Mr. Venkata Krishna Azith Teja Ganti
IMPLEMENTING CAPITATION MODELS IN PRIMARY CARE: FINANCIAL AND CLINICAL IMPLICATIONS FOR PROVIDERS AND PATIENTS
Abstract:
The transition to capitation models in primary care represents a significant shift from traditional fee-for-service reimbursement to value-based payment structures. This research explores the financial and clinical implications of implementing capitation models for providers and patients. Capitation, where healthcare providers are paid a fixed amount per patient, regardless of the services provided, aims to incentivize cost efficiency and preventive care while discouraging unnecessary treatments.
The study examines the potential benefits, such as improved financial predictability for providers, enhanced focus on preventative care, and reduced overall healthcare costs. It also addresses challenges, including risks of under-service, provider concerns over revenue stability, and potential impacts on patient outcomes. Through a combination of case studies, financial analyses, and patient satisfaction surveys, this research identifies best practices for implementing capitation models effectively.
Findings suggest that while capitation can improve care coordination and patient outcomes when appropriately managed, success depends on robust infrastructure, equitable risk-sharing, and ongoing monitoring of both clinical and financial metrics. This research provides actionable insights for policymakers and healthcare organizations seeking to balance financial sustainability with high-quality patient care under capitation models.