McKesson Breaks New Ground with InterQual 2012


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McKesson Breaks New Ground with InterQual 2012

Latest Release Further Supports Payer-Provider Partnerships in Evidence-Based Decision Making and Administrative Cost Reduction

NEWTON, Mass. — May 8, 2012 — McKesson has released the 2012 update of its InterQual® clinical criteria and software, market-leading solutions that help payers and providers determine the appropriate use of healthcare resources and improve the quality of care. Enhancements this year include the extension of a “condition-specific” model to the full InterQual Acute Care suite, driving the further efficiency and effectiveness of care management processes, as well as a comprehensive set of criteria for the use of oncology drugs and biologics, in partnership with the National Comprehensive Cancer Network® (NCCN®), to help address the skyrocketing costs of cancer treatment.

“Each year, we listen carefully to our clients and work to introduce the type of enhancements that will help payers and providers more easily collaborate to achieve better clinical and financial outcomes,” explained A. Jacqueline Mitus, MD, senior vice president of clinical development and strategy for McKesson Health Solutions. “Solutions that support more holistic care management, reduce gaps in payer-provider communications, create more efficient workflows, help address oncology drug costs, and ultimately yield better decisions were all significant achievements this year.”

The InterQual suite helps payers, providers and other organizations share a common language for determining the evidence-based clinical appropriateness of both medical and behavioral health patient services, ranging from care settings to diagnostics and treatments. Combining clinical decision support criteria with innovative, flexible technology to bring that criteria directly to the point of decision making, InterQual solutions are used by over 300 health plans, over 3,900 provider organizations and leading government entities, representing 76 percent of all U.S. admissions and 95 percent of all reasons for admissions, procedures, and imaging studies.

The 2012 release continues to create a more proactive, intuitive and collaborative review process that can help ensure clinically appropriate admissions and manage lengths of stay while lowering administrative costs. All InterQual Acute Criteria now utilize a “condition-specific” approach, which organizes the criteria by primary condition and then integrates a wealth of additional information designed to address relevant complications, co-morbidities and guideline standard treatments. This condition-oriented model presents criteria for all levels of care in one workflow, combines severity and intensity criteria for admission and continued stay review, and incorporates unique “response to treatment” assessments.

In addition, in partnership with NCCN, McKesson has introduced a comprehensive set of oncology criteria to its InterQual Specialty Rx Criteria product offering. This newly developed Specialty Rx Oncology criteria set includes on-label use of oncology drugs and biologics as well as off-label use based on the NCCN Drugs & Biologics Compendium (NCCN Compendium®). The full Specialty Rx Oncology criteria set is available via McKesson’s workflow technology, CareEnhance® Review Manager and Clear Coverage™. This authoritative, scientifically derived information helps physicians and health plans more readily collaborate in applying evidence-based standards to the use of drugs and biologics for treating cancer, improving the quality, effectiveness and efficiency of oncology services.

The 2012 release also gives hospitals and health plans greater flexibility in creating and modifying clinical criteria, as well as improves access to this customized criteria directly in their InterQual-based software applications. The InterQual Content Customization Tool helps organizations address local or regional variations in care management guidelines, implement their own medical and business policies, or add guidelines for emerging healthcare services. At the same time, all utilization management criteria can be stored in one location and used in automated workflows, minimizing misinterpretation, increasing efficiency and supporting sound care decisions.

Finally, organizations can now electronically share medical necessity reviews and additional patient information (e.g., diagnosis codes, patient/member identifies), thus rendering the review process more efficient, reducing administrative costs and improving decision making. Review Transmission, an enhancement to the CareEnhance Review Manager software for automating care reviews, facilitates concise dialog between payer and provider organizations while cutting down on manual, repetitive data entry, the errors inherent in that process, and the miscommunication that can result.

About McKesson

McKesson Corporation, currently ranked 14th 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

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