Voices: Praba Manivasager, President, Cashé Software

This article is sponsored by Cashé Software. In this Voices interview, Home Health Care News sits down with Cashé (pronounced: Cash-ay) President Praba Manivasager to learn about the company’s new person-centered agency management tool, Pavillio. Manivasager describes why Cashé is going all in on this new platform, the impact Pavillio is having on personal care providers and how the system is designed to accommodate the surge of in-home care brought on by COVID-19.

HHCN: You have spent your career in cutting edge technology, including your position as president of Cashé since 2017. Tell us about your journey.

Manivasager: I’ve been the president for almost four years. When I jumped in and looked at the software business itself, it was intriguing. My path has been in technology all along, but the health care business was an area that I was not familiar with.

I quickly realized the work I would be doing at Cashé would be pertinent to personal experiences. There are three people in my life who’ve been affected or are related to the industry. My best friend had a stroke and is requiring services. My niece has cerebral palsy. And my child, she’s beautiful and everything is fine with her, but she was also very close to receiving services, because she was premature by three months. All of that changed my perspective.

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I very quickly realized that my expertise in technology and what I’ve learned throughout my career could be applied toward something that could help a lot of people. Now, the technology part of my life is just a backdrop. The passion is, “Go build something and touch two million lives in the fastest possible way.” We believe that Cashé can do that.

Cashé has a robust billing service. Was that in place when you arrived? If not, what was?

Cashé’s DNA is billing. When the company was started more than 15 years ago, it was to serve a very specific population and a set of companies in Minnesota that served the PCA (personal care assistance) population. Over the years, our platform has become better and more sophisticated to a point where we not only provide software, but we also provide billing services.

Yet the technology sophistication required work. We set out to improve the platform and the technology to automate and streamline billing. We still, over the last three years or so, did a number of things to improve how billing was done, how validations for billing were done, how we connected with the payors, and how we give the end user information about how billing through Medicaid was actually being handled better than if they chose any other avenue.

You developed a new tool, Pavillio. What does it deliver that Cashé could not previously do?

Honestly, when we bought the company, we recognized that the shelf life of the current platform was limited. It had a few years left — maybe four or five. We recognized that we needed to have a platform that did a few things. One, it had to be easy, for both technical reasons and business reasons.

The technical reasons were that the legacy platform was outdated and had limitations. Think of it as multiple coats of paint on a wall over the years. It meant that improving that platform was starting to be difficult, because we couldn’t maintain it as well. The first business reason was the platform was not capable of traveling across states. We have our business in the Midwest, and we wanted to be national. For us to be national the platform would require a lot of configurability, and the legacy platform didn’t have that capability.

The second business reason was the platform was very billing-focused and not care delivery-focused. Given these limitations, we said, “Look, we knew we were going to build the platform. If we are to build it, it must be different from the legacy platform.”

Pavillio was built on the premise that everything starts with the person being served. They’re at the center of the universe and we build the technology around them. Pavillio is more human. It is a person-centered platform that has all the capabilities of billing, but we built it to serve the person.

What did you see when you came to Cashé that led you to push the company down this path toward Pavillio, and how did you develop it?

The company has an objective — a set of core values. The purpose of the organization is to make a difference in the lives of people in need. That’s our mission. We do that through data-driven technology for smaller care.

We had to make this transformation from being a de facto billing company in the state of Minnesota, to being a company on a mission to make a difference in the lives of people in need nationwide. That changed fundamentally how the whole organization thought and behaved, because now we wake up and we talk about, “How many lives are we touching?” We wake up and we talk about, “How did we help an agency grow?” We wake up and talk about, “How did we work towards our goal of two million lives?”

Writing a new platform for a small company like ours is a make-or-break decision. We weren’t willing to simply put a new coat of paint on the old system. We said, “we’re starting from scratch and we are betting the farm, so to speak, on Pavillio.”

There is no company in this industry in 2020 writing a new platform, except us. We built it with ideas and tools and technologies that are current today and will grow with us, so that we can get the platform across the country and touch two million lives.

Pavillio launched in the personal care space, which I think speaks to the company’s person-centered, agency-focused approach to technology that we’ve discussed. What results have you seen so far?

Great results. We launched in the personal care space because, while the first part of our DNA was billing, the second part was serving the personal care industry in the state of Minnesota. When we launched Pavillio, the first thing we wanted to do was support a large customer base of PCA agencies. But the intent of the platform was not just to do PCA services, but to have service packs.

So far, the platform has been a great success. The ease of usability of the platform is off the charts. It is very user-friendly, intuitive and comprehensive, and has taken everything that we’ve known from legacy and built it into Pavillio. The billing capabilities and the ideas that we want to implement in legacy, but couldn’t, were all done in Pavillio.

One of our biggest successes so far has to do with submitting claims for reimbursement. The industry average denial rate for first-time submissions is around 18%. In Pavillio, we are already seeing that rate drop as low as 2%. That makes the biggest difference for our customers. because the system is preventing bad claims from going out in the first place.

The other early win is how accessible we’ve made the system. Every person who is part of the care team can have access to the system, because it’s one system, one platform, and person-centered.

What is Pavillio’s key differentiator, and what is the most important way it helps users and enhances the home health industry?

I would say the number one capability of the platform is portability of the health record. Somehow we’ve gotten ourselves, as an industry, into believing in having to talk about portability of the health record because these large EHR systems have been so closed in managing data. We, on the other hand, built the platform with portability in mind, so that a person receiving Medicaid services has the ability to take their records with them as they travel.

Number two, we are truly person-centered. We’re not just saying those words; we’re constantly thinking about them, and that thinking alters what features go in, how the features are built, and how the patient is using those features.

Number three, if you look at the continuum of starting on the left side with the person, and moving to the right side where you get paid for the services delivered, most existing platforms are focused on the care delivery documentation, which is in the middle. But with Pavillio, we focused on the whole continuum. We do all the things necessary for person-centered care and to operationally run the business. That includes a focus on managing billing so that operators maximize their reimbursements.

Ultimately, these agencies are a business and businesses run on a fuel called cash. Getting cash flow and managing cash flow is a huge part of running an agency. What we’ve done with Pavillio is give agencies a better Swiss Army knife to run their business.

Well said. What are Cashé’s plans for expansion with Pavillio?

We continue to add service packs, which means service capability within the platform. We are specifically built for home and community-based services. To grow, we want to make this platform available nationwide, and we have to go state by state, since every state has a different definition of what their set of services are for HCBS (home and community-based services). To make that effective, we have to have a platform that we can quickly add service lines to as we move into each state. The plan is that in four to five years, we’ll be in every state in the U.S.

Lastly, how has COVID-19 changed the equation for Pavillio?

What we saw with COVID was that there is an even greater need for services in the home versus in institutional settings. Within about a month of COVID, it was evident that institutional settings were being hit hard. Our mission and our purpose is even more important today than it was six months ago, because there are going to be more people receiving services in the home, which is the preferred method of service delivery.

We feel like we’re positioned really well to support that. In fact, the next release has a built-in capability for remote service delivery, and a video capability built right into the platform. We’ve recognized our mission is even more important today. We recognize that the industry is changing, and we facilitate success in the changing industry by being nimble, and by building in those capabilities, so that the person receiving care ultimately gets better quality of care quicker because they’re with an agency that’s on Pavillio.

Editor’s note: This interview has been edited for length and clarity.

Cashé Software is Minnesota’s leading provider of agency management software for home and community-based services agencies. To learn more about Pavillio, visit pavillio.com

The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact sales@agingmedia.com.

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