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The Marble Health Plan Sets Aside a PMPM Amount for Each

Question 38

Multiple Choice

The Marble Health Plan sets aside a PMPM amount for each specialty. When a PCP in Marble's provider network refers a Marble plan member to a specialist and the specialist provides medical services to the member, the specialist begins to receive a share of those funds on a monthly basis. Marble determines the monthly payment for each specialist by dividing the number of active patients for that specialty by the total specialty pool for that month. This form of payment, which is similar to a case rate, is known as


A) Referral circle capitation
B) Risk pod capitation
C) Contact capitation
D) Retrospective reimbursement capitation

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