A large southern health system with many employed and affiliated physicians is working with Cave Consulting Group, Inc. (CCGroup) to support their clinically integrated network (CIN), tiered network strategy. The tiered CIN strategy is based on efficiency (cost of care) and effectiveness (quality of care). A tiered CIN is necessary to successfully manage value based payments from local area health plans and the Centers for Medicare & Medicaid Services (CMS).
“The large health system selected to work with CCGroup for several reasons,” stated Dr. Douglas Cave, President of CCGroup. “Primarily, CCGroup has the most proven, transparent, and published, market accepted, and accurate efficiency and effectiveness methods and analytics. These criteria are important to successfully stratify and tier CIN providers.”
The health system also desires access to a large external database to supplement internally available data for efficiency and effectiveness measurement. There is recognized need to measure as much of a provider’s overall performance as possible – and not just a portion.
Dr. Cave continued, “The CCGroup-CMS Innovator Project meets this southern health system’s needs by allowing access to over 80% of all practicing PCPs’ and specialists’ efficiency performance in the southern state.” The accurate provider efficiency performance is derived using several million Medicare beneficiaries’ claims and encounter data in the southern state. This claims/encounter data includes all acute care, post-acute care, physician visits, procedures, and pharmacy services.
Once the health system is successfully tiered, Tier 2 physicians will desire to understand how to achieve Tier 1 status. “Therefore, the southern health system needs access to a clinical decision support system based on medical condition, clinically appropriate ranges of clinical practice. CCGroup has a developed, reliable clinical decision support system,” defined Yuri Alexandrian, Chief Operating Officer of CCGroup.
Mr. Alexandrian also mentioned, “The foundation is MedMarkers™ and Clinical MedMarker Protocol Ranges™. MedMarkers™ are process of care quality measures, defined in clinical guidelines. However, they also are the key services most associated with cost of care in treating a medical condition. Clinical MedMarker Protocol Ranges™ are achievable and clinically appropriate ranges of clinical practice for a MedMarker™. These ranges are developed by presenting the CCGroup National Comparative MedMarker Database™ results to the CCGroup National Specialist Panels.”
“Tier 2 physicians want to understand the services they need to focus on to reduce unwarranted practice variations. The medical condition MedMarkers™ answer this need. Also, physicians want to know the appropriate level of utilization that does not represent potential under- or over-utilization of services. Clinical MedMarker Protocol Ranges™ answer this latter question,” Dr. Cave confirmed.
About Cave Consulting Group, Inc. (CCGroup)
CCGroup is a software and consulting firm located in San Mateo, California. The company is focused on improving the efficiency (cost-of-care) and effectiveness (quality-of-care) of the healthcare delivery system. Senior management of CCGroup has assessed the performance of physicians and hospitals for over 30 years for health systems, physician groups, clinically-integrated networks, health plans, HMOs, TPAs, and employers.
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Contacts
Mr. Yuri Alexandrian, CCGroup (Yalexandrian@cavegroup.com)
