SAN MATEO, Calif.--(BUSINESS WIRE)--CCGroup is the market innovator and leader in reliably measuring physician efficiency. Just one year ago, a California federal jury awarded Cave Consulting Group, Inc. (CCGroup) more than $12 million after determining that OptumInsight’s Impact Intelligence infringes CCGroup’s patent for measuring physician efficiency. “No other competitor to CCGroup is allowed to offer our analytics, methods, and system – unless they have a license from CCGroup to do so,” declared Dr. Douglas G. Cave, President of CCGroup.
“CCGroup continues to innovate, and now leads the market in developing analytics, methods, and systems to support provider value-based payment programs,” Dr. Cave stated, “A foundation for successful value-based payment programs is MedMarkers™ and Clinical MedMarker™ Protocol Ranges. We first define what these are, and then illustrate their importance to value-based payment programs.”
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 USPTO Patent Numbers 8,301,464 and 8,751,263. “CCGroup is the only company in the market that has developed MedMarkers™ for all prevalent medical conditions,” Dr. Cave said.
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 the CCGroup National Specialist Panels. Specialists on the CCGroup National Specialist Panel need to have an academic appointment or affiliation at a targeted, well-respected U.S. medical school. 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. The specialists also are instructed to ensure the percentage of patients is not too low to represent underutilization of care.
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.
MedMarkers™ and Clinical MedMarker™ Protocol Ranges are important to value-based payment programs. 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.”
He continued, “A recent 2016 CCGroup survey of health plan medical directors found that over 80% of health plans and other payers will offer uplift/shared savings programs, downside/shared risk programs, or both in the next 12-to-18 months. For these value-based payments, many medical directors stated that MedMarkers™ and Clinical MedMarker™ Protocol Ranges will be a foundation for their programs. A common response is to start with 2-to-4 medical condition MedMarkers™, starting with the MedMarkers™ that have the most unintended practice variability – and grow the program to 10-to-15 MedMarkers™ over several years. With respect to downside/shared risk programs, a common response is to withhold $2-to-$5 per member per month (PMPM) until performance improves to within Clinical MedMarker™ Protocol Ranges. This withhold amount will increase as additional MedMarkers™ are implemented over time.”
For each health system and provider group, MedMarkers™ and Clinical MedMarker™ Protocol Ranges: prioritize the services to work on first; quantify the savings from reduced practice variations; and allow healthcare organizations to annually monitor and quantify the success of their implemented value-based payment programs.
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 26 years for health plans, HMOs, physician groups, health systems, TPAs, and employers.