Centricity Financial Risk Manager
Helping to reduce the risk of value-based reimbursement
A provider-focused solution to manage risk
For healthcare organizations engaged in risk-based contracts spanning from shared savings to global capitation, Centricity Financial Risk Manager is a proven, highly scalable and provider-focused technology solution that streamlines management of administrative costs, utilization, and care coordination of patient populations. From managing attributed members and their benefits, to processing and adjudicating claims for capitated payments, Centricity Financial Risk Manager automates the decision making and financial management of value-based care.
As a result of the Affordable Care Act and the Triple Aim, healthcare reform is forcing providers to adapt to new care delivery models focused on value-based care rather than volume of services. Thus, the risk is shifting from payers to provider organizations. To successfully manage risk or provider-sponsored health plans, healthcare organizations must provide high quality care delivery to their patient populations at a low cost while ensuring that strong financial processes are in place to manage the unique workflows and business term requirements that accompany value-based reimbursement.
Proven track record
Many prominent healthcare systems in the U.S. use Centricity Financial Risk Manager to help them efficiently manage financial risk and control costs associated with managing patient populations across a health system.
Centricity Financial Risk Manager enables healthcare provider organizations to scale from a few thousand covered lives to over a million covered lives while supporting multiple health plans on a single platform.
Focused on providers
Unlike traditional revenue cycle products, Centricity Financial Risk Manager was built to meet the needs of healthcare providers taking on risk. Organizations can manage all risk-based contracts under one solution, helping to enable standardized business processes and workflows across the enterprise.
Support for Value-Based Reimbursement
Automate administrative tasks
On average, healthcare organizations spend $45 per member per month on administrative functions associated with managing risk-based contracts. Centricity Financial Risk Manager automates these processes to help you reduce costs.2
Monitor utilization of health services
Centricity Financial Risk Manager offers flexible, customizable tools that enable you to refer patients to cost-effective, in-network locations for care, helping you maintain profitability and efficiently manage utilization of health services.
Coordinate patient care
Centricity Financial Risk Manager helps you effectively manage your patient populations enabling you to proactively monitor patients’ care needs, and direct them to appropriate facilities across your enterprise.
Helping you manage risk based contracts Centricity Financial Risk Manager offers comprehensive solutions for provider organizations, health plans, and accountable care organizations that manage partially or fully capitated risk-based contracts as a part of the journey toward value-based care delivery.
2. Sherlock Company, 2016.
Centricity Financial Risk Manager offers the following features:
At the core of Centricity Financial Risk Manager, Enrollment collects demographic, insurance and enrollment data including employer, physician and benefit information. It enhances the enrollment workflow and supports a wide spectrum of user-defined benefit plans that can be linked to multiple employer groups.
Referrals is s comprehensive system that integrates with enrollment and claims to offer authorization tracking, procedure limits, duplicate checking, concurrent review, estimated liability calculation and more.
Claims automatically adjudicates insurance claims entered manually or through Electronic Data Interchange (EDI). It enables you to manage a variety of reimbursement arrangements including withholds, discounts, per diems, RVUs, DRGs, and APCs, and facilitates streamlined processing of individual or groups of claims.
Capitation and risk management
Capitation and Risk Management helps you manage and administer reimbursement arrangements with primary care and specialty care providers. It enables you to track and monitor reimbursement to capitated providers and medical groups, as well as flexibly administer withhold and stoploss arrangements.
Tightly integrated with Enrollment, Premium Billing enables you to calculate and produce premium bills for employer groups and self-pay members, manage receivables, and administer broker commissions. You can flexibly negotiate rates with employers differentiated by member type, employer group, benefit plan and other variables.
Integrated Case Management supports your quality of care initiatives and helps you manage the cost of complex and high-risk episodes of patient care. It enables case managers to identify cases, track care plans, simulate costs of care under different scenarios, generate form letters and link multiple service records related to a single case.
Electronic Data Interchange (EDI)
Centricity Financial Risk Manager comes with standard EDI transaction sets that include: Healthcare Claims (837), Healthcare Remittance (835), Referral Verification (278), Eligibility (270/271), Claim Status (276/277), Premium Payment (820) and Enrollment (834).
Implementation and Consulting Services
GE Healthcare offers implementation, project management and training services. An operational business process review provides configuration recommendations and suggested interface development for third-party integration. Business process outsourcing is also available for claims management, claims overflow and customer service.
"GE does well with the fundamental pieces of the system. Those pieces work extraordinarily well, and the system is very stable. We have thrown a ton at it. We have integrated it with many different EMRs and with scheduling and have created charge interfaces left and right, and still the speed of the system is incredible. We have a huge database, and we can find accounts in a millisecond. Fundamental things my colleagues are struggling with are taken care of for us." - Director1
1. Collected about Centricity Business (Hospital) KLAS in October 2012 ©KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com
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Amid industry upheaval, healthcare organizations are under greater pressure than ever to be productive. Only by getting the most out of every tool can you deliver the care patients need with the efficiency the market demands.
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