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  2. Healthcare payment - Wikipedia

    en.wikipedia.org/wiki/Healthcare_payment

    Secondary capitation is a relation arranged by care organization between a physician and a secondary or specialist provider, i.e. or ancillary facility or an X-ray facility. Global capitation is a relationship based on a provider who provides services and is reimbursed per-member per-month for the entire network population.

  3. Capitation (healthcare) - Wikipedia

    en.wikipedia.org/wiki/Capitation_(healthcare)

    HMOs and insurers manage their costs better than risk-assuming healthcare providers and cannot make risk-adjusted capitation payments without sacrificing profitability. Risk-transferring entities will enter into such agreements only if they can maintain the levels of profits they achieve by retaining risks.

  4. Bundled payment - Wikipedia

    en.wikipedia.org/wiki/Bundled_payment

    By 2001, "case rates for episodes of illness" (bundled payments) were recognized as one type of "blended payment method" (combining retrospective and prospective payment) along with "capitation with fee-for-service carve-outs" and "specialty budgets with fee-for-service or 'contact' capitation."

  5. Fee-for-service - Wikipedia

    en.wikipedia.org/wiki/Fee-for-service

    Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. [ 1 ] In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.

  6. Healthcare reform in the United States - Wikipedia

    en.wikipedia.org/wiki/Healthcare_reform_in_the...

    Projects at CMS are examining the possibility of rewarding health care providers through a process known as "bundled payments" [93] by which local doctors and hospitals in an area would be paid not on a fee for service basis but on a capitation system linked to outcomes. The areas with the best outcomes would get more.

  7. Health care finance in the United States - Wikipedia

    en.wikipedia.org/wiki/Health_care_finance_in_the...

    Doctors and hospitals are generally funded by payments from patients and insurance plans in return for services rendered (fee-for-service or FFS). In the FFS payment model, each service provided is billed as an individual item, which creates an incentive to provide more services (e.g., more tests, more expensive procedures, and more medicines).

  8. Accountable care organization - Wikipedia

    en.wikipedia.org/wiki/Accountable_care_organization

    ACO's incentive payments are determined by comparing the organization's annual costs relative to CMS-established benchmarks. These benchmarks are based on an estimation of the total fee-for-service expenditures associated with management of a beneficiary based on fee-for-service payment in the absence of an ACO.

  9. Health insurance in the United States - Wikipedia

    en.wikipedia.org/wiki/Health_insurance_in_the...

    Before the development of medical expense insurance, patients were expected to pay all other health care costs out of their own pockets, under what is known as the fee-for-service business model. During the middle to late 20th century, traditional disability insurance evolved into modern health insurance programs.