Change Healthcare Transforms Utilization Management with InterQual AutoReview

Feb 27, 2018, 8:00 AM
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NEWTON, Mass., Feb. 27, 2018—Today Change Healthcare announced a breakthrough in utilization management with the release of InterQual AutoReview™, the first healthcare solution to automate the medical review process by pulling clinical data directly from the EHR, and producing a medical review within providers' case management systems.

"We're not only transforming utilization management with InterQual AutoReview, but impacting the entire clinical delivery process" said Jackie Mitus, M.D., general manager and senior vice president of Decision Support with Change Healthcare. "By easing the administrative burden through automation and delivering evidence-based decision support within the physician's workflow, we're able to help customers reduce costs and enable improved care quality."

A flexible SaaS solution that integrates into leading EHR applications and connects to case management systems, InterQual AutoReview brings true automation to the medical review process. A clinician simply submits an order in the EHR, and InterQual AutoReview takes over—extracting the necessary data and creating an InterQual medical necessity review enriched with real-time clinical data. It then transmits the review directly to the partnering case management system and simultaneously sends notification of the appropriate care determination back to the EHR.

The release of InterQual AutoReview follows successful beta testing at Christiana Hospital, a 913-bed facility in Newark, Delaware. The hospital operates one of the nation's 25 busiest emergency departments (ED) and is the only Level 1 trauma center in Delaware. InterQual AutoReview was deployed with the InterQual Initial Review Criteria to support the admission decision—helping to ensure that ED patients are admitted to the appropriate level of care.

"The results were better than we anticipated any automated solution could deliver," said Patty Resnik, vice president, Care Management at Christiana Care Health System. "If we can fully automate even a third of our medical reviews, that would be a substantial boost to our admission utilization management efficiency."

InterQual evidence-based criteria and technology solutions from Change Healthcare support improved clinical decision-making and care management across the medical and behavioral health continuums of care. The InterQual clinical development team synthesizes the most current, best evidence into a fully referenced decision support tool. InterQual's development process is founded on rigorous review of the literature, and includes extensive peer review by practicing clinical experts across the United States.

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