“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.
CCGroup successfully launched the CCGroup Cloud/SaaS subscription model in 2021.
“The reason CINs/provider groups need immediate access to performance information is that value based payments are tied to a CIN/provider group delivering healthcare services to a contracted group of health plan members or CMS Medicare beneficiaries. Therefore, CINs/provider groups need to sign on enough physicians and other healthcare professionals to ensure access to care for these members and beneficiaries. Contracted physicians need to be efficient and effective to maintain a high-performing network,” continued Dr. Cave.
“Most CINs/provider groups desire to access physician efficiency and effectiveness data through the CCGroup Cloud/SaaS subscription model,” stated John T. Calvin, Vice President of Clinical Systems. “They often have few internal IT resources, and those IT resources are devoted to many different projects. As a result, our CIN/provider group clients desire the CCGroup Cloud/SaaS subscription model because there is little-to-no client software and hardware management,” defined Mr. Calvin.
Dr. Cave mentioned, “The CCGroup Cloud/SaaS subscription model has received enormous interest from both the provider and health plan communities.”
However, interest in working with CCGroup stems from other important factors. “CCGroup has the most proven accurate, transparent, well-published and market accepted efficiency and effectiveness methods and analytics,” explained Dr. Cave. These criteria are important for CINs/provider groups to build and maintain high-performing networks – and obtain clinical and financial success under value based agreements.
Mr. Calvin mentioned, “For several decades, CCGroup has remained the market leader in reliably and accurately measuring physician and health system efficiency. The foundation of our reliability is the use of medical condition episodes-of-care and analysis of a relevant set of medical conditions for PCPs and specialists.” CCGroup has many patents protecting its provider efficiency methods, analytics, and software.
Another reason is our relationship with CMS through the CCGroup-CMS Innovator Project. For many years, CCGroup has worked on CMS efficiency-related measurement studies – stemming back to 2003. “The CCGroup-CMS Innovator Project now allows CCGroup access to more than 60 million Medicare beneficiaries’ claims data over multiple years. With this claims data, as well as other datasets, CCGroup has one of the largest, complete claims databases in the country. This allows CCGroup to produce accurate and reliable overall efficiency and effectiveness scores for more than 75% of all practicing PCPs and specialists nationwide. For a good number of specialty types, over 90% of all physicians’ efficiency are measured,” confirmed Dr. Cave.
This fact is of significant importance to our clients, as they build and maintain high-performing networks and improve medical management activities.
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 30 years for health plans, health systems, HMOs, physician groups, CINs, ACOs, TPAs, and employers.