The California Department of Corrections and Rehabilitation reins in costs and helps ensure appropriate care with InterQual

The California Department of Corrections and Rehabilitation (CDCR) is one of the largest prison systems in the country, with more than 135,000 inmates housed in 33 prisons. In 2008, the prison health system’s most pressing problem was runaway specialty costs. Medical costs and hospital stays were increasing and the prison system had no mechanism for determining whether each request for specialty services was justified, given the patient’s unique needs and evidence-based best practices.

The health system licensed InterQual Specialty Referral Criteria, InterQual Acute Criteria, InterQual Imaging Criteria and InterQual Procedures Criteria, which it accesses via Web-based CareEnhance^® Review Manager Enterprise software, to help prison clinicians determine when specialty care is appropriate and when a patient should remain in the hands of a generalist. With real-time access to InterQual for provider and nursing staff, CDCR was able to reduce specialty referrals from 25,000 per month to 4,000 per month. In addition, the health system saw other benefits, including average inpatient length of stay decreased and annual medical costs reduced.

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