Clinical Decision Support Solutions

Clinical decision support solutions for healthcare providers, payers, and government agencies that enable clinically appropriate medical utilization and care decisions informed by evidence-based criteria.

Rely on Integrated, Value-Focused Decision Support 

Validate appropriate care with evidence-based criteria 

Payers and providers share the same goal: to provide quality care in an efficient, cost-effective manner.

The foundation of Change Healthcare’s clinical decision support portfolio depends upon three pillars: rigorously developed clinical criteria; EHR and care management system integration; and the technology to enable seamless payer/provider connectivity.

InterQual® and CareSelect provide evidence-based guidelines and criteria to inform care decisions across the patient continuum. Our solutions help payers and providers validate appropriateness, establish standards of care, and streamline care delivery workflows.

Delivering Exception-Based Utilization Management

Point-of-Order Guidance

Drive patient-first, value-based care decisions at the point of order

Hospitals and health systems need to understand how inappropriate ordering impacts patient outcomes as well as resource utilization, costs, and downstream reimbursement from CMS and private payers. CareSelect’s data-centric approach helps you benchmark and improve order appropriateness and comply with important federal mandates.

Explore CareSelect™ solutions

Utilization Management

Make clinically appropriate medical utilization decisions

InterQual provides actionable, evidence-based clinical intelligence and automated processes to support appropriate care, align payers and providers, and optimize resources. Our solutions transform utilization management into an efficient, proactive, risk-reducing function via medical review automation and AI-enabled predictive analytics. 

Explore InterQual® AutoReview with predictive analytics

Automated Authorization

Automate prior authorizations requiring a medical review within existing workflows

Payers and providers can reduce their administrative burden, speed response time, and improve collaboration by automating the prior authorization process. Our integrated medical review and connectivity solution automates prior authorizations, even those needing a medical review, within existing payer and provider workflows. 

Explore InterQual® Connect

Complex Care Management

Manage complex care with a blended care plan 

Bridge the gap between payers and providers to effectively manage care for your high-risk members and patients.

Create a customized, workflow-integrated care management program using patented patient assessments that address common care barriers and merge condition components.  

Explore InterQual® Coordinated Care

For providers with increased exposure to CareSelect Imaging, ordering appropriateness increased by:

8.5%

CareSelect data published in "Improved Appropriateness of Advanced Diagnostic Imaging After Implementation of Clinical Decision Support Mechanism," Journal of Digital Imaging, February 25, 2021.

For one facility using CareSelect Lab, the number of labs per discharge decreased by:

20%

Riverside Medical Center data, published in: "Aligning the Lab with the Hospital’s Strategic Priorities," white paper

For patients admitted to hospitals that rely on InterQual® Criteria, hospital stays were shorter by:

7.8%

Sources: Change Healthcare 2018 analysis of two randomly matched sample groups of 809 hospitals each.

Drive Value-Based Decisions Across the Care Continuum

Explore Our Clinical Decision Support Solutions

CareSelect

InterQual Criteria, Access and Optimization

InterQual AutoReview

InterQual Connect