Contrary to some critics, HMO/insurance capitation have no negative effect to the integrated medical centers.

Let me explain.

What Is a Capitated Contract?

A capitated contract is a healthcare plan that allows payment of a flat fee for each patient it covers. Under a capitated contract, an HMO or managed care organization pays a fixed amount of money for its members to the health care provider. Capitated contracts are also referred to as capitation agreements, capitation contracts and managed care capitated contracts. Within a capitated contract, the healthcare provider is paid a set dollar amount per month to see patients regardless of how many treatments or the number of times the physician or clinic sees the patient. The agreement is that the provider will get a flat, prearranged payment in advance per month. Whether or not the patient needs services in a particular month, the provider will still get paid the same fee. The more treatment a patient need, the less money a health provider makes per treatment.

Traditionally, payers have reimbursed healthcare providers for the costs of services delivered or for the volume of services delivered. However, new types of healthcare plans are moving from paying for volume to paying for value – incorporating cost, consumer health outcomes, and consumer experience – with capitation rates based on performance at the “most advanced” end of the scale.

Capitation-style healthcare contracts were created with the intention of creating better incentives for efficiency, cost control, and preventive care in healthcare. Given that most individuals enrolled in a health plan will never use the services in any given month, capitation arrangements should naturally balance out high-frequency users with plan members who use little or no healthcare every month. Also, because the physician, or health system are responsible for the enrolled member’s health regardless of cost, in theory, capitation motivates the healthcare provider to focus on health screenings and other preventative care that can help keep plan members healthy, with less reliance on costly specialists. Because integrated medical centers are operated with the guidance of a DC as the gate keeper, the HMO option becomes a viable opportunity. Indeed, the very fact that DCs encourage maintenance care while ensuring preventative health habits, the medical integration model is a perfect answer and solution to the nation’s largely mismanaged health care problems.    

At COA, we are proud that our integrated centers play a critical role solving the nation’s health care problems. This greatly anticipated concept gives rise to a new generation of healthcare philosophy called:

“The patient philosophy!”

The Nation’s #1 Medical Integration Program

COA’s Medical Integration is USA’s most trusted and reputable program. Dr. Dahan, America’s most recognized leading expert authority on Medical Integration has guided thousands of doctors reach their ultimate potentials. Dr. Dahan owned and managed his two clinics for twelve years in Southern California before he became a consultant. His direct and simple approach as well as his ability to take very complex business and life issues and translate them into real life lessons, has been the hallmark of his success. In the fall of 2019, Dr. Dahan was exclusively chosen to host the Doctors Daily Live Radio Show, addressing physicians’ issues while influencing doctors to reach higher potentials. With brilliant marketing strategies, unmatched healthcare consulting experience and clinic integration expertise, Dr. Dahan has so much to offer. A gifted speaker and accomplished writer, Dr. Dahan shares his advice in his unique, informative manner. His Wisdom Podcasts are downloaded by 52,000 global listeners daily. Dr. Dahan also writes blogs for the VJ Posts and has appeared on the Charlie Harary Radio Show. 

https://www.acponline.org/about-acp/about-internal-medicine/career-paths/residency-career-counseling/guidance/understanding-capitation

https://healthpayerintelligence.com/news/how-capitated-payments-prompt-payer-provider-innovation

https://www.verywellhealth.com/capitation-the-definition-of-capitation-2615119

https://biotech.law.lsu.edu/map/CapitationAgreements.html