CCGroup,
the market leader in reliably measuring physician efficiency, supports
key components of value-based agreements using the company’s Centers for
Medicare & Medicaid Services (CMS) Innovator project. The CCGroup
Innovator project allows access to all Medicare fee-for-service (FFS)
claims through the CMS Virtual Research Data Center (VRDC) – including
all acute care, post-acute care, physician visits, physician procedures,
and pharmacy services for more than 38 million individuals each year.
This includes all 50 states and the District of Columbia.
“We support value-based agreements by identifying and monitoring the
medical condition practice efficiency of primary care physicians (PCPs)
and specialists,” defined Dr.
Douglas G. Cave, President of CCGroup. “A foundation for this
support is MedMarkers™ and Clinical MedMarker Protocol Ranges™. We first
define what these are, and then illustrate their importance to
value-based initiatives.”
MedMarkers™ are process of care quality measures, well-defined in
clinical guidelines. However, they are also the key services and
procedures most associated with cost-of-care in treating a medical
condition. For instance, MRI of Spine is the main MedMarker™ (or
correlated service) in treating non-complicated low back pain.
MedMarker™ technology is protected under numerous patents.
CCGroup is the only company in the market that has developed MedMarkers™
for all prevalent medical conditions. “Access to the Medicare FFS
beneficiary claims will only enhance our medical condition MedMarker™
capabilities,” Dr. Cave stated. “For instance, we will determine
additional MedMarkers™ responsible for efficient and inefficient
condition-specific practice variations.”
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. Each specialist
on a CCGroup National Specialist Panel is asked to review medical
condition-specific MedMarker™ results. Then, they define the percentage
of patients where a MedMarker™ service is likely clinically warranted.
Based on the CCGroup National Specialist Panel results, an appropriate
Clinical MedMarker Protocol Range™ is selected for each medical
condition. “For example, the acceptable Clinical MedMarker Protocol
Range™ for routine low back pain is no more than 0-to-20 out of every
100 episodes with an MRI of Spine,” stated John Calvin, VP of Clinical
Systems at CCGroup.
MedMarkers™ and Clinical MedMarker Protocol Ranges™ are important to
value-based agreements between health plans and health systems. Dr. Cave
asserted, “Providers want to understand the services they need to focus
on to reduce unwarranted practice variations. The medical
condition-specific MedMarkers™ answer this need. Also, providers want to
know the appropriate level of utilization that does not represent
potential under-utilization of services. Clinical MedMarker Protocol
Ranges™ answer this later question.”
For each physician and health system, MedMarkers™ and Clinical MedMarker
Protocol Ranges™ prioritize the healthcare services to work on first by
quantifying the savings from reduced practice variations and improved
quality of care. Then, CCGroup monitors and quantifies the success of a
value-based program through reduced MedMarker™ practice variations.
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, CINs, ACOs, TPAs, and
employers.
View source version on businesswire.com: https://www.businesswire.com/news/home/20200107005117/en/