Features of Real-Time Point of Care Solutions Tackle Industry Challenges

Healthcare leaders are being pushed to find solutions to increase efficiency and control costs while increasing satisfaction of all stakeholders involved in the ecosystem. Major challenges to consider are uncertainties of the healthcare reform movement, changes in implementing policies and the growth of an aging population.


Changes in Policies Will Increase Federal Government Spending

In October 2017, the current administration eliminated the cost-sharing reduction (CSR) payments which in turn prompted insurers to increase premiums to cover this loss. Rosemarie Day, president of Day Health Strategies, said that for 2018, insurers have mostly loaded these premium increases onto silver plans. As the silver plans’ premiums increase, the individual Advance Premium Tax Credit (APTC) from the federal government will also increase. She concluded that the federal government will not have to spend money on CSR payments but will end up spending the same or even more because of the APTCs increase.


Furthermore, a number of states are looking to expand Medicaid coverage. Based on the latest Congressional Budget Office projection, the estimated net amount of federal subsidies in 2018 for health insurance coverage for people under age 65 is projected to rise at an average annual rate of about 6%  between 2018 and 2028 and 5.2 percent yearly for Medicaid in 2018.


SOURCE: Enrollment growth for FY 2016‐2017 is based on KFF analysis of CMS, Medicaid & CHIP Monthly Applications, Eligibility Determinations, and Enrollment Reports, accessed September 2017. The spending growth rate for FY 2016 is derived from KFF Analysis of CMS Form 64 Data. All other growth rates are from the KFF survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, October 2017.


A report by this same office informs that in 2018 net subsidies for noninstitutionalized people under the age of 65 will total $685 billion. Included is the cost of tax credit for work-related insurance coverage, the cost of Medicaid and Medicare coverage for people under the age of 65 and government payments for other kinds of health insurance coverage—such as plans purchased through the marketplaces established under the Affordable Care Act (ACA).



Major Challenges to the Healthcare System – Aging Population

According to statistics posted by the Population Reference Bureau the number of Americans ages 65 and older is projected to more than double from 46 million today to over 98 million by 2060.


The Centers for Medicaid and Medicare inform that the National Health expenditure (NHE)  is projected to grow at an average rate of 5.5 percent per year for 2017-26 and to reach $5.7 trillion by 2026. The data explains that the growth in spending for Medicare (7.4 percent per year) and Medicaid (5.8 percent per year) are both substantial contributors to the rate of national health expenditure growth for the projection period. Both trends reflect the impact of an aging population.


Total of Medicare share spending 2010-2028 per the Kaiser Family Foundation:




So what are the implications of the aging population on health care?

A study published by J.R. Knickman and Emily K. Snell at the National Center for Biotechnology Information (NCBI) mentions that the real challenges of caring for the elderly in 2030 will involve making sure society develops payment and insurance systems for long-term care that work better than existing ones.


In other words, modern tools and resources are not always used to facilitate seamless communication between a patient’s multiple providers. Caregivers, medical professionals and patients fail to communicate effectively without the proper technological platforms to allow interoperability.


For example, Conexia Real-Time at the Point-of Care solutions will streamline the administrative workflow improving the “revenue cycle management”, which will reduce costs and improve finances. The customizable software solutions will also allow entities that provide health services to obtain better health outcomes. How? complete thought by suggesting we can reduce the healthcare provider’s administrative burden and therefore allow more time for actual patient care.  


What measures could Medicaid, Medicare and private health insurers take in order to face the challenge for the complex medical needs of this growing population without putting a burden on national spending?


Consultation with Healthcare Solutions Experts

To help all health entities reduce spending, all aspects of the healthcare ecosystem need to be examined. Consultation with Health industry experts who have deep knowledge of the industry, proven experience, and cutting edge technological tools allows the integration of all stakeholders in the ecosystem improving communication between them.


Implementation of Real-Time at the Point-of-Care

Real-time at the point of care transactions, which have been proven around the world and in the US, foster positive changes in the healthcare industry accelerating informed decision making for providers and allowing reduced Return-to-Work (RTW) from 6 days to less than one day.


Essential Services for Profitable Health Management

Selecting the right healthcare software features for each particular business will enable long-term success. Compliance, streamlining operations, and improving quality of patient care, are the core of a sustainable healthcare system.


The key to attaining this transition successfully is partnership with clients to create a balance between the quality of the service for the covered patient population and optimization of administrative and medical costs. Services on a subscription basis with shared performance goals will foster successful, lasting partnerships with clients.


Advantages of the  Real-Time Circuit Transactions

Below represents results achieved by health payers leveraging real-time point-of-care technologies according to statistics compiled by Conexia:  

  1. Average of 10% reduction in administrative costs.
  2. Average of 5% reduction in medical costs.
  3. Adjudicate up to 85% of authorization request in real-time at the point-of-care.
  4. Reduction in authorization turnaround time from an average of 6 days to ½ day.
  5. Increased automated authorization approval/denial rate generating extensive savings.
  6. Performed targeted provider integrations increasing provider adoption percentage by double digits.
  7. Leveraged real-time circuits to manage over 50 disease and 7 case management programs with automated protocols and tasks reducing administrative and medical costs.
  8. Generated administrative efficiency resulting in FTE reductions during a period of 15% membership growth.?
  9. Provider satisfaction of over 80%



Real-Time at the Point of Care    

Real-time point-of-care collaborative technologies are successfully operating in a number of public and private markets. Advances allow key stakeholders to be aligned in order to improve the delivery and administration of high quality, cost-effective care, with demonstrable results.


Roughly 20 million beneficiaries and 20,000 providers are currently utilizing this model. As a leading provider of these services to public and private healthcare organizations in the US and Latin America, Conexia Inc. operates a SaaS model for custom and ongoing process design and provider support services. These services leverage existing infrastructure (systems and processes), drawing on multiple sources (EHR, charts, claims history, pharma, diagnostics, and user-entered data) and media (web, system, fax, voice and mail) to coordinate, accelerate and simplify the eight core care administrative activities outlined below:


Features of the Proposed Circuit:

The features needed to re-define the administrative workflow of each institution need to be customized to accommodate to the client’s needs while being compliant with federal and state laws.

In conclusion, federal government agencies and private health entities need to take a fresh outlook into the less known but most effective modern solutions available in the market.  These leading-edge systems will contribute to increasing efficiency and ROI, control costs, and will enhance the quality of care.


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