New Onpoint Issue Brief: Calculating FFS Equivalents for Capitated Services

April 2026 – All-payer claims databases (APCDs) collect claims data from commercial payers, Medicaid, and Medicare to track healthcare utilization and spending over time and across different factors like age, sex, and geography. Increasingly, they also collect data on non-claims-based payments, including those for services paid under capitation. 

In a capitated payment model, providers are paid a fixed fee per patients regardless of how many individual services each patient receives. Health plans then submit the resulting “encounter data” to APCDs. Encounter data details the services provided to a patient but does not request payment amounts. Many state APCDs require these plans to report their data with a fee-for-service (FFS) equivalent, or the amount that would have been paid for the service had it been paid under a traditional FFS payment arrangement. This way, these services can be included in reporting about cost as well as utilization.  

In our latest issue brief, health data analyst Nathaniel Ferguson describes how Onpoint worked with one of our clients, the California Department of Healthcare Access and Information (HCAI), to evaluate the quality of submitter-supplied FFS equivalents in the Healthcare Payments Database (HPD), the state’s APCD. In addition, he discusses how Onpoint was able to impute FFS equivalents for health plans whose data was determined to be unreliable.

Read the issue brief here.