--- title: "PGP and capitation in Colombia: a provider guide | Arbol AI" description: "What PGP and capitation are, how the nota técnica is calculated, how contracts are monitored and where the money is lost. Based on Decreto 441 de 2022." url: https://www.getarbol.com/en/colombia/pgp-and-capitation/ lang: en alternates: es-CO: https://www.getarbol.com/colombia/pgp-y-capita/ --- # PGP and capitation: what they are and *how to manage them*. Both are agreed in advance: PGP is one global sum for a group of people; capitation, a fixed sum per person. [Book a demo](https://cal.com/tomas-giraldo-pdfbl9/30-min-arbol-ai-demo) Updated October 2026, based on Decreto 441 de 2022 and resolutions 2335 de 2023 and 1809 de 2026. **PGP** One sum for the whole group set by that population's health risk Ringed: higher risk **Capitation** One sum for each person for low-complexity services Both are agreed before the care is given. ## What is PGP? The pago global prospectivo (PGP), or prospective global payment, is *a fixed sum agreed in advance* to care for a defined group of people over a set period. Colombian regulation defines it as a payment for a defined group of people, agreed before services are delivered, with frequencies of use adjusted to the group's health risk and to changes in the size of the population. Unlike capitation, it is not limited to low-complexity care. In practice it is negotiated over a population and a package of services: for example, the people with hypertension and diabetes in one municipality, with their check-ups, tests and medicines for the year. The provider (IPS) receives the agreed amount in the instalments the contract sets and answers for that care actually happening. > Modalidad de pago por grupo de personas determinadas, mediante la cual se pacta por anticipado el pago de una suma fija global para la prestación de servicios o el suministro de tecnologías en salud a esa población durante un periodo de tiempo definido… Source: [Decreto 441 de 2022, art. 2.5.3.4.2.3](https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%20No.%20441%20de%202022.pdf) ## What is capitation? Capitation (cápita, or pago por capitación) is *a fixed sum for each person assigned*, paid in advance, to cover low-complexity services. The health insurer (EPS) assigns the provider an identified population and pays the same amount for each person over the agreed period, whether or not that person comes in. That sum covers what the population might need from a set of low-complexity services: for example, general practice, nursing, health promotion and prevention, and basic lab tests, depending on what is contracted. Capitation is not the UPC. The UPC is what the system pays each EPS per member: in 2026, COP 1,658,912 a year in the contributory regime and COP 1,541,706 in the subsidized one. The provider's capitation is negotiated separately and only covers the contracted services, so it is a fraction of that amount. > Modalidad de pago prospectiva que aplica para la prestación o provisión de la demanda potencial de un conjunto de servicios y tecnologías en salud, que se prestan o proveen en los servicios de baja complejidad… **With Arbol.** Want to run the numbers for your population? Arbol's capitation simulator, in Spanish, is free and needs no sign-up. [Open the simulator (in Spanish)](https://www.getarbol.com/tools/capitation-simulator/) Sources: [Decreto 441 de 2022, art. 2.5.3.4.2.3](https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%20No.%20441%20de%202022.pdf) · [Resolución 2764 de 2025 (UPC 2026)](https://www.minsalud.gov.co/Normatividad_Nuevo/Resolucion%20No%202764%20de%202025.pdf) ## How do they differ from fee-for-service? Under fee-for-service (pago por evento), the provider bills each service after delivering it. Under PGP and capitation it *receives a fixed amount set in advance* and takes on, within the agreed terms, the risk that the population uses more care. | | Pays per service | Pays the agreed sum | | | -------------------------------- | ------------------------------------------------------- | ---------------------------------------------------- | ---------------------------------------------------- | | | Fee-for-service | Capitation | PGP | | What is paid for | Each service delivered | Each person assigned | A group of people and their services | | Complexity | Any | Low complexity | Whatever is agreed | | If the population uses more care | The EPS pays for it | The provider absorbs it, with the agreed adjustments | The provider absorbs it, with the agreed adjustments | | Nota técnica | Optional, but the population profile is always required | Required | Required | | What makes the contract pay off | Using every slot and billing without objections | Preventing illness and solving it in primary care | Meeting the frequencies and avoiding complications | One agreement can combine modalities: for example, capitation for primary care, PGP for a chronic-care program and fee-for-service for everything else. The regulation recognizes a fourth: payment per case, package or basket, a fixed sum for each case treated of a defined condition. Source: [Decreto 441 de 2022, arts. 2.5.3.4.2.3 and 2.5.3.4.2.4](https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%20No.%20441%20de%202022.pdf) ## How is it calculated? With the nota técnica. The nota técnica is the annex that backs the contract's value: *who the people are, what services they need, how many times a year and what each one costs*. It is required in every PGP or capitation contract and forms part of the agreement. The regulation asks it for at least four elements: - Population The total population and the population eligible for each service, with its profile: risk factors, coexisting conditions and their severity. - Frequencies How often each service will be used over the contract term. If the contract covers an integrated care pathway (RIAS), the frequencies come from the regulation that governs it. - Costs The agreed cost of each service. - Monitoring How often it will be monitored and evaluated, which can never be equal to or longer than the contract term. Services are written with the codes of the Ministry's reference tables, such as CUPS for procedures. The arithmetic is simple: people × frequency × cost, service by service. The total is the contract's value. **Nota técnica · Diabetes program** Example 1,240 people with diabetes | Service | Times a year × cost | Value for the year | | ----------------------------------------- | ------------------- | ------------------ | | `890301` General practice follow-up visit | 4 × COP 40,000 | COP 198,400,000 | | `903426` Glycated hemoglobin (HbA1c) | 2 × COP 30,000 | COP 74,400,000 | | `903895` Serum creatinine | 1 × COP 25,000 | COP 31,000,000 | | `890306` Nutrition follow-up visit | 1 × COP 40,000 | COP 49,600,000 | | Value for the year | | COP 353,400,000 | | Per month | | COP 29,450,000 | | Per person per month | | COP 23,750 | The frequencies and costs of your contract come from your own nota técnica and from the regulation of each pathway. **With Arbol.** In Ámbar, Arbol's governance, the nota técnica is followed activity by activity: what was delivered against what was agreed, without waiting for the close. [Meet Ámbar](https://www.getarbol.com/en/governance/) Source: [Decreto 441 de 2022, arts. 2.5.3.4.1.3 and 2.5.3.4.2.4](https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%20No.%20441%20de%202022.pdf) ## How is the contract monitored? The EPS and the provider review together, *as often as the contract sets*, what was delivered against the nota técnica: population, frequencies and amounts, with indicators that have a baseline, a target and ranges. Each indicator has its technical sheet, a baseline, targets, thresholds and compliance ranges. There are quality indicators (timeliness, access, patient safety, experience), management indicators (use of services, billing, objections, receivables) and health outcome indicators. Monitoring is joint and looks at the technical, operational and financial sides. It checks the minimum frequencies per person set by the technical standards and puts the integrated care pathways and chronic and high-cost conditions first. Whatever is outside the provider's control cannot be objected to: the nota técnica and the indicators are adjusted instead. If the contract sets incentives or objection percentages for non-compliance, they are calculated from the per-capita distribution of the value and the weight of each service in the nota técnica. - Agreed range - Within range - Below range - Pending Diabetes check-ups delivered against the agreed range, month by month. Example. **With Arbol.** Ámbar shows the gap before the review meeting: which activities are below range and which patients are missing, by name. [See governance](https://www.getarbol.com/en/governance/) Sources: [Decreto 441 de 2022, arts. 2.5.3.4.3.1 and 2.5.3.4.3.5](https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%20No.%20441%20de%202022.pdf) · [Resolución 2335 de 2023, arts. 3 and 4](https://www.minsalud.gov.co/Normatividad_Nuevo/Resoluci%C3%B3n%20No%202335%20de%202023.pdf) ## What happens when reality drifts from the nota técnica? The *risk adjustment mechanisms* agreed in the contract apply. They are required in PGP and capitation, and the regulation sets the minimum situations in which they must work. A nota técnica is an estimate, and over a year the population, the network, the illnesses and the costs all change. Resolución 2335 de 2023 requires adjustments to be planned for at least seven situations: - The population grows or shrinks because members are reassigned. - A change in the provider network shifts the population or the frequencies. - The disease profile does not match the population profile the EPS delivered. - The territory prioritizes services because of public health or primary care indicators. - The incidence of chronic or high-cost conditions rises. - Monitoring shows changes in frequencies of use or in costs. - A force majeure event or unforeseeable circumstance occurs. The regulation separates two risks that must be in the nota técnica where they apply: primary risk, the unavoidable variation in how many people fall ill and how seriously; and technical risk, the variation in resource use or complications from unforeseeable factors in care. Asking for an adjustment takes data: who joined the population, what changed in its illnesses, which frequencies moved. **With Arbol.** Ámbar keeps the timeline of every person in the contract: their cohort, their care and their contacts. That is the evidence behind an adjustment conversation. [Meet Ámbar](https://www.getarbol.com/en/governance/) Sources: [Resolución 2335 de 2023, art. 5](https://www.minsalud.gov.co/Normatividad_Nuevo/Resoluci%C3%B3n%20No%202335%20de%202023.pdf) · [Decreto 441 de 2022, arts. 2.5.3.4.1.3 and 2.5.3.4.3.5](https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%20No.%20441%20de%202022.pdf) ## Where is the money lost in a PGP or capitation contract? Rarely in a single invoice. It is lost in *what did not happen*: the check-up that was skipped, the person no one reached and the complication that ended up in the emergency room. 1. ### Frequencies that are not met If the provider fails, without justification, to meet the minimum frequencies for health promotion and prevention, the maternal and perinatal pathway or chronic-care follow-up, the EPS can deduct their value at the nota técnica price and deliver them through another provider in its network. [Decreto 441 de 2022, art. 2.5.3.4.5.5](https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%20No.%20441%20de%202022.pdf) 2. ### A member list that is out of date Phone numbers that no longer answer cost missed check-ups. And when ADRES, the fund that administers the system's money, orders a refund for deceased members, the provider returns, in proportion, what it received for them since their death. [Decreto 441 de 2022, art. 2.5.3.4.5.4; Resolución 2335 de 2023, art. 13](https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%20No.%20441%20de%202022.pdf) 3. ### The complication that ends up in the emergency room Care the provider was meant to give that ended up with another provider, through a referral or an emergency, is paid to that provider and, with prior notice, can be deducted from the contract at the nota técnica value. [Decreto 441 de 2022, art. 2.5.3.4.5.4](https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%20No.%20441%20de%202022.pdf) 4. ### An advance without an invoice From November 2026, a provider that receives a capitation or PGP advance by direct payment must invoice on time, with the RIPS service records. If it does not, it gets no new direct-payment scheduling until it corrects it. [Resolución 1809 de 2026, arts. 6 and 11](https://normograma.com/keralty/compilacion/docs/resolucion_minsaludps_1809_2026.htm) 5. ### A close without evidence At the close the parties sign a record with what was delivered, the indicators and the nota técnica. Whatever was not recorded during the year is hard to defend that day. [Decreto 441 de 2022, art. 2.5.3.4.6.2](https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%20No.%20441%20de%202022.pdf) ## How do you manage a PGP or capitation contract well? With *six habits, every month*: know every person, measure without waiting for the close, go after whoever is missing, open the schedule for the program, look after the highest risk first and document every visit. | Habit | What to do | With Arbol | | ------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Know every person | Match the EPS member list with your medical records: who they are, how to reach them, what condition they have and whether they are in their program. | Ámbar places every person in their cohorts using the medical record, the lab and the insurer's data. [Ámbar](https://www.getarbol.com/en/governance/) | | Measure every month, not at the close | Compare what was delivered with the nota técnica service by service, and check the ranges before the review meeting. | Ámbar compares what was delivered with what was agreed, activity by activity. [Ámbar](https://www.getarbol.com/en/governance/) | | Go after whoever is missing | Frequencies are met one person at a time: call, message and book whoever has not come in. | Arbol calls and writes by WhatsApp, text and email, and books in the same conversation. [Contactability](https://www.getarbol.com/en/contactability/) | | Open the schedule for the program | Hold slots for the contract's check-ups and offer the cancelled ones again. | Arbol books and confirms on the schedule you already use, or on Agenda by Arbol, and offers every slot that opens up. [Agenda](https://www.getarbol.com/en/agenda/) | | Look after the highest risk first | A rising creatinine or a pregnant woman with no check-up weighs more than the average: prioritize. | Proyecto Crónico and Proyecto Bebé follow every chronic patient and every pregnant woman all year. [Proyecto Crónico](https://www.getarbol.com/en/chronic-care/) [Proyecto Bebé (in Spanish)](https://www.getarbol.com/proyecto-bebe/) | | Document every visit | Invoice on time with RIPS and keep the evidence of every contact and every visit for the audit and the close. | Every conversation is recorded, transcribed and auditable. [Trust Center](https://www.getarbol.com/legal/trust-global/) | ## How is the contract closed and renewed? When it ends, the contract is settled within the agreed term or, if none was agreed, *within the following four months*, with a closing record. If it is renewed, the nota técnica is updated before the new period starts. 1. **Contract year** Reviews as often as agreed; here, every quarter 2. **End** **Up to 4 months** if no other term was agreed 3. **Closing record** Delivery, indicators and nota técnica Example The closing record (acta de liquidación) states how the contract was monitored, how far each party met its obligations, and the final indicators and nota técnica. In it the parties can declare each other released (paz y salvo). Automatic renewal can be agreed, but the amounts are updated for every term and, before the extension starts, the nota técnica is adjusted with what monitoring showed. Source: [Decreto 441 de 2022, arts. 2.5.3.4.6.1 and 2.5.3.4.6.2](https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%20No.%20441%20de%202022.pdf) ## What changes in 2026? The UPC went up and, *from November 1, 2026*, Resolución 1809 changes how direct payment is reported for capitation and PGP. - The 2026 UPC It rose 9.03% in the contributory regime and 16.49% in the subsidized one. - Capitation, by the full month The billing period runs from the first to the last day of the month, and the invoice cannot be issued before it starts. - The monthly value, reported ahead The EPS reports the monthly value of the capitation contract by the 15th business day of the previous month, so the direct payment can be scheduled. - Advances need invoices With an advance, the electronic invoice with RIPS is mandatory: for capitation, within five business days of the payment; for PGP, within the first five business days of the following month. - The unique contract code Direct payment requires the unique contract code (CUCON) from SIIFA, on the dates set by Resolución 1962 de 2025; until then, the contract number. Sources: [Resolución 1809 de 2026](https://normograma.com/keralty/compilacion/docs/resolucion_minsaludps_1809_2026.htm) · [Resolución 2764 de 2025](https://www.minsalud.gov.co/Normatividad_Nuevo/Resolucion%20No%202764%20de%202025.pdf) ## Sources Regulations in force as of October 2026, linked to their text (in Spanish). 1. [Decreto 441 de 2022 Ministry of Health and Social Protection, March 28, 2022 Service agreements: payment modalities, nota técnica, monitoring, deductions and closing. Replaces chapter 4, title 3, part 5, book 2 of Decreto 780 de 2016.](https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%20No.%20441%20de%202022.pdf) 2. [Resolución 2335 de 2023 Ministry of Health and Social Protection Indicators and monitoring of agreements, and the minimum situations for risk adjustment mechanisms.](https://www.minsalud.gov.co/Normatividad_Nuevo/Resoluci%C3%B3n%20No%202335%20de%202023.pdf) 3. [Resolución 1809 de 2026 Ministry of Health and Social Protection, August 5, 2026 Reporting for the direct payment of the UPC, capitation and PGP included. In effect from November 1, 2026.](https://normograma.com/keralty/compilacion/docs/resolucion_minsaludps_1809_2026.htm) 4. [Resolución 2764 de 2025 Ministry of Health and Social Protection The UPC amount for 2026.](https://www.minsalud.gov.co/Normatividad_Nuevo/Resolucion%20No%202764%20de%202025.pdf) **Reviewed: October 2026.** This guide is for information only and does not replace legal advice on your contract. ## What Arbol brings to your contract. Arbol does not replace your medical records or your schedule: it sits on top of what you already use and works with your population every day. - [**Ámbar** Governance Your population in cohorts, each person's risk and the nota técnica up to date.](https://www.getarbol.com/en/governance/) - [**Contactability** Calls and messages WhatsApp, calls, text and email to reach every person and book them.](https://www.getarbol.com/en/contactability/) - [**Agenda by Arbol** Schedule and medical records Doctors, sites and medical records in one place, if you want it. If not, Arbol works on yours.](https://www.getarbol.com/en/agenda/) - [**Proyecto Crónico** Program Hypertension and diabetes, with their check-ups all year.](https://www.getarbol.com/en/chronic-care/) - [**Proyecto Bebé** Program, in Spanish Every pregnant woman found in your data, with her first check-up before week 10.](https://www.getarbol.com/proyecto-bebe/) - [**Capitation simulator** Free tool, in Spanish Your contract's numbers with your population, no sign-up.](https://www.getarbol.com/tools/capitation-simulator/) Real figure: **3,250+** visits found before the close, at a single client. ## Bring your contract. We'll show you who to reach first. A 30-minute demo with physicians, nurses and engineers: your population, your nota técnica and the cohort it makes sense to start with. Governance is quoted once we know how you operate. [Book a demo](https://cal.com/tomas-giraldo-pdfbl9/30-min-arbol-ai-demo) [Message us on WhatsApp](https://wa.me/573185230045?text=Hi%2C%20I%27d%20like%20to%20review%20my%20PGP%20or%20capitation%20contract%20with%20Arbol.) **Colombia**, in operation · Built for Latin America --- **Arbol AI** — AI agents for clinics and healthcare providers: they answer and reach patients by phone, WhatsApp, SMS, email and web chat, book their appointments 24/7 and keep a record of every conversation. - Original page: - Book a demo: · Pricing: - Agent index: · Support: