Prospective Capitation Rate Development Methodology
For larger providers participating in the Primary Care VBP model, payers and providers may agree to develop practice-specific PMPM rates on a case-by-case basis or utilize a standard PMPM capitation rate based on a market-wide calculation. For smaller providers, payers may offer a standard PMPM capitation rate based on a market-wide or small practice-only calculation. Payers may also offer PMPM capitation rates specific to practices with special patient profiles, such as children with high medical complexity.