Capacity Funded + P4P
Consider how almost all fire departments are funded and why. The fire department planners determine how many fire trucks and fire fighters are needed to cover one shift at a fire station. Stations will vary in size depending on how many of what types of vehicles need to be in service at a given time, generally based on geographic area and population demographics. Once the capacity needs are established, the resources requirements are computed to derive a given fire station’s budget.
Capacity Funded Definition: Funding a program based on an agreed upon budget that includes sufficient staffing and other resources to field necessary capacity to meet potential demand. Generally, service demand in a Capacity-Funded program will fluctuate over time, but the program is funded to meet staffing coverage requirements, not projected units of service; think fire department. Generally a Capacity Funded program is paid on a 1/12th basis, as determined by an annual budget.
What Behavioral Health Services Should be Capacity Funded?
Short answer: Services that operate like the fire department. Longer answer: Services such as:
This is not a definitive list. There are also situations where some of the above services might be paid with another Payment Model such as being included in a Sub-Capitation benefit or possibly through a Case Rate (see below).
Capacity Funded + P4P Definition: Funding a program based on an agreed upon budget. This model also includes a Pay for Performance bonus layer to incentivize better care, better health, and better cost. P4P is discussed in detail in the P4P section.
Capacity Funded payments should be priced at rates that are “adequate to cover the providers’ costs of delivering the new approach to care at the levels of quality that are expected for the types of patients they see and at the levels of cost or efficiency that are feasible for them to achieve.” (The Building Blocks of Successful Payment Reform, Harold Miller, NRHI/CHQPR, 2015, http://www.nrhi.org/uploads/nrhi_pymntrfrm_3_r9-2.pdf)
Capacity Funded Definition: Funding a program based on an agreed upon budget that includes sufficient staffing and other resources to field necessary capacity to meet potential demand. Generally, service demand in a Capacity-Funded program will fluctuate over time, but the program is funded to meet staffing coverage requirements, not projected units of service; think fire department. Generally a Capacity Funded program is paid on a 1/12th basis, as determined by an annual budget.
What Behavioral Health Services Should be Capacity Funded?
Short answer: Services that operate like the fire department. Longer answer: Services such as:
- 1-800 Crisis Line
- 1-800 Access Line
- Warm Line
- Community Health Teams
- Mobile Crisis Teams
This is not a definitive list. There are also situations where some of the above services might be paid with another Payment Model such as being included in a Sub-Capitation benefit or possibly through a Case Rate (see below).
Capacity Funded + P4P Definition: Funding a program based on an agreed upon budget. This model also includes a Pay for Performance bonus layer to incentivize better care, better health, and better cost. P4P is discussed in detail in the P4P section.
Capacity Funded payments should be priced at rates that are “adequate to cover the providers’ costs of delivering the new approach to care at the levels of quality that are expected for the types of patients they see and at the levels of cost or efficiency that are feasible for them to achieve.” (The Building Blocks of Successful Payment Reform, Harold Miller, NRHI/CHQPR, 2015, http://www.nrhi.org/uploads/nrhi_pymntrfrm_3_r9-2.pdf)
