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

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.

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Cave Consulting Group (“CCGroup”) Provides Advanced Analytics to Meet New NCQA Category PHM 3 – Delivery System Supports – for 2018 NCQA Health Plan Accreditation

Cave Consulting Group (“CCGroup”) Provides Advanced Analytics to Meet New NCQA Category PHM 3 – Delivery System Supports – for 2018 NCQA Health Plan Accreditation

SAN MATEO, Calif.–(BUSINESS WIRE)–The National Committee for Quality Assurance (NCQA) requires health plans and other payers to meet new Population Health Management (PHM) standards for PHM 3: Delivery System Supports for accreditation. CCGroup’s advanced analytics meet these new PHM 3 standards.

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Cave Consulting Group (“CCGroup”) Provides Advanced Analytics to Meet New NCQA Category PHM 2 – Population Identification – for 2018 NCQA Health Plan Accreditation

Cave Consulting Group (“CCGroup”) Provides Advanced Analytics to Meet New NCQA Category PHM 2 – Population Identification – for 2018 NCQA Health Plan Accreditation

SAN MATEO, Calif.–(BUSINESS WIRE)–The National Committee for Quality Assurance (NCQA) requires health plans and other payers to meet new Population Health Management (PHM) standards for PHM 2: Population Identification for accreditation. CCGroup’s advanced analytics meet these new PHM 2 standards.

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“Targeted Gatekeeper Model” Needed for Successful CPC+ Payment Reform and Delivery Transformation

“Targeted Gatekeeper Model” Needed for Successful CPC+ Payment Reform and Delivery Transformation

SAN MATEO, Calif.–(BUSINESS WIRE)–Comprehensive Primary Care Plus (CPC+) is designed by the federal government to strengthen primary care through payment reform and care delivery transformation. The CPC+ payment design gives primary care physician (PCP) practices additional financial resources to improve quality of care and reduce the number of unnecessary services their patients receive.

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“Targeted Gatekeeper Model” Provides High Return on Investment Through Improved Patient Cost and Quality of Care

“Targeted Gatekeeper Model” Provides High Return on Investment Through Improved Patient Cost and Quality of Care

SAN MATEO, Calif.–(BUSINESS WIRE)–Primary care physicians (PCPs) need to become more active participants in treating medical conditions with significant practice variations. “Currently, PCPs are involved in treating only 40% of the top 10 medical condition episodes of care with the most practice variations. Some of these medical conditions include low back pain, degenerative joint disease, sleep apnea, and headaches,” stated Dr. Douglas G. Cave, President of Cave Consulting Group (“CCGroup”).

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“Targeted Gatekeeper Model” for Specialist Referrals Gains Momentum Under Accountable Care and Value-Based Reimbursement

“Targeted Gatekeeper Model” for Specialist Referrals Gains Momentum Under Accountable Care and Value-Based Reimbursement

SAN MATEO, Calif.–(BUSINESS WIRE)–In the 1980s and 1990s, health plans and other payers depended on primary care physicians (“PCPs”) to be the gatekeeper for referrals to specialists. Covered members were required to select a gatekeeper in order to receive medical coverage. This gatekeeper model was not successful for several reasons. “Research studies showed that gatekeeper models generally were no more efficient at curtailing medical trend than non-gatekeeper plan designs. Also, large employers wanted more open access to specialist care for their employees,” stated Dr. Douglas G. Cave, President of Cave Consulting Group (“CCGroup”).

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Primary Care Physicians Can Better Manage the Total Cost of Care for an Accountable Care Population

Primary Care Physicians Can Better Manage the Total Cost of Care for an Accountable Care Population

SAN MATEO, Calif.–(BUSINESS WIRE)–Primary care physicians (“PCPs”) can more effectively manage the total cost of care when managing the healthcare needs of a covered population. Cave Consulting Group (“CCGroup”) reached this conclusion after evaluating the performance of several health plan accountable care and value-based reimbursement programs.

“On average, PCPs are involved in treating 57% of all prevalent medical condition episodes of care. This means patients are self-referring to specialists 43% of the time,” stated Dr. Douglas G. Cave, President of CCGroup. Continue reading

National Specialist Panels Uphold Established Clinical MedMarker Protocol Ranges™

National Specialist Panels Uphold Established Clinical MedMarker Protocol Ranges™

SAN MATEO, Calif.–(BUSINESS WIRE)–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 on an ongoing basis. This effort helps to ensure the validity of established Clinical MedMarker Protocol Ranges™,” stated Dr. Douglas G. Cave, President of CCGroup. CCGroup is the market innovator and leader in reliably measuring physician efficiency. Dr. Cave continued, “MedMarkers™ are process of care quality measures, well-defined in clinical guidelines. However, they also are the key services and procedures most associated with cost-of-care in treating a medical condition. MRI of spine is the main MedMarker™ (or correlated service) in treating low back pain; and upper gastrointestinal (GI) endoscopy is the main MedMarker™ in treating GERD (or heartburn). MedMarkers™ technology is protected under USPTO Patent Numbers 8,301,464 and 8,751,263.”

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