How are most specialists compensated by managed care organizations (MCOs)?

Managed care organizations (MCOs) often utilize various payment methods to compensate specialists, but the most common method is capitation. In a capitation model, specialists receive a set fee per patient for a defined period, regardless of the amount of services delivered. This approach incentivizes efficiency and preventive care, as specialists are rewarded for keeping patients healthy rather than for the number or intensity of services provided.

Although fee-for-service does exist within the MCO structure, it is less predominant. In fee-for-service models, providers are compensated for each individual service they perform, which can lead to over-utilization of services. Therefore, specialists are more commonly associated with capitation in the context of MCOs, as it aligns with the goals of cost containment and patient management.

Understanding the differences between these compensation structures is important for medical assistants and healthcare professionals, as it impacts how specialists approach patient care within managed care settings.