The report was prepared by The Pace Group in conjunction with HIN's "Ask the Consultants" program, which allows healthcare executives to submit their healthcare management questions to the team of leading healthcare consultants at The Pace Group. HIN will select a question each month to pose to The Pace Group and answers will be posted at the HIN web site.

According to The Pace Group, capitation arrangements often covered both Medicare Risk and commercial lives. Unfortunately, many hospitals did not build infrastructures with their respective physician organization "partners" to manage their capitated patients. Physicians did not significantly change their utilization practices and continued to admit to hospitals outside of the capitated partner. Additionally, the revenue streams for the hospitals began to shift. Membership growth within the capitated arrangements increased to 25 percent, 30 percent and 40 percent of their revenues while other fee-for-service sources decreased.

Unfortunately, many providers enter the risk business (accept capitation) without a full evaluation of the consequences and without a clear understanding of what it takes to manage risk.

HIN, the gateway to healthcare business information on the Internet, has a number of resources available to help healthcare providers negotiate their capitated agreements:

15 Cost Reduction Strategies Under Capitation
2000 Capitation Survey
Capitation Rates & Data, Volume III
Healthcare Price, Cost & Utilization Benchmarks, Vol II

15 Cost Reduction Strategies Under Capitation

If you’re determined to cut clinical and operational costs as managed care continues to squeeze margins, you’ll want the proven cost-cutting ideas found only in this 50-page special report. You’ll find detailed, behind-the-scenes case studies of the best cost-cutting programs at health care organizations across the country. From contracting strategies that will boost your profit potential to implementing medical management programs that eliminate waste and inefficiency, this special report covers all the areas of critical importance to your cost-cutting program, including clinical processes, operational efficiency, and medical supply costs.

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2003 Capitation Survey

The anticipated results of National Health Information's 2003 Capitation Survey are now available, featuring completely updated rate benchmarks based on 2003 contracts. The exclusive survey, published by NHI for nine consecutive years, features the most reliable PMPM rate benchmarks available for 35+ specialties. Rates are also reported for primary care, hospital services, global coverage, and other categories. The rates in nearly all cases are reported separately for commercial and Medicare populations, and include the average, high, low, and median reported PMPM rate benchmark. Select Medicaid rates are also included, and 3-year trends in rates are shown.

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Capitation Rates & Data, Volume III

The third edition of this wildly popular report is packed cover-to-cover with critical data and information you need to guide your risk contracting decisions -- from determining appropriate physician panel sizes to setting your PMPM rates. You'll find the most current, one-of-a-kind interpretation and data in this comprehensive volume. Capitation Rates & Data, Volume III walks you through the complex world of capitation with easy-to-understand and insightful guidance and strategies. Within the 115 data-packed pages, you'll find a comprehensive collection of rate development strategies, as well as specific rate-building models and formulas.

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Healthcare Price, Cost & Utilization Benchmarks, Vol. II

National Health Information has just released an all-new third volume of its most popular benchmarking resource. Healthcare Price, Cost, & Utilization Benchmarks - Volume III is filled with completely new data and benchmarks in the three most critical areas of performance for health care organizations, which comprise the 130+ page report's four major sections: Pricing & Capitation; Cost Benchmarks; Utilization Benchmarks; and Performance & Quality Measures.

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