Which payment method pays a set amount per enrolled member per period, regardless of services rendered?

Which payment method pays a set amount per enrolled member per period, regardless of services rendered?

• A. Capitation
• B. Block payment
• C. Utilization management
• D. Fee-for-service

Answer: (A)

Capitation is a payment model in which a provider is paid a fixed amount for each enrolled member for a defined period, regardless of how many or what kind of services the member uses. This setup means the provider’s revenue isn’t tied to the number of visits or procedures, so there’s a strong incentive to manage care efficiently and emphasize prevention and care coordination across the population. The fixed per-period payment can be adjusted for risk (risk-adjusted capitation) to account for differences in patient health status. This differs from fee-for-service, which pays for each service; and from block or global payments, which are lump sums for a defined scope rather than per-member-per-period coverage; and from utilization management, which is a control process, not a payment method.

Capitation is a payment model in which a provider is paid a fixed amount for each enrolled member for a defined period, regardless of how many or what kind of services the member uses. This setup means the provider’s revenue isn’t tied to the number of visits or procedures, so there’s a strong incentive to manage care efficiently and emphasize prevention and care coordination across the population. The fixed per-period payment can be adjusted for risk (risk-adjusted capitation) to account for differences in patient health status. This differs from fee-for-service, which pays for each service; and from block or global payments, which are lump sums for a defined scope rather than per-member-per-period coverage; and from utilization management, which is a control process, not a payment method.