CCGroup Selected to Build Specialist Referral Network for Multi-State Medicare ACO

Cave Consulting Group, Inc. (CCGroup) has been chosen by a multi-state Medicare Accountable Care Organization (ACO) to develop and manage a Specialist Golden Referral Network aimed at enhancing Medicare ACO operational efficiency. The network focuses on reducing practice variations in elective procedures, which account for up to 80% of all procedures and are key to controlling costs and improving care quality in Medicare ACOs. Unlike commercial payer networks that organize at the group level, CCGroup's approach targets individual specialists, recognizing that efficiency varies significantly among practitioners within the same group. CCGroup’s proprietary methodology uses detailed analysis of medical condition episodes and weighted scoring to produce transparency and accuracy in specialist efficiency ratings, with robust data coverage encompassing up to 95% of practicing specialists nationwide. This large-scale data access allows Medicare ACOs to make informed referral decisions that align with cost savings and quality objectives. The client also considered CCGroup’s competitive pricing and strong market reputation as critical factors in selecting them. Based in San Mateo, California, CCGroup has over three decades of experience in physician and hospital performance evaluation, catering to a broad spectrum of healthcare stakeholders including ACOs, health plans, and integrated networks. This engagement underscores the growing emphasis on data-driven specialist referral strategies in managing Medicare ACO cost structures and delivering value-based care.