Blue Shield coming up with a new Pay for Value program they are offering (a
hybrid between capitated and PPO), they are calling it “health care
reimagined” wondering if anyone has any thought or experience with this
program with them.
You’re now the third practice to mention in my earshot in the last
Capitation can be a good thing for a practice. Those of you who
were appropriately capitated going into COVID should have seen little
However, the devil is in the details. And for all the fancy language
about the goals or the clinical benefits, etc., it boils down to a
math problem. You need to find out:
- who is capitated?
- how much is being paid for those capitated patients?
- what fees are carved out?
- what risk do your capitation payments have?
Each of one of these questions has a half dozen beneath it, like peeling back
We recently walked through an analysis for a PCC practice and learned
we didn’t even have to get past the process of determining “which kids
are even capitated?” to realize there would be a problem. If folks
are interested, perhaps I can write a blog piece about this.