Capitated pricing is a payment arrangement in which a fixed amount of money is paid per employee to a provider, regardless of how many services the employee uses. It is commonly used in healthcare, where employers or insurers pay healthcare providers a set fee per employee or member, known as a capitation fee, covering all the services that may be needed during a given period.
Under capitated pricing, the provider assumes the financial risk of delivering care within the fixed payment. This model encourages cost efficiency, as providers are incentivized to manage care effectively to stay within budget. The model contrasts with fee-for-service arrangements, where providers are paid per individual service rendered.
Select the Right Providers: Partner with providers who have a strong track record in managing care efficiently.Clear Communication: Ensure all parties understand the terms of the capitated pricing agreement, including the services covered.Regular Monitoring: Continuously monitor the quality of care provided to ensure it meets required standards.Incorporate Flexibility: Build in provisions for adjusting payment levels if service demand changes significantly.
Fixed Payment: A set amount paid per employee/member.Provider Risk: Financial responsibility shifts to the provider.Cost Efficiency: Encourages careful management of resources.
It can lower healthcare costs for employers and incentivize efficient care delivery by providers.
Providers may underutilize services to stay within budget, potentially leading to lower-quality care.
