1. 25 Years of Capitation Lessons Learned and Future Direction
Robert Margolis, M.D.
CEO, HealthCare Partners
Chair, NCQA
Washington, DC
October 20, 2008

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

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

4. 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

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

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

7. 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