Health Information Management: Reimbursement Models Comparison

This report delves into a comparative analysis of two key value-based reimbursement models within Health Information Management: Capitation and the Patient-centered Medical Home (PCMH) model. The report highlights the core principles of each model, explaining how Capitation compensates physicians based on the number of enrolled patients, while the PCMH model focuses on patient-centered care led by primary care physicians. The report differentiates between the two models by emphasizing the PCMH model's focus on overall patient outcomes and collaborative care, as opposed to Capitation's potential to prioritize patient numbers over care quality. The analysis points out the PCMH model's advantages, including better healthcare outcomes, cost-saving mechanisms, and increased patient satisfaction. The report recommends the PCMH model for the Urgent Care Company, suggesting it as a more appropriate choice for achieving improved reimbursements, enhanced patient care, and overall healthcare outcomes. The report references several studies to support the claims.

Running head: HEALTH INFORMATION MANAGEMENT 1
Health Information Management
Student Name
University Affiliation

HEALTH INFORMATION MANAGEMENT 2
Health Information Management
The compensation based on either Capitation or the Patient-centered medical home
model for value-based reimbursement are focused towards ensuring the health of the patients is
properly addressed and the information kept well. According to Salzberg, et al., (2017), Patient-
centered medical home model ensures that primary care physicians lead the care teams on
focusing on meeting the needs of the patients. As a result, the provider teams coordinate properly
with the patients to ensure their healthcare interests are met. Moreover, the conditions and test
results obtained by these practitioners are used to improve the quality of care disseminated for
these individuals as well as for benchmarking the quality outcomes of the patients.
On the other hand, capitation compensates a physician or a group of physicians
depending on the number of patients enrolled to them over a given period of time regardless of
whether the individuals seek care or not. As a result, Hasselt, McCall, Keyes, Wensky, & Smith,
(2015) comment that the more the number of people assigned to a specific Physician, the more
they will be paid. The amount of enumeration is primarily based on the average expected care
utilization of the said patient, with more of the pay coming for the patients who are already
known and have a significant medical history and that is of interest in the healthcare sector.
One of the differentiating factors for Capitation and Patient-centered medical home
model is that the former tends to lead more of the physicians to focus on the number of patients
assigned, while the latter considers the overall quality of outcomes for the patients. According to
Farmer, et al., (2016), issues such as patient choices are hindered in the Capitation model since a
physician is assigned to a number of patients, thus having to delegate decisions rather than
collaborate with them for the same. The Patient-centered medical home model, however, has the
practitioners assigned to specific individuals and timelines set on when they can meet directly.

HEALTH INFORMATION MANAGEMENT 3
This gives enough time for interaction and socialization, thus having specific care objectives for
individual patients, which presents better healthcare outcomes.
Additionally, the Patient-centered medical home model ensures to save quite a lot of
money as compared to Capitation. Maeng, et al., (2015) purport that capitation enforces care
even for the individuals who do not seek for the same, which shows that reimbursement for such
individuals increases the cost care. However, since the PCMH model has its focus on specific
patients to address their needs, then much cost is saved especially because the needs of the
patients are addressed directly. This approach helps to maximize the reimbursements provided to
the physicians and ensures to direct the care specifically to the patients.
As a result, it is best for the Board to understand the cost-saving mechanisms and patient-
centered care practice that the PCMH model provides to the patients. Moreover, they need to
consider the overall healthcare outcomes that are fully addressed as well as patient satisfaction
levels in the same before selecting any of the two models. However, the PCMH model would be
more appropriate in the Urgent Care Company and is highly recommended.

HEALTH INFORMATION MANAGEMENT 4
References
Farmer, S. A., Shalowitz, J., George, M., McStay, F., Patel, K., Perrin, J., ... & McClellan, M.
(2016). Fully capitated payment breakeven rate for a mid-size pediatric
practice. Pediatrics, e20154367. Retrieved from
https://www.scholars.northwestern.edu/en/publications/fully-capitated-payment-
breakeven-rate-for-a-mid-size-pediatric-p
Hasselt, M., McCall, N., Keyes, V., Wensky, S. G., & Smith, K. W. (2015). Total cost of care
lower among medicare fee‐for‐service beneficiaries receiving care from patient‐centered
medical homes. Health services research, 50(1), 253-272.
Maeng, D. D., Khan, N., Tomcavage, J., Graf, T. R., Davis, D. E., & Steele, G. D. (2015).
Reduced acute inpatient care was largest savings component of Geisinger Health
System’s patient-centered medical home. Health Affairs, 34(4), 636-644. Retrieved from
http://www.healthaffairs.org/doi/full/10.1377/hlthaff.2014.0855
Salzberg, C. A., Bitton, A., Lipsitz, S. R., Franz, C., Shaykevich, S., Newmark, L. P., ... & Bates,
D. W. (2017). The impact of alternative payment in chronically Ill and older patients in
the patient-centered medical home. Medical care, 55(5), 483-492.