InterQual Milestones

The history of InterQual continues to be written, but what it has achieved in 30 years is remarkable. Thousands of people in hospitals, health plans and government agencies use InterQual evidence-based clinical decision support criteria daily to help answer critical questions about the appropriateness of levels of care and resource use. The criteria have helped define and legitimize the disciplines of utilization and care management, giving medical directors and other hospital and health-plan professionals support in making the type of objective, evidence-based decisions that define top-quality, efficient care and open the door to greater transparency and collaboration between payors and providers.

2007 — McKesson introduces the Custom Criteria Utility extension to CareEnhance Review Manager, giving organizations the ability to add regional and organizational policies to InterQual Care Planning Criteria for increased workflow efficiencies. The InterQual Interrater Reliability Suite offered online gives test-takers more flexibility and instant results while streamlining administration and reporting for managers. The InterQual Transparency Solution addresses the growing demand for sharing healthcare information among payors and providers.

2006 — McKesson raises the clinical quality bar ever higher as its InterQual clinical content development team undergoes rigorous training with the Delfini Group, a world-renowned consulting firm in evidence-based medicine. InterQual Criteria becomes integrated with more care management applications than any other clinical decision support product via the InterQual Alliance Partner Program.

2005 — Care facilitation criteria are added to the InterQual Subacute & SNF product. Criteria for several “controversial” procedures and imaging studies are introduced. The CareEnhance Review Manager 4.0 product family adds powerful integration capabilities, including enhanced options for using Solucient® length-of-stay data files.

2004 — McKesson launches Enterprise Plus Pak, an extension to the CareEnhance Review Manager. Care facilitation criteria extend to InterQual Long-Term Acute Care and InterQual Rehabilitation products.

2003 — The Centers for Medicare & Medicaid re-license InterQual Criteria. Proactive “care facilitation” features are introduced in InterQual Acute Criteria to support proactive reviews and discharge planning. Behavioral Health Criteria now span the spectrum from pediatric through geriatric psychiatry and include adult and adolescent dual diagnosis/chemical dependency as well as new residential adolescent care criteria. URAC certifies CareEnhance Review Manager, marking the first time this quality standards organization certifies a software solution.

2002 — CareEnhance Review Manager 1.0, a new format for browser-based access to the criteria that streamlines clinical reviews, is released. Also released are two InterQual Level of Care products: Long-Term Acute Care and Outpatient Rehabilitation & Chiropractic. InterQual Clinical Evidence Summaries offer a companion product to InterQual that are designed to inform physician to physician communications.

2001 — InterQual Durable Medical Equipment Criteria are released to meet the need for medically defensible durable medical equipment (DME) authorizations. SmartSheets debut, placing criteria in a checklist format to facilitate information gathering and decision-making.

2000 — InterQual Criteria can be accessed via a Web browser with the creation of InterQual WEB. InterQual Behavioral Health Criteria are introduced to support the burgeoning managed behavioral health market.

1999 — The Health Care Financing Administration (now the Centers for Medicare & Medicaid Services) licenses InterQual Criteria for use in reviewing Medicare hospital inpatient services.

1998 — Access Health acquires InterQual and then is in turn acquired by McKesson.

1996 — InterQual AutoBook provides access to InterQual Criteria via interactive software.

Mid-1990s — Criteria are released for surgery, invasive procedures and imaging appropriateness, mirroring the industry’s explosive growth in these areas. In addition, criteria to assist in decision-making in rehabilitation, subacute, skilled nursing and home care settings are introduced to accommodate managed care’s emphasis on postacute care.

1987 — The SIM product is launched to provide “tissue committees” with a support for retroactive monitoring of surgery and procedures.

1984 — InterQual adds pediatric criteria to the product line.

1982 — Responding to requests by hospitals and Professional Standard Review Organizations, InterQual adds criteria for helping determine the appropriateness of hospital discharge planning, forming the basis of what is now known as InterQual Level of Care products.

1978 — InterQual publishes Severity of Illness-Intensity of Service (SI-IS) criteria for acute care, making practical review of the appropriateness of hospitalization possible.

1976 — InterQual, Inc., is founded.