Long-Term Care Market Drivers

The long-term care market often faces the challenge of balancing the conflicting goals of containing healthcare costs, while maintaining and even improving the health of nursing home residents. This is especially significant in the new millennium, when the aging of the baby boomers will dramatically increase the demand for a broad array of long-term care services. The dynamics of the nursing home facility/pharmacy/resident relationship, in addition to regulatory restrictions governing the health, safety and well-being of residents, drive this market’s need for efficient pharmacy management.

Long-term care facilities — including assisted living and skilled nursing facilities — are looking for integrated systems that offer efficient claims processing and adjudication services, cost-saving clinical opportunities, census management and business analysis capabilities. One SXC long-term care client was searching for a solution to manage their Medicare Part D residents across multiple processing platforms. This client was looking for a solution to help manage the complexities involved in changing from one payer (Medicaid) to multiple payers (Medicare Part A/Medicare Part D). SXC integrated payment methodologies across their IT environment, enabling the customer to better manage their revenue stream and cash flow while improving the quality of care provided to their nursing home residents.

We deliver advanced pharmacy management solutions

SXC has been involved with complete long-term care claims processing since 2003 and understands the needs and challenges of this market. In 2007, SXC processed more than 95 million transactions for its long-term care customers.

SXC’s products and services for long-term care include:

     RxCLAIM^® for Pre- and Post-adjudication
     RxTRACK^® for all reporting and tracking capabilities
     RxACT for therapeutic intervention
     RxEXCHANGE™ which supports e-Prescribing
     RxVIEW™ for real-time access to billing information

Web Services for ensuring the integrity of census management
Resident Care Management™, a set of Pre- and Post-adjustification tools
Expected Value Billing™, a tool set to manage Part A contract compliance.
The application of these solutions allow our long-term care clients to monitor claims and validate reimbursement with the introduction of true managed care. The flexibility and adaptability of SXC’s solutions make them effective for long-term care facilities, their pharmacy providers and their auditors.