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Cave Analytics 

Blue Cross Blue Shield has partnered with Cave Analytics to provide reports that measure specialty provider quality and cost information. An industry leader in provider reporting, Cave reports are based on our claims data. With this new partnership, we seek to offer transparency and information that will benefit both providers and their patients. 


Specialists can request reports by calling Provider Service at 1-800-950-0051.

View frequently asked questions below or click the link for instructions on how to read your report (you'll need to log in with your provider credentials).

 

 

 

Frequently Asked Questions

Who is Cave Consulting Group?

Cave Consulting Group is an independent and nationally recognized healthcare analytic software company focused on improving effectiveness (quality-of-care) and efficiency (cost-of-care). Used nationally, their practice-level reports offer insights to specialists about their quality and cost by comparing their performance with peers in the same specialty and region.

Why have you partnered with Cave?

Like you, we want your patients to have high-quality care while also considering cost. Cave is a resource that offers transparency of information as a part of that solution.

Cave’s analytics can help us objectively share quality and cost information with our network of providers that is based on our actual claims data. This allows us to provide specialists and PCPs with relevant data analyzed by a third party, offering greater transparency. PCPs have asked us for information about specialists regarding patient health outcomes as well as value. Patients with high deductible plans, who pay for much of their care out of their own pockets, are also looking for high quality care while keeping cost in mind. With this partnership, we hope to support excellence in patient care, appropriate use of medical resources, and informed referral decisions. 

Where does their data come from?

Cave’s report comes directly from Blue Cross Blue Shield claims data.

How does Cave measure specialist providers?

Cave compares physicians to a specialty-specific peer group. The methodology uses a standardized set of prevalent medical condition episodes, which minimizes the influence of patient case mix. 

Is their analysis meant for Specialists or PCPs?

Cave analytics offer insights to specialists about their performance and help PCPs make informed referral decisions.

What is meant by "Effectiveness" and "Efficiency"?

Effectiveness refers to quality of care. Efficiency refers to cost of care.

How are Effectiveness and Efficiency measured?

Effectiveness (or quality of care) has been determined by using evidence-based, specialty-specific quality measures and expert consensus on appropriateness of care.

Efficiency (or cost of care)
is based on the price and volume of services, as well as the cost of diagnostic testing, prescribed medications and facility charges incurred.

What is included in the Specialist report?

The specialist report shows cost and quality measures – referred to as efficiency and effectiveness in the Cave report – compared to other similar specialty groups. For example — if you’re an allergist, your report will compare you to other allergists in your area. Specialists will receive this information in a de-identified report showing how their practice performed over the past year versus other similar specialty practices in the same area.

What is included in the corresponding report that is provided to PCPs

The corresponding PCP report is designed to support Cave analytical results. It shows PCPs their specialty referring patterns and provides Cave specialist performance for quality and cost. Quality and cost directly impact a PCP’s total cost of care and BestPractice reimbursement.

How does the data account for severity of illness?

Each patient’s medical condition episode is labeled with a severity-of-illness marker based on ICD.10 diagnosis codes. Cave’s severity-of-illness classification has its foundation within an established, well-published disease staging methodology by Dr. Joseph Gonnella and is based on physiological progression of a medical condition.

There are up to three (3) severity-of-illness (SOI) levels for each of the 538 medical conditions. Class SOI-1 is the least severe (routine, noncomplicated), and SOI-3 is the most severe. Some medical conditions have only one or two severity-of-illness levels. 

What is an episode of care?

An episode of care refers to all services (outpatient, inpatient, lab/pathology, prescription drug utilization) delivered for a single medical condition within a specified period of time. This does not just refer to one office visit or encounter.

What is a Marketbasket?

A marketbasket consists of the most common conditions treated by each physician specialty type, generally accounting for 70% to 90% of the episodes treated by that specialist type. 

What is variation analysis?

Variation analysis is a process by which researchers look at health care cost and utilization patterns to better understand otherwise unexplained variation in patient care. In some cases, substantial differences in utilization and cost volumes can’t be explained by patient variables. Many researchers conclude that these variations result from physician practice patterns. 

What is a "MedMarker™"?

Cave’s MedMarkers™ are the services (diagnostics and therapeutics) most highly correlated to unwarranted variations in clinical practice patterns that drive inefficiency (cost-of-care).