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.
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.
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.
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.
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