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Risk Based Reimbursement


Risk-Based Reimbursement

For your Dropbox assignment, a primary care physician is often reimbursed by Health Maintenance Organizations (HMOs) via capitation, fee-for-service, relative value scale, or salary. Capitation is considered as a risk based compensation.

In an effort to understand the intricacies involved with physician reimbursement, particularly in an era of health care reform, identify and interview an expert in the field, such as:

  • Hospital Administrator 
  • Managed Care Organization (MCO) executive 
  • Health care Consultant 
  • Legal Professional 

Assumption: MCOs use risk-based reimbursement for primary care physicians.

Ask the following questions in the interview:

  • What kind of risk do the MCOs assess? 
  • Does risk-based compensation limit the freedom of primary care physicians in any way in terms of patient care? Why or why not? 
  • How does the capitation model of reimbursement work? Do physicians generally prefer one model over the other? Why or why not? 
  • Why do HMOs prefer the prepaid, monthly premium? 
  • Is pay-for-performance a better model than existing models of compensation? Are there limitations to it as well? 

Feel free to add additional follow-up questions for depth and clarification as you see fit.

Create a 4- to 5-page report in Microsoft Word document, analyzing the responses provided (which should be included as part of the report) using the evidence from the literature to help support or refute the responses provided.

Support your responses with examples.


Title: Risk Based Reimbursement
Length: 3 pages (3 Words)
Style: APA


Risk-Based Reimbursement

Risk-reimbursement models have improved with the evolution of technology, these models include; shared savings, payment bundling, fee for service, capitation and also salary. In the world, today, hospitals and health institutions are keen to navigate the many drastic and significant changes that relate to the way business is run and provision of care to the patients. The obligations are changing from the long-existing volume-based healthcare requirements to the value-based care models. Value-based care models seek to align extensively payment and objective measures to clinical service quality. Managed Care Organizations often use risk-based reimbursement to reward the physicians; they use it especially to pay the primary care physicians. The terms of payment are usually under a contract agreed by both parties and without any intermediary taking part in the negotiations. There exist three basic forms of reimbursing physicians; they include; fee-for-service, capitation, and salary. Management Care organizations employ activities such as health risk appraisals, coordination, and assessment on members to determine or identify the risks.


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