A contract with Kopf is a health plan that allows the payment of a flat fee for each patient it covers. Under a rental agreement, an HMO or a managed care organization pays a fixed amount of money to its members to the health care provider. Capitated contracts are also called head, helmet and managed care contracts. Payment rates for head administration are developed using local costs and average service usage and may therefore vary from region to region. Many plans define risk pools as a percentage of premium payments. Per capita financing payments are set for each person enrolled in an insurance plan with a head, periodically ”per patient” (usually monthly). For example, a provider could be paid per month per patient, even if the patient comes to treatment or how many benefits are needed. Capitation programs can cover individuals or families. HMOs and IPAs often use capitation programs. It is not uncommon for large groups or physicians involved in distribution network models to also receive an additional per capita package for diagnostic and sub-specialized treatments.
The family doctor will use this additional money to pay for these transfers. This appears to be a greater financial risk for the primary service provider when the total cost of transfers exceeds the premium payment, but the potential financial benefits are also greater when diagnostic transfers and sub-specialization services are controlled. Alternatively, some plans pay for test and sub-specialization recommendations through service-based pricing agreements, but are generally paid through contractual pricing plans, which are reduced from 10% to 30% compared to the usual local fees. This approach to group payments is sometimes referred to as the ”disease head.” It`s a very small step away from full capitation. It attempts to reduce actuarial risk analysis at the individual level of patients rather than analyzing risk for a group of patients. Such an analysis is technically difficult. In addition, this approach could provide a strong incentive for care groups to select patients, conditions and treatments based on financial performance, not patient needs. When the primary care provider signs a top performance agreement, a list of specific services that must be made available to patients will be included in the contract. The level of the per capita plan is determined in part by the number of benefits provided and varies from one health plan to another, but most payments for primary care services include: as part of a head/deposit agreement, a list of specific services must be made available to patients in the contract. Traditionally, payers have reimbursed health care providers for the costs of the services provided or the volume of services provided. But new types of health plans are moving from volume payment to value payment – taking into account costs, consumer health outcomes and consumer experience – with top performance rates based on the most ”advanced” performance on the scale.
The guarantee is a fixed amount per patient per unit of time paid in advance to the physician for the provision of health care. The actual amount of money paid is determined by the offers, the number of patients involved and the period during which the services are provided. Head administration rates are developed using local costs and average service usage and can therefore vary from region to region of the country. Many plans define a pool of risks as a percentage of the premium payment. Money from this pool of risks is denied to the doctor until the end of the exercise. If the health plan works well financially, the money goes to the doctor; If the health plan is bad, the money is maintained to pay the cost of the deficit.