Cambia uses i-Sight to reduce costs for its members

Cambia Health Solutions

Since implementing i-Sight, Cambia has been able to save time, track cases more accurately and generate detailed reports that help it operate more efficiently

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Cambia Case Study Snapshot

Cambia strives to make a positive impact through jobs, local business partnerships and investments that drive a more person-focused, economically sustainable health care system.

The company’s business operations support approximately $1.4 billion in economic activity, including more than 11,000 regional jobs, $741 million in income and $150.5 million in tax and fee revenues for state and local governments.

The Challenge

  • The company was using a 13-year old system for tracking and managing investigations
  • There was no mechanism for communication among state fields; investigators could not collaborate.
  • Reporting function was limited, difficult to follow and required manual input.
  • The old technology was no longer supported by the company.

The Solution

  • i-Sight provides a flexible, collaborative solution for managing investigations.
  • The i-Sight reporting tools make it easier for Cambia to achieve compliance with regulatory bodies.
  • i-Sight’s flexible, powerful and easy-to-use reporting mechanism allows Cambia to respond quickly to audit requests and provide detailed reports containing the exact information requested.
  • Cambia is able to track funds recovered from insurance claims identified as fraudulent and document recovery of funds and reimbursements.

The Result

  • Cambia Health Solutions has reduced its reporting time to one-fifth of the time it previously took.
  • Cambia’s investigators have more control over their cases.
  • Managers have access to instant updates on cases without having to call the investigator.
  • The internal email system saves the company time and money.
  • Cambia tracks cases more accurately and generates detailed reports that help it operate more efficiently, translating into reduced health care costs for its members and covered group.

Read the Full Case Study

Cambia Health Solutions is a nonprofit total health solutions company with a century of experience in developing and providing health solutions for its members.

Previously known as The Regence Group, the company was renamed to symbolize the growth rings in the trunk of a tree in honor of the “new growth from within” direction of the company, which strives to make a positive impact through jobs, local business partnerships and investments that drive a more person-focused, economically sustainable health care system.

Cambia’s portfolio of companies includes:

  • health care information technology and software development
  • retail health care
  • health insurance plans that carry the Blue Cross and Blue Shield brands
  • pharmacy benefit management
  • life, disability, dental, vision and other lines of protection
  • alternative solutions to health care access
  • free-standing health and wellness solutions

The company’s business operations support approximately $1.4 billion in economic activity, including more than 11,000 regional jobs, $741 million in income and $150.5 million in tax and fee revenues for state and local governments.

The Challenge

To help achieve the company’s cause to make health care more affordable and accessible, a robust and reliable anti-fraud program was critical. To that end, Cambia Health Solutions needed a bulletproof system to track complaints and manage investigations.

In July of 2010, when Pat Guiton joined the company as Manager of External Audit and Investigations (EAID) Special Investigations Unit (SIU), he realized that Cambia was using a 13-year old system for tracking and managing investigations.

After a career in law enforcement with the US Department of Treasury, Guiton knew the advantages of a robust tracking system for complaints, investigations and financial recoveries, and agreed with the company’s assessment that the in-house solution had run its course. “It was built by programmers and developers within the company, and it was outdated,” he says.

The system didn’t have a mechanism for communication among the different state fields, so it didn’t allow investigators to work collaboratively. Although it had a reporting function, it wasn’t comprehensive, intuitive or automated. And in addition to its shortfalls, the system was no longer being supported by the company because it was old technology and the engineers and programmers who built it had all retired.

The Solution

Cambia Health Solutions needed a flexible, collaborative solution for managing the investigations process from tracking initial complaints through to completing investigations.  In addition, the increasing state and federal requirements for reporting and auditing meant that the company needed a case management solution that made compliance easier to achieve.

The reporting function was of particular importance to Guiton, because he receives auditing requests from groups that Cambia supports, sometimes with very short notice. Audits required that an analyst conduct a manual search, the results of which weren’t always comprehensive. Not only did it require many hours of research time, but it also meant that the analyst would be away from his or her regular duties for that time.

A flexible, powerful and easy-to-use reporting mechanism would allow Cambia to respond quickly to audit requests with the ability to provide detailed reports containing the exact information requested.

Cambia also needed a tool for tracking funds recovered by vendors from the claims identified by a company. They needed a way to document that funds were actually posted and recovered into the company claims system and that vendors received their percentage payments.

Guiton attended the NHCAA conference in November of 2010 to identify and meet with case management software companies capable of providing a solution that met all of Cambia’s diverse needs. He shortlisted six companies and decided on i-Sight as the ideal vendor for the solution Cambia needed.

The Result

Since implementing i-Sight case management software to manage its investigations, Cambia Health Solutions has reduced its reporting time to one-fifth of the time it previously took. “Our reporting is outstanding,” says Guiton. “I’m so happy that we have this system.”

And the reporting tool has already paid off.  “Just yesterday we got a notification that we were going to be audited next week by this particular [Medicare insurance] group we support. And this was just dropped on us.”

Guiton immediately accessed the i-Sight special investigations database and entered the company name. “And boom! It dropped out probably ten cases that we have entered in there which have some connection to that line of business. So then I ran a Yellowfin report and it identified the cases that are actually dedicated to [the group]. The old fashioned way you would have to manually go through the fields to try to identify information,” he says.

“With i-Sight, because what you enter is what you get we really stress the point that you should put the details in the database. It’s simple to enter hit words or the parameters of what you’re searching, and it rolls it out and delivers it into a nice report package,” he adds.

Cambia’s investigators appreciate i-Sight’s ability to track cases and monitor deadlines. “They have more control over their cases,” says Guiton. “It’s an excellent tool for me because I don’t have to call that investigator any more to get an update on a case. If I get a call from legal or from a client or law enforcement agency, I can just go into the case and read the activity. I don’t have to contact an investigator who may be on vacation, may be off, or may be on an audit. I don’t have to bother them or take them away from their current duties to get an answer.”

Guiton finds that the convenience of the internal email system saves the company time and money.  The ability to send messages to managers and co-workers from within a case eliminates the need to track people down on the telephone and disturb investigators who are in the field.

“When you get the email you can just click on it to get right into that case or complaint. You don’t have to dig up your passwords, and at the same time it’s documenting what you are doing in the system. It really shortens the time and it’s really a great tool. We love it!” he says.

Since Cambia Health Solutions implemented i-Sight case management software, the company has been able to save time, track cases more accurately and generate detailed reports that help it operate more efficiently. This all translates into reducing health care costs, making it more affordable for all of its members and covered employer groups.

“Our reporting is outstanding.

I’m so happy that we have this system.”

– Pat Guiton, Manager of External Audit and Investigations (EAID) Special Investigations Unit (SIU)

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