Policy Examples

• The large insurer Humana offers full capitation with certain providers who are able to take on risk. Much of this is determined by resources or the provider’s ability to be able to handle 100% of the risk. source

Outcome Evidence

• Formed in 2010, a capitated ACO partnership between Blue Shield of California and Hill Physicians IPA (Dignity, now CommonSpirit) was developed to serve the 41,000 members of CalPERS, the California Public Employees Retirement System. The partnership aimed to reduce savings through a capitation model. After four years, Blue Shield of California reported a savings of $95 million. source
• A 2016, Health Care Learning and Payment Action Network white paper cited that 29% of all Tufts Health Plan members participate in a full capitation model. Tufts realized favorable outcomes including decreased medical expenses, increased provider engagement in reporting data on cost and quality, and a positive change in referral patterns. source
• In review of 2017 clinical quality data in California, the Integrated Healthcare Association found that providers who were taking on full risk or full capitation scored higher in terms of clinical quality rates. On average, providers taking on no risk had a 57.9% rating, some risk had a 65.6%, and full risk had a 67.1% rating. source