Commission for Case Manager Certification (CCMC) Practice Exam

In the context of health services, capitation refers to a payment model where a healthcare provider is paid a fixed amount for each enrolled person assigned to them, regardless of the number of services provided. This payment structure is designed to incentivize providers to offer timely and effective care while managing costs. By receiving a predetermined amount per person, providers are encouraged to focus on preventive care and overall patient health rather than the volume of services rendered, as their payment does not fluctuate with the level of care provided.

This model is distinct from fee-for-service arrangements, where providers are reimbursed based on the specific services delivered, which can sometimes lead to unnecessary tests or procedures. The capitation approach supports the ethos of value-based care, aiming to improve health outcomes while controlling expenditures.

The other options do not accurately capture the essence of capitation. For instance, the notion of a commission paid to insurance agents or a type of service in health guidelines does not relate to the financial arrangements of care delivery. A payment model based on services provided clearly aligns more with fee-for-service models rather than capitation.