{"id":49281,"date":"2022-10-06T17:01:47","date_gmt":"2022-10-06T15:01:47","guid":{"rendered":"https:\/\/pharma-trend.com\/en\/part-2-ccgroup-clinical-decision-support-system-quantifies-covid-effect-on-decreased-healthcare-utilization-in-the-united-states\/"},"modified":"2022-10-06T17:01:47","modified_gmt":"2022-10-06T15:01:47","slug":"part-2-ccgroup-clinical-decision-support-system-quantifies-covid-effect-on-decreased-healthcare-utilization-in-the-united-states","status":"publish","type":"post","link":"https:\/\/pharma-trend.com\/en\/part-2-ccgroup-clinical-decision-support-system-quantifies-covid-effect-on-decreased-healthcare-utilization-in-the-united-states\/","title":{"rendered":"Part 2: CCGroup Clinical Decision Support System Quantifies \u201cCOVID Effect\u201d on Decreased Healthcare Utilization in the United States"},"content":{"rendered":"<div>\n<p>SAN MATEO, Calif.&#8211;(BUSINESS WIRE)&#8211;This <a target=\"_blank\" href=\"https:\/\/cts.businesswire.com\/ct\/CT?id=smartlink&amp;url=http%3A%2F%2Fwww.cavegroup.com%2F&amp;esheet=52937725&amp;newsitemid=20221006005078&amp;lan=en-US&amp;anchor=Cave+Consulting+Group+Inc.&amp;index=1&amp;md5=78a6c5ecd90034330680835874286492\" rel=\"nofollow noopener\" shape=\"rect\">Cave Consulting Group Inc.<\/a> (CCGroup) study quantifies the COVID Effect\u2019s impact on decreased U.S. healthcare utilization. Decreased utilization is a function of at least two components: (1) decreased volume of medical condition episodes seen by PCPs and specialists; and (2) decreased volume of key medical services (MedMarkers\u2122) used to diagnose and\/or treat those medical condition episodes that are seen by PCPs and specialists.\n<\/p>\n<p><a href=\"https:\/\/mms.businesswire.com\/media\/20221006005078\/en\/808308\/5\/CCG-AAA_800x434_transparent.jpg\"><img decoding=\"async\" src=\"https:\/\/mms.businesswire.com\/media\/20221006005078\/en\/808308\/21\/CCG-AAA_800x434_transparent.jpg\"><\/a><\/p>\n<p>\nPart 1 results examined the decreased volume of medical condition episodes \u2013 and results were published in a press release on <a target=\"_blank\" href=\"https:\/\/cts.businesswire.com\/ct\/CT?id=smartlink&amp;url=https%3A%2F%2Fwww.businesswire.com%2Fnews%2Fhome%2F20220825005058%2Fen%2F&amp;esheet=52937725&amp;newsitemid=20221006005078&amp;lan=en-US&amp;anchor=August+25%2C+2022&amp;index=2&amp;md5=2f9a20468d719473a2cf1d22a4bceb95\" rel=\"nofollow noopener\" shape=\"rect\">August 25, 2022<\/a>. Those results showed <span class=\"bwuline\">episode volume decreased 17%<\/span> attributed to the 2020 COVID Effect. Primary care physician (PCP) episode volume decreased 13%, while specialist episode volume decreased 18%.\n<\/p>\n<p>\nPart 2 results published here evaluate the second component of decreased utilization attributed to the 2020 COVID Effect: decreased volume of MedMarkers\u2122 per episode used to diagnose and\/or treat medical condition episodes seen by PCPs and specialists. \u201cMedMarkers\u2122 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,\u201d stated <a target=\"_blank\" href=\"https:\/\/cts.businesswire.com\/ct\/CT?id=smartlink&amp;url=https%3A%2F%2Fcavegroup.com%2Fcompany-leadership%2F&amp;esheet=52937725&amp;newsitemid=20221006005078&amp;lan=en-US&amp;anchor=Dr.+Douglas+Cave&amp;index=3&amp;md5=ca804e20c109f1c14f989dc5e5b72f58\" rel=\"nofollow noopener\" shape=\"rect\">Dr. Douglas Cave<\/a>, President of CCGroup.\n<\/p>\n<p>\nDr. Cave said, \u201cIn total, <span class=\"bwuline\">MedMarker\u2122 per episode rates decreased 9%<\/span> because of the COVID Effect.\u201d\n<\/p>\n<ul class=\"bwlistdisc\">\n<li>\nMedMarker\u2122 rates for services greater than $10,000 decreased 11% (range: +9% to -33%).\n<\/li>\n<li>\nMedMarker\u2122 rates for services $2,500-to-$10,000 decreased 11% (range: +5% to -35%).\n<\/li>\n<li>\nMedMarker\u2122 rates for services less than $2,500 decreased 8% (range: +14% to -48%).\n<\/li>\n<\/ul>\n<p>\n\u201cCombining the two components tested in this study, the 2020 COVID Effect reduced medical condition MedMarker\u2122 volume by 27% (or 17% decreased episode volume x 9% decreased MedMarkers\u2122 per episode),\u201d defined Dr. Cave.\n<\/p>\n<p>\nImportantly, the CCGroup Clinical Decision Support System (CDSS) depends on medical condition MedMarkers\u2122 and associated Clinical MedMarker Protocol Ranges\u2122 to evaluate providers\u2019 clinical performance with respect to the following: limit prior authorization programs to outlier provider groups whose ordering patterns differ significantly from clinically appropriate ranges of clinical practice; implement value based payment based on both cost and quality of care; and steer members to \u2018preferred\u2019 specialists by medical condition procedure based on cost, quality, and access to care.\n<\/p>\n<p>\nDr. Cave stated, \u201cTherefore, we need to quantify the 2020 COVID Effect on MedMarker\u2122 volume to adjust for the COVID Effect on observed provider practice variations. With COVID Effect adjustment, clinical leaders and utilization management teams may determine actual reductions in provider pattern variations.\u201d\n<\/p>\n<p>\nStudy Part 2 (published here) showed a 9% reduction in MedMarker\u2122 volume per episode. This reduction was somewhat higher for more expensive healthcare services as compared to less expensive services. \u201cFor a provider group, MedMarker\u2122 rate reductions mean that more CDSS clinical rows will fall within defined Clinical MedMarker Protocol Ranges\u2122 \u2013 and pass clinical evaluation. Consequently, without adjusting for the COVID Effect, more provider groups will be classified both as non-outliers with respect to prior authorization and into higher-paying value based payment tiers,\u201d mentioned Dr. Cave.\n<\/p>\n<p>\nAs the COVID Effect diminishes in 2022-2023, true outlier provider groups will return to their outlier status. This is because MedMarker\u2122 rates will again increase to more normal levels. Then, true outlier provider groups will fall outside achievable Clinical MedMarker Protocol Ranges\u2122 \u2013 and fail clinical evaluation.\n<\/p>\n<p>\nFor this study, CCGroup used the CCGroup-CMS Innovator Project and the 32 million Medicare fee-for-service (FFS) beneficiaries claims data for 2017, 2018, 2019, 2020. CCGroup controlled for differences in Medicare beneficiary case mix by using a marketbasket of relevant, prevalent medical conditions for PCPs and each specialty type. Each marketbasket of medical conditions accounts for greater than 80% of episodes treated by a specialty type. Also, we used 2017, 2018, and 2019 medical condition episode volume to control for other potential environmental factors affecting utilization over time. CCGroup removed high-end and low-end outlier MedMarker\u2122 clinical rows based on MedMarker\u2122 utilization volume within each stratification category: &gt;$10,000; $2,500 to $10,000; and &lt;$2,500.\n<\/p>\n<p>\n<b>About Cave Consulting Group, Inc. (CCGroup)<\/b>\n<\/p>\n<p>\nCCGroup 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.\n<\/p>\n<p> <b>Contacts<\/b> <\/p>\n<p>\nMr. Yuri Alexandrian, <a target=\"_blank\" href=\"https:\/\/cts.businesswire.com\/ct\/CT?id=smartlink&amp;url=http%3A%2F%2Fwww.cavegroup.com&amp;esheet=52937725&amp;newsitemid=20221006005078&amp;lan=en-US&amp;anchor=CCGroup&amp;index=4&amp;md5=6d7f2f250772c4a1e6530db24192d68f\" rel=\"nofollow noopener\" shape=\"rect\">CCGroup<\/a> (<a target=\"_blank\" href=\"&#109;&#97;&#x69;l&#116;&#x6f;&#x3a;Y&#97;&#x6c;&#x65;x&#97;&#x6e;d&#114;&#x69;&#x61;n&#64;&#x63;&#x61;v&#101;&#x67;r&#111;&#x75;&#x70;&#46;&#99;&#x6f;&#x6d;\" rel=\"nofollow noopener\" shape=\"rect\">&#89;&#x61;&#x6c;e&#120;&#x61;n&#100;&#x72;&#x69;&#97;&#x6e;&#x40;c&#97;&#x76;e&#103;&#x72;&#x6f;&#117;&#x70;&#x2e;c&#111;&#x6d;<\/a>)\n<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>SAN MATEO, Calif.&#8211;(BUSINESS WIRE)&#8211;This Cave Consulting Group Inc. (CCGroup) study quantifies the COVID Effect\u2019s impact on decreased U.S. healthcare utilization. Decreased utilization is a function of at least two components: (1) decreased volume of medical condition episodes seen by PCPs and specialists; and (2) decreased volume of key medical services (MedMarkers\u2122) used to diagnose and\/or &#8230; <span class=\"more\"><a class=\"more-link\" href=\"https:\/\/pharma-trend.com\/en\/part-2-ccgroup-clinical-decision-support-system-quantifies-covid-effect-on-decreased-healthcare-utilization-in-the-united-states\/\">[Read more&#8230;]<\/a><\/span><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13],"tags":[],"class_list":{"0":"entry","1":"post","2":"publish","3":"author-business","4":"post-49281","6":"format-standard","7":"category-industry"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Part 2: CCGroup Clinical Decision Support System Quantifies \u201cCOVID Effect\u201d on Decreased Healthcare Utilization in the United States - Pharma Trend<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pharma-trend.com\/en\/part-2-ccgroup-clinical-decision-support-system-quantifies-covid-effect-on-decreased-healthcare-utilization-in-the-united-states\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Part 2: CCGroup Clinical Decision Support System Quantifies \u201cCOVID Effect\u201d on Decreased Healthcare Utilization in the United States - Pharma Trend\" \/>\n<meta property=\"og:description\" content=\"SAN MATEO, Calif.&#8211;(BUSINESS WIRE)&#8211;This Cave Consulting Group Inc. (CCGroup) study quantifies the COVID Effect\u2019s impact on decreased U.S. healthcare utilization. Decreased utilization is a function of at least two components: (1) decreased volume of medical condition episodes seen by PCPs and specialists; and (2) decreased volume of key medical services (MedMarkers\u2122) used to diagnose and\/or ... 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(CCGroup) study quantifies the COVID Effect\u2019s impact on decreased U.S. healthcare utilization. Decreased utilization is a function of at least two components: (1) decreased volume of medical condition episodes seen by PCPs and specialists; and (2) decreased volume of key medical services (MedMarkers\u2122) used to diagnose and\/or ... 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