Manage the care of high-risk patients with InterQual Coordinated Care Content

Managing chronic disease has become a core business challenge for health systems and health plans, as individuals with at least one chronic illness account for more than 75% of the nation’s $2 trillion in healthcare services.¹

Many payers offering care management programs for their members with potentially high-cost conditions develop homegrown guidelines.  However, maintaining content that is evidence-based and up-to-date can be challenging because of the advanced skills and significant staff time required.  Assessments are often duplicative for members with multiple conditions, which may lead to provider and payer frustration.

InterQual Coordinated Care Content helps manage the care of patients with high-risk conditions and complex cases and can help mitigate readmissions.  This offering recognizes when a patient has more than one condition and merges questions from all relevant conditions to help create one blended assessment. 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 may gain even greater administrative efficiency.

Enhancements to InterQual Coordinated Care Content this year include:

• Introduction of a new readmission reduction assessment to aid in mitigating avoidable readmissions within 30 days of hospital discharge
• Addition of even more condition-focused modules (see full list of InterQual Coordinated Care Content modules below).  We placed a heavier focus this year on behavioral health conditions in order to help effectively manage dual eligible members.

InterQual Coordinated Care Content Modules

• Barriers & Common Care
• Case Management
• Readmission Reduction
• Condition-Focused Modules, including:
• Agoraphobia
• AIDS
• Asthma
• Alcohol Abuse
• Back Pain
• Bipolar Disorder
• BMT / SCT Transplant
• Cancer
• Cerebral Vascular Disease (w/o stroke or TIA)
• Chronic Kidney Disease (w/o kidney transplant)
• Chronic Obstructive Pulmonary Disease
• Chronic Pain
• Chronic Wound
• Cirrhosis
• Cocaine Abuse
• Coronary Artery Disease
• Crohn’s Disease
• Depression (w/o bipolar)
• Diabetes
• End of Life
• ESRD (w/o kidney transplant)
• General Anxiety Disorder
• Heart Failure
• Hepatitis B&C
• High-Risk Pregnancy
• HIV
• Hypertension
• Low Back Pain
• Lupus
• Migraine Headache
• Multiple Sclerosis
• Obesity
• Obsessive Compulsive Disorder
• Opioid Abuse
• Panic Disorder
• Rheumatoid Arthritis
• Schizophrenia
• Solid Organ Transplant
• Stroke
• Transient Ischemic Attack
• Ulcerative Colitis

Do you want to learn more about InterQual Coordinated Care Content? Contact us at 800.782.1334 or MHS@mckesson.com to request more information.

1 Centers for Disease Control and Prevention, Rising Healthcare Costs are Unsustainable, April 2011.