In healthcare pricing strategies, capitation is used by organizations and is a fixed amount of money per patient per unit of time for the delivery of health care services. The actual amount of money paid is determined by the ranges of services that are provided, the number of patients involved, and the period of time during which the services are provided. Capitation rates are developed using local costs and average utilization of services and therefore can vary from one region of the country to another. In many plans, a risk pool is established as a percentage of the capitation payment. Money in this risk pool is withheld from the physician until the end of the fiscal year. If the health plan does well financially, the money is paid to the physician; if the health plan does poorly, the money is kept to pay the deficit expenses.
Upon successful completion of this assignment, you will be able to:
Analyze the general factors and drivers that influence pricing in health care settings and understand how prices are set.
Apply the general pricing strategies used in health care organizations and plans, and explain the differences and implications of these plans.
Determine if the prices set by providers are defensible and how that impacts the health care plan contract.
Sample Solution
