Montana-Based Quality Improvement And Utilization Review Organization Expands Use Of InterQual Evidence-Based Criteria With Behavioral Health

Montana-Based Quality Improvement and Utilization Review Organization Expands Use of InterQual Evidence-Based Criteria with Behavioral Health

  • November 14, 2017

Mountain-Pacific Quality Health (Mountain-Pacific) has been a long-time user of InterQual® Criteria, including the Level of Care and Care Planning Criteria suites. Now, in a move to expand its offerings, the Montana-based organization has added InterQual Behavioral Health Criteria for Medicaid utilization reviews. For more than two decades, Mountain-Pacific clinicians have combined clinical knowledge and experience, documented clinical evidence, and utilized InterQual Criteria to make appropriate medical necessity and utilization decisions for hospital admissions. The addition of Behavioral Health will enable them to widen their offerings even further, as Mountain-Pacific uses InterQual inpatient behavioral health criteria for the utilization review…

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The High Cost Of Unneeded Procedures

The High Cost of Unneeded Procedures

  • November 2, 2017

Suresh Yarlagadda, Change Healthcare Medical Director, Clinical Strategy, has a new feature piece on Healthcare Informatics about unnecessary medical care. In it, he examines a recent survey on the issue and looks at what’s behind medical decisions. Read the article

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State Rep. Kay Khan Visits Change Healthcare Newton Office

State Rep. Kay Khan Visits Change Healthcare Newton Office

  • October 27, 2017

On Thursday morning, October 26th, Massachusetts State Representative Kay Khan (D-Newton) visited Change Healthcare’s Newton, Mass., office to learn more about the company and to meet with our InterQual team. A nurse by training, Rep. Khan is a 23-year veteran of the Massachusetts legislature. She works on issues related to behavioral health, domestic violence, and criminal justice reform. She also serves as the House Chair of the Joint Committee on Children, Families, and Persons with Disabilities, and is the Chair of the Mental Health Caucus. Rep. Khan joined the Newton staff for breakfast and engaged in a wide-ranging and informative…

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Unnecessary Care: It’s Not Necessary

Unnecessary Care: It’s Not Necessary

  • October 26, 2017

By Suresh Yarlagadda, MD, Medical Director, Clinical Strategy, Change Healthcare Unnecessary care is unnecessarily in the news these days. We say “unnecessarily” because such care—as well as the associated costs it incurs and risks it poses for patients—can be mitigated. Kaiser Health News just published a report, “So Much Care It Hurts: Unneeded Scans, Therapy, Surgery Only Add to Patients’ Ills” which describes aggressive over-treatment for breast cancer. And a story in Health Affairs, “Low-Cost, High-Volume Health Services Contribute the Most to Unnecessary Health Spending” showed that a preponderance of prescribed low-value health services offered little medical value while increasing…

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InterQual Connect Helps Partners Automate, Streamline Reviews For Providers

InterQual Connect Helps Partners Automate, Streamline Reviews for Providers

  • October 3, 2017

A growing number of healthcare technology vendors are streamlining preauthorizations by integrating the InterQual Connect cloud-based interactive medical review and connectivity solution into their own offerings. Most recently, InfoMC and HealthTrio both announced they are integrating InterQual Connect with their own solutions to automate exception-based utilization management for their provider customers. InfoMC, a provider of cloud-based healthcare management and care coordination solutions, has integrated InterQual Connect into its Incedo Healthcare Management System. The integration will support a more efficient, standardized clinical review process by allowing care managers to easily access care guidelines from within the Incedo decision-support workflow. HealthTrio, which…

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The Genetic Testing Conundrum

The Genetic Testing Conundrum

  • July 28, 2017

By Lynanne B. Morganstern, MD, MBA Medical Director, InterQual Care Planning Genetic tests are revolutionizing more than medicine. They’re revolutionizing the doctor-patient experience as they increasingly become a consumer-driven service. And that’s raising questions for providers and challenges for payers. The direct-to-consumer 23andMe DNA test kit was FDA-approved in early April. For $200, anyone can order a test that reports on genetic markers for certain health conditions, and genetic variants for certain health conditions’ carrier status. For just $50 more, consumers can order the Color test panel which looks at 30 genes to provide a risk assessment for common hereditary…

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Reinventing Utilization Management To Bring Value To The Point Of Care

Reinventing Utilization Management to Bring Value to the Point of Care

  • June 6, 2017

How an automated exception-based approach can make UM more efficient and effective By Nilo Mehrabian How can health systems deliver the right care, at the right cost, in the right setting, without overwhelming delivery and reimbursement systems with administrative burden? The shift from volume to value-based care requires the deft combination of value-based delivery (enabled through actionable intelligence and new care delivery models) and value-based payment (enabled through select provider networks and new reimbursement models). Providers and payers must operate across a transparent, administratively simple, shared ecosystem. This giant leap from today’s world in which healthcare stakeholders currently operate might…

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