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.”

“For several decades, CCGroup has remained the market leader in accurately and reliably measuring physician efficiency (cost) and quality. The foundation of our reliability is the use of medical condition episodes, and analysis of a relevant set of medical conditions for PCPs and specialists. This marketbasket of medical condition episodes is weighted together to determine overall efficiency and quality scores for each PCP and specialist,” confirmed Dr. Cave.

“Moreover, we use the CCGroup Clinical Decision Support System to further evaluate each physician’s cost and quality of care. Medical condition MedMarkers™ and associated Clinical MedMarker Protocol Ranges™ are the backbone for the CCGroup Clinical Decision Support System,” explained Yuri Alexandrian, Chief Operating Officer of CCGroup.

MedMarkers™ are process of care quality measured, defined in clinical guidelines. However, MedMarkers™ also are 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 CCGroup National Specialist Panels.

Mr. Alexandrian explained, “Each physician’s ranking is based on six (6) quality and cost metrics with respect to treating medical condition episodes of a specific severity-of-illness level.”

• Medical condition efficiency score: measure of both cost and quality;
• MedMarker™ rate: measure of both cost and quality;
• MedMarker™ volume: measure of quality process of care;
• MedMarker™ complication rate: measure of quality outcomes;
• Practice percentage for medical condition: measure of quality process of care; and
• Overall efficiency score: measure of both cost and quality.

“Health systems and health plans use the CCGroup-CMS Innovator Project Database to support strategic initiatives, often producing an immediate return on investment,” defined Dr. Cave.

• Position health system or clinically integrated network (CIN) in favorable network contracts and benefits. Health systems desire: inclusion in Tier 1 networks with health plans; healthcare service fee increases; and prior authorization relief.
• Improve performance of health system or CIN in delivering value based care. Health systems want to: build-out networks in new regions with efficient, quality PCPs and specialists; and steer patients to ‘preferred’ efficient, quality specialists.
• Transform health system physicians’ treatment processes for those medical conditions with current, significant practice patterns variation.

About Cave Consulting Group, Inc. (CCGroup)

Cave Consulting Group, Inc. 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 31 years for health plans, health systems, HMOs, physician groups, CINs, ACOs, TPAs, and employers.

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“Health systems and health plans use the CCGroup-CMS Innovator Project Database to support strategic initiatives, often producing an immediate return on investment,” defined Dr. Cave.