What is a Capitated Payment Model?

A capitated payment model is a healthcare reimbursement system where providers receive a fixed amount per patient per period (usually monthly) to cover all necessary services, regardless of how much care the patient actually uses. This prepaid arrangement transfers financial risk from insurers to providers, encouraging efficient care delivery and preventive services to keep patients healthy.

Why capitated payment models matter

• Promotes preventive care: Incentivizes keeping patients healthy to minimize costs
• Controls healthcare spending: Creates predictable costs for insurers and employers
• Changes provider incentives: Shifts focus from service volume to patient health outcomes

How Solace can help

A Solace advocate can help you understand how capitated payments affect your care access, ensure you receive necessary services despite payment models, and address concerns about potential under-treatment. Advocates can also help navigate care coordination in capitated systems.

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