Cave Consulting Group, Inc. (CCGroup) is a software and consulting company focused on improving the efficiency and effectiveness/quality in the healthcare delivery system. We recognize the need to address all components of medical trend (not just service price discounts), if cost-efficiency and effectiveness are to be improved and trend is to be controlled.
We believe market efficiency and effectiveness will be improved once practitioner and hospital efficiency and effectiveness are accurately and reliability measured, practitioners are informed of their performance results, and patients have knowledge of—or are directed to—the most efficient and effective practicing providers. Finally, we believe market efficiency and effectiveness will be improved once patients with unstable chronic medical conditions are accurately identified and properly managed.
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.
The CCGroup Marketbasket System™ also examines provider effectiveness (quality-of-care) using 154 unique, claims-based process of care. Clients may also build custom effectiveness measures and modify existing effectiveness measures, to meet their medical management needs.
Additionally, the CCGroup Marketbasket System™ provides member and population management solutions including a predictive model and gaps-in-care analysis. Our Coordinated Care Action Plan (CCAP) Report provides care managers with the actionable information they need to assess and prioritize members. For example, we calculate a Care Need Index for each member, based on five values that are needed to assess and prioritize patients: Predictive Score; Recent Facility Encounters/Avoidable Events; Effectiveness Gaps-in-Care; Medical Condition Resource Intensity; and, Clinical Lab Results (where available).
Derivations of our measurement methods have gone through testing and research on 90 million members and 705,000 physicians in the commercial, Medicare, and Medicaid health systems. Over 50 articles have been published on derivations on the CCGroup Marketbasket System™ methods and software. We work with large, national health plan clients as well as numerous Blue Plans and regional non-Blue plans.
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