March, 2019 - Cave Consulting Group

30MarMay 8, 2019

Company Overview

Vision Statement

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.

30MarJune 14, 2022

By devadmin

Company Leadership

Douglas G. Cave Ph.D, MPH

Douglas G. Cave Ph.D, MPH, President & Founder

Doug Cave is the founder of CCGroup, and oversees all aspects of the company’s operations, development and sales. Doug has served as CEO, President and COO of several healthcare companies. He has over 30 years of experience in the HMO, health insurance, pharmacy and physician-hospital organization industries, as well as over 20 years experience in consulting to these industries. He has also been involved in the large employer, employer coalition, TPA, utilization management, and disease management markets, and has published over 100 articles in academic and trade journals and performed numerous speaking engagements at healthcare and trade association meetings. Doug holds a Ph.D in Health Policy and Planning, as well as a Masters’ of Public Health in Infectious Disease Epidemiology.

Yuri Alexandrian

Chief Operating Officer and Chief Information Officer

Yuri Alexandrian is responsible for CCGroup’s Product Development and Technology organizations and Operations team, including Account Management and Client Support. He is a seasoned healthcare technology leader with over 20 years of diverse healthcare and IT experience. Previously, he was a Vice President of Operations and Development at Fortune 16 McKesson Corporation, a leading healthcare company where he directed many enterprise-wide IT and eBusiness initiatives. Yuri obtained his MBA from Santa Clara University and his BS degree in Computer Engineering from California Polytechnic State University, San Luis Obispo.

John T. Calvin

Vice President of Clinical Systems

John Calvin directs CCGroup’s Product Development team and is responsible for all software lifecycles including development, maintenance, and testing. He has over 20 years of experience in the healthcare and biosciences arenas. He was previously the Director of Software Development at Iconix Biosciences, a company dedicated to the application of gene expression profiling during early discovery and pre-clinical drug development trials. John obtained his BS in Computer Sciences and his BS in Biology from California State University, Chico.

Kelah Nieto

Director of Operations and Account Management

Kelah Nieto is responsible for day-to-day operational delivery activities, and overall client experience and satisfaction. Kelah consults with clients to ensure successful implementations and ongoing derived business value in use of CCGroup’s product suite. She has over 10 years of experience in healthcare, client relationship management, and project management. Kelah joined CCGroup in 2015 as an Account Manager where she provided excellent, quality service to her clients.

Dr. Cynthia Fenton

Medical Director

In this role Cindy serves as Chair of CCGroup’s Medical Advisory Board, provides clinical guidance for MedMarker and Effectiveness Measure development, and supports clients’ use of CCGroup analytics with clinicians. Cindy has prior experience as a primary care physician. She is currently clinically active as a Hospitalist and Professor of Medicine at the University of California, San Francisco. She earned her B.S. from UCLA in Mathematics/Computer Science and has prior experience as a programmer. This combination of clinical and computer science experience has informed Cindy’s work in a variety of settings aimed at improving quality and value in healthcare, including analyzing large medical and pharmacy claims datasets to provide actionable insights about quality, safety and practice patterns. Cindy is also an accomplished medical educator, former Associate Chair for Education in the UCSF Department of Medicine and recent recipient of the UCSF Kaiser Award for Excellence in Teaching for Inpatient Medicine.

30MarMarch 14, 2024

By devadmin

Current Patents

The following CCGroup products are protected by patents in the United States. This website is provided to satisfy the virtual patent marking provisions of Section 16 of the America Invents Act. The following list of CCGroup products may not be all inclusive, and other CCGroup products not listed here may be protected by one or more patents.

Cave Grouper™, CCGroup EfficiencyCare™

CCGroup BullsEye™

23MarFebruary 18, 2020

By devadmin

Relationship Manager

About the Company

Company: Cave Consulting Group (CCGroup) is a financially stable, high growth healthcare software company focused on improving the efficiency and quality in the healthcare delivery system. CCGroup works with well-known and respected health plans and physician groups. Our area of focus crosses three key areas: physician efficiency measurement; physician quality/effectiveness measurement; and predictive modeling.

Account Manager

Job Description:
CCGroup is seeking a dynamic and detail oriented individual who is comfortable and savvy with analytics and technology and knowledgeable about the US healthcare delivery system. This individual must have an absolute commitment to customer service and be able to effectively guide clients in the strategic use of CCGroup’s products and services. Successful candidates will have excellent written and oral communication skills, be computer savvy, love problem-solving and be able to work in a fast-paced environment.

Opportunity:

Extensive learning opportunities
Dynamic and fast-paced environment
Competitive salary and benefits
Performance based culture with excellent growth opportunities
Team oriented workplace

Responsibilities:

Provide client account management and support functions to ensure highest level of quality and client satisfaction
Guide clients in strategic use of CCGroup products and develop short and long term client retention strategies for each client
Lead clients through CCGroup software implementation
Assist clients with analytic goal setting, data validation, and interpretation of outputs and reports from large claims-based data files
Train clients on CCGroup products.
Communicate professionally and at multiple levels within the client’s organization; anticipate client needs and correspond proactively
Perform other duties as assigned

Required Qualifications:

Excellent interpersonal skills and written and oral communication skills in English
Attention to detail and ability to manage multiple projects simultaneously
Strong analytic skills and problem solving abilities
Proficiency in Excel and experience with other analytic tools
Proficiency in PowerPoint
Strong interpersonal skills, including excellent written and oral communication skills
Strong proficiency in Excel and experience with other analytic tools
Highly-motivated self-starter with ability to multi-task

Desired Qualifications:

Excellent interpersonal skills and written and oral communication skills in English.
Attention to detail and ability to manage multiple projects simultaneously.
Strong problem solving abilities.
Proficiency in Excel and PowerPoint
Highly-motivated self-starter with ability to multi-task

To apply to any position please e-mail a cover letter and resume to [email protected]

Exempt position; salary commensurate with job experience; performance-based bonus; competitive benefits; location is San Mateo, California
Valid U.S. work permit required. Local candidates only. No relocation.

23MarMarch 31, 2019

By devadmin

Disease and Population Management

Example Project: Implement Disease Management Programs

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. We worked closely with ERISA (Employee Retirement Income Security Act of 1974) attorneys to ensure appropriate patient confidentiality, patient contact, program implementation, and program quality monitoring. We helped establish fiduciary standards and responsibilities. The initial two disease management programs–diabetes and asthma–were developed in 1992-1993 and implemented in 1993-1994.

Experience

Developed a patented system that integrates all inpatient, outpatient, ambulatory, and prescription drug claims data into episodes of care by medical condition (Cave et al, Patent Number 5,970,463). The system was designed to accurately and reliability determine patients with chronic medical conditions, patients at high-risk for a future flare-up of their condition, and patients with an undiagnosed medical condition (e.g., diabetes, hypothyroidism, depression, migraine headaches).
Worked with health plans and physician-hospital organizations to support disease and patient management programs, including Allina Medica, Humana Health Plans, Harvard Pilgrim Health Plan, and Blue Cross/Blue Shield of Missouri.
Worked with large self-insured employers to implement catastrophic case management programs and disease management programs–including diabetes, asthma, cancer, and rheumatoid arthritis.
Developed patient outcome measures to evaluate the impact of disease management programs. These measures included reduced emergency use, reduced readmission rates, improved short-form 36 health status measures, increased compliance with prescription drug therapies, reduced cholesterol levels, reduced high blood pressure readings, and reduced lost work time.
Performed speaking engagements for trade organizations on disease and patient management, and published many articles in peer-reviewed journals and trade journals on the topic.
Obtained from the University of California, Los Angeles, a Ph.D. in Health Planning and Policy, and a Masters in Public Health in infectious disease epidemiology–providing a strong clinical, statistical, and methodological background.

23MarMarch 31, 2019

By devadmin

Efficiency and Quality Measurment

Example Project: Improve Efficiency of Practitioner Network

We have worked with leading health plans and physician-hospital organizations on improving the efficiency and quality of their practitioner networks. In this capacity, the audit of each practitioner’s medical claims data and charts focused on quality of care and cost-effectiveness of service delivery–two components of care that are inextricably linked because patients are often subject to health risks associated with unnecessary procedures and tests. In each case, a consistent, valid method for measuring practitioner practice patterns variability was employed.

On one assignment, we worked with a large health plan and employed a well-published, claims-based episode of care methodology to identify dermatologists, orthopedists, and cardiologists that had a significantly different practice pattern from their immediate peer group. A subsequent chart audit validated the medical claims results. Several practitioners from each specialty type were eventually deselected from the network.

Experience

Developed a patented system that integrates all inpatient, outpatient, ambulatory, and prescription drug claims data into episodes of care by medical condition (Cave et al, Patent Number 5,970,463). The system was designed to accurately and reliability measure practitioners’ efficiency and quality of care.
Worked with health plans and physician-hospital organizations to evaluate practitioners’ efficiency and quality of care, including Allina Medica, Humana Health Plans, Harvard Pilgrim Health Plan, UniHealth America, and Blue Cross/Blue Shield.
Familiar with the any willing provider laws, freedom of choice laws, and the Health Care Quality Immunity Act.
Worked with health plans and physician-hospital organizations on strategies to improve practitioners’ practice patterns through feedback programs, and to deselect practitioners’ from networks.
Performed speaking engagements for trade organizations on practitioner efficiency and quality measurement, and published many articles in peer-reviewed journals and trade journals on the topic.
Obtained from the University of California, Los Angeles, a Ph.D. in Health Planning and Policy, and a Masters in Public Health in infectious disease epidemiology–providing a strong clinical, statistical, and methodological background.

23MarMarch 31, 2019

By devadmin

Cost and Utilization Management

Example Project: Implement Managed Care Networks

We were involved in developing and implementing some of the first preferred provider organizations (PPOs) on the west coast for self-insured employers. We contracted with hospitals, physician groups, and solo practice physicians. We worked with third party administrators (TPAs) to administer the PPO network and other cost management programs (e.g., utilization review, large case management, controls for unbundling and upcoding of services). We established fiduciary standards and responsibilities. The initial PPOs were developed in the mid-to-late 1980s. The PPOs provided coverage for about 100,000 self-insured individuals (employees and dependents).

Experience

Worked with large employers to develop, implement, and monitor inpatient utilization review programs, PPOs and other managed care networks (e.g., mental health networks), large case management and disease management programs, and continuous quality improvement programs.
Performed speaking engagements for trade organizations, and published articles on cost and utilization management topics.
Worked with health plans and physician-hospital organizations to evaluate practitioners’ efficiency and quality of care, including Allina Medica, Humana Health Plans, Harvard Pilgrim Health Plan, UniHealth America, and Blue Cross/Blue Shield.
Experienced in the field of group benefits as a practice leader and consultant at two leading employee benefits consulting firms.
Reviewed cost and utilization management vendor contracts to ensure appropriate transfer of legal risk from employers to vendors, documentation of processes for monitoring program quality and service delivery, wording of risk-sharing agreements between vendor and employer, and contract termination clauses.
Obtained from the University of California, Los Angeles, a Ph.D. in Health Planning and Policy, and a Masters in Public Health in infectious disease epidemiology–providing a strong clinical, statistical, and methodological background.