What capitation is
Capitation flips the incentives of fee-for-service. Instead of billing each visit, a provider gets a set monthly amount for every patient assigned to it. That payment covers an agreed scope of services. The provider profits by keeping patients healthy and avoiding preventable care, and loses money when costs exceed the payment.
Scope defines the risk. Primary care capitation covers office-based primary care services. Professional capitation covers physician services more broadly. Global or full capitation covers nearly all care, including hospital stays, and puts the provider at risk for total cost. Payers usually risk-adjust the rate using RAF scores, so sicker patients bring higher payments.
Under capitation, every avoidable hospital stay comes out of the provider's margin, so outreach becomes part of the business model. Rivvi is a HIPAA-compliant AI workspace where care teams analyze their capitated panel. They find patients overdue for visits or recently discharged, and reach them by phone and text.