Value-Based Reimbursement—once focused on incentives and shared savings—now more often means capitation. Whether adopting Medicare Alternative Payment Models (APMs) or contracting with health plans, physician groups and health systems have signaled greater willingness to adopt these new Risk payment models with their guaranteed payments for attributed patients.
But here’s the problem: If you don’t have good data on your costs, you are flying blind.
Let’s look at the myths and realities of what you really need both to measure your success under global capitation and to ensure that your Risk program is on track to be successful.
Do You Need Claims Data for Calculating and Evaluating Costs?
The short answer is that the more open your system, with patients using practices and facilities outside your own, the more claims data is necessary for calculating key cost indicators. The most important of these indicators is your Per Patient Per Year Costs. That is a key benchmark that you can compare against global capitation levels. While that number may indicate you have a problem, however, it won’t tell you what that problem is.