The best way to understand healthcare reform is to understand how the money will flow.

What are global payments?

A global payment is a lump sum paid to physician groups per patient per month (or year), regardless of how much care they need.  This model shifts the financial risk of care to providers.  More risk is shifted to providers than with bundled payments.

An example of global payments can be found in BlueCross BlueShield, Massachusetts's largest insurance company.  BCBSMA has shifted 75% of their HMO patients to their "Alternative Quality Contract" AQC which is a global payment system.  They, and other private sector insurance companies note that the current iteration of global payments are different from capitation in that:

• the payment per patient is calculated on individual patient's health status (with sicker patients garnering higher per month payments)
• quality measures must be met for physician groups to collect full payment

In theory, this should avoid problems with capitation, where physician groups were financially penalized for caring for the sickest of patients, and less care, rather than quality care was incentivised. 

How will global payments effect neuropsychologists and psychologists?

Jerry Grodin, Ph.D., Director of Professional Affairs for the New York State Psychological Association has written a superbly readable dispatch on capitation and global payments.  Click here to read.