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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McKesson Entity Now Change Healthcare

McKesson Entity Now Change Healthcare

  • May 6, 2017

McKesson Technology Solutions and Change Healthcare have merged to create a new healthcare information technology company. The new Change Healthcare includes all of Change Healthcare's businesses and the majority of McKesson Technology Solutions, and will employ about 15,000 people. Read the article

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Consistent Review Outcomes Are Quality Outcomes

Consistent Review Outcomes are Quality Outcomes

  • May 2, 2017

By Steven Silverstein, MD Recent articles in the Journal of the American Medical Association (here1 and here2) reported on the use and misuse of clinical practice guidelines, and the need to avoid hedging and equivocation when writing them. These articles also discussed the differences inherent in targeting individual physician decision support versus more general purposes, as well as issues related to lack of adherence to guideline development standards published by the Institute of Medicine3. A related issue is that it is not uncommon for guidelines developed by different specialty societies to advocate different approaches to a given clinical situation. This…

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Change Healthcare’s InterQual Expert To Share Blueprint For Case Management Optimization At ACMA 2017

Change Healthcare’s InterQual Expert to Share Blueprint for Case Management Optimization at ACMA 2017

  • April 17, 2017

The American Case Management Association's annual conference, ACMA 2017, gets underway in Washington this week, and attendees looking to gear their case management programs for the industry shift to value should be sure to attend the “Blueprint for Case Management Optimization” presentation. That's where Change Healthcare’s Carol Everhart will share nine best practices to help assess the health of a case management program. Read the News Release

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New Version Of Clinical Decision Support Released

New Version of Clinical Decision Support Released

  • April 11, 2017

McKnight's covered the launch of InterQual 2017, the latest version of the evidence-based clinical decision support solution. McKnight's reports this new release includes more than 120 new criteria and enhancements that help enable faster, safer, and better clinical decisions at the point of care. Read the Article  

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

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

  • April 3, 2017

Today, we unveiled InterQual 2017, a faster, more streamlined version of our flagship clinical decision support solution. InterQual 2017 introduces a new time-saving product, Medicare Procedures powered by InterQual,  which automates more than 400 Medicare National and Local Coverage Determinations. It also provides a more efficient set of level of care criteria, Initial Review, that supports faster, earlier decisions in the ER. Customers will benefit from a host of new updates, enhancements, and technological advancements, including more than 125 new content areas. Read the news release

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The Interoperability Imperative

The Interoperability Imperative

  • September 19, 2016

Interoperability in healthcare is not just about moving financial and clinical data between payer or provider or moving clinical data from one application to another. True interoperability allows enterprise applications to "talk" and collaborate in a smart, open, and agile manner. "The Interoperability Imperative" explains what this means; how and why interoperability is necessary to scale complex value-based reimbursement models; and how payers, providers, and vendors can get started. Read now or download and read later

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Short-Stay Inpatient Rate Is Zero? Time For Documentation Improvement

Short-Stay Inpatient Rate is Zero? Time for Documentation Improvement

  • May 11, 2016

Hospitals will need to reevaluate their documentation improvement programs because of revisions to the two-midnight rule, which allow for a case by case review of less-than-two-midnight stays. The quality improvement organizations have stated that the review will include InterQual screening criteria. Read the article

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The Two-Midnight Rule: Changes For 2016

The Two-Midnight Rule: Changes for 2016

  • February 1, 2016

Medical Necessity Documentation Still Required Have you heard the news? In the 2016 Outpatient Prospective Payment System Final Rule the Centers for Medicare & Medicaid Services (CMS) has modified the two-midnight rule evaluation and enforcement process. The “probe and educate” period ends on January 1, 2016. Enforcement of the rule will be the responsibility of the two BFCC Quality Improvement Organizations (Livanta and KEPRO). Their charge is to evaluate the appropriateness of short-stay inpatient admissions that extend over less than two midnights. Both BFCC Quality Improvement Organizations (BFCC-QIOs) will use InterQual as a decision support tool to help evaluate whether…

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