Banner health and morehead memorial hospital report enhanced care
management efficiency, cost savings with interqual®
criteria from mckesson
Newton, mass.--(business wire)--facing significant pressure to more efficiently address quality requirements in the age of health reform, innovative organizations are using interqual® criteria from mckesson to create a common clinical language for payers and providers and increase their collaboration. banner health of phoenix, arizona, and morehead memorial hospital of eden, north carolina, are both using interqual solutions to drive improved care management and cost savings. for banner health, one of the largest nonprofit health systems in the united states, interqual solutions have improved the ability of case managers to appropriately and consistently apply the criteria, increased the rate of overturned denials from 72 to 99 percent, and decreased days in accounts receivable by 50 percent within the first year. when morehead memorial hospital transitioned to careenhance® review manager, an automated version of the criteria, it realized vast process and productivity improvements. these include increasing initial review rates by 20 percent and becoming significantly more compliant with review processes to ensure appropriate patient care. “banner health and morehead memorial hospital are great examples of the versatility and meaningful results that our interqual solutions deliver. we are helping provider and payer organizations of all sizes to collaborate more fully in care management, while exceeding productivity and cost reduction goals,” said matthew zubiller, vice president of decision management, mckesson health solutions. “evidence-based decision support tools that are easy to apply improve patient outcomes and ensure the most efficient use of healthcare resources. this is vital in our reform-driven healthcare environment.” at banner health, inconsistent case management processes were affecting medical review efficiency and hindering progress towards an accountable care model. banner health used interqual software to capture, manage, track and measure utilization-related information via one standard workflow within its new centralized case management department. it also turned to the interqual® interrater reliability suite assessment tool and interqual train-the-trainer program to help case management staff approach patient hospital stays more strategically. “the interqual criteria, software and training solutions empowered our case management team to have more productive conversations with physicians about appropriate admissions, lengths of stay and transitions to the most appropriate level of care,” said tamara pruett, system educator for case management at banner health. “if you look at what an accountable care organization is in theory, you are looking at delivering quality care at the appropriate level, as well as efficiency — interqual has all of the capabilities to support this model and also helps us get the maximum benefit from it.” morehead memorial hospital is the only full-service hospital in the rural area of eden, north carolina. it had been using the interqual criteria in a semi-automated system for years, and was looking to improve its care management processes. morehead memorial transitioned to a fully automated review process, and enhanced staff training with training services and the interqual interrater reliability suite. seventeen months after implementation, morehead memorial was able to review an increased number of emergency room admissions and better direct to the most appropriate level of care, reducing the number of patients being admitted with an inaccurate status. “now that we have streamlined our review process with interqual software, i am able to meet with each staff member on a monthly basis to make sure we are on track and compliant,” said renee anguilli, director of case management at morehead memorial hospital. “we are a testament to the fact that transitioning to automation works, and we have proven that advanced technology along with rigorous training can make a huge difference in workflow and compliance.” interqual evidence-based decision support empowers healthcare stakeholders to more easily communicate, collaborate and ultimately pursue what is best for patients by creating a common clinical language. used by more than 300 health plans, over 4,000 hospitals, the centers for medicare and medicaid services, the military health system, 21 veterans integrated service networks, quality improvement organizations in over 40 states, and medicare administrative contractors, interqual products are unmatched in their ability to drive alignment among payers, providers, and regulatory and accreditation entities. about banner health banner health is one of the largest nonprofit healthcare systems in the united states. headquartered in phoenix, arizona, it operates in seven states: alaska, arizona, california, colorado, nebraska, nevada and wyoming. it has 23 acute-care hospitals, long-term care centers, outpatient surgery centers and an array of other services including family clinics, home care and hospice services, and a nursing registry. banner health provides more than $80 million a year in charity care and has been named one of the nation’s top 10 health systems and one of the top 10 integrated health networks. about morehead memorial hospital morehead memorial hospital is a full service, not-for-profit community hospital located in eden, north carolina, serving north central north carolina and southern virginia. licensed for 108 acute-care and 134 long-term care beds, the main campus includes inpatient and day hospital services, an emergency department, a birthing center, a nursing center, a cancer treatment center and office buildings for physicians. an independent facility governed by a community board, morehead is the only full service hospital facility located in north central north carolina. about mckesson mckesson corporation, currently ranked 15th on the fortune 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. we partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. mckesson helps its customers improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. for more information, visit http://www.mckesson.com.
