Capitation Creates Big Opportunities for Call Centers

A 3-dimensional heart and cross, a sphere, and money sign

GeauxPoint is experiencing an influx of clients who need help opening call centers. We believe that this is indicative of opportunity for existing health and human services call centers at large.

Many new healthcare-related call centers are springing up because of a reform-related payment structure known as “capitation.” Under a capitated payment system, insurers give healthcare providers lump sums to care for entire populations. For example, one million dollars might be allocated to care for the elderly, mentally ill, crippled, etc.

Also, under capitation, the healthcare providers keep what they don’t spend. This encourages efficiency. Under the old system, providers were commonly reimbursed for whatever clients spent.

An infographic of capitation that showsa 3-dimensional money sign and heart with cross dropping into a sphere. The sphere has three sets of icons, including one group of elderly, one group with high blood pressure, and one with hurt backs.

CAPITATION. Under a capitated payment systems, healthcare providers are allocated funds for entire populations at once — such as the elderly, mentally ill, etc. The providers keep what they don’t spend, which leads to the creation of efficient “care” centers.

One way that healthcare providers are becoming thriftier under capitation is by setting up call/contact centers, most often referred to as care centers by the providers.

There are several reasons why the care centers are cutting costs. One is that the centers provide cost-effective alternatives for patients to receive information. For instance, under the old model, patients might unnecessarily go to the ER just for information. With care centers in place, the patients have an accessible and cost-effective alternative.

Another way that care centers are more efficient is through technology-empowered communication. For example, automated reminders are proving to be effective at reducing expensive and wasteful appointment no-shows.

A third way that care centers are increasing efficiency is by created a better-informed client base. The call centers help patients understand what their obligations are and how they can prepare for hospital exams and events.

Capitation Opportunity

So where is the opportunity for existing call-centers?

There is no good reason for healthcare providers to waste millions setting up and operating call centers when others can do it better and cheaper.

Currently, the providers are creating care-centers in vacuums, essentially re-inventing the wheel for each unit. Once the care centers are implemented, the providers are left to figure out what makes a care center tick. When left alone, items like quality control, scheduling, management, and reporting are figured out largely by trial and error. Often times, the care centers operate under woefully inefficient processes for lack of knowledge of an alternative.

If the providers won’t give up control of their care center completely, existing call centers can at least help them set up the facilities. Lately, GeauxPoint has been perfecting a model to develop these centers. A major component for the model is taking the business objectives of the providers and retrofitting these with existing best practices of health and human service call centers. Also, the methodology includes components for training (management and specialists), quality control, staffing, and recruiting.


Existing call centers that are seeking new revenue-generating opportunities should be on the lookout for new care centers. For a more aggressive approach, the established call centers can propose their own care-center programs to healthcare providers who have recently come under capitated funding structures.

If existing call centers work quickly to fill this space, the result could be long-term revenue generating relationships. However, if the healthcare providers fill this need for themselves, the opportunity could be gone for good.

Expect more content on this subject to come.

Have any questions or comments about capitation and capitated payments? Drop a comment below.