8 Reasons to Customize your Healthcare Service

The US healthcare system has long wrestled with how to effectively monitor their population health. With evidence-based standards of care regarding preventive treatments and chronic conditions management we can better monitor and measure the care that the is provided.


One way healthcare organizations can address this challenge is through partnering with a healthcare management solutions company. Such a partnership can lead not only to reduced costs, but also to ensuring that healthcare entities maintain control of their systems and ensure that security is constantly monitored.


Other challenges  that industry stakeholders commonly find are:

  • Provider abrasion, frustration and criticism with the UR process.
  • Introduce changes in the ecosystem with proven adoption and impact.


A practical solution to consider is a customized service model to obtain:

  1. Improved processes and efficiency with real-time solutions at the point-of care
  2. Access to healthcare expertise not currently available
  3. Solutions that can overlay or replace existing systems and functionalities
  4. Allow staff to focus on more strategic work



Improved processes and efficiency

When information on patient history, payment responsibility and evidence-based care is available in real-time at the point of care,  payers and providers can identify, screen, monitor, intervene, direct, follow-up and track outcomes of patients in a fraction of time.



8 Benefits of a customized model

As leaders in the healthcare ecosystem, Conexia provides an innovative service model that can improve healthcare activities:


Eligibility verification

Each time a patient or injured worker presents their identifier number, eligibility is instantly confirmed verified.

Care Coordination

Diagnoses and treatments are exchanged in real time allowing all authorized providers to have access to the same patient information.


Medical management / Utilization review

Disparity in treatment patterns and adherence to evidence-based medical standards is prevalent  in our current system. Adjudicating medical transactions in real-time at the point of care enables the payer to have a meaningful role in promoting adherence to standards, which results in better care and lower medical spending.


Service Model



Statutory and management reporting

Because patient data and new medical information is available in real-time, reporting and monitoring become much simpler than in the current model of disconnected, disparate, and time-lagged data. Payers and other entities can easily monitor utilization patterns, diagnosis trends, quality measures, and other relevant information.


Claims processing

Real-time validation of medical transactions replaces the claims model. Dynamically changing alternative payment models including risk and value-based payment are applied in real-time. As a result, patients and providers are given financial certainty at the point of care and invoicing becomes a simple, largely automated task.

Provider billing

The same transaction that provided the provider with real-time authorization of the medical service automatically generates an electronic invoice. Once the service is complete, the provider simply submits the invoice. Most activities that are currently part of the provider billing process (fee schedule application, utilization review coding validation, reconciliation, with pre-authorization) have already been completed.


Population health

Having patient’s health information available in real-time allows payers and providers to dynamically track individuals and populations, and if appropriate flag the need for case management intervention. This becomes particularly important in ensuring that preventive services, screenings and therapies are being delivered and adhered to especially for high-risk patients with emerging or complex and chronic conditions.

Fraud, waste and abuse deterrence

The point-of-care model enables payers and regulatory entities to immediately identify and flag potentially fraudulent or abusive activity by providers or patients. The provider can be made aware of the business rules at the point of care which prevents deviations before they happen. Real-time prevention, monitoring and interventions are far more effective and less expensive than “pay and chase” approaches prevalent today.


The real-time at the point-of-care technologies are complementary to and further enable numerous payment and delivery models including bundled payments, global capitation, risk management quality, value-based reimbursement, voucher programs, and single-payer systems. Our experience demonstrates that the Conexia approach significantly enhances the effectiveness of these models in transforming the delivery of care while controlling medical and administrative costs while improving the patient experience.


The implementation of a real-time point-of-care collaborative technology in the healthcare ecosystem aligns key stakeholders and supports regulatory and provider interests reducing costs and improving care delivery and outcomes.


The real-time point-of-care technologies have proven effective for a fraction of the cost of full systems in both public and private sectors, typically delivered on a SaaS subscription basis with minimal or no required capital investment.  Return on investment ranges 3:1 or higher with an average of 5% reduction in claims costs and 10% in administrative costs.


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