Master the Advanced eClinical Challenge 2026 – Step Up Your Training Game!

Capitation is a payment model where a provider is paid a fixed amount per enrolled patient per month to cover that patient’s healthcare needs. Because the payment stays the same regardless of how many or which services the patient uses, the provider bears the financial risk and is incentivized to manage care efficiently, emphasize prevention, and coordinate services to stay within the budget. This contrasts with fee-for-service, where payment comes for each service provided. HMOs and PPOs describe managed care plan structures and networks rather than the reimbursement method, though capitation can be used within those plans. In capitation, payments are typically per-member, per-month and may include adjustments for patient health status or risk to keep funding fair and sustainable.