Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Financing Health Care - Part 2
Lecture:The Billing Process of Various Health Care Enterprises
Slide content:EOC : Capitation - 2 Group practice agreement with payor Payor pays the practice $25 per 100 members per month If costs of care are less than $25 per 100, the practice makes money If costs of care are greater than $25 per 100, the practice loses money Provider must balance provision of care with the costs 15
Slide notes:To illustrate this, consider a group practice that enters into an agreement with a payor to receive twenty-five dollars per member per month. For every 100 members assigned to the practice, the provider receives 2,500 dollars per month even if none of the member patients are seen. If during a single month, the cost of care for all 100 members is actually 3,500 dollars, then the group practice loses 1,000 dollars that month and must absorb the expense of the additional cost of care. The payor makes no additional payments to the provider. The provider must balance provision of care with the costs. Health IT Workforce Curriculum Version 4.0 15