Category: News

BCBS Western New York – Provider Insights with Cave Analytics Reports
By devadmin

BCBS Western New York – Provider Insights with Cave Analytics Reports

Date:
August 28, 2020

BlueCross BlueShield of Western New York has partnered with Cave Analytics to help us objectively share quality and cost information – based on claims data – with our network of providers. With this new partnership, we seek to offer transparency and information that benefits both providers and patients.   

About Cave 

Cave Consulting Group, Inc. (CCGroup, Inc.) is an independent company focused on improving effectiveness (quality-of-care) and efficiency (cost-of-care) in the health care delivery system. Health plans throughout the nation use their comprehensive analytical tools to generate practice-level reports. 

Cave Specialty Care Reports

Cave produces reports that analyze our claims data to provide you with a better understanding of area specialty provider quality and cost. The reports give specialty providers insights into the care they’re providing and help PCPs make informed referral decisions for their patients. 

Click here for additional information.

About 30% of Specialists Are Not ‘Outlier Providers’ and Should Receive Relaxed Prior Authorization or Be Gold-Carded
By devadmin

About 30% of Specialists Are Not ‘Outlier Providers’ and Should Receive Relaxed Prior Authorization or Be Gold-Carded

SAN MATEO, Calif.–(BUSINESS WIRE)–Cave Consulting Group, Inc. (CCGroup) has determined that 30% of specialists should receive relaxed prior authorization and utilization management (PA/UM). At issue is that many health plans and other payers have yet-to-implement an evidence-based, clinical decision support system to gold card network specialists.

Read full article here.

Is Kaiser Permanente Health Plan More Efficient Than Competing Blue Cross Blue Shield Health Plans and Regional Health Plans?
By devadmin

Is Kaiser Permanente Health Plan More Efficient Than Competing Blue Cross Blue Shield Health Plans and Regional Health Plans?

SAN MATEO, Calif.–(BUSINESS WIRE)–Cave Consulting Group, Inc. (CGroup), the market leader in reliably measuring physician and health system efficiency for several decades, is answering this question using results from the company’s Centers for Medicare & Medicaid Services (CMS) Innovator Project. The CCGroup Innovator Project allows access to all Medicare fee-for-service (FFS) and Medicare Advantage (MA) 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 60 million individuals each year. This includes all 50 states and the District of Columbia.

Read full article here.

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

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
By devadmin

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
By devadmin

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
By devadmin

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
By devadmin

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.

Cave Consulting Group (“CCGroup”) Integrates Social Determinants of Health Into Advanced Analytics for Value-Based Population Health Management
By devadmin

Cave Consulting Group (“CCGroup”) Integrates Social Determinants of Health Into Advanced Analytics for Value-Based Population Health Management

SAN MATEO, Calif.–(BUSINESS WIRE)–Healthcare leaders at the federal, state, and healthcare organization levels are progressively shifting towards population health to address current health inequities. “A key source of today’s health inequities is social determinants of health (SDOH), such as income, race, education, and social support,” stated Dr. Douglas G. Cave, President of CCGroup.

Read full article here.

POM ACO Works with CCGroup to Identify Pattern Variations in Treating Medicare Shared Savings Program Beneficiaries
By devadmin

POM ACO Works with CCGroup to Identify Pattern Variations in Treating Medicare Shared Savings Program Beneficiaries

SAN MATEO, Calif.–(BUSINESS WIRE)–The Physician Organization of Michigan ACO, LLC (POM ACO) is working with Cave Consulting Group, Inc. (CCGroup) as part of POM ACO’s efforts to provide better health at lower overall healthcare costs for approximately 100,000 Michigan Medicare beneficiaries with traditional Medicare coverage. POM ACO entered into a Medicare Shared Savings Program (MSSP) with the Centers for Medicare and Medicaid Services (CMS) to better manage these Medicare beneficiaries, focusing on higher quality, more coordinated, and less variable care.

Read full article here.