As efforts to repeal and replace the Affordable Care Act seem to have died, the movement toward value-based healthcare is very much alive. Meanwhile, healthcare leaders observe the continued prevalence of high costs and ask: Is there any solution?
America's Physician Groups (APG) is a national professional association composed of physician groups dedicated to coordinated, accountable care. It is the nation’s largest trade association that explicitly promotes capitation as the payment model for its members, all of whom accept various forms of risk-based capitation or other population-based payment.
Simply put, capitation is when a group of physicians is paid in advance to take care of a population of patients for a period of time. Groups accepting population-based payment are in the forefront of national healthcare reform and represent the care model and payment methodologies adopted by federal legislation for the entire nation.
The California Regional Health Care Cost & Quality Atlas combines data from Medicare, Medi-Cal, and 10 major health plans to offer a comprehensive comparison of capitated-integrated care vs. the fragmented fee-for-service model. According to the Atlas, compiled via collaboration between nonprofit, nonpartisan organizations including the California Health Care Foundation, HMOs (capitated-integrated) outperform PPOs (fee-for-service) on both quality and cost. For example, Medicare Advantage outperforms Original Medicare fee-for service (FFS) on clinical quality, hospital utilization, and cost.1
According to the Atlas, as compared to fee-for-service, the capitated-integrated model:
These statistics prompt questions, including:
In response to these questions, APG has undertaken a variety of initiatives, including:
Donald H. Crane, JD, is the President and CEO of America’s Physician Groups.
1Integrated Healthcare Association, California Health Care Foundation, California Health and Human Services. California Regional Health Care Cost & Quality Atlas, 2nd ed. 2018. https://atlas.iha.org/. Accessed August 2, 2018.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.