CCGroup to Utilize National CMS Medicare Claims to Support Value-Based Agreements Between Health Plans and Health Systems

CCGroup to Utilize National CMS Medicare Claims to Support Value-Based Agreements Between Health Plans and Health Systems

SAN MATEO, Calif.–(BUSINESS WIRE)–CCGroup, the market leader in reliably measuring physician efficiency, supports key components of value-based agreements using the company’s Centers for Medicare & Medicaid Services (CMS) Innovator project. The CCGroup Innovator project allows access to all Medicare fee-for-service (FFS) claims through the CMS Virtual Research Data Center (VRDC) – including all acute care, post-acute care, physician visits, physician procedures, and pharmacy services for more than 38 million individuals each year. This includes all 50 states and the District of Columbia.

Read full article here.

CCGroup Receives Access to National CMS Medicare Claims to Improve Physician and Hospital Efficiency of Care

CCGroup Receives Access to National CMS Medicare Claims to Improve Physician and Hospital Efficiency of Care

SAN MATEO, Calif.–(BUSINESS WIRE)–CCGroup, the market innovator and leader in reliably measuring physician efficiency, is pleased to announce that the Centers for Medicare & Medicaid Services (CMS) approved our Innovator project to access all Medicare fee-for-service (FFS) claims through the CMS Virtual Research Data Center (VRDC). With this distinction, CCGroup gains access to all acute care, post-acute care, physician visits, physician procedures, and pharmacy services for more than 38 million individuals each year. This includes all 50 states and the District of Columbia.

Read full article here.

Cave Consulting Group (“CCGroup”) Success Stories on Healthcare Clinical Transformation

Cave Consulting Group (“CCGroup”) Success Stories on Healthcare Clinical Transformation

SAN MATEO, Calif.–(BUSINESS WIRE)–CCGroup published a 2016 press release stating that nationally over 230,000 primary care physicians (PCPs) and specialists are evaluated based on achieving acceptable clinical protocol ranges in treating medical conditions, or Clinical MedMarker Protocol Ranges™. “CCGroup works with CCGroup National Specialist Panels to develop and maintain the Clinical MedMarker Protocol Ranges™, which are achievable, appropriate ranges of clinical practice. This effort with our panels helps to ensure the validity of established Clinical MedMarker Protocol Ranges™,” stated Dr. Douglas G. Cave, President of CCGroup.”

Read full article here.

Cave Consulting Group (“CCGroup”) Releases New Version of CCGroup BundleCare™ to Support Bundled Payments for Care Improvement

Cave Consulting Group (“CCGroup”) Releases New Version of CCGroup BundleCare™ to Support Bundled Payments for Care Improvement

SAN MATEO, Calif.–(BUSINESS WIRE)–“CCGroup supports all three (3) ways our clients desire to drive towards high-value care,” stated Dr. Douglas G. Cave, President of CCGroup. One area of focus is bundles-of-care. The CMS Innovation Center introduced the Bundled Payments for Care Improvement (BPCI) initiative as a way to improve performance accountability when actually performing the bundle of interest – and the current 48 bundles in BPCI are supported by CCGroup.

Read full article here.

 

A National Healthcare Predicament: Most PCPs Are Not Involved in Managing the Top 10 Medical Conditions with Significant Practice Variations

A National Healthcare Predicament: Most PCPs Are Not Involved in Managing the Top 10 Medical Conditions with Significant Practice Variations

SAN MATEO, Calif.–(BUSINESS WIRE)–Primary care physicians (PCPs) need to become more active participants in treating the Top 10 medical conditions with significant practice variations. “Nationally, PCPs are solely involved in treating less than 25% of medical condition episodes with the most practice variations,” stated Dr. Douglas G. Cave, President of Cave Consulting Group (CCGroup). “And these medical conditions – such as low back pain, degenerative joint disease, headaches, sleep apnea, cataracts, and heartburn – drive well over 50% of all potential patient cost and quality improvements.”

Read full article here.

Company Overview

Company Overview

Vision Statement

Company OverviewCave 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.

Company Leadership

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.

Doug Cave
Yuri Alexandrian

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.

Heather Simpson

Manager of Business Development

Heather Simpson is responsible for developing, fostering strong, and lasting genuine relationships with prospective clients. She is adept at creating effective business plans with each of CCGroup’s prospective clients to demonstrate optimum value potential. Heather strives to be well-versed in the business needs of CCGroup’s prospective clients and to deliver the right healthcare solutions to meet their needs. Heather is native to the Bay Area and has worked in both the private and public sectors since 2008. Heather received her Business Administrative degree at Whittier College.

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.
Current Patents

Current Patents

Current Patents

Current PatentsThe 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™

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 employment@cavegroup.com

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.

Disease and Population Management

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.