Press release

Change Healthcare Introduces InterQual 2019

Sponsored by Businesswire

Change Healthcare today unveiled InterQual® 2019, the latest
edition of the company’s flagship clinical
decision support solution
. The new release builds on Change
Healthcare’s tradition of continuous innovation in content and
technology. Among the new features is support for ‘Hospital in the Home’
programs, which have gained traction as an alternative option to acute
inpatient stays. This latest edition also advances the technology in InterQual
with Episode Day One review functionality. These
additions complement the rigorous, ongoing review of InterQual criteria,
which includes thousands of new content updates and enhancements.

The Hospital
in the Home
clinical model is gaining traction in the U.S. with the
availability of advanced telemonitoring and point-of-care diagnostics
and services. It has demonstrated significant cost savings, fewer
readmissions, and increased patient satisfaction. InterQual
now makes it possible for payers and providers to use evidence-based
clinical guidelines to help clinicians identify patients who are
candidates for these programs. Working in partnership with healthcare
leaders with deep expertise in establishing Hospital in the Home
programs, Change Healthcare has developed InterQual criteria for seven
conditions that would be considered appropriate for management in the
home at the acute level of care.

“As more organizations move into value-based relationships, developing
creative solutions that help us achieve the triple aim of improving the
patient experience, improving the health of populations, and reducing
the per capita cost of health is paramount,” said Laura Coughlin, RN,
vice president of Strategy and Clinical Development with Change
Healthcare. “Innovative programs like Hospital in the Home can help to
move the nation toward these goals, but payers and providers need
guidance about which patients can be safely managed in this setting. We
have invested in the criteria to support customers with programs in
place and those who are interested in establishing a program.”

InterQual 2019 also expands the reach of its automation solutions,
InterQual AutoReview and InterQual
, with greater interoperability between electronic health
records (EHRs) and care management systems. With this release, InterQual
AutoReview now includes continuous updates of the clinical data from the
EHR over the first 24 hours to gather a more complete picture of an
admitted patient. InterQual AutoReview can now provide a full admission
review for more than 50 high-volume conditions. On average, 75% of the
data needed for initial reviews can be automatically populated with data
pulled from the EHR—significantly reducing time spent on manual entry.

InterQual’s content has been updated to reflect the current best
evidence, impacting nearly half of existing subsets. There are also
significant additions including more than 80 new subsets, 250 new
indications, new molecular diagnostic tests, specialty drugs, and
imaging recommendations. The enhanced criteria help payers and providers

Address Outpatient Care Trends with: 1) restructured criteria to
direct patients to the Observation level of care first when appropriate;
2) new criteria to help determine the optimal inpatient or outpatient
setting for procedures such as total hip replacement, along with; 3) new
benchmark data on the percentage of hospital stays reimbursed as
Outpatient with Observation Services that can help organizations compare
their performance to national norms.

Combat Opioid Abuse with Expanded Coverage with a new subset for
urine drug testing, expanding InterQual’s comprehensive coverage for
opioid management.

Support Physician Decision-Making with customized tools such as
the Physician IRR test, which helps medical directors assess the
accuracy and consistency of secondary reviews, and a Physician Admission
Guide, which summarizes the key differences in severity and treatment
criteria between the Observation and Acute levels of care for common

With these updates, InterQual continues to lead the way in providing
trusted, evidence-based criteria and technology solutions to improve
clinical decision-making and care management.

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About Change Healthcare

Change Healthcare is inspiring a better healthcare system. Working
alongside our customers and partners, we leverage our software and
analytics, network solutions, and technology-enabled services to enable
better patient care, choice, and outcomes at scale. As a key catalyst of
a value-based healthcare system, we are accelerating the journey toward
improved lives and healthier communities. Learn more at