Reevaluation of capitation contracting in New York and California.
We obtained detailed quantitative and interview data from Aetna U.S. Healthcare and six physician organizations to examine changes between 1998 and 2000 in the scope of capitation contracting and delegation of responsibility for claims payment and medical management in New York and California. The physician organizations in New York included Benchmark (Continuum), Montefiore IPA, and Lenox Hill Healthcare Network. In California they included Brown and Toland Medical Group, Monarch Healthcare, and Santa Clara County IPA. In both California, where global and shared risk capitation have been common, and New York, where they have not, we find movement to reduce the scope of prepayment and a rethinking of the delegated contractual relationship by physician organizations and health plans. This represents a departure from the 1990s, when many industry participants and analysts expected capitated and delegated relationships to spread across the nation.
Robinson
James C
JC
University of California, Berkeley, USA. jamie@socrates.berkeley.edu
Casalino
Lawrence P
LP
D019985:Benchmarking; D002140:California; D002204:Capitation Fee / Q000706:statistics & numerical data / Q000639:trends*; D003284:Contract Services / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D006759:Hospital-Physician Joint Ventures / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D007193:Independent Practice Associations / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D007349:Insurance, Health, Reimbursement; D006278:Medicare / Q000458:organization & administration / Q000706:statistics & numerical data; D009518:New York; D019982:Organizational Case Studies; D011216:Practice Management, Medical / Q000191:economics* / Q000706:statistics & numerical data; D011243:Preferred Provider Organizations / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends