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.
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.
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).
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.
SAN MATEO, Calif.–(BUSINESS WIRE)–A large southern health system with many employed and affiliated physicians is working with Cave Consulting Group, Inc. (CCGroup) to support their clinically integrated network (CIN), tiered network strategy. The tiered CIN strategy is based on efficiency (cost of care) and effectiveness (quality of care). A tiered CIN is necessary to successfully manage value based payments from local area health plans and the Centers for Medicare & Medicaid Services (CMS).
SAN MATEO, Calif.–(BUSINESS WIRE)–The Hawaii Independent Physicians Association (Hawaii IPA) is working with Cave Consulting Group, Inc. (CCGroup) to access accurate and reliable physician efficiency (cost-of-care) and effectiveness (quality process of care) scores. “A main reason is that Hawaii IPA accepts capitation payment for Medicare Advantage patients. Therefore, we need to identify and reduce practice variations to improve quality and cost of care to successfully live within a global budget,” stated Dr. Richard Chung, Chief Medical Strategist for Hawaii IPA.
SAN MATEO, Calif.–(BUSINESS WIRE)–“Clinically integrated networks (CINs) and provider groups need immediate access to accurate and reliable physician efficiency (cost-of-care) and effectiveness (quality process of care) scores to better prepare for value base payments from health plans and the Centers for Medicare & Medicaid Services (CMS),” stated Dr. Douglas G. Cave, President/CEO of Cave Consulting Group, Inc. (CCGroup). CINs/provider groups want access to this physician performance information through the easy-to-use, CCGroup Cloud/SaaS subscription model.
BlueCross BlueShield of Western New York is offering a new plan to small groups for January 2021 that will include a network of high-performing provider practices. Only small groups (1-100 members) in Erie and Niagara Counties will have the option to choose Apex.
The network will be limited to only the highest performing primary care physicians (PCPs) and specialty groups who practice in those same counties. Not all specialty groups will be limited, in order to ensure that patients have adequate access to a variety of providers.
The limited network includes:
Providers will receive a contract amendment to Attachment A of our standard provider agreement by December 1, 2020. The amended Attachment A will indicate whether a provider is included in the Apex network.
Cave analytics
Cave Consulting Group 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 produces reports that analyze our claims data to provide a better understanding of area specialty provider quality and cost.
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.
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.