Articles from Cave Consulting Group, Inc.

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).

“Using our extensive benchmarking database, CCGroup identifies a Midwest health system client as being in the upper performance tier for treating lower extremity joint replacements (LEJR) under the CMS Transforming Episode Accountability Model (TEAM),” stated Dr. Douglas G. Cave, President/CEO of CCGroup.

“Our academic medical center client is mandated to participate in the CMS Transforming Episode Accountability Model (TEAM) and will be paid for all knee/hip replacements on a 30-day bundle basis,” stated Dr. Douglas G. Cave, President/CEO of Cave Consulting Group, Inc. (CCGroup). He continued, “Our client partnered with CCGroup to determine if the health system’s redesigned joint replacement program allows for profitability under CMS TEAM payment.”

Cave Consulting Group, Inc. (CCGroup) and healthcare researchers (such as Yale University) performed studies that show a 350,000 member Medicaid health plan will save between $2 million and $15 million annually by moving from auto-assignment to smart-assignment. Over a billion dollars are saved across all Medicaid health plans.

Cave Consulting Group, Inc. (CCGroup) is working with a Western Region health system to improve the efficiency of the system’s clinically integrated network (CIN). “Our client’s CIN was built on quality and access to deliver healthcare to 170,000 capitated ACO REACH and Medicare Advantage patients,” stated Dr. Douglas G. Cave, President of CCGroup. “Little attention was paid to specialists’ efficiency in managing to a global budget – until losses began mounting over several years.”

“Value based payment incentivizes health systems and provider groups to develop interventions that reduce clinical waste and overutilization,” stated Dr. Douglas G. Cave, President/CEO of Cave Consulting Group, Inc. (CCGroup). He continued, “A procedure with the greatest potential for clinical waste and overutilization is knee/hip replacements.”

Cave Consulting Group, Inc. (CCGroup) maintains the largest database on physician cost and quality of care with respect to managing and treating prevalent medical conditions. This database is called the CCGroup-CMS Innovator Project Database. “We accurately and reliably measure the cost and quality of over 80% of all practicing primary care physicians (PCPs) and specialists in the United States,” stated Dr. Douglas G. Cave, President/CEO of CCGroup. Dr. Cave continued, “For a good number of specialty types, over 90% of all physicians cost and quality are measured.”

This Cave Consulting Group Inc. (CCGroup) study quantifies the COVID Effect’s impact on decreased U.S. healthcare utilization. Decreased utilization is a function of at least two components: (1) decreased volume of medical condition episodes seen by PCPs and specialists; and (2) decreased volume of key medical services (MedMarkers™) used to diagnose and/or treat those medical condition episodes that are seen by PCPs and specialists.

Cave Consulting Group, Inc. (CCGroup) initiated this study to quantify the COVID Effect’s impact on decreased U.S. healthcare utilization. Decreased utilization is a function of at least two components: (1) decreased volume of medical condition episodes seen by PCPs and specialists; and (2) decreased volume of key medical services (MedMarkers™) used to diagnose and/or treat those medical condition episodes that are seen by PCPs and specialists. “We examine here only the initial component, decreased volume of medical condition episodes,” stated Dr. Douglas Cave, President of CCGroup.

A mountain-based health plan is working with Cave Consulting Group, Inc. (CCGroup) in the area of prior authorization and utilization management (PA/UM) transformation. “Over time, an objective is to limit PA/UM programs to outlier providers whose ordering patterns differ significantly from clinically appropriate ranges of clinical practice as well as their peers,” stated Dr. Douglas Cave, President of CCGroup.

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 Hawaii Independent Physicians Association (Hawaii IPA) is working with Cave Consulting Group, Inc. (CCGroup) to access accurate and reliable physician efficiency (cost-of-care) and effectiveness (quality process of care) scores. “A main reason is that Hawaii IPA accepts capitation payment for Medicare Advantage patients. Therefore, we need to identify and reduce practice variations to improve quality and cost of care to successfully live within a global budget,” stated Dr. Richard Chung, Chief Medical Strategist for Hawaii IPA.

“Clinically integrated networks (CINs) and provider groups need immediate access to accurate and reliable physician efficiency (cost-of-care) and effectiveness (quality process of care) scores to better prepare for value base payments from health plans and the Centers for Medicare & Medicaid Services (CMS),” stated Dr. Douglas G. Cave, President/CEO of Cave Consulting Group, Inc. (CCGroup). CINs/provider groups want access to this physician performance information through the easy-to-use, CCGroup Cloud/SaaS subscription model.