UnitedHealth study shows capitation model works to improve value-based care

Primary care physicians paid under global capitation achieve key quality metrics at higher rates than those paid under traditional fee-for-service, according to new research by UnitedHealth Group. 

UHG identified quality differences using metrics from the National Committee for Quality Assurance’s Healthcare Effectiveness Data and Information Set (HEDIS) related to preventive care and chronic conditions.

The study showed patients treated under global capitation compared to FFS were screened at higher rates for breast cancer (80{bcdc0d62f3e776dc94790ed5d1b431758068d4852e7f370e2bcf45b6c3b9404d} versus 74{bcdc0d62f3e776dc94790ed5d1b431758068d4852e7f370e2bcf45b6c3b9404d}) and colorectal cancer (82{bcdc0d62f3e776dc94790ed5d1b431758068d4852e7f370e2bcf45b6c3b9404d} versus 74{bcdc0d62f3e776dc94790ed5d1b431758068d4852e7f370e2bcf45b6c3b9404d}); demonstrated higher controlled blood sugar levels (89{bcdc0d62f3e776dc94790ed5d1b431758068d4852e7f370e2bcf45b6c3b9404d} versus 80{bcdc0d62f3e776dc94790ed5d1b431758068d4852e7f370e2bcf45b6c3b9404d}) and were given more eye exams (84{bcdc0d62f3e776dc94790ed5d1b431758068d4852e7f370e2bcf45b6c3b9404d} versus 74{bcdc0d62f3e776dc94790ed5d1b431758068d4852e7f370e2bcf45b6c3b9404d}); and received higher rates of functional status assessment (96{bcdc0d62f3e776dc94790ed5d1b431758068d4852e7f370e2bcf45b6c3b9404d} versus 86{bcdc0d62f3e776dc94790ed5d1b431758068d4852e7f370e2bcf45b6c3b9404d}) and medication review (97{bcdc0d62f3e776dc94790ed5d1b431758068d4852e7f370e2bcf45b6c3b9404d} versus 92{bcdc0d62f3e776dc94790ed5d1b431758068d4852e7f370e2bcf45b6c3b9404d}).  

The analysis of more than 5 million UnitedHealthcare Medicare Advantage enrollees and tens of thousands of primary care physician practices concluded that physicians paid under capitation are better positioned to prioritize preventive services and care management programs, spend more time engaging with patients and use evidence-based clinical guidance.

They also avoid unnecessary patient interventions and focus on keeping patients out of the hospital, according to the study.


The findings indicate that capitation provides the right incentives for value-based care, UHG said.

Capitation pays a set amount per month per patient and is risk-based, giving providers motivation for savings due to better outcomes.

Medicare Advantage plans are paid on a capitation basis, with numerous insurers, including UnitedHealthcare, doing very well in the MA market.

UHG’s Optum provides health information technology solutions to providers looking to move from fee-for-service to value-based care.


Insurer UnitedHealthcare works with more than 113,000 physicians and 1,200 hospitals in some form of value-based relationship, including more than 1,250 accountable care organizations. 


“Global capitation benefits patients, physicians and, more broadly, the healthcare system,” said Dr. Richard Migliori, chief medical officer, UnitedHealth Group. “Patients benefit because their doctors prioritize preventive care to keep them healthy and out of the hospital.”

Twitter: @SusanJMorse
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