Cave Consulting Group, Inc. (CCGroup) was selected by a multi-state Medicare accountable care organization (Medicare ACO) to build, implement, and maintain their preferred specialist referral network (Specialist Golden Referral Network).
“The Specialist Golden Referral Network is a proven strategy to achieve savings and improve quality when integrated into a Medicare ACO’s day-to-day operational processes,” stated Dr. Douglas G. Cave, President/CEO of CCGroup.
He continued, “Changing specialist behaviors to reduce elective (planned, non-emergency) procedure variations has been a significant challenge. Yet, elective procedures account for up to 80% of all procedures, and reducing their variations is critical for Medicare ACO success. For these reasons, our Medicare ACO client recognized that establishing a Specialist Golden Referral Network is imperative to reduce practice variations.”
“The client’s Specialist Golden Referral Network is built at the individual specialist level,” mentioned Dr. Cave. The individual level is important because commercial payers build Medicare Advantage provider networks at the group level. And specialist groups employ both efficient and inefficient specialists.
“Accordingly, successful Specialist Golden Referral Networks (those that save millions of dollars and improve quality of care) need to accurately identify individual efficient specialists,” stated Dr. Cave. “This is no easy task. Many firms produce a specialist efficiency score, but this score is mostly reflective of patient case mix differences (rather than specialist efficiency). Consequently, our client recognized that working with such firms may not achieve desired savings.”
“Our Medicare ACO client understands that CCGroup is the market leader in accurately measuring specialist efficiency,” defined Dr. Cave.
“CCGroup’s foundation for efficiency measurement is the use of medical condition episodes, analysis of a relevant set of medical condition episodes for each specialty type, and proper weighting of those medical conditions episodes to derive an overall specialist efficiency score,” asserted Yuri Alexandrian, COO/CIO of CCGroup. CCGroup methods and analytics are very transparent supported by our published patents and peer-reviewed articles.
Another need for successful Specialist Golden Referral Networks is access to most practicing specialists’ efficiency scores. CCGroup maintains the largest national database on accurate specialist efficiency and quality scores (CCGroup-CMS Innovator Project Database) with over 80% (often up to 95%) of all practicing specialists measured. Scores are updated on a regular basis.
The other selection criterion was CCGroup’s outstanding client service and price. Our Medicare ACO client stated CCGroup has an excellent market reputation and priced our Specialist Golden Referral Network services very competitively.
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 32 years for health systems, physician groups, clinically-integrated networks, ACOs, health plans, HMOs, TPAs, and employers.
View source version on businesswire.com: https://www.businesswire.com/news/home/20251203544403/en/
“Our Medicare ACO client understands that CCGroup is the market leader in accurately measuring specialist efficiency.”
Contacts
Mr. Yuri Alexandrian, CCGroup (Yalexandrian@cavegroup.com)