CCGroup Marketbasket System™
The CCGroup Marketbasket System™ includes solutions for provider and network management, as well as member and population management.
For provider efficiency (cost-of-care) profiling, the CCGroup Marketbasket System™ compares individual physician efficiency to a specialty-specific peer group using a standardized set of prevalent medical condition episodes to minimize the influence of patient health status and methodology statistical errors.
Cave Grouper™
Medical condition episode of care grouper
The Cave Grouper™ groups over 15,000 unique ICD.9 and 70,000 unique ICD.10 diagnosis codes into 538 meaningful medical conditions. The 538 medical conditions in the Cave Grouper™ account for 100% of all medical conditions and expenditures as identified by ICD.9 and ICD.10 medical condition diagnostic codes. An episode of care is defined as all services linked together that are used to treat a patient’s medical condition within a specified period of time—including all ambulatory, outpatient, inpatient, and prescription drug experience (when available). Derivations of the Cave Grouper™ have been tested over the past 26 years on over 101 million members and 857,000 physicians nationwide.
- This output is then taken and used with CCGroup EfficiencyCare™ and CCGroup EffectivenessCare™
- Episodes of care may also be found in the CCGroup PatientView™ reporting front end for member and population management
CCGroup EfficiencyCare™
Physician efficiency measurement software
The CCGroup EfficiencyCare™ Module takes the output from the Cave Grouper™ and develops specialty-specific physician (or physician group) efficiency scores. Compare physician efficiency against the efficiency of a peer group of interest using a standardized set of prevalent medical condition with the intent of minimizing the influence of patient health status and methodology statistical errors.
- This output is then used with CCGroup BullsEye™
- Efficiency scores and drill-down detail may be accessed via CCGroup Analytics™ reporting front end
- Automated CCGroup Batch Reports (pdf) may be produced for each physician or physician group
CCGroup BullsEye™
Software to target CPT-4 codes responsible for physician inefficiency
The CCGroup BullsEye™ Module takes the output from the Cave Grouper™ and CCGroup EfficiencyCare™ and uses the Pearson’s “r” Correlation to identify those procedures and services (CCGroup MedMarkers™) most associated with physician efficiency scores. MedMarkers™ also identify potential areas of significant procedure and service over utilization, upcoding, and unbundling. Knowing these MedMarkers™, the software identifies those physicians meeting established MedMarker™ criteria. On drill-down, it is already known that the established MedMarker™ practice patterns per identified physician will be found.
- This output may be accessed via CCGroup Analytics™ reporting front end
- Automated CCGroup Batch Reports (pdf) may be produced for each physician or physician group
CCGroup EffectivenessCare™
Physician effectiveness or quality measurement software
The CCGroup EffectivenessCare™ Module takes the output from the Cave Grouper™ and develops patient gaps-in-care information as well as specialty-specific physician effectiveness (i.e., process of care quality) scores that compare individual physician effectiveness (or physician group effectiveness) against the effectiveness of a peer group of interest. There are 154 effectiveness metrics derived from national expert resources: National Quality Forum (NQF), and Ambulatory Care Quality Alliance (AQA), NCQA/HEDIS, Physician Quality Reporting System (PQRS), Agency for Health Research and Quality (AHRQ), Centers for Medicaid and Medicare Services (CMS), and The RAND Corporation.
- This output may be accessed via CCGroup Analytics™ reporting front end
- Automated CCGroup Batch Reports (pdf) may be produced for each physician or physician group
- Patient gaps in care output may be accessed via CCGroup PatientView™ for member and population management
CCGroup MediScreen™
High-cost patient predictive model and patient health-risk stratification software
The CCGroup MediScreen™ Module takes the output from the Cave Grouper™ and develops accurate and reliable member scores for predicting the chance of being a high-cost patient in the near future. The senior management of CCGroup has been involved in predictive modeling since 1986, and published our initial predictive modeling article in Medical Care (Cave et al, Medicare 1988). Understand the independent variables (in descending order of importance) having the greatest impact on the patient’s overall predictive score. Moreover, stratify patients based on health-risk factors across all medical conditions.
- This output may be accessed via CCGroup PatientView™ for member and population management