Dr. Emily's Blog

California's Managed Care Medi-Cal I thought if I wrote about  “Medi-Cal Managed Care” that my readership may run screaming in the opposite direction.  But hey, what is life without risk?  Anyway, look at this--you’re still here.  Kudos to you for your determination and tenacity.  Here we go:   CAPITATION In 2013 California decided to change the way Medi-Cal reimburses primary care providers from fee for service to capitation 1,2 .  Lots of private insurance Health Maintenance Organizations (HMO’s) also reimburse under this model.  For those of you lucky enough not to understand capitation, here’s the quick and dirty:  Traditionally physicians have been paid a set amount for each service rendered:  aptly named fee-for service. Under capitation, a physician is assigned a number of patients and gets paid a monthly fee, generally a few dollars per patient per month (PPPM), regardless of whether the patient receives services or not.  In theory, this is supposed to motivate ph