Is Kaiser Permanente Health Plan More Efficient Than Competing Blue Cross Blue Shield Health Plans and Regional Health Plans?

SAN MATEO, Calif.–(BUSINESS WIRE)–Cave Consulting Group, Inc. (CGroup), the market leader in reliably measuring physician and health system efficiency for several decades, is answering this question using results from the company’s Centers for Medicare & Medicaid Services (CMS) Innovator Project. The CCGroup Innovator Project allows access to all Medicare fee-for-service (FFS) and Medicare Advantage (MA) claims through the CMS Virtual Research Data Center (VRDC) – including all acute care, post-acute care, physician visits, physician procedures, and pharmacy services for more than 60 million individuals each year. This includes all 50 states and the District of Columbia.

“For decades, self-insured employers have asked whether Kaiser Permanente Health Plan (KPHP) is really more efficient than locally operated Blue Cross Blue Shield health plans, national health insurance companies, and community-based health plans,” stated Dr. Douglas G. Cave, President/CEO of CCGroup. “There are several ways our health plan clients are comparing their performance to Kaiser as well as other potential health plan competitors.”

Yuri Alexandrian, COO/CIO of CCGroup asserted, “Under our subscription model, CCGroup shares overall efficiency results as well as medical condition-level efficiency results with health plans, health systems, physician groups, and employers.” He continued, “We have accurate overall efficiency scores for more than 75% of all practicing PCPs and specialists.”

CCGroup has invested significant time and effort to develop the most appropriate methods to obtain accurate, reliable, and supportable physician and hospital efficiency scores. CCGroup’s novel approach is the most tested and transparent method in the market today.

Dr. Cave continued, “CCGroup built-out the initial, national commercial and Medicare Advantage high performance networks (HPNs). Selected PCPs and specialists had stable and supportable overall efficiency scores. For two decades, CCGroup has been involved in building many HPNs and clinically integrated networks (CINs).”

“Importantly, health systems and hospitals are also coming to CCGroup to measure their efficiency performance as compared to Kaiser Permanente Medical Groups (PMGs), academic medical centers, and community-based health systems. Identifying areas of efficiency are important for their marketing efforts to larger self-insured employers and other payers. And determining areas of inefficiency are necessary for clinical transformation efforts to reduce unintended practice variations,” stated Mr. Alexandrian.

CCGroup has many patents protecting its provider efficiency methodology, analytics, and software. The basic foundations of the CCGroup patents relate to the use of medical condition-based episodes-of-care, analysis of a relevant set of medical conditions for PCPs and specialists, and proper weighting of those medical condition episodes-of-care to derive overall physician efficiency scores.

“Some in the industry wrongly believe that by using the public CMS grouper, or other competitive grouping products, they are automatically operating outside the scope of our patented methods, but this is incorrect,” mentioned Dr. Cave. Dr. Cave suggests that those with questions regarding the scope of CCGroup’s patent portfolio contact him directly to determine whether a license to the portfolio may be required.

We recognize that our narrowly defined approach is just one of many physician efficiency methodologies being applied in the market today, but the approach provides valuable increased stability and has become widely adopted for that reason.

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 29 years for health plans, HMOs, physician groups, health systems, CINs, ACOs, TPAs, and employers.