Shared risks provide added incentive for each of the contractual partners to control costs, and, of course, shared risk minimizes any catastrophic results for either partner. Pluses and Minuses Capitation really can lower health care costs. Under a capitated plan, the at-risk provider will pay added attention to controlling utilization, making generic or therapeutic substitutions, and negotiating acquisition costs with manufacturers. Bob Burnside, M.B.A. of Nursing Home Consultant Pharmacy in Easley, South Carolina, agrees that capitation can result in vastly increased efficiency. Unfortunately, the fiscal picture is not all rosy.
Capitation can raise costs and cause other problems.
And aggressive utilization control has the potential to result in unsatisfactory compliance behavior. Someone's going to win, and, unfortunately, someone's going to lose. Playing the Odds Watt compares capitation to a craps game. Under a capitated pharmacy program, the risks for the provider skyrocket. No wonder so many pharmacy providers run the other way when faced with a decision about capitated plans.