April 22, 2021 — Change Healthcare unveiled InterQual 2021, the latest edition of the company’s flagship clinical decision support solution. The new release features four new Medicare criteria modules in addition to a significant number of evidence-based content updates and enhancements, including new guidance on caring for COVID-19 patients, addressing social determinants of health, and the appropriate use of telehealth.
“As an Associate CMO overseeing utilization review at a large health system, I have been using InterQual criteria since 2014. Through the years, the criteria have undergone frequent updates that are in line with evolving clinical evidence and literature,” said Kalyana Kanaparthy, M.D., Rochester Regional Health. “These updates are critical as medicine evolves. I continue to see InterQual criteria provide a superior evidence-based screening tool for hospital admissions.”
This release marks the first development cycle led by Monique Yohanan, M.D., M.Ph., who assumed the role of InterQual Chief Medical Officer. With a clinical background that spans the care continuum, including inpatient hospital, primary care, extended care, and house calls, Yohanan is board certified in Internal Medicine and Geriatric Medicine and has extensive expertise in the development of medical necessity criteria.
“When I first joined Change Healthcare in September 2019, I was impressed with the rigor of the team’s approach to developing unbiased, evidence-based content,” said Yohanan. “My goal was to maintain that integrity while building on the objective criteria we offer to support patient-centered care.”
Change Healthcare also relied on the broad and diverse clinical perspective brought by its three new medical directors:
- Sarah Johnson, M.D., MS, practicing clinician in substance use facilities, board certified in Psychiatry, Neurology, and Addiction Psychiatry
- Katy Kehl, M.D,. practicing intensivist at Mount Auburn Hospital, board certified in Internal Medicine, Pulmonary Disease, and Critical Care Medicine
- Judith A. Melin, M.D., MA, FACP, physician at Beth Israel Lahey Health, board certified in Internal Medicine
For example, Kehl’s experience working in the ICU at the frontlines of the pandemic helped inform InterQual condition-specific criteria to address the diagnostic testing, imaging, and inpatient management of COVID-19 patients. More than 500,000 reviews have been completed nationwide using the InterQual Covid-19 criteria, which will continue to be updated as the related evidence evolves.
The 2021 release incorporates guidance on the use of telehealth throughout the InterQual Outpatient Rehabilitation and Chiropractic, Behavioral Health, and Ambulatory Care Planning criteria, and includes additional guidance to help case managers address their patients’ social determinants of health as care progresses. By supporting proactive, ongoing needs assessment regarding factors such as housing, transportation, and food insecurity, the guidance helps organizations intervene in a timely manner to improve health outcomes.
The robust suite of InterQual criteria has been updated to reflect the latest clinical evidence, providing frontline clinicians with valuable, relevant decision support. Based on new research and evolving standards of care, more than half of the existing InterQualcriteria were impacted by these changes. As always, these changes went through a rigorous critical appraisal and peer review process to defend against bias.
This marks the launch of four new modules to the Medicare criteria Powered by InterQual, which converts Medicare policies into the solution’s trademark question-and-answer format: Medicare Molecular Diagnostics and Lab, Medicare Imaging, Medicare Pharmacy, and Medicare Behavioral Health. Clinicians can easily access the information they need within their workflow, instead of struggling to find and apply local and national coverage guidelines from disparate sources.
For more information: www.changehealthcare.com
May 17, 2024 
