Value-Based Risk Management

Providers Moving to Value-Based Risk Models

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. Partnering with the most robust platform to manage risk along with deployment options such as Citra Cloud to ensure the most cost effective technology investment, providers can focus less on risk and more on flexibility and care with EZ-Suite. 

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Our Solutions Enable Providers in ACO and Value-Based Risk Models to:

  • Maximizes 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
  • Controls complex processes involving benefit plans, provider contracts, and member populations
  • Manages value-based care and varied benefit management requirements
  • Comprehensive regulatory and audit support and 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
  • Calculates 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
  • Automates timely and accurate payment to capitated providers based on PMPM expenses
  • Role-based user and security at the module, screen and field level
  • Complete before and after editing; Audit Trail at the field level

EZ-Suite, Citra's comprehensive technology platform and advanced population health analytics enable IPAs managing their own risk directly, the ability to address critical functions without outsourcing to MSOs or TPAs, ensuring you succeed in all aspects of delegated risk management. 


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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 

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