OREANDA-NEWS. A major regional health plan, and the oldest and largest health insurance company in its state, has signed a new multi-year agreement to use InterQual®, replacing a competing solution in the process. Key to this decision was McKesson’s InterQual Connect™ authorization and connectivity solution, unveiled in March, which helps the plan expand auto-authorization to cover requests requiring medical review, all within their existing care management workflow.

The advantages of pairing InterQual Criteria with InterQual Connect’s authorization connectivity—including connecting to InterQual’s large footprint of nearly 4,000 hospitals—were understood as unique and compelling by the health plan. By using InterQual Connect to implement an exception-based UM (utilization management) process, the plan expects to eliminate a large amount of administrative work by fully automating inpatient and outpatient authorizations. This more efficient and collaborative process will also help speed authorizations for providers and members, helping improve consumer engagement and provider relations.

The health plan uses ZeOmega®’s Jiva™, a leading population health management platform, for its care management workflow. Thanks to ZeOmega’s integration of InterQual Connect into Jiva, the health plan’s in-house nurses and network providers will gain the speed and efficiency of automated exception-based UM without ever leaving their familiar Jiva application or InterQual workflow.

In addition to InterQual Connect, the health plan licensed 12 InterQual Criteria modules, including all of the InterQual Level of Care Criteria, as well as the InterQual Content Customization Tool, to help incorporate unique business and medical policies into its workflow; and the InterQual Interrater Reliability Suite, to help improve criteria usage and quality across its organization.

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.

 

About McKesson

McKesson Corporation, currently ranked 5th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. McKesson partners with payers, hospitals, physician offices, pharmacies, pharmaceutical companies, and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting.