Reevaluation of capitation contracting in New York and California.

Full Abstract

We obtained detailed quantitative and interview data from Aetna U.S. Healthcare and six physician organizations to examine changes between 1998 and 2000 in the scope of capitation contracting and delegation of responsibility for claims payment and medical management in New York and California. The physician organizations in New York included Benchmark (Continuum), Montefiore IPA, and Lenox Hill Healthcare Network. In California they included Brown and Toland Medical Group, Monarch Healthcare, and Santa Clara County IPA. In both California, where global and shared risk capitation have been common, and New York, where they have not, we find movement to reduce the scope of prepayment and a rethinking of the delegated contractual relationship by physician organizations and health plans. This represents a departure from the 1990s, when many industry participants and analysts expected capitated and delegated relationships to spread across the nation.

Author information

Author/s: Robinson, James C (JC); Casalino, Lawrence P (LP);

Affiliation: University of California, Berkeley, USA. jamie(-atsign-)socrates.berkeley.edu

Journal and publication information

Publication Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't

Journal: Health affairs (Project Hope) (Health Aff (Millwood)), published in United States. (Language: eng)

Reference: 2001-; vol Suppl Web Exclusives (issue ) : pp W11-9

Dates: Created 2002/03/25; Completed 2002/04/08; Revised 2006/11/15;

PMID: 11911321, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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