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.
“Health plans need to demonstrate how they support their network health systems, physician groups, and ACOs to better deliver value-based care and make value-based decisions,” stated Dr. Douglas G. Cave, President of CCGroup. Health plans need to provide health systems with medical condition-specific: (1) care pattern reports on an “episode-of-care” basis covering all ambulatory, outpatient facility, inpatient facility, and prescription drug services; (2) performance measures based on evidence-based guidelines; (3) care pattern reports on utilization and quality; and (4) efficiency and quality information on a relative rate and relative range basis.
“CCGroup continues to innovate, and leads the market in developing advanced analytics, methods, and systems to support NCQA PHM 3: Delivery System Support,” continued Dr. Cave. The foundation for successful value-based care, decision, and payment programs is MedMarkers™ and Clinical MedMarker Protocol Ranges™. We first define what these are, and then illustrate their importance to value-based care and payment programs.
MedMarkers™ are process of care quality measures, well-defined in clinical guidelines. However, MedMarkers™ 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 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™, and we have done this 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 Panels 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 non-complicated 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 care, decision, and payment programs. Mr. Yuri Alexandrian, Chief Information Officer of CCGroup, asserted, “MedMarkers™ and Clinical MedMarker Protocol Ranges™ cover most of the NCQA PHM 3 requirements for health plans to deliver to health systems meaningful care pattern reports on an episode-of-care basis. They are performance measures based on evidence-based guidelines. MedMarkers™ and Clincial MedMarker Protocol Ranges™ meet the requirement to present efficiency and quality information on a relative rate and range basis.”
“As importantly, physicians and other providers want to understand the services they need to focus on to reduce unwarranted practice variations. The medical condition-specific MedMarkers™ answer this need. Physicians want to know the appropriate level of utilization that does not represent potential under-utilization of services. Clinical MedMarker Protocol Ranges™ answer this latter question,” declared Mr. Alexandrian.
Under PHM 3, Delivery System Supports, health plans and payers also need to provide their network health systems, physician groups, and ACOs with member gaps-in-care quality measures. These measures, developed by national expert panels for NCQA, AQA, NQF and PQRS are based on medical condition-specific, evidence-based guidelines.
Dr. Cave stated, “CCGroup meets all 150+ effectiveness measures tracked to 90 medical conditions that can be quantified by claims, encounters, and electronic records. For example, diabetes has assigned gaps-in-care measures of HbA1c testing, cholesterol monitoring, semi-annual check-ups, and eye exams. We always try to live to the letter-of-the-law with respect to calculating each gap-in-care specific rate.”
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.