capitation
A payment model where community mental health organizations receive a fixed per-member payment for providing services, regardless of actual utilization.
Full Definition
Capitation is a managed care payment arrangement where mental health providers receive a predetermined monthly or annual payment per enrolled member to provide comprehensive psychiatric services. This model shifts financial risk from payers to providers and requires careful population health management. In community psychiatry, capitation arrangements often cover outpatient therapy, medication management, and crisis services for defined populations. The model incentivizes preventive care and efficient service delivery while potentially creating tension between cost containment and quality care.
Usage
Usage note: Distinguish from copayment, which is a patient cost-sharing mechanism.
In Context
- "The managed care organization offered a capitation rate of $45 per member per month for comprehensive community mental health services." — Contract negotiation documentation
- "Under the new capitation model, the CMHC must carefully track utilization patterns to ensure financial sustainability." — Administrative policy manual