Today McKesson announced its InterQual Coordinated Care Content has received new accreditation and vendor certification from URAC for achieving recognized standards in Case Management and Disease Management. McKesson Health Solutions also earned a three-year renewal reaccrediting CareEnhance Review Manager for Utilization Management (UM). The accreditations mark 13 years of continuous recognition by URAC, a leader in quality standards for the healthcare industry.
A more collaborative, automated UM model could create a bridge between the current system, where authorizations happen after care decisions, and real-time communication between payers and providers that provides immediate decisions at the point of care.
That bridge is what we call an “exception-based utilization management model.” New technology can help payers identify which providers are getting approvals, for which care events, and how often.
Then, using that knowledge, most care events can be automatically authorized, letting the payer limit their focus to the outliers. And even then, many of those decisions can be automated.
Learn more about this new thinking and the technology innovations that make it possible in Reinventing Utilization Management to Bring Value to the Point of Care.