Welcome to Cave Consulting Group

CCGroup is a software and consulting company focused on improving the efficiency and quality in the healthcare delivery system.

Cave Consulting Group

We recognize the need to address all components of medical trend, if efficiency and quality are to be improved and trend is to be controlled.

CCGroup Marketbasket System™

The CCGroup Marketbasket System™ includes solutions for provider and network management, as well as member and population management.

Products – Home

About our software – 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.

  • Because of the stability and reliability of our provider efficiency scores, we are able to pinpoint MedMarkers™ – the services driving inefficiency.
  • Our clients use MedMarkers™ as the foundation for a variety of performance improvement programs.
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Cave Grouper™

The Cave Grouper™ groups over 15,000 unique ICD.9 and 70,000 unique ICD.10 diagnosis codes into 538 meaningful medical conditions.


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CCGroup EfficiencyCare™

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.

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CCGroup BullsEye

CCGroup BullsEye™

MedMarkers™ identify potential areas of significant procedure and service over utilization, upcoding, and unbundling.



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CCGroup EffectivenessCare™

Develops patient gaps-in-care information as well as specialty-specific physician effectiveness scores that compare individual physician effectiveness, or physician group effectiveness, against the effectiveness of a peer group of interest.

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CCGroup MediScreen

CCGroup MediScreen™

Develops accurate and reliable member scores for predicting the chance of being a high-cost patient in the near future.



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Company

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Company Overview

Company Overview
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Company Leadership

Company Leadership
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Current Patents

Current Patents

Case Studies

Cost and Utilization Management

Cost and Utilization Management

We were involved in developing and implementing some of the first preferred provider organizations (PPOs) on the west coast for self-insured employers.

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Efficiency and Quality Measurement

Efficiency and Quality Measurement

We have worked with leading health plans and physician-hospital organizations on improving the efficiency and quality of their practitioner networks. In this...

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Disease and Population Management

We were involved in designing and implementing one of the first disease management programs in the country. The client was a multi-state, energy supply company.

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Medicaid Health Plans Save Millions by Moving from Auto-Assignment to Smart-Assignment

SAN MATEO, Calif.–(BUSINESS WIRE)–Cave Consulting Group, Inc. (CCGroup) and healthcare researchers (such as Yale University) performed studies that show a 350,000 member Medicaid health plan will save between $2 million and $15 million annually by moving from auto-assignment to smart-assignment. Over a billion dollars are saved across all Medicaid health plans.

Read full article here.

Western Region Health System Works with CCGroup to Improve Clinically Integrated Network Efficiency and Reduce Losses on Capitation Arrangements

SAN MATEO, Calif.–(BUSINESS WIRE)–Cave Consulting Group, Inc. (CCGroup) is working with a Western Region health system to improve the efficiency of the system’s clinically integrated network (CIN). “Our client’s CIN was built on quality and access to deliver healthcare to 170,000 capitated ACO REACH and Medicare Advantage patients,” stated Dr. Douglas G. Cave, President of CCGroup. “Little attention was paid to specialists’ efficiency in managing to a global budget – until losses began mounting over several years.”

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Healthcare Organizations Direct Patients to Knee/Hip Replacement Surgeons with Better Patient Outcomes

SAN MATEO, Calif.–(BUSINESS WIRE)–“Value based payment incentivizes health systems and provider groups to develop interventions that reduce clinical waste and overutilization,” stated Dr. Douglas G. Cave, President/CEO of Cave Consulting Group, Inc. (CCGroup). He continued, “A procedure with the greatest potential for clinical waste and overutilization is knee/hip replacements.”

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CCGroup Maintains the Largest, Most Accurate, and Accepted Database on Physician Cost and Quality in Treating Prevalent Medical Conditions

SAN MATEO, Calif.–(BUSINESS WIRE)–Cave Consulting Group, Inc. (CCGroup) maintains the largest database on physician cost and quality of care with respect to managing and treating prevalent medical conditions. This database is called the CCGroup-CMS Innovator Project Database. “We accurately and reliably measure the cost and quality of over 80% of all practicing primary care physicians (PCPs) and specialists in the United States,” stated Dr. Douglas G. Cave, President/CEO of CCGroup. Dr. Cave continued, “For a good number of specialty types, over 90% of all physicians cost and quality are measured.”

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Part 2: CCGroup Clinical Decision Support System Quantifies “COVID Effect” on Decreased Healthcare Utilization in the United States

SAN MATEO, Calif.–(BUSINESS WIRE)–This Cave Consulting Group Inc. (CCGroup) study quantifies the COVID Effect’s impact on decreased U.S. healthcare utilization. Decreased utilization is a function of at least two components: (1) decreased volume of medical condition episodes seen by PCPs and specialists; and (2) decreased volume of key medical services (MedMarkers™) used to diagnose and/or treat those medical condition episodes that are seen by PCPs and specialists.

Read full article here.

CCGroup Clinical Decision Support System Quantifies “COVID Effect” on Decreased Healthcare Utilization in the United States

SAN MATEO, Calif.–(BUSINESS WIRE)– Cave Consulting Group, Inc. (CCGroup) initiated this study to quantify the COVID Effect’s impact on decreased U.S. healthcare utilization. Decreased utilization is a function of at least two components: (1) decreased volume of medical condition episodes seen by PCPs and specialists; and (2) decreased volume of key medical services (MedMarkers™) used to diagnose and/or treat those medical condition episodes that are seen by PCPs and specialists. “We examine here only the initial component, decreased volume of medical condition episodes,” stated Dr. Douglas Cave, President of CCGroup.

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CCGroup Enables Intelligent Patient Steerage to Efficient Specialists Providing Specific Procedures in a Timely Manner

SAN MATEO, Calif.–(BUSINESS WIRE)–With value based payment, health plans and clinically integrated networks (CINs) need to provide access to the best possible healthcare in a timely manner at the lowest total cost. “One important way to meet this goal is to steer patients to those network specialists that efficiently provide a specific procedure and have time availability,” stated Dr. Douglas G. Cave, President of Cave Consulting Group (CCGroup). Issues today are health plan and CIN leaders: do not know the efficient specialists and sub-specialists; do not know those specialists that perform specific procedures or how often; and recognize patients wait too long to receive a needed procedure (often two months or longer).

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Mountain-Based Health Plan Works with CCGroup to Relax Prior Authorization and Build High Value Networks

SAN MATEO, Calif.–(BUSINESS WIRE)–A mountain-based health plan is working with Cave Consulting Group, Inc. (CCGroup) in the area of prior authorization and utilization management (PA/UM) transformation. “Over time, an objective is to limit PA/UM programs to outlier providers whose ordering patterns differ significantly from clinically appropriate ranges of clinical practice as well as their peers,” stated Dr. Douglas Cave, President of CCGroup.

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Southern Health System Works with CCGroup to Tier Clinically Integrated Network Based on Cost and Quality