Western Region Health System Works with CCGroup to Improve Clinically Integrated Network Efficiency and Reduce Losses on Capitation Arrangements
SAN MATEO, Calif. – Cave Consulting Group, Inc. (CCGroup) is working with a Western Region health system to improve the efficiency of the system’s clinically integrated network (CIN). “Our client’s CIN was built on quality and access to deliver healthcare to 170,000 capitated ACO REACH and Medicare Advantage patients,” stated Dr. Douglas G. Cave, President of CCGroup. “Little attention was paid to specialists’ efficiency in managing to a global budget – until losses began mounting over several years.”
“Little attention was paid to specialists’ efficiency in managing to a global budget – until losses began mounting over several years.”
He continued, “There are three phases to our CIN efficiency improvement project: (1) identify and remove the most inefficient affiliated specialist groups; (2) quantify employed specialists’ practice variations resulting in significant waste, and meet with those specialists responsible for the potential waste; and (3) identify for recruitment efficient PCPs and specialists to maintain CIN efficiency, quality, and access.”
“A reason the health system selected CCGroup is our accurate, accepted, and actionable efficiency analytics,” defined Yuri Alexandrian, Chief Operating Office of CCGroup. “Our advanced analytics and methods are required to ensure appropriate detection of inefficient affiliated specialists, to quantify employed specialists’ healthcare waste, and to recruit efficient providers for the CIN.
Mr. Alexandrian mentioned, “For instance, healthcare waste is identified using the CCGroup Clinical Decision Support System (CCGroup CDSS).” The foundation for the CCGroup CDSS is well-vetted MedMarkers™ and associated Clinical MedMarker Protocol Ranges™. MedMarkers™ are process of care quality measures, well-defined in clinical guidelines, and also are the key services most associated with cost-of-care in treating a medical condition. Clinical MedMarker Protocol Ranges™ are achievable and clinically appropriate ranges of clinical practice for a MedMarker™. Ranges are developed with CCGroup National Specialist Panels.
“Another reason is CCGroup’s access to large, complete Medicare and commercial claims databases – allowing CCGroup to accurately measure and monitor over 80% of all practicing PCPs’ and specialists’ efficiency in the United States,” revealed Dr. Cave. “The health system has limited access to claims data, which means without CCGroup our client can measure only some of their CIN specialists’ efficiency.”
Mr. Alexandrian continued, “Our client also has limited internal IT resources to perform this important CIN efficiency improvement project. For this reason, they chose CCGroup because of our Cloud/SaaS Subscription Model to rapidly access provider efficiency and effectiveness information. We jointly defined the cardiology and ophthalmology affiliate groups to keep in the CIN.”
About Cave Consulting Group, Inc. (CCGroup)
CCGroup 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 providers for over 30 years for health systems, physician groups, clinically-integrated networks, health plans, HMOs, TPAs, and employers.
