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Change Healthcare unveils InterQual 2018

by John R. Fischer, Senior Reporter | May 23, 2018
Health IT
Change Healthcare debuted this week the latest edition of its flagship clinical decision support solution, InterQual 2018, designed to provide users with updated and enhanced clinical criteria.

Equipped with InterQual AutoReview, the cloud-based platform now offers real-time automation of the InterQual medical review using clinical EHR data to streamline communication of information and collaborations within healthcare ecosystems, speeding up implementation and bringing the most current, evidence-based guidance to decision-makers.

"InterQual 2018 provides evidence-based updates to almost two-thirds of our content suite, as well as the addition of more than 50 new content areas, including more content to help the hospital at the admission decision-point, covering 90 percent of admissions through the emergency department," Laura Coughlin, vice president of InterQual development and clinical strategy at Change Healthcare, told HCB News.

The new release comprises a new proprietary literature surveillance system that automatically evaluates more than 3,000 medical literature sources daily, flagging newly published data for clinical teams to assess and potentially use in their work.

It also addresses hundreds of new areas relating to current challenges experienced in healthcare, including:

• Admission considerations to help organizations consider significant social or safety concerns that help aid in decision-making
• Proactive Care Management Guidance for substance use disorders, particularly in regard to the opioid crisis
• Expansion of the Initial Review Criteria to address common conditions responsible for more than 90 percent of ED admissions.
• Updating more than 350 procedures and adding almost 50 new ones to keep up with changes in Medicare Local Coverage Determinations and National Coverage Determinations. An example is the addition of evidence for the safe use of outpatient settings for knee replacements to Procedures Criteria following CMS’ decision to remove knee replacements from the Inpatient Only list.

Further support is provided by AutoReview, which frees up resources and decreases administrative burdens for providers when determining whether a patient should be admitted and what level of care they should receive.

"InterQual 2018 will help by lowering the overall cost of care for the provider by decreasing the administrative burden of the utilization management process with AutoReview," said Coughlin. By providing physicians immediate feedback concerning medical appropriateness of admission at the point of order through AutoReview, providers are better equipped to help ensure the safest and most cost-effective decision-making for hospitalization, currently almost a third of the healthcare spend."

Nearly two-thirds of existing InterQual content has been upgraded to provide the most recent and useful forms of information, ensuring solutions such as AutoReview and InterQual Connect can effectively support appropriate decisions.

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