CCGroup published a 2016 press release stating that nationally over 230,000 primary care physicians (PCPs) and specialists are evaluated based on achieving acceptable clinical protocol ranges in treating medical conditions, or Clinical MedMarker Protocol Ranges™. “CCGroup works with CCGroup National Specialist Panels to develop and maintain the Clinical MedMarker Protocol Ranges™, which are achievable, appropriate ranges of clinical practice. This effort with our panels helps to ensure the validity of established Clinical MedMarker Protocol Ranges™,” stated Dr. Douglas G. Cave, President of CCGroup.”
Dr. Cave continued, “MedMarkers™ are process of care quality measures, well-defined in clinical guidelines. However, they also are the key services and procedures most associated with cost-of-care in treating a medical condition. MRI of spine is the main MedMarker™ (or correlated service) in treating low back pain; and upper gastrointestinal (GI) endoscopy is the main MedMarker™ in treating GERD (or heartburn).
“Our clients use their medical condition MedMarker™ results to support clinical transformation efforts,” stated Yuri Alexandrian, COO/CIO of CCGroup. “We want to share four success stories.”
A northwest health system changed its existing practice pattern for non-complicated low back pain. Before the change, over 20% of patient episodes had an MRI of spine. The implemented clinical transformation requires back pain patients to have an initial combined visit with a physical therapist and a physician. Also, evidence-based decision rules are embedded in the scheduling process for radiology. After the change, only 8% of low back pain episodes have an MRI of spine.
A clinically integrated network (CIN) changed its practice pattern for menstrual disorders. Before the change, 65% of patient episodes had a transvaginal ultrasound. CIN clinical leaders reviewed MedMarker™ results with OB/GYNs and discussed that the ultrasounds did not lower the average episode cost to treat menstrual disorders. Subsequently, the CIN developed more definitive evidence-based indications for transvaginal ultrasound. After the change, about 30% of episodes had a transvaginal ultrasound.
An upper Midwest CIN reversed an emerging trend for treating most basal cell carcinomas with Mohs surgery, as opposed to the traditional more cost-effective skin lesion excision. Before the change, close to 60% of patient episodes had Mohs surgery. CIN clinical leaders reviewed MedMarker™ results with dermatologists and showed the statistically greater average episode cost attributed to Mohs surgery and associated pathology readings. This result sharing and monitoring feedback lowered Mohs surgery to about 30% of patient episodes.
The last health system used medical policy to affect practice patterns in treating seasonal rhinitis. About 60% of adult episodes seen by allergists had allergen immunotherapy, a high percentage of patients. Health system clinical leaders decided to reduce the initial number of vials filled for a patient’s immunotherapy treatment. More vials were filled later, if needed. The medical policy change improved the health system’s overall efficiency in treating seasonal rhinitis.
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 28 years for health plans, HMOs, physician groups, health systems, TPAs, and employers.