, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Barth
mesh_terms: D000206:Actuarial Analysis; D002204:Capitation Fee; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000458:organization & administration; D006279:Health Maintenance Organizations / Q000191:economics*; D006759:Hospital-Physician Joint Ventures / Q000191:economics*; D007343:Insurance Carriers; D007345:Insurance Claim Review / Q000191:economics; D017146:Models, Organizational; D012308:Risk Management / Q000191:economics / Q000379:methods* / Q000458:organization & administration; D014481:United States