The results of the 1999 Capitation Survey show that as capitation rates continue to be squeezed, significantly fewer providers are reporting profits associated with capitation contracts than last year.
The results of the 1999 Capitation Survey show that as capitation rates continue to be squeezed, significantly fewer providers are reporting profits associated with capitation contracts than last year.
The survey data reflects rates and other risk contracting benchmarks as reported by nearly 500 provider groups and HMOs who received a survey questionnaire.
According to David Schwartz, publisher of the survey, the findings reflect the ongoing tightening of the risk contracting market, as health plans have attempted to stem recent financial problems in part by ratcheting down capitation rates.
Despite the general decline in rates and in providers' profits, however, the survey did reveal some bright spots, as well as a prediction from industry analysts that rates have bottomed out in many markets and will soon rebound, as insurers begin to pass along some of their recent premium hikes to providers.
Highlights of the 1999 survey include the following:
•Â Average commercial primary care rates declined 9% compared with the 1998 average, falling from $12.22 per member per month to $11.07.
•Â Eleven specialties saw higher cap rates, including chiropractic, dermatology, allergy, behavioral health and pharmacy. Declining this year were 17 specialties including cardiology, radiology, infectious diseases, rheumatology, endocrinology, emergency medicine and home health.
•Â A significantly higher percentage of capitated physicians and physician groups are opting for stop-loss insurance, indicating a rising level of risk contracting sophistication.
•Â The average number of capitation contracts held by providers declined significantly. However, revenues represented by capitation as a percentage of total revenues increased, suggesting a consolidation rather than a retreat from risk.
•Â Continuing a trend noted last year, the percent of providers reporting profits under capitation declined from 42% to 34%. That percentage had been at 52% in 1997.
Not all the data featured in the report was negative. More than two-thirds of respondents reported that contracted rates had been increased in the past year, with an average increase of 4%.
"There's no doubt, risk contracting is getting tougher," Schwartz said. "The good news is, rates appear to have bottomed out in many areas, and providers should start to see their share of the premium hikes in next year's contracts." PR
Young & Partners Pharmaceutical Executive Summit 2024: Brave New World – Where Are We Heading?
October 23rd 2024Peter Marks, director, Center for Biologics Evaluation and Research, FDA, presented the keynote presentation on the future of gene therapy as part of the 20th Annual Young & Partners Pharmaceutical Executive Summit held at the Yale Club of New York.
The Transformative Role of Medical Information in Customer Engagement
October 3rd 2024Stacey Fung, Head of Global Medical Information at Gilead Lifesciences, delves into the evolving role of Medical Information (MI) in the pharmaceutical industry. Covering key topics like patient engagement through omnichannel strategies, combating misinformation, and leveraging AI to enhance medical inquiries, the conversation with Stacey highlights MI's critical role in ensuring patient safety and supporting drug development. She also shares her professional journey and tidbits for early career professionals on professional development.
Unlocking value and cost savings in patient services with technology and talent
October 2nd 2024Traci Miller, Director, Sonexus™ Access and Patient Support, Cardinal Health, discusses the current digital trends in the patient services industry and how the optimal balance of technology and talent can transform manufacturer-sponsored patient support programs. Hear how Cardinal Health combines best-in-class program and pharmacy operations with smart digital tools to ensure product and patient success and reduce operational costs.