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.
Dr. Douglas G. Cave, President of CCGroup, defined, “Health plans need to demonstrate how they identify and assess: (1) members' needs based on social determinants; (2) needs of child and adolescent members; (3) members requiring complex case management; (4) members with severe persistent mental illness (SPMI); (5) members with emerging risk (adults and children); and (6) members with medical conditions having a high probability of having an elective, high-cost procedure.”
“CCGroup continues to innovate, and leads the market in developing advanced analytics, methods, and systems to support NCQA PHM 2: Population Identification,” continued Dr. Cave. The foundation for successful population identification and assessment is CCGroup PrevalenceView™, CCGroup PatientView™, and CCGroup BullsEye™.
CCGroup PrevalenceView™ allows health plans (and other payers including ASO employer groups) to stratify members based on social determinants of health. CCGroup PrevalenceView™ allows health plans to understand the needs of child and adolescent members, members requiring complex case management, and members with SPMI. For instance, members near the end of life have a significantly higher prevalence rate of chronic obstructive pulmonary disease (COPD), diabetes with multiple complications (specifically renal and circulatory), and congestive heart failure.
Children and adolescents with diabetes, 2-19 years of age, have a higher prevalence of major depression, other endocrine disorders (where we know other endocrine disorders parallel diabetic patients), and urinary tract infections.
“Healthy, middle-aged males, 20-44 years of age, have a higher prevalence of sports injuries as evidenced by more bursitis of shoulder and knee, contusions of limbs and torso, and contusions of arms and legs. Women with single newborn, complicated delivery – have a significantly higher prevalence of autoimmune disorders (lupus, rheumatoid arthritis, psoriatic arthritis), cardiomyopathy, benign neoplasms of uterus, and diabetes,” stated Dr. Cave.
Heath plans need to understand each risk group’s population characteristics to devote the necessary activities and resources to improve health and reduce patient flare-ups resulting in unnecessary emergency room visits and hospital admissions.
CCGroup PatientView™ allows health plans and other payers to identify members with “emerging health risk” – elderly, working adults, and children. Emerging risk is based on each member’s Care Need Index (CNI). Mr. Yuri Alexandrian, Chief Information Officer of CCGroup, defined, “The CNI for a member identifies and prioritizes her/his rank for being high-risk, high-cost, and the ability to impact current healthcare delivery. A member’s CNI score is comprised of several components, including each member’s predictive risk score, current gaps-in-care for treatment, chronic medical conditions, recent emergency room and hospital admission utilization, and clinical lab results. A member’s CNI varies from 0 (very healthy) to 5.00 (in need of immediate medical attention).”
Mr. Alexandrian mentioned, “For emerging risk, a health plan needs to focus on members whose CNI score has increased on average 15% over the past three measurement intervals. These members need the most immediate attention.”
CCGroup BullsEye™ delivers that actionable information necessary to meet the remaining needs identified for PHM 2 – Population Identification. “Here, we need to understand those members with medical conditions that have a high probability of having an elective, high-cost service or procedure in-the-near-future,” stated Dr. Cave.
He continued, “CCGroup BullsEye™ elicits all the necessary MedMarker™ and Clinical MedMarker Protocol Range™ actionable information needed for a health plan (or other payer) to understand the effectiveness and efficiency measures to deliver the triple aim of NCQA: better care, lower costs, improved health.”
MedMarkers™ are process of care quality measures, well-defined in clinical guidelines. However, MedMarkers™ also are 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 currently protected under three USPTO Patent Numbers 8,301,464 and 8,751,263 and, most recently, 9,881,129 issued on January 30, 2018.
“CCGroup is the only company in the market that has developed MedMarkers™ for all prevalent medical conditions,” Dr. Cave said. MedMarkers™ are identified for over 175 adult medical conditions and over 100 children medical conditions (including individuals covered by Commercial, Medicaid, and Medicare health plans).
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.
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.
CCGroup’s advanced analytics meet the new NCQA Population Identification for accreditation standards. The foundation for successful population assessment is CCGroup PrevalenceView™ and CCGroup PatientView™.
About Cave Consulting Group (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, TPAs, and employers.