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What are capitated payments? - YouTube
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some NHS commissioners are introducing
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contracts that use capitated payments
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which broadly speaking means paying one
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provider or group of providers to cover
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all the care of a specific group of
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people but how could this help make
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services more integrated and
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patient-centered to understand it helps
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to look at how we pay for healthcare now
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at the moment different commissioners
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pay lots of different providers for
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delivering different health and social
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care services to individual patients but
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often the same people need to use
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several services at the same time
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especially if they have more than one
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health problem the different services in
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the local health and care system all try
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their hardest for the patients but the
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system as a whole doesn't necessarily
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serve each person in the way that best
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suits him or her with capitated payments
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all the commissioners in a local area
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can contract a lead provider or provide
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a network to meet all of the healthcare
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needs physical mental or social of a
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given group of people and pay a regular
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lump sum for each individual in the
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group
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now just one leave provided with a
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regular income is responsible for
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arranging and paying all the services
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those people need in line with agreed
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quality and outcome standards that are
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written into the contract and patients
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in the group helped to specify those
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standards but you might ask what
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difference will patients see won't the
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lead provider just make loads of
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contract with other care providers and
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people will still have to shuttle
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between them
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well capitated payments tackle that risk
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by aligning financial rewards for
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service providers in the network so all
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the providers are incentivized to make
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sure the group of people they serve are
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happy with their care research indicates
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that most people with multiple
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conditions would prefer to have as much
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of their care as close to home as
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possible and for all their care to be
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more joined up the lead provider is in
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charge of making that joined up care
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happen and all the providers in the
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network are awarded when they succeed
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imagine a lead provider holds the
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capitated contract for meeting all the
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health and care needs of people with
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multiple conditions in a local area
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commissioners carefully scrutinized the
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network's performance of the contract is
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it delivering the kind of joined-up care
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that patients in a group of asked for
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and how is it doing compared to similar
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provider networks commissioners only
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hand over the last part of the budget to
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the leap provider when the performance
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measures show that the network is
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delivering the health and quality
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standards specified in the contract then
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the lead provider shares this bonus with
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the other providers in the network there
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are lots of ways of organizing patients
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care in more seamless user-friendly ways
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once you start looking at the whole care
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system from the users viewpoint and make
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a single budget holder accountable for
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organizing it like that commissioners
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may worry that this will make care cost
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more than it does today there is more
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research to be done on this important
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point but evidence so far from places in
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Spain Germany and the US where they use
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capitated payment shows that when it's
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used well patients can become happier
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and healthier at the same time as costs
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come down that's partly because
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capitated payments give the Lea provider
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an incentive to focus on prevention and
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health management as well as a bonus for
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improving outcomes if Lea providers
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manage to keep cost down they get to
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keep a share of any savings to invest in
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new services the incentive works like
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this the lead providers total capitated
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budget is based on the estimated needs
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of people in a defined group and the
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cost of treating them if the providers
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arrangements deliver the health outcomes
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and experiences that service users want
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for less than anticipated there's a net
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gain to the local health system some of
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this goes back to the commissioners to
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spend on more care for their local
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population some of it the lead provider
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can keep to invest in improved services
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to people in their group
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of course providers mustn't cut costs at
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the expense of quality but remember they
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only get paid in full if they meet the
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quality standards outlined in the
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contract evidence shows that providers
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in networks do in fact tend to keep
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costs down by investing more in
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prevention helping patients to stay
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healthy and stay out of hospital which
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is what patients mostly want but they're
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also geared up to undertake essential
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interventions there are still big
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questions hanging over capitated
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payments and more risks to tackle how
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can all the commissioners pool their
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budgets how can commissioners and
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providers share risks fairly how can
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providers in a network challenge the
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lead provider across the NHS people
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experimenting with capitated contracts
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are finding answers to these and other
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questions monitor and the other central
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NHS bodies support these experiments and
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are monitoring and sharing the results
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so that everyone can learn from them if
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you think capitated payments might help
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your local health system deliver good
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value and integrated care you'll find
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more useful information here
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you
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