Providers

Value-based risk models impact providers in a number of material ways, including the need for specialized and experienced staff and resources, such as capital reserves and sophisticated information technology solutions, to understand and manage financial benchmarks. Additionally, the variation of approaches in Medicaid, Medi-Cal, Medicare Advantage and Commercial arrangements can lead providers to believe the move to be even more daunting. Risk can also be a great motivator for focused management of care and a catalyst to more cost-effective and profitable business models. Providers need to be nimble and able to support a dynamically changing environment. By partnering with the most robust platform to manage risk, along with deployment options such as Citra Cloud, ensuring the most cost-effective technology investment, providers can focus less on risk and more on flexibility and care with EZ-Suite.

• 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 via 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.