Faster, Simpler, Smarter: InterQual 2017 Streamlines Clinical Care Decisions

Apr 3, 2017, 1:00 AM

NEWTON, Mass.--(BUSINESS WIRE)--Change Healthcare today unveiled InterQual 2017, the latest version of the company’s flagship clinical decision support solution. This year’s release introduces a time-saving new product, Medicare Procedures powered by InterQual®, and a more efficient set of Criteria, Initial Review, that help drive rapid care decisions. InterQual 2017 also boasts an extensive number of enhanced features and content, all designed to quickly inform and guide clinicians more efficiently and effectively.

“InterQual 2017 identifies the essence of what is needed to foster faster, safer, and better clinical decisions,” said Jackie Mitus, MD, General Manager & SVP, Decision Management, of Change Healthcare. “For forty years, our focus has been on supporting appropriate care while streamlining administrative burdens. This year we’re bringing more clinical intelligence, more automation, and more know-how to the forefront, all so the clinician can devote more time to direct patient care. That’s at the heart of what we do.”

Smarter, Simpler Decisions: New Medicare Procedures powered by InterQual automates more than 400 Medicare National and Local Coverage Determinations for inpatient and outpatient surgical procedures, making this CMS content easily accessible in InterQual’s streamlined workflow. Bringing InterQual’s proven technology and easy Q&A structure to Medicare Procedures improves review consistency and simplifies the cumbersome prior auth process, which helps reduce denials for both payers and providers.

Earlier, Faster Decisions: Time is always of the essence in healthcare. And for conditions covering roughly 90% of Emergency Department (ED) admissions nationally, care managers can use the new Initial Review Criteria to determine the appropriate level of care using just the patient data typically available at the time of admission. The result: ED staff can quickly and correctly place patients in the appropriate level of care. Initial Review Criteria are part of InterQual 2017’s Acute Adult Level of Care module.

Safer, Evidence-Based Decisions: New and enhanced content is a hallmark of the InterQual annual release, and this year is no different. InterQual 2017 customers gain a wealth of new updates, enhancements, and technological advancements, including more than 125 new content areas. In addition, ongoing literature review led to extensive updates of InterQual content, reflecting the latest medical evidence and standards of care which help ensure appropriate decisions. This year’s featured advances include:

  • New Level of Care Features and Criteria: A highlight of the new additions to InterQual Acute Adult is CMS’s geometric mean length of stay (GMLOS) data that provide a target length-of-stay for Medicare beneficiaries. In addition, new Early Responder Criteria helps reduce LOS of those patients who respond to treatment earlier than average with guidance to move them through the care continuum properly and safely. Lastly, InterQual Subacute/SNF gains a new Medicare Skilled Nursing Facility subset that aligns with the latest Medicare SNF guidelines.
  • New Care Planning Criteria: Highlights include the addition of five oncology and eight non-oncology specialty drugs to InterQual Specialty Rx, bringing the total to 156 drugs to help manage rising specialty drug costs. InterQual Molecular Diagnostics gains five new tests covering four conditions and three multi-gene panels for oncology (colorectal, ovarian, and prostate). New to InterQual Procedures is a length-of-stay assignment for inpatient procedures using the CMS GMLOS, as well as the addition of new procedures in areas such as early elective vaginal deliveries and gender reassignment surgeries, among others.
  • Updated Behavioral Health Criteria: InterQual Behavioral Procedures was revamped into an easy-to-use Q&A format, making it consistent with the established format of InterQual’s Care Planning suite. A new level of care was also added to InterQual Substance Use Disorders, Inpatient Rehabilitation, aligning with the level of care that Medicare recognizes.
  • Updated InterQual Coordinated Care Content: A new Opioid Risk Assessment screening tool was added in response to the opioid epidemic, to help identify members who might need further evaluation for this disorder. New content was also added to help address challenging conditions such as Sleep Apnea, Dyslipidemia, and High-Risk Neonate and Caregiver Discharge.

Technology Investments and Innovations: Enhancements that streamline administration and advance technological capabilities were added to both the software and SaaS products. Most notably, the InterQual Review Manager workflow software underwent a significant update to the user interface improving ease of use. And with the 2017 release, InterQual is now fully and exclusively a digital clinical decision support platform, available on desktop PC, mobile devices, on-demand in the cloud, and integrated into care management systems offered by InterQual Alliance Partners. In closing the book on the print version, InterQual 2017 opened the door to faster updates and greater innovation.

InterQual evidence-based criteria and technology solutions help improve 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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