Free public grouper of medical condition episodes-of-care from CCGroup

CCGroup is pleased to announce the release today of a free download version of the Cave Grouper™ software known as CaveGrouper-Lite™. This is the first public grouper of medical condition episodes-of-care.

“The CaveGrouper-Lite™ is a key foundation for accountable performance measurement because the methods and algorithms are 100% transparent, free to the public, and tested and validated on all study populations.”

The Cave Grouper™ is the oldest and most established grouper of episodes-of-care in the market today. The first article on the Cave Grouper™ was published in 1992 based on work formed since 1989. Over the past 22 years, derivations of the Cave Grouper™ have been applied and validated using a wide variety of study populations totaling over 86 million individuals and 684,000 physicians. The study populations include Medicare, Medicaid, insurance companies, HMOs, third party administrators, physician groups, health systems, and employers.

Similar to the Cave Grouper™, the free download CaveGrouper-Lite™ groups over 15,000 ICD-9 and 68,000 ICD-10 diagnosis codes into meaningful medical conditions. The medical conditions account for 100% of all medical conditions and expenditures.

CaveGrouper-Lite™ builds longitudinal episodes of care for acute conditions (e.g., upper respiratory infections, sinusitis) and for chronic conditions (e.g., diabetes, asthma). A longitudinal episode-of-care is defined as all services linked together that are used to treat a patient's medical condition within a specified period of time - including physician services, facility, lab and diagnostic tests, and prescription drugs. CaveGrouper-Lite™ employs a static window period. Initially, output from CaveGrouper-Lite™ will present detailed episode-of-care information for 25 of the most prevalent medical conditions in the United States today.

CCGroup is proud to be the first company to release a free grouper of medical condition episodes to the public. "This is a key phase to allow all of CCGroup's methods and algorithms to be 100% transparent for public use - including health plans, health systems, and the Federal and State governments," stated Douglas G. Cave, Ph.D., President of CCGroup. Dr. Cave commented, "We have invested significant time and effort to determine and develop the most appropriate methods to build episodes-of-care and to obtain reliable, stable provider efficiency scores, especially the method on using a predefined set of medical conditions for a specialty type."

Reasons for health systems and physician groups to download CaveGrouper-Lite™ include the following. Clinical leaders may track episodes of care to physicians and compare their average costs and utilization patterns to one another as well as a large comparative database; areas of practice variation may be identified. For resource planning purposes, clinical leaders gain a complete view of the medical condition prevalence of their covered population base. Healthcare resource needs may be adjusted with changes in the condition-specific prevalence rates. Furthermore, under the CMS Bundled Payments initiative, the episodes of care may be used for clinical leaders to examine possible bundled payment models.

Dr. Cave affirmed, "With new Accountable Care Organization (ACO) and Patient Centered Medical Home (PCMH) legislation, a public-use grouper is almost mandatory for consistent episode-of-care analytics and performance measurement." Both ACOs and PCMHs attempt to link organizational provider structures to episode-of-care payments and performance measurements for quality and cost-of-care accountability. Dr. Cave stated, "The CaveGrouper-Lite™ is a key foundation for accountable performance measurement because the methods and algorithms are 100% transparent, free to the public, and tested and validated on all study populations."