Care Management: Value-Based Healthcare

Change Healthcare is inspiring a better healthcare system. As a key catalyst of value-based healthcare, we are working alongside our customers and partners to create a stronger, better coordinated, increasingly collaborative and more efficient system, and accelerate the journey toward improved lives and healthier communities.

InterQual® solutions align payers and providers with actionable, evidence-based clinical intelligence to support appropriate care and foster optimal utilization of resources. InterQual Connect™ seamlessly integrates InterQual Criteria into Clinical CareAdvance® and CareAdvance Provider® Portal, and TriZetto® Touchless Authorization Processing (TTAP) supports a native integration to InterQual criteria, streamlining the medical review process and enabling the automation of the prior-authorization process.

Health and Wellness Content

Healthwise products, integrated with CareAdvance, offer a total-population health management solution for your enterprise. This solution improves health outcomes and reduces cost of care by engaging clinicians and members with shared decision-making tools and behavior change programs through Clinical CareAdvance®, health coaching and symptom triage for Clinical CareAdvance®, and online health content with the Treatment Cost Navigator. Healthwise is a nonprofit organization that develops health information and tools for healthcare organizations so people can make better health decisions.

Clinical Guidelines

MCG, an integrated partner product, is a series of annually updated, evidence-based clinical guidelines that support the care management of nearly two-thirds of US health plan membership. Access to the Care Guidelines is provided through the integration of TriZetto’s Clinical CareAdvance® care management application with MCG’s CareWebQI® interactive software, which enables consistent point-and-click care management; easy access to current best evidence; and documentation of variances from best practice. The result is reporting based on real-time data, supporting the elimination of gaps in care, resource delays and other variances.

Unlike other clinical criteria alternatives, CareWebQI software provides diagnosis-specific evidence summaries, citations and quality measures. This evidence is integrated within all criteria and content—including detailed care pathways—to support proactive care and the capture of variances from evidence-based best practice.