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Hot Off The Press

Online Survey Reveals Health and Managed Care Executives' Thoughts on Capitated Reimbursement

Manasquan, N.J. -- Healthcare and managed care executives indicated capitated reimbursement is more effective for health plans than healthcare providers, according to an online survey conducted at The Managed Care Information Center (MCIC) Web site,

While 75 percent of the survey's respondents said capitation is effective for health plans, only 45 percent of said capitation was effective for providers, MCIC's "Managed Care Question of the Month" showed.

While, respondents' comments dealt with several issues concerning capitation and its relationship/effect on providers and health plans, results showed many executives view risk as the key concern with capitation.

"HMOs are not taking risk for benefits they are adding," according to a California hospital executive. "However, HMOs want providers to take downside risk for something that benefits the HMO. The industry needs more risk-sharing arrangements between HMOs and providers -- rather than HMOs just shifting the risk to providers," commented a respondent from Texas.

Nevertheless, "Providers need to be open to and prepare for accepting global risk," a consultant from New York explained. "With the right risk arrangements, providers can do very well and at the same time increase their sense of participation and control in the managed care system."

The availability of quality data, as well as the ability and likelihood of providers to effectively use data also were important issues.

"Capitation is successful only if providers understand the reimbursement and how it relates to current utilization and practice patterns," an executive from a Georgia-based consulting firm wrote. "Too often providers accept capitation with no idea of how it relates to their practice. They continue business-as-usual, only to find they lose money. Health plans fail to provide the data up-front and/or providers refuse to study the data. If the providers can modify their business, they can make money under reasonable capitation. But, it forces them to make the types of decisions they condemn health plans for making."

Results represent data gathered through MCIC's "Managed Care Question of the Month." Each month, MCIC posts a new question for online health and managed care executives. To respond to this month's question, go to the Surveys and Research section of MCIC's Web site, or go directly to:

For more information contact The Managed Care Information Center, 1913 Atlantic Avenue, Suite F4, Manasquan, NJ, 08736, toll-free telephone 1-888-THE-MCIC (1-888-843-6242), fax 1-888-FAX-MCIC (1-888-329-6242), e-mail or online at

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