Blended Capitation Models

There are basically two kinds of capitation models: “Global Capitation” and “Blended Capitation”. Each one can be applied in various scenarios. Under global capitation, whole networks of hospitals and physicians agree to receive single fixed monthly payments for enrolled health plan members. Payment is made on a per member basis. Basically, providers sign a single contract with a health plan to cover the care of groups of members, and then must determine a method of dividing up the capitated check among the provider group. Under a blended capitation model, a single payment is made for a specific set of services, while other services involved in a patient’s care are paid for on a fee-for-service basis. Under each model of capitation, risk adjustment