As leading brokers in Capitation Provider Stop-Loss for 34 years, we at McPhee & Associates regularly stay in touch with medical groups, hospitals, and health systems.  We are always interested in the trends in managed care as it relates to capitation.  This year we have seen a definite change regarding the response on taking on risk in a capitation form.

Two years ago, most medical groups that did not have capitation risk already would not even consider a capitation agreement.  Recently, as of 6 months ago we noticed a change in this attitude.  A much larger percentage now foresee eventually moving into capitation and taking on risk within the next year.

As you consider taking on risk, you’ll want to partner with an experienced broker to guide you through the terms, coverages and premiums that the Managed Care Excess Loss industry has to offer. This is our area of expertise.

The trend has been to gradiently move towards accepting more and more risk in the stages noted below.

Stage 1. No downside risk and an opportunity for a percentage of the savings.

Stage 2. Shared risk –  A percentage of potential downside risk and a potential for a higher percentage of savings.

Stage 3. Taking on full risk with capitation contracts.

If you are considering or have begun taking on more risk this is what we advise:

  • Download the Provider Excess Loss application here. This will give you an understanding of the information needed by all capitation stop loss carriers to insure your risk.
  • Consult with an expert broker who has relationships with the limited carriers in capitation and can advise and educate you on the pitfalls to get the best customized program to suit you.
  • Make sure your broker offers an implementation of the policy so that your staff are educated in the vital administrative actions and claim requirements.

McPhee & Associates has the best stop-loss team in the industry with exceptional service. If you are considering moving into risk, contact us.  We can answer questions and prepare you to safely and successfully move into full risk.

Susan Kattoo
Senior VP
(818) 541-7900