Independent Practice Associations

In supporting the delegated model, Citra provides all of the tools necessary to manage the financial risk for healthcare services transferred from an insurance company to healthcare providers (e.g., physicians or hospitals), such as capitation for all professional services for each health plan member, and variations, such as full or partial risk for hospital services provided to those same members. Citra also manages shared risk arrangements for hospital expenses, sharing with the health plan in any differences between actual and budgeted hospital expenses and supporting acceptance risk for all healthcare services, global or full-risk capitation.

• 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 IPAs directly managing their own risk the ability to address critical functions without outsourcing to MSOs or TPAs, ensuring you succeed in all aspects of delegated risk management.