Utilization, Case and Disease Management Workflow in One Interoperable Platform
Many care management programs operate UM, DM and CM in disparate silos that don't "talk" to one another, share data, or allow care managers to easily flag gaps in care, inefficiencies or communication breakdowns. The result is wasted productivity for the user, fragmented data, missed opportunities to close gaps in care, poor health outcomes and unnecessary cost to the health care system.
The McKesson VITAL Platform eliminates those silos to improve workflow, care coordination, efficiency, productivity, communication and decision-making.
Offered as installed or hosted, our workflow tool solution is scalable, automated software that integrates utilization, disease and case management activities. The solution includes evidence-based clinical guidelines to help payer and provider organizations share a common language when determining the most appropriate care, driving financial and clinical outcomes.
Our workflow tool features:
Utilization Management is offered as software only. Our UM capabilities allow for pre-certifications and concurrent and retrospective reviews, enabling payers to evaluate the effective use of health care services. Including InterQual® criteria with workflow adds evidence-based medical reviews to the process.
Disease Management and Chronic Condition Management programs teach your members to learn new, effective ways to self-manage their chronic illnesses through a combination of nurse-directed activities and technology-driven tools. Our solution offers personalized interventions to help address the physical and behavioral needs of an individual through counseling from registered nurses and regular communication with the member's primary care physician. Delivered through the Platform as software or separately as a service, our chronic care management offerings are designed to help payers meet NCQA and HEDIS® requirements.
Case Management is designed for those individuals who can't self-manage their conditions. They rely completely on a professional care team to coordinate care, help them get to doctor's appointments, take their medications properly and arrange outside services from other facilities. Care managers refer members to appropriate local and community services, including behavioral health programs and home health agencies. Case Managers can also identify and manage critical pathways of key care plan events to achieve the desired outcome in a timely manner. Case management is available through the Platform as software or through McKesson staff as a service.
InterQual® Coordinated Care Content (PDF, 262 KB) is embedded in the McKesson VITAL Platform. InterQual® Coordinated Care Content helps you manage your members with high risk conditions and complex cases using evidence-based clinical content. Coordinated Care Content provides assessments in Q&A format and generates a care plan. The solution recognizes when a patient has more than one condition and creates a blended assessment. This type of assessment makes more efficient use of time by asking questions just once and automatically applying the response in each of the questionnaires where it is relevant. The result is a more complete picture of each patient, so care managers are better able to improve outcomes and prevent readmissions.
Clear Coverage™, a software-as-a-service (SaaS) offering, supplies clinical and financial decision support at the point of care to help payers and providers lower administrative costs and inappropriate medical spend. A powerful utilization management, coverage determination, and network compliance platform, Clear Coverage incorporates InterQual® criteria in a fully automated, interactive workflow to support shared decision-making between payers and their network providers. Clear Coverage enables automated medical review, authorization, notification, eligibility and direction of members to in-network service providers.
Learn More about McKesson VITAL Care Management
- Engagement Strategies: Get providers and consumers more involved in health care through these valuable tools.
- Nurse Advice: 24/7 access to highly trained nurses by phone, chat or email/secure messaging helps reduce unnecessary ED visits and ensure proper redirection of care.
- Business Insight: Business intelligence tools that allow you to analyze program data. Specialists to help you make sense of it all.
- Wellness Programs: Our wellness offerings will help keep your healthy members well with a focus on prevention.
- Proven Track Record of Solid Program Results: Allow us to help you improve members' health while achieving savings, as we've done for other health plans.
To learn more about McKesson Care Management solutions or any McKesson Health Solutions products and services, email us at MHS@McKesson.com, call 800-782-1334 or contact your Sales Representative.