"Capitation, Payers, and Provider Behavior" Please respond to the followin

May 9th, 2015
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Capitation, Payers, and Provider Behavior" Please respond to the following: Suggest at least one (1) method by which capitation rates are set for health maintenance organizations in Medicare. Provide one (1) example of an HMO with these types of set rates in order to support your response. Compare the primary available economic resources that health insurance payers may use to monitor, assess, and regulate health care providers’ behavior. Evaluate the degree to which alternative provider payment methods (e.g., capitation, pay for performance, etc.) impact HMO economic and business performance. Provide one (1) example of such a type of method to support your response.

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Healthcare PaymentsName:Instructor:Date:Method of Determining Capitation RateFee-for-service is one the methods that is employed by Health Maintenance Organizations (HMO) in setting capitation rate for inpatients. The fee-for-service method entails basing capitation rate on negotiated charges and expected usage instead of the underlying costs. This implies that a healthcare organization estimates the percentage number of members in a given group of members insured who are likely to visit the hospital each day and the average service charge on a patient in each inpatient day in a competitive environment. However, the costs and charges are linked in determining the capitation rate. The formula employed in determining the capitation rate under the fee-for-service method is reflected below.Capitation rate = (per member utilization * fee-for-service rate)/ 12One of the HMO tha

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