Commonwealth Fund April 11, 2024
TOPLINES
In capitated payment models, risk adjustment helps ensure providers are paid enough to deliver appropriate care to all their patients, regardless of their care needs
Accurately predicting patients’ future care needs can be challenging; if done poorly, risk adjustment could exacerbate health inequities
In capitated health care payment models, commonly used in managed care plans and value-based care, providers receive a lump sum per patient that’s intended to cover all costs, regardless of the type or frequency of services delivered. In this way, capitation can encourage the delivery of more cost-effective, higher-quality care. But different patients need different levels of care, and the cost of that care varies. If providers’ costs end up exceeding what they were prospectively paid,...
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