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Question Covered in the Solution:
What are the implications of expanded use of capitation, Accountable Care Organizations, and related payment approaches that put providers and/or payors at financial risk for high levels of utilization? What is the difference between management’s efforts to control utilization and maintain adequate services, and management’s efforts to maximize utilization? How can provider groups that accept capitation risk internally allocate payments to clinical professionals and institutional providers in a manner that creates appropriate incentives?
Sample of Solution
What are the implications of expanded use of capitation, Accountable Care Organizations, and related payment approaches that put providers and/or payers at financial risk for high levels of utilization?
The implications of the use of capitation and other related approaches extend to the HealthCare operational smoothness. For Instance, the payment approaches may use quality, utility, time period or outcome as the parameter of reimbursement or payment. These approaches are essentially realized to ensure dedicated utilization of health care services without discrepancies or disagreements between the providers and the payers. While these payment approaches may include capitation, multilateral gain/loss sharing, Improving Access to Psychological Therapies Payment, Outcome-based payment for mental Healthcare or 3-part payment for urgent and emergency care.