Hawaii IPA Works with CCGroup to Address Practice Variations for Medicare Advantage Patients Under Risk-Adjusted, Capitation Payments
The Hawaii Independent Physicians Association (Hawaii IPA) is working with Cave Consulting Group, Inc. (CCGroup) to access accurate and reliable physician efficiency (cost-of-care) and effectiveness (quality process of care) scores. "A main reason is that Hawaii IPA accepts capitation payment for Medicare Advantage patients. Therefore, we need to identify and reduce practice variations to improve quality and cost of care to successfully live within a global budget," stated Dr. Richard Chung, Chief Medical Strategist for Hawaii IPA.
He continued, "We selected to work with CCGroup for several reasons. Primarily, we believe CCGroup has the most proven accurate, transparent, and market accepted efficiency and effectiveness methods and analytics." These criteria are important for our Hawaii IPA physicians to positively engage in behavioral change - as we educate practitioners on unintended practice variations.
"Moreover, Hawaii IPA may access physician efficiency and effectiveness information in several ways. Many IPAs and clinically integrated networks (CINs) hav few internal IT resources, and those IT resources are devoted to many different projects. As a result, our IPA/CIN clients desire the CCGroup/SaaS subscription model because there is little-to-no client software and hardware management," mentioned Dr. Douglas G. Cave, President/CEO of CCGroup. Another common way to access the scores and supporting results is to deliver the efficiency information through secure file transfer to our clients.
Also, Hawaii IPA desires access to large external databases to supplement internally available data for efficiency and effectiveness measurement. Dr. Chung defined, "We recognize the need to measure as much of a practitioner's overall performance as possible - and not just a portion. The CCGroup-CMS Innovator Project allows Hawaii IPA access to over 75% of all practicing PCPs' and specialists' efficiency performance across Hawaii. For a good number of specialty types, over 90% of all physicians are measured."
The accurate physician efficiency performance is derived using 240,000 Medicare beneficiaries' claims and encounter data in Hawaii. This data includes all acute care, post-acute care, physician visits, procedures, and pharmacy services. For many years, CCGroup has worked on CMS efficiency-related measurement studies - stemming back to 2003.
About Hawaii IPA
The Hawaii Independent Physicians Association (Hawaii IPA) is Hawaii's largest association of independent physicians with nearly 900 doctors and growing. Hawaii IPA's mission is physicians helping physicians through education, support, and leadership to better care for the people of Hawai'i. Hawaii IPA desires to preserve independent practice by creating an engaged, connected health community that empowers our physicians and their patients.
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 physicians and hospitals for over 30 years for health systems, physician groups, clinically-integrated networks, health plans, HMOs, TPAs, and employers.
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