25 Years of Capitation Lessons Learned and Future Direction

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Presentation transcript:

25 Years of Capitation Lessons Learned and Future Direction Robert Margolis, M.D. CEO, HealthCare Partners Chair, NCQA Washington, DC October 20, 2008

Agenda Who accepts capitation and why? When does it work? The Evolution of Capitation The future payment models

Who accepts Capitation and Why? When does it work? Coordinated Care Systems – size matters Integration / complex cases Emphasis on Wellness / Prevention Systems and Processes

The Evolution of Capitation The Golden Years 1980 – 1997 Hospital Supply FFS owned the market TEFRA Risk Contracting Shared Risk / Full Risk Premium Cycle / BBA

The Not So Golden Years 1997 - 2003 Managed Care Backlash PPM’s come and go Hospital Supply No more low hanging fruit

The Maturity Years 2003 - 2008 MMA Premium cycle Consolidation Maturing Systems and Processes P4P New PPO products and resurgence Proving the Delegated Model

The Future Impact of Economy on Health Benefits Healthcare Reform Bundled Case Rates Pay for results / Mature P4P High Quality / Efficient and Accountable Systems of Care