The Sustainability of Very High-Needs Primary Care Practices in a Capitated Environment

NHC recently published a report to articulate equity considerations regarding the sustainability of very ‘high needs’ Primary Care practices in a capitated environment. It is contended that the base capitation formula is based on incomplete and unreliable data which does not adequately account for access issues and differential health need by ethnicity. Therefore, the current capitation funding arrangements including the Very Low Cost Access component (VLCA), are not appropriate or sustainable for those with high numbers of ‘high-needs’ patients.

The base capitation formula is based on
incomplete and unreliable data which does
not adequately account for access issues
and differential health need by ethnicity.

This poses an unfair cost burden on those practices that is ultimately unsustainable both fiscally and clinically, for the provision of optimal care. This paper is conceived in response to ongoing commentary and consideration of the VLCA funding contribution to capitation.

Some explanation, analysis and demonstration of the capitation and VLCA capitation formula and impacts are provided. Overall it is suggested that the current focus on reviewing the VLCA funding in isolation from the greater pool of capitation funding continues to ignore the inequities experienced by primary care providers serving very ‘high needs’ populations.

You can access the full report here.