MCG Enhances Cite® Product Line for Health Plans

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Utilization Management, Chronic Care, and Prior Authorization Product Updates Include the Latest Clinical Research and Tools to Manage Readmission Risk

Integrated with the most current research on best clinical practices covering the continuum of care.

MCG today announced significant improvements to its products for health plans and other healthcare payors. Released in combination with the 17th edition of the care guidelines, new versions of the Cite product line are integrated with the most current research on best clinical practices covering the continuum of care.

“Chronic conditions command an increasing proportion of medical resources. Health reform changes the dynamics of relationships with providers and members. So health plans are intensely focused on reducing medical costs while assuring their members receive high quality care,” said Dr. Nick Beard, MCG’s senior vice president of product management. “Health plans need tools that help assure success in these efforts. These needs drive the development of all MCG Cite products – CareWebQI®, Cite for Health Management, and Cite AutoAuth Module – and have prompted us to develop new risk-stratified content for chronic conditions, assessments to screen for 30-day readmission risk, and tools to better manage level of care transitions.”

MCG has also made a number of enhancements based on user requests and regulatory requirements, including easier processing of automated prior authorization requests; code-mapping for the new ICD-10 standard; and new tools to easily calculate TIMI risk score, MASCC risk index, and other standard indices.

Enhancements by Product

CareWebQI 5.0 continues to provide clinical guidance that helps health plan staff quickly review hospital admissions and level of care decisions and analyze variances in care provision – the functionality that has made CareWebQI the industry standard for utilization management. To improve CareWebQI and respond to industry trends and customer requests, MCG has:

  •     Reviewed and updated clinical necessity criteria based on the current best evidence.
  •     Updated search functionality and code-mapping to comply with the conversion to ICD-10 well in advance of the federally-mandated 2014 deadline.
  •     Added additional care pathways to support effective management across the continuum of care.
  •     Embedded readmission and extended stay risk assessments, as well as care tasks to address identified risks.

Cite for Health Management 2.0 includes updates that better help payors manage members with complex and chronic conditions. Enhancements include:

  •     Substantial additions to Chronic Care guidelines, which now cover a total of 22 conditions, each with specific guidance for high-risk and lower-risk members.
  •     Support for case reporting required by NCQA and URAC.

Cite AutoAuth Module 3.0 includes updates that make the prior authorization process even more efficient, without sacrificing decision quality. Improvements include:

  •     Changes to make provider request submission easier, including streamlined documentation for procedure and admission requests; the ability to capture clinician-observed conditions rather than document against a guideline; and the ability to easily cancel a preauthorization request.
  •     Modifications that allow case managers to work with episodes more efficiently and easily access key data and links to other relevant information.
  •     Support for the Safari browser.

About MCG

MCG, formerly Milliman Care Guidelines, independently develops and produces evidence-based clinical guidelines and software used by more than 2,200 clients, including 1,200 hospitals and seven of the eight largest U.S. health plans. Updated annually by an experienced team of clinicians, the care guidelines support the care management of a majority of Americans. For more information, visit http://www.careguidelines.com

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Nick Beard
MCG
+1 206 389 5300
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