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Overview

Cambria’s software solutions are developed to solve our clients’ most challenging business problems. Our solutions are designed to meet regulatory and legislative mandates, while also meeting or exceeding performance targets. Our innovative approach fosters a culture in which collaboration and flexibility solve today’s and tomorrow’s problems.

What is Evalucare?

Cambria’s evalucare™ solution, which has been implemented in California, automates, updates and streamlines the Federally-mandated mental and behavioral health Pre-Admission Screening and Resident Review (PASRR) process, enabling states to issue a determination and care plan within the federally mandated timeline of 7-9 days and quickly provide patients with much-needed care. Additionally, it automates the Level I screening and Level II evaluation and determination processes, providing a full end-to-end solution with more efficiency for every facility, clinician, patient and caregiver involved.

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The Federally-compliant evalucare™ solution automates and streamlines the entire evaluation process, allowing evaluators to survey a patient onsite and recommended a specific level of care. It also helps states generate a care plan in a timely and accurate manner, providing long term plans with ease and efficiency.

Additionally, data analytics allow the State to monitor key performance indicators and detect anomalies in the program.

The Federal government’s PASRR program requires that individuals be assessed for Mental Illness, Mental Retardation, and Developmental Disabilities when they apply to a Nursing Facility and again on a systematic basis after admission.

Challenges in implementing the PASRR program often include:
  • Use of paper, mail and fax makes the PASRR process extremely long, expensive and cumbersome.
  • Legacy systems do not integrate all processes.
  • Lack of comprehensive training leads to lack of comprehensive data.
  • Data quality and consistency limits the ability to manage PASRR program objectives with performance-based decision-making.

evalucare™ is a fully-hosted software-as-a-solution that seamlessly automates and consolidates paper-based PASRR processes for improved data accuracy, timeliness, and data analytics. This automated, HIPAA-compliant solution enables Federal compliance and better resident care in the least restrictive setting.

evalucare™ features end-to-end data capture, from nursing facilities, hospitals, and care agencies (Level I) to evaluators (Level II) and agency clinicians (Determination) to improve care analytics. Moreover, by automating the Level I, Level II, and Determination process, every facility, independent evaluator, and clinician can easily record, store and view the data they need to make critical health care decisions. Users can also access evalucare™ on their mobile devices from virtually anywhere.

evalucare™ is a scalable solution, currently deployed with over 10,000 users and over 1,000 facilities.


Paces

What is Paces?

PACES is one of the largest managed care encounter systems in the country designed to decisively solve the major data quality and communication issues related to encounters data. The solution is modular, stand-alone and outside the core MMIS.

Cambria’s PACES system is a modular solution based on a service oriented architecture (SOA). Its foundation in an open-close design pattern is key to rapidly adapting new policies and legislative mandates without massive coding changes and change orders. Moreover, states are finding that a separate encounter processing solution enhances the oversight over MCOs and provides direct access to data analytics and rate setting, which are essential to tomorrow’s Medicaid environment.

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QUALITY AND COMPLIANCE
PACES contains hundreds of built-in data-quality measures and is able to validate every received encounter against those measures. PACES is also HIPAA-compliant and NCPDP-compliant.

FLEXIBILITY
PACES’ flexible design enables it to meet future mandates without significant modification.

OPEN ARCHITECTURE
PACES’ open-ended architecture supports multiple formats from multiple systems, allowing managed care health plans to submit data of any kind, as long as it is in HIPAA and NCPDP format.

VALIDATION OUTCOMES
PACES shares validation outcomes with managed care organizations and health plans in an easily accessible format.

IMPROVEMENT
Through encounter replacement and void features, PACES guides health plans to improvement by enabling the use of shared information to correct denied encounters.

The California Department of Health Care Services (DHCS) faced a challenge when a majority of its Medi-Cal population transitioned from the FFS model to the managed care model. The goal was to facilitate this transition while reducing the cost of health care, without sacrificing quality. DHCS’s encounter processing system was receiving encounters using proprietary data formats, which were not flexible enough to be HIPAA compliant. In addition, the system was not able to check completeness and accuracy of an encounter, and the collected information was insufficient to construct any benchmarks or use for rate negotiations with MCOs. As a result, DHCS staff concluded that the collected encounters data could not be used to realize benefits of a managed care model.

PACES receives encounter data from over 37 health care providers and over 100 health plans. The application currently processes approximately 20M encounters per month. Cambria’s PACES solution processes encounter data in compliance with the Health Insurance Portability and Accountability Act of 1996 and the National Council for Prescription Drug Programs (NCPDP). The software tracks encounters based on provider and/or member IDs and the core application business rule engine validates that information is complete and complex validations are run. All data received, along with their outcomes, are stored and loaded to a data warehouse, which is used to assess the quality of health care provided by the health plans.