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

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

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

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

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).

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Hawaii IPA Works with CCGroup to Address Practice Variations for Medicare Advantage Patients Under Risk-Adjusted, Capitation Payments

Hawaii IPA Works with CCGroup to Address Practice Variations for Medicare Advantage Patients Under Risk-Adjusted, Capitation Payments

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.

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CCGroup Launches Cloud/SaaS Subscription Model for Access to National Physician Efficiency Results from CCGroup-CMS Innovator Project

CCGroup Launches Cloud/SaaS Subscription Model for Access to National Physician Efficiency Results from CCGroup-CMS Innovator Project

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.

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BCBS Western New York – CCGroup: New Apex Network to Debut January 2021

BCBS Western New York – CCGroup: New Apex Network to Debut January 2021

Date:
September 24, 2020

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:

  • Top 40% of Erie and Niagara County primary care network groups (based on quality and efficiency, as measured in BestPractice)
  • Top 90% of all Erie and Niagara County specialty groups (based on Cave Consulting Group analytics)  

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.

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BCBS Western New York – Provider Insights with Cave Analytics Reports

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

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.

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

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.

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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.

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