Tag Archives: costs

Understanding the Design Characteristics of Primary Care Capitation

Capitation, as a value-based payment model, has been around for decades. Many of us have experimented with variations of capitation, ranging from full capitation for all healthcare services to specialist capitation, to primary care (PCP) capitation. Currently, Primary Care Clinicians are much more comfortable with the nuances of these models because of the expansion of Medicare Advantage. This… Read More »

Does the Employer-Provider Direct Payment Program Lower Episode Costs?

Bundled payments for episodes of services such as joint replacements are not a new concept. Throughout the years, the Centers for Medicare & Medicaid Services (CMS) have experimented with Bundled Payment Programs with limited success. After factoring in bonus payments to providers, the net savings to Medicare has been minimal, and on the positive side, there is no… Read More »

How Alternative Payment Models in Healthcare Can Impact Cost

As we continue to focus on value-based payment models, there is a strong belief that moving away from fee-for-service payments towards a per-patient rate for primary care providers will decrease overall costs. The counter concern is that this may also lead to reduced care because of the financial incentive to avoid services. Primary care providers (PCPs) have the… Read More »

Does Reducing Hospital-based Care Actually Reduce Overall Costs?

There is a definite belief that if we invest in care that prevents Emergency Room visits and hospitalizations, there is a positive impact on outcomes and costs. For instance, a recent study in Health Affairs by Wright et al. evaluated this belief in the Iowa Medicaid Healthy Behaviors Program. In their research, they found a substantial decrease in… Read More »