FFS & Self-Funded Risk-Based Management

Integrated Delivery Systems Moving to Risk-Based Models

Citra helps physicians, hospitals and health systems simplify and streamline business processes for Fee-for-service and Self-funding plans, as well as manage eligibility.  

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Our solutions enable Integrated Delivery Systems moving to risk to:

  • Maximize electronic data interchange, accelerated time to value and flexibility for expansion for various payer mixes, including Commercial HMO/PPO, Medi-Cal, Covered California (Exchange), Medicare Advantage and Medi-Medi, including Cal MediConnect product lines
  • Control complex processes involving benefit plans, provider contracts and member populations
  • Manage value-based care and varied benefit management requirements
  • Support comprehensive data needs through collection of provider and member profiles, health plan benefit data, primary care encounters, specialists, authorizations, physician and hospital FFS claims, risk-sharing arrangements, and industry standard codes required for end-to-end UM, C/QM and claims processing
  • Calculate member months with a variety of methodologies: % of Premium, Risk-Adjusted, Tiered Membership or the more traditional health plan benefit option, primary care physician, member condition, age and gender
  • Automate timely and accurate payment to capitated providers based on PMPM expenses
  • Utilize role-based user and security at the module, screen and field level
  • Complete before-and-after editing of audit trail at the field level

Citra's comprehensive technology platform and advanced population health analytics enable Integrated Delivery Systems to manage FFS and movement to risk-based models. 


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Accountable Care Organizations

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Self-Insured Employers

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Health
Plans

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Independent Practice Associations

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Integrated Delivery Systems

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Management Services Organizations

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Providers

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Third Party Administrators

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Commercial

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Duals

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Medi-Cal

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Medicaid

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Medicare Advantage

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PACE

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Specialty/Carve-Out

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We are Citra

"If you are listening with intent to your clients, you will be a fantastic vendor and a very successful company."

Scott Sanner, CEO

Discover what Citra has to offer. Schedule your demo.

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