InterQual® Coordinated Care

An integrated, cloud-based care coordination solution that helps payers and providers offer complex care management of high-risk members and patients with a single, blended care plan.


ManageHigh-risk and Complex Cases

  • Assess and manage complex cases efficiently with a single, blended care plan, created from a patented assessment that merges condition components.

  • Manage care holistically with assessment questions covering medical, behavioral, and social needs, in addition to comorbidities and cross-condition issues.

  • Enable evidence-based decision making with content developed with the same clinical integrity and standards as InterQual Criteria.
  • Streamline case management with a SaaS solution that is integrated into your existing workflow, offering greater efficiency, timely alerts, and support for clinician delivery of quality, appropriate care.

  • Create a tailored care management program to better control the medical costs of high-risk members and patients, help prevent readmissions and improve clinical outcomes.

  • Meet regulatory requirements with a solution that is URAC accredited for both for care management and disease management. The solution helps you meet NCQA PHM5, MBHO QI9, and SNP requirements.

Integrated Assessments and Patient Information

  • Comprehensive assessments

    • Provide assessments in simple Q&A format, including a Primary Assessment, which addresses common care barriers and can include multiple components.
    • Leverage 40 condition-focused modules, industry-validated screening tools, and five assessments: common barriers to care, case management, condition management, readmission reduction, and palliative care. 
  • Easy integration

    • Integrate our cloud-based solution into homegrown or third-party care management delivery systems. 
    • Leverage the SaaS architecture to provide access throughout a networked system – without increasing IT burden.
    • Gain real-time access to content and software upgrades without waiting for installation and validation, while maintaining control of upgrade timelines.
  • Support for case managers and members/patients

    • Help improve member/patient education with materials to guide case managers through the consistent presentation of condition-related information.
    • Reinforce education concerning specific conditions and condition management with companion member- and patient-facing fulfillment materials.

Our outcomes

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