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Change Healthcare Launches InterQual® 2021 Solution Providing Guidance on Telehealth, Social Determinants of Health, and the Testing and Treatment of COVID-19 Patients

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Change Healthcare (Nasdaq: CHNG) released InterQual® 2021, enhancing its clinical decision support solution with new Medicare criteria modules and updates focused on COVID-19 care, social determinants of health, and telehealth usage. This edition, developed under the leadership of Monique Yohanan, MD, includes significant evidence-based updates to over half of the existing criteria. Notably, more than 500,000 reviews have utilized the InterQual® COVID-19 criteria. The updates aim to assist clinicians in improving patient outcomes through timely intervention and data-driven decision-making.

Positive
  • Launch of InterQual® 2021 with four new Medicare criteria modules.
  • Incorporation of telehealth guidance across multiple criteria.
  • Updates reflect evolving clinical evidence, impacting over half of existing criteria.
  • More than 500,000 reviews using COVID-19 criteria completed nationwide.
Negative
  • None.

Today Change Healthcare (Nasdaq: CHNG) unveiled InterQual® 2021, the latest edition of the company’s flagship clinical decision support solution. The new release features four new Medicare criteria modules in addition to a significant number of evidence-based content updates and enhancements, including new guidance on caring for COVID-19 patients, addressing social determinants of health, and the appropriate use of telehealth.

“As an Associate CMO overseeing utilization review at a large health system, I have been using InterQual criteria since 2014. Through the years, the criteria have undergone frequent updates that are in line with evolving clinical evidence and literature,” said Kalyana Kanaparthy, MD, Rochester Regional Health. “These updates are critical as medicine evolves. I continue to see InterQual® criteria provide a superior evidence-based screening tool for hospital admissions.”

This release marks the first development cycle led by Monique Yohanan, MD, MPH, who assumed the role of InterQual® Chief Medical Officer. With a clinical background that spans the care continuum, including inpatient hospital, primary care, extended care, and house calls, Dr. Yohanan is board certified in Internal Medicine and Geriatric Medicine and has extensive expertise in the development of medical necessity criteria.

“When I first joined Change Healthcare in September 2019, I was impressed with the rigor of the team’s approach to developing unbiased, evidence-based content,” said Dr. Yohanan. “My goal was to maintain that integrity while building on the objective criteria we offer to support patient-centered care.”

Change Healthcare also relied on the broad and diverse clinical perspective brought by its three new medical directors:

  • Sarah Johnson, MD, MS, practicing clinician in substance use facilities, board certified in Psychiatry, Neurology, and Addiction Psychiatry
  • Katy Kehl, MD, practicing intensivist at Mount Auburn Hospital, board certified in Internal Medicine, Pulmonary Disease, and Critical Care Medicine
  • Judith A. Melin, MD, MA, FACP, physician at Beth Israel Lahey Health, board certified in Internal Medicine

For example, Dr. Kehl’s experience working in the ICU at the frontlines of the pandemic helped inform InterQual® condition-specific criteria to address the diagnostic testing, imaging, and inpatient management of COVID-19 patients. More than 500,000 reviews have been completed nationwide using the InterQual® Covid-19 criteria, which will continue to be updated as the related evidence evolves.

The 2021 release incorporates guidance on the use of telehealth throughout the InterQual® Outpatient Rehabilitation and Chiropractic, Behavioral Health, and Ambulatory Care Planning criteria, and includes additional guidance to help case managers address their patients’ social determinants of health as care progresses. By supporting proactive, ongoing needs assessment regarding factors such as housing, transportation, and food insecurity, the guidance helps organizations intervene in a timely manner to improve health outcomes.

The robust suite of InterQual® criteria has been updated to reflect the latest clinical evidence, providing frontline clinicians with valuable, relevant decision support. Based on new research and evolving standards of care, more than half of the existing InterQual® criteria were impacted by these changes. As always, these changes went through a rigorous critical appraisal and peer review process to defend against bias.

This marks the launch of four new modules to the Medicare criteria Powered by InterQual®, which converts Medicare policies into the solution’s trademark question-and-answer format: Medicare Molecular Diagnostics and Lab, Medicare Imaging, Medicare Pharmacy, and Medicare Behavioral Health. Clinicians can easily access the information they need within their workflow, instead of struggling to find and apply local and national coverage guidelines from disparate sources.

About Change Healthcare

Change Healthcare (Nasdaq: CHNG) is a leading healthcare technology company focused on insights, innovation, and accelerating the transformation of the U.S. healthcare system through the power of the Change Healthcare Platform. We provide data and analytics-driven solutions to improve clinical, financial, administrative, and patient engagement outcomes in the U.S. healthcare system.

For more information on Change Healthcare, please visit our website, hear from our experts at Insights; Follow us on Twitter; Like us on Facebook; Connect with us on LinkedIn; and Subscribe to us on Apple Podcasts, Google Podcasts, and YouTube.

FAQ

What is the purpose of InterQual® 2021 released by CHNG?

InterQual® 2021 enhances clinical decision-making by providing updated medical criteria, including new modules for Medicare and guidance on COVID-19 and telehealth.

How many reviews have been completed using InterQual® COVID-19 criteria?

More than 500,000 reviews have been completed using InterQual® COVID-19 criteria nationwide.

What updates were made in InterQual® 2021?

InterQual® 2021 includes new Medicare criteria modules, guidance on telehealth, and updates addressing social determinants of health, impacting over half of existing criteria.

Who led the development of InterQual® 2021?

The development of InterQual® 2021 was led by Monique Yohanan, MD, MPH, who is the Chief Medical Officer for InterQual®.

What are the new Medicare modules included in InterQual® 2021?

The new Medicare modules include criteria for Molecular Diagnostics and Lab, Imaging, Pharmacy, and Behavioral Health.

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