How Capitation Contracts Benefit Providers, Payers and Patients

For healthcare organizations to fully support capitation reimbursement models, they must ensure:

• Alignment between primary care and specialty care
• A good experience for patients/members that includes appropriate delivery of care according to quality measures associated with outcomes
• A digital infrastructure that supports a network of multiple stakeholders that may include hospitals and physician groups, payers, social service networks, and community-based organizations (CBOs)

Capitation contracts can benefit providers, payers, and patients. But they require thoughtful planning, careful alignment between PCPs and specialists, a commitment to optimizing the patient/member experience within a narrower network of providers, and a robust digital infrastructure.