San Mateo, CA. – CCGroup is pleased to announce that the United States Patent and Trademark Office has issued Patent No. 7,739,126 on its grouper of medical condition episodes of care and provider efficiency methodology and system. “The main advantage of our patent is that the efficiency methods allow our health plan and physician group clients to obtain accurate and reliable efficiency scores, something that has been very elusive to date,” stated Douglas G. Cave, Ph.D., President of CCGroup.
The foundation of the 7,739,126 patent is Claim 1 for performing provider efficiency analysis ‘using a predefined set of medical conditions for a specialty type’ and calculating weighted episode of care statistics across the predefined set of medical conditions. Other claims include the following: form medical condition episodes of care; assign episodes of care to a provider; calculate medical condition-specific episode of care statistics; calculate weighted episode of care statistics across medical conditions using a predefined set of medical conditions for a primary care physician (PCP) or specialist; and determine efficiency scores for providers from the calculated weighted episode of care statistics for the provider and for the peer group.
“Our grouper and efficiency measurement patent is valuable for several reasons,” stated Douglas G. Cave, Ph.D., President of CCGroup. “Our entire methods are now 100% transparent for the public to see, including health plans, health systems, physician groups, employers, and the Federal and State governments. This transparency includes all our methods on the Cave Grouper™ of episodes of care and on our CCGroup EfficiencyCare™ analytics for provider efficiency measurement. CCGroup is proud to be the first company to meet this long felt need in the marketplace,” Dr. Cave also commented. “We have invested significant time and effort to determine and develop the most appropriate methods to obtain reliable and stable provider efficiency scores, especially the method on using a predefined set of medical conditions. The issuance of the patent will allow CCGroup to protect this investment, but at the same time make our leading technology available to the health services industry.”
Recent health services research supports the narrowing down to a predefined grouping of medical condition episodes. For instance, a recent New England Journal of Medicine article showed that examining all episodes assigned to a physician results in low reliability of provider efficiency scores [New England Journal of Medicine, Provider Cost Profiling: Reliability and Risk of Misclassification (JL Adams, A Mehrotra, JW Thomas et al 2010)]. Dr. Cave explained, “We believe that a main reason for the low reliability involves the tested method’s evaluation of ‘all medical condition episodes’ assigned to a physician (including the really complex, low prevalence episodes). Then, the authors applied a patient case mix index to adjust for differences in expected costs within episodes that reflect the complexity of the patient’s condition.”
However, in most claims-based studies for health plans, a physician has less than 150 assigned episodes of care (known as the law of low episode numbers); this study was no exception. With the law of low episode numbers, you cannot examine all episodes assigned to a physician, and then depend on a patient case-mix index to calculate an accurate expected cost. This is because no predictive model based on claims data explains more the 30% of the variance in a patient’s total health care expenditures. Consequently, up to 70% of the expected cost for an episode may be attributed to uncontrolled patient case mix. In essence, this means that the expected episode cost is often inaccurate, resulting in non-reliable physician efficiency scores.
“Our innovation,” according to Dr. Cave, “is to focus on a predefined set of medical conditions, removing from evaluation those episodes that are infrequent heterogeneous patient episodes and those episodes that are not generally related to the PCP’s or specialist’s practice of medicine. In effect, you need to examine a constant blend of prevalent, lower resource intensive episodes. A specific blend of medical conditions should be built for PCPs and for each specialty type. The blend should reflect the majority of a PCP’s and each specialty type’s panel of patients.”
About Cave Consulting Group
Cave Consulting Group, LLC 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) in the healthcare delivery system. Senior management of Cave Consulting Group has assessed the performance of physicians and hospitals for over 20 years for health plans, HMOs, TPAs, and employers.
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