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.

We support value-based agreements by identifying and monitoring the medical condition practice efficiency of primary care physicians (PCPs) and specialists,” defined Dr. Douglas G. Cave, President of CCGroup. “A foundation for this support is MedMarkers™ and Clinical MedMarker Protocol Ranges™. We first define what these are, and then illustrate their importance to value-based initiatives.”

MedMarkers™ are process of care quality measures, well-defined in clinical guidelines. However, they are also the key services and procedures most associated with cost-of-care in treating a medical condition. For instance, MRI of Spine is the main MedMarker™ (or correlated service) in treating non-complicated low back pain. MedMarker™ technology is protected under numerous patents.

CCGroup is the only company in the market that has developed MedMarkers™ for all prevalent medical conditions. “Access to the Medicare FFS beneficiary claims will only enhance our medical condition MedMarker™ capabilities,” Dr. Cave stated. “For instance, we will determine additional MedMarkers™ responsible for efficient and inefficient condition-specific practice variations.”

Clinical MedMarker Protocol Ranges™ are achievable and clinically appropriate ranges of clinical practice for a MedMarker™. These ranges are developed by presenting the CCGroup National Comparative MedMarker Database results to CCGroup National Specialist Panels. Each specialist on a CCGroup National Specialist Panel is asked to review medical condition-specific MedMarker™ results. Then, they define the percentage of patients where a MedMarker™ service is likely clinically warranted.

Based on the CCGroup National Specialist Panel results, an appropriate Clinical MedMarker Protocol Range™ is selected for each medical condition. “For example, the acceptable Clinical MedMarker Protocol Range™ for routine low back pain is no more than 0-to-20 out of every 100 episodes with an MRI of Spine,” stated John Calvin, VP of Clinical Systems at CCGroup.

MedMarkers™ and Clinical MedMarker Protocol Ranges™ are important to value-based agreements between health plans and health systems. Dr. Cave asserted, “Providers want to understand the services they need to focus on to reduce unwarranted practice variations. The medical condition-specific MedMarkers™ answer this need. Also, providers want to know the appropriate level of utilization that does not represent potential under-utilization of services. Clinical MedMarker Protocol Ranges™ answer this later question.”

For each physician and health system, MedMarkers™ and Clinical MedMarker Protocol Ranges™ prioritize the healthcare services to work on first by quantifying the savings from reduced practice variations and improved quality of care. Then, CCGroup monitors and quantifies the success of a value-based program through reduced MedMarker™ practice variations.

About Cave Consulting Group, Inc. (CCGroup)

Cave Consulting Group, Inc. is a software and consulting firm located in San Mateo, California. The company is focused on improving the efficiency (cost-of-care) and effectiveness (quality-of-care) of the healthcare delivery system. Senior management of CCGroup has assessed the performance of physicians and hospitals for over 28 years for health plans, HMOs, physician groups, health systems, CINs, ACOs, TPAs, and employers.

Contacts

Mr. Yuri Alexandrian, CCGroup 650-286-4100 yalexandrian@cavegroup.com

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