Help for Managing the Care of High-risk Members

InterQual Coordinated Care Content recognizes when a patient has more than one condition and merges questions from all relevant conditions to create one blended assessment, minimizing staff resources. The care plan that results is based on a more complete picture of each member, so care managers are better able to improve outcomes and prevent readmissions. And because the content can generate alerts for gaps in care to case management workflow systems, care managers gain even greater administrative efficiency while doing the right thing for members.

InterQual Coordinated Care Content provides a general module, a case management module and 24 comprehensive condition-specific modules, all in Q&A format. Care managers can select which conditions to manage and gauge a member’s knowledge of his or her disease, adherence to treatment plan, barriers to managing the disease, support systems, self-management, medical history, labs and medications.

Benefits

InterQual Coordinated Care Content helps:

  • Increase efficiency. General, case management and disease-specific questions are blended into one real-time assessment. Questions, answer choices and interventions that are common to multiple diagnoses are not duplicated, saving time for clinicians and members and improving member satisfaction.
  • Manage care holistically. Assessment questions take into consideration comorbidities and cross-condition issues for a clearer overall picture of a member’s health.
  • Reduce costs. Evidence-based, tailored care management programs allow you to better control the medical costs of high-risk patients as well as member out-of-pocket costs.
  • Enable consistent decisions based on evidence-based content. With industry-leading content from InterQual Criteria, you save time and resources developing and updating clinical content. In addition, you can ensure that internal and third-party resources are using the same clinical content when you pair InterQual Coordinated Care Content with care management workflow solutions.
  • Meet regulatory requirements. The case management module is designed to help health plans meet NCQA’s QI7, QI8, and SNP standards, which require plans to have various processes and systems in place to support members.